Using a Mixed Methods Approach to Examine the Association of Racial Residential Segregation and Fruit and Vegetable Consumption among Older African Americans
Janelle Armstrong-Brown, MPH, PhD 1; Eugenia Eng, MPH, DrPH 2; Catherine Zimmer, PhD 3; Wizdom Powell Hammond, PhD, MPH 2; J. Michael Bowling, PhD 2; Malcolm Cutchin, PhD 4; Marci K. Campbell, PhD, MPH, RD 5
1 Institute on Aging, University of North Carolina at Chapel Hill
2 Department of Health Behavior and Health Education, University of North Carolina, School of Public Health CB #7440, Chapel Hill, NC 27599
3 Odum Institute for Research in Social Science, University of North Carolina, 04 Manning Hall, CB#3355, Chapel Hill, NC 27599-3355
4 Occupational Science and Occupational Therapy, Department of Allied Health Science, School of Medicine, University of North Carolina at Chapel Hill
5 Department of Nutrition, University of North Carolina at Chapel Hill, Gillings School of Global Public Health
Background: Neighborhood availability of supermarkets has been linked to a healthier diet while living in close proximity to fast food restaurants and convenience stores has been found to be associated with a poorer diet. The inequitable distribution of food resources in predominantly African American neighborhoods may negatively impact the fruit and vegetable (fv) consumption of African Americans.
Methods: Participants were 472 older African Americans, aged 52-99 years, living in urban counties of NC who were assessed by questionnaire, geographic information systems, and semi-structured interviews. Multilevel regression analyses were conducted to determine bivariate relationships among variables. In order to better understand the findings from the quantitative data, interviews were conducted with 12 participants from predominantly African American neighborhoods.
Results: Participants living in predominantly African American neighborhoods were more likely to live within 3 miles to more convenience stores than participants living in integrated neighborhoods (β=.494, p<.01). No other significant associations were observed. Interviewed participants were more likely to purchase food items at supermarkets located outside of their neighborhoods because of better food variety and food quality, more reasonable prices, and store ambience. The qualitative interviews revealed that participants living in predominantly African American neighborhoods did not find the supermarkets in their neighborhoods to be comparable to those outside of their neighborhoods.
Conclusion: The impact of food store availability may have been more pronounced in this study by examining overall diet as opposed to fv consumption alone. Future intervention research should consider multilevel strategies in improving fv consumption among older African Americans.
Perceptions and Psychosocial Correlates of Bullying Among Lumbee Indian Youth: The Lumbee Rite of Passage Project
Ronny Bell, PhD, MS 1; Elizabeth Arnold, PhD 1; Alfred Bryant, PhD 2; Andrea Anderson, MS 1; Shannon Golden, MA 1; Sarah Langdon, MPH, CHES 1; Rhonda Faircloth 1
1 Wake Forest School of Medicine, Winston-Salem NC
2 University of North Carolina at Pembroke, Pembroke, NC
Introduction: Bullying is recognized as a major contributor to poor psychosocial health among youth. However, little is known about this behavior in American Indian youth, who are at high risk for suicide and suicidal behavior.
Methods: Data come from an NIMH-funded community-based participatory, mixed methods study designed to understand the mental health perceptions and needs of Lumbee Indian youth in Robeson County, North Carolina. Phase 1 included a qualitative study with focus groups among Lumbee Indian youth ages 12 – 18 and in-depth interviews with community gatekeepers. Phase 2 involved assessing the impact of a tribally-run cultural enrichment program on psychosocial health among Lumbee youth ages 11 – 18.
Results: Qualitative data indicated that youth recognized bullying and fighting as very common in their community, and that bullying can lead to depression and suicide. Youth also expressed feeling powerless to overcome being bullied. Phase 2 baseline data (n = 80) showed that youth who reported being bullied (11.5%) had significantly lower self-esteem (measured using the Rosenberg Self-Esteem scale) and more depressive symptoms (measured using the Centers for Epidemiologic Studies – Depression Youth scale). These data indicate that bullying is common among Lumbee youth and contributes to poor psychosocial health in this population. Further research is needed to more fully understand this behavior to develop interventions to address this public health problem.
Kathleen Bush, PhD, ASPH/EPA Environmental Health Fellow, Office of Research and Development, US Environmental Protection Agency; Tara McAlexander, MPH, ASPH/EPA Environmental Health Fellow, Office of Research and Development, US Environmental Protection Agency; Katherine King, PhD, ORISE Postdoctoral Researcher, Office of Research and Development, US Environmental Protection Agency; Laura Jackson, PhD, Office of Research and Development, US Environmental Protection Agency; Rochelle Araujo, PhD, Office of Research and Development, US Environmental Protection Agency
Introduction: Proximity to resources in the urban built and natural environment is linked to improved mental and physical health and well-being. Given the spatial distribution of socio-demographic attributes within the Durham-Chapel Hill, NC area, access to resources may vary by social context. Socio-demographic disparities in proximity and access to resources may partially explain health disparities across distinct socio-demographic groups.
Methods: This study examined social disparities in neighborhood walkability, food outlets, and natural amenities potentially linked to human health. Socio-demographic data were obtained from the 2010 U.S. Census. Walkability was evaluated through land-use mix and street intersection densities. The location of food outlets was geocoded. Access to natural amenities was based on block-group percentages of tree cover, total green space, and proximity to parks based on land cover data from EPA's EnviroAtlas at 1m resolution and geocoded locations of parks. Correlation coefficients were calculated between block group socio-demographic characteristics and availability of resources, adjusted for spatial autocorrelation. Statistical associations between socio-demographic attributes and healthful resource proximity and access were evaluated using advanced statistical methods adjusted for spatial autocorrelation.
Results: Preliminary observations suggest significant spatial autocorrelation among neighborhood socio-demographic variables. Observations further suggest traditionally marginalized populations and low SES block groups have reduced access to resources that promote health and well-being.
Conclusions: Identifying neighborhoods with limited access to important amenities can help prioritize community interventions to improve neighborhood vitality and population health.
This project abstract was supported by Cooperative Agreement Number X3-83388101 from the U.S. Environmental Protection Agency and the Association of Schools of Public Health. The findings and conclusions of this project abstract do not necessarily represent the official views of EPA or ASPH.
Carter-Edwards., Lori, PhD, Deputy Director, UNC Center for Health Promotion Disease Prevention; Barnes, Katie, BRE, UNC Center for Health Promotion Disease Prevention; Johnson, La-Shell, MA, UNC Center for Health Promotion Disease Prevention; Blackman, Kate, BA, UNC Center for Health Promotion Disease Prevention; Harris, Barbara, MEd, Leysath, Darlene, BA, Cornerstone LLC; Locklear, Andrea, UNC Center for Health Promotion Disease Prevention; and Brewer, Tabatha, Coharie Intra-Tribal Center
The Seeds of HOPE (Health, Opportunities, Partnerships, and Empowerment) Project Team, comprised of community partners and researchers, are working together to disseminate HOPE Works, a community-based health promotion and social and economic empowerment program for overweight and obese rural, low-income minority women. Circle Leaders (CLs), women recruited from the rural communities that we serve, receive health promotion training to recruit women from their social networks as circle participants. These circles are used as vehicles to promote health through goal setting, social support and information sharing. Initial strategies by the Seeds of HOPE Project Team involved recruitment of organizations for program dissemination. Bi-weekly meetings were held with community members and the Seeds of HOPE Project Team to identify community organizations for recruitment. Using recruitment logs and conversations with organizational contacts, the Project Team discussed and collaboratively identified a set of real-world, practical barriers to organizational participation: inability to meet organization inclusion criteria (i.e., not enough women in the organization to participate); seasonality of organizational recruitment; program fit with organization agendas; perceived duplication of existing organization services; program support agreement between organization leadership and persons identified to be Circle Leaders; and impact of project staffing and transition on recruitment retention momentum. Using CBPR processes, through lessons learned, the Project Team and the Community Action Council discussed/approved the expansion to two additional strategies for dissemination. Processes for identifying these barriers, the two additional strategies for dissemination, and lessons learned are described.
The Effects of Video-Telemedicine on Biomarkers in Rural-Dwelling Korean Older Adults with Chronic Illnesses
Jennie C. De Gagne, PhD, RN-BC, CNE 1; Aeyoung So, PhD, MPH, RN 2; YoungOak Kim, CHP, RN 3; Sunah Park, PhD, RN 4
1 Assistant Professor, Byrdine F. Lewis School of
Nursing and Health Professions, Georgia State University, Atlanta,
2 Professor, Department of Nursing, Gangneung-Wonju National University, Wonju-Si, South Korea
3 Community Health Practitioner, Sosah Primary Health Care Post, Hoengseong-gun, South Korea
4 Visiting Scholar, School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
Introduction: Primary Health Care Posts (PHCPs) provide health services to residents living in underserved areas of South Korea. Some of the PHCPs in rural areas have adopted a video-telemedicine system to monitor and manage the progress of older adults with chronic illnesses. The purpose of this study was to examine the effects of the video-telemedicine system on physical health status among rural-dwelling Korean older adults with hypertension or diabetes.
Methods: A pre-post single group design was used to compare blood pressure and laboratory test results (HbA1c/TChol/TG/HDL/LDL) before and after implementing the video-telemedicine system. Using a paired t-test, medical records of 86 subjects with hypertension or diabetes were analyzed from the Sosah PHCP.
Results: The mean of the systolic blood pressure decreased by 20 mmHg (t = 8.12, p < .001) and the diastolic blood pressure by 8 mmHg (t = 6.05, p < .001). HbA1c levels were reduced by 19.5% after the implementation (t = 5.98, p < .001). There were significant decreases in total cholesterol (t = 5.48, p < .001) and in triglycerides (t = 4.03, p < .001). The mean of HDL increased by 8 mg/dl (t = -6.05, p < .001) while LDL decreased by 32 mg/dl (t = 21.78, p < .001).
Conclusion:Video-telemedicine is an effective system to manage physical symptoms of hypertension and diabetes in Korean older adults living in a rural area. Self-management programs integrated into the video-telemedicine system would better support rural older adults who have high rates of chronic illnesses and little access to healthcare resources.
Clinical Collaboration(s): Epistemological Differences in Dietary and Lifestyle Interventions and Management on the South Side of Chicago, 1960-1980
Epstein, Ari J., AB, Department of History, Biological Sciences Collegiate Division, University of Chicago
Introduction: From 1960 to 1980, physicians from conventional and non-conventional medicine discussed methods of reforming chronic disease management models. They attempted to increase patient adherence to dietary and lifestyle interventions and reduce the incidence of epidemics like obesity and diabetes. However, they implemented different interventions among urban African Americans based upon disparate conceptions of health and disease.The conventional medical establishment framed the knowledge of and barriers to chronic disease management and education by characterologically omitting African Americans from the data. This poor methodology constrained the research questions the establishment asked and healthcare they ultimately provided because it dismissed African Americans' self-legitimized healthcare alternatives, such as community-derived models and non-conventional practitioners, to fill that healthcare void. In locales like Chicago's South Side, naturopathic physician, community activist, and entrepreneur Dr. Alvenia Fulton (1907-1999) represented an alternative set of healthcare practitioners documenting and responding to the obesity epidemic. By collaborating with her patients to learn their spiritual and emotional needs, Fulton produced individualized dietary and lifestyle interventions.
Methods: The author synthesizes national and Chicago-based medical sources from 1960 to 1980, including official health initiative records, patient and practitioner oral histories, and periodicals documenting non-conventional physician practices. This review of formal and informal databases introduces a unique and useful frame to construct social histories from medicine and encourage additional scholarship that consults these underutilized archives and figures.
Conclusions/Implications: Although non-conventional physicians like Dr. Fulton gained positive clinical outcomes in the African American population, the conventional medical establishment only acted upon knowledge derived from biomedicine and data. This prevented the establishment from implementing collaborative healthcare in Chicago until studies after 1980 produced statistically significant data to support reform. Ultimately, the epistemological differences between the two fields reveal a missed opportunity for culturally competent and individualized public health programming at the beginning of the diabetes and obesity epidemics. Even more, those differences demonstrate the need for additional social science and healthcare policy research on collaboration between both fields to improve dietary and lifestyle intervention models.
Understanding urban low income minority families' food shopping behaviors to better promote fruit and vegetable consumption and use of alternative food sources
Fish, Caitlin A., BA, Clinical Studies Coordinator, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine; Shepherd, Jonisha, BA, BS, MD Candidate, Wake Forest School of Medicine; Quandt, Sara A., PhD, Professor, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine
Introduction: Urban low income minority families often reside in neighborhoods with few chain supermarkets or alternative food sources (e.g., farmers markets, produce stands, community gardens), making fresh produce difficult and expensive to obtain. This study used qualitative data to identify (1) factors influencing fruit and vegetable shopping behaviors, and (2) barriers to and promoters of the use of alternative food sources.
Methods: Twenty-four immigrant Latinas and 24 African-American women with children in North Carolina completed semi-structured interviews regarding food shopping habits and use of and attitudes toward alternative food sources. Interviews were recorded and transcribed, and then subjected to thematic analysis.
Results: Fruit and vegetable shopping behaviors were motivated by costs and family preference. Lack of transportation, placement of food sources, and family schedules influenced the types of fruits and vegetables purchased. For the African American women, a lack of cooking skills restricted the variety of fruits and vegetables purchased. Latinas were receptive to alternative food sources but did not frequent them because these alternative food sources were inconvenient. African American women were not receptive to alternative food sources, citing concerns about food safety and the inability to use eSNAP or WIC benefits.
Conclusion: Improvements in attitudes toward acceptable foods and cooking skills may be as important as increased access to fruits and vegetables to promote greater consumption of fruits and vegetables. Latinas appear more accepting of alternative food sources, suggesting that expanding these options in urban areas may need greater attention to attitudinal barriers among African American families.
- Identify factors influencing food shopping habits among minority residents in urban North Carolina
- Evaluate the influence of knowledge of and use of alternative sources of food on food shopping habits
- Compare and contrast patterns of fruit and vegetable purchasing and attitudes toward alternative food sources between two minority groups
Examination of Cultural Factors Influencing HPV Vaccine Uptake in African Americans: A Literature Synthesis
Objective: To examine the literature for cultural influences that may result in differences in knowledge, perceptions, beliefs, and attitudes for Human Papillomavirus (HPV) and HPV vaccine among African American parents, adolescents, and young adults compared to Hispanic and non-Hispanic whites.
Method: 22 peer-reviewed articles published between 2007 and 2012 met the study inclusion criteria. Studies were predominantly cross sectional design and descriptive.
Findings: Overall, there is a lack of studies that examine cultural influences that effect the perceptions of the HPV vaccine in African Americans. Two main themes were identified: (a) a deficit in knowledge about HPV and HPV vaccine; and (b) cultural beliefs influence cervical cancer knowledge and HPV vaccine uptake. Although African American and Hispanic parents possessed lower HPV knowledge than Whites, they had high acceptability of HPV vaccine when associated with positive attitudes towards vaccination and when given more information. Adolescents had very low knowledge of the HPV vaccine, while sexually active teens and young adults were accepting of HPV vaccine. The limited cultural influences examined in African Americans were health care distrust and racial pride. Health care distrust was not a significant factor in HPV vaccination however higher racial pride was associated with lower HPV vaccine uptake.
Conclusion: With the HPV vaccine possessing stigmatizing connotations relevant to the African American community, cultural influences in perceptions of the HPV vaccine is an important area of HPV vaccine research that has not been sufficiently examined in this group.
Harris, Gayle, MPH, RN, Director, Durham County Department of Public Health; Califf, Robert M., MD, Vice Chancellor for Clinical and Translational Research, Duke University; Davis, Lisa P., PhD, MSPH, Senior Project Manager, Durham Diabetes Coalition, Duke Translational Medicine Institute; King, Linda B., MPA, Public Health Education Specialist, Durham Diabetes Coalition, Durham County Department of Public Health; Newkirk, Chasity J., MPH, Public Health Education Specialist, Durham Diabetes Coalition, Durham County Department of Public Health; Mortiboy, Marissa J., MPH, Information Communications Specialist, Durham Diabetes Coalition, Durham County Department of Public Health
Diabetes in Durham County: Diabetes is a major health problem in North Carolina and is the fifth leading cause of death in Durham County. In 2008, it was estimated that 9.3% of Durham County adults were diagnosed with diabetes, 2.2% were undiagnosed, and another 6.0% of the adult population had prediabetes. This poster presentation will demonstrate the Durham Diabetes Coalition's efforts to link and mobilize community resources to address diabetes health outcomes, health service usage, and health care costs.
The Durham Diabetes Coalition (DDC):The DDC is a collaborative partnership between Durham County Department of Public Health, Duke University, the University of Michigan Center for Geospatial Medicine, and Durham community partners. The central objectives of the DDC are to: 1) improve population-level diabetes management, health outcomes and quality of life for diagnosed and undiagnosed adults with type 2 diabetes and 2) reduce disparities in diabetes management, health outcomes, and quality of life for adults living with T2DM. This will be achieved through the implementation of a county-wide, community-based, population-level suite of interventions. Spatially–enabled informatics systems will support the development and implementation of the interventions while allowing for real time monitoring and evaluation. The DDC has identified two pilot sites and begun linking residents to existing clinical and community resources and, where gaps exist, facilitated placement of additional community resources through partnerships created between community, public, and private organizations including the DDC Community Advisory Board. The five year project is funded by the Bristol-Myers Squibb Foundation.
Godley, Paul A., MD, PhD, MPP, Professor, Division of Hematology/Oncology, Executive Associate Dean for Faculty Affairs and Faculty Development, UNC School of Medicine, The University of North Carolina at Chapel Hill; Vines, Anissa, PhD, MS, Research Assistant Professor, Department of Epidemiology, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill; White, Brandolyn, MPH, Special Projects Manager, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill
Background/Introduction: African Americans in North Carolina are more likely to suffer disproportionately from cancer compared to Whites. The goals of CCN II are to: 1) increase the community's knowledge of, access to, and use of beneficial biomedical and behavioral procedures; 2) develop and perform evidence-based intervention research aimed at reducing cancer health disparities; and 3) increase the number of qualified health disparity researchers experienced in using the Community-Based Participatory Research approach.
Methods: CCN II is comprised of an Administrative Core and three programs-Community Outreach, Research, and Training. Learning clusters are used to identify, implement and evaluate cancer education, outreach, and interventions based on community need. Pilot and full research studies are being conducted to explore clinical trial under-enrollment and to address gaps in colorectal cancer screening and survival rates among African Americans. The development and training of early-stage UNC investigators interested in developing their own cancer health disparities & CBPR research careers is supported through training resources and opportunities. The RE-AIM model is used as the evaluation framework for the Center.
Results: The Center has reached a number of community members in Central and Eastern NC with cancer education; recruited and enrolled study participants in studies addressing clinical trial participation and gaps in colorectal cancer screening; and recruited a diverse cohort of junior investigators as trainees in cancer health disparities research.
Conclusions: Through cancer research, training and education in collaboration with established partners, the Carolina Community Network Center to Reduce Cancer Health Disparities operates as a cohesive initiative to contribute towards the reduction in cancer health disparities among the African Americans in NC.
Jobs and Jail: An Exploration of the Social Determinants of Sexual Risk Behavior among African American Male Substance Users
Heckert, Andrea, MPH, Doctoral Candidate, Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill; Costenbader, Elizabeth, PhD, MPH, Associate Social Scientist II, FHI 360, Durham, North Carolina; Zule, William, DrPH, MPH, Senior Research Health Analyst, RTI, International, Research Triangle Park, North Carolina
Introduction: African American male substance-users in the Southeastern US experience some of the highest HIV rates in the country. Little research has explored how social conditions and social networks drive HIV-risk behavior including the sale of sex for drugs or money among this population.
Methods: Data are from in-depth interviews (n=16) and cross-sectional network study survey data (n=201) from two North Carolina-based studies. Content analysis of the qualitative data documented emergent themes regarding the social conditions experienced by African American male substance users. Among a similar study population, the strength of association between peer network composition and social support function on the sale of sex for drugs or money was tested using logistic regression models with GEE.
Results: Peer employment and peer history of incarceration are associated with selling sex among the network study respondents. These findings will be discussed in relation to the qualitative findings which revealed a pattern of political, structural, symbolic and everyday experiences of violence. Such violence includes joblessness, incarceration, and other assaults to the respondents' personhood and dignity which arguably give rise to an organization of self-worth and coping that discourages sexual and substance-use risk reduction.
Conclusion: Findings from this mixed-methods study will inform socially-relevant network-based interventions to prevent and control transmission of HIV and other STI among this population. Skills- and norms-based interventions that develop new and bolster existing health-promoting network ties, facilitate multifaceted social support through lay health advising, and strengthen health-promoting dynamics within social networks will be discussed.
Ilombu, Onyebuchi V., MBBS, MPH, Tulane University School of Public Health and Tropical Medicine
Introduction: Over 500,000 women still die from childbirth and pregnancy related complications with about 99% of these deaths still occurring in developing countries where the woman's adult lifetime risk of maternal death is about 40 times that of her counterparts in developed countries (Ijadunola K.T., Ijadunola M.Y., Esimai &Abiona, 2010). Although Nigeria makes up 2% of the world's population, it contributes 10% of the world's maternal deaths. In Nigeria the MMR has been estimated at 1100 per 100,000 live births (WHO et al., 2005).
Methods:The women's data set from the 2008 Nigeria Demographic and Health Survey was analyzed using SPSS 20.0 statistical software. Bivariate and multivariate analysis was done using the background characteristics to determine significant predictors of utilization of postpartum care services for women in the survey after their last childbirth.
Results: Only 44.9% of the women sampled had received postpartum care at any time after their last childbirth, 33.3% of them received a postpartum examination within 24 hours of delivery and 39.1% within 3 days of delivery. After controlling for confounding factors all but daily radio listening and daily television watching were significant predictors.
Conclusion: Some predictors had a positive influence on utilization of postpartum care services, while others had a negative influence. Qualitative studies are indicated to find out why and how these predictors influence the health care seeking behaviors of women. The findings from this study should form the basis for interventions to increase the rate of utilization of postpartum care services.
King, Katherine, PhD, Visiting Assistant Professor, Sociology Department, Duke University & Postdoctoral Researcher, Environmental Protection Agency, Chapel Hill, NC.
Introduction: Differences in spatial context contribute to health disparities, so tracing causal mechanisms and confounding factors is crucial. "Big 5" personality traits (neuroticism, conscientiousness, openness to experience, extraversion, agreeableness; NEO-PI) predict multiple health outcomes and are also socially patterned. Geographic differences in personality may contribute to spatial health disparities, allowing more accurate estimation of modifiable environmental mechanisms.
Methods: Nationally representative cross-sectional multilevel models linking the Health and Retirement Study (n>10,000; age 50+; 2006-8) with geographic Census socioeconomic and urbanization data. Extensive sociodemographic controls.
Results: Neighborhood and regional variation in "Big 5" personality measures exist in a large, representative study of older-adults. Neighborhood variation may be primary, and neighbors appear as similar in personality as in body mass index or blood pressure. Within tracts, Blacks vs. Whites, Hispanics vs. Whites, and immigrants vs. native-born are less dissimilar in personality compared to models not considering place. Personality is associated with neighborhood social composition (disadvantage, affluence, immigrant composition, and age composition) and to some extent urban hierarchy. Movers differ from stayers for lifetime regional moves and recent moves between tracts for all five personality measures.
Conclusion: Personality varies by region of U.S. and local neighborhood. Spatial personality variation is related to personality predictors of health disparities, consistent with social rather than genetic interpretations of personality. Personality is likely a factor in selection into residential contexts of varying quality. Although further work is needed to explore causal and compositional pathways, personality may confound models of how neighborhood socioeconomic status predicts health behaviors and outcomes.
DJ Oberlin, Lori Mattox, Vince Henrich, Ellen Jones, Laurie Kennedy-Malone, Laurie Wideman
Department of Kinesiology and department of Nursing, University of North Carolina, Greensboro; and the Center for Biotechnology, Genomics & Health Research
Introduction: Type 2 diabetes (T2D) and impaired glycemic control greatly increases the risk of cardiovascular disease mortality, and African-Americans (AA) are at an increased risk of developing T2D. Therefore, it becomes important to identify individuals at increased risk of progressing from pre-diabetic to T2D. The purpose of the current study was to compare a scoring system based on anthropometric data for predicting insulin sensitivity (IS), in AA compared to scores based on SNPs for T2D.
Methods: As part of a larger study, ten subjects [5 control (age=31±9.4 yr, BMI=29.4±5.2, % body fat=34.5±6.9%, FBG=4.6±0.54 mmol/L) and 5 pre-diabetic (age=35±9.3 yr, BMI=32.1±4.0, % body fat=32.4±12.4%, FBG=5.65±0.07 mmol/L)] were recruited. Data was analyzed using SAS (Cary, North Carolina). Principal component (PC) analysis was used to produce scores for anthropometric and SNP variables. The three components that explained the most variance were then regressed against QUICKI (IS).
Results: The PCs for anthropometrics were significantly correlated with IS (p= 0.0348, adj. R2= 0.6087), however, the PCs for the genetic markers were not (p= 0.7755, adj. R2= -0.2639). A follow-up of anthropometric PCs on insulin sensitivity showed that the second PC, (age, gender, and percent body fat) as well as the third PC (physical activity, sagittal diameter, and BMI) were significantly correlated with QUICKI (p=0.0126, adj. R2= -0.6316).
Conclusion: In this pilot study, composite scores based on anthropometric measures more accurately predict IS (QUICKI) than T2D SNPs and may provide a cost effective way of assessing risk of progression toward T2D in a high risk population.
Racial Disparities on Diagnostic Mental Disorder among Immigrant Women Aged 50 and above Living in the US
Ma P, PhD candidate; Theall K, PhD, Global Community Health and Behavioral Sciences, School of public health and Tropical Medicine, Tulane University
Introduction: With the constant influx of numerous immigrants, the number of old immigrants has constituted one of the most important components among elderly population in the US. However, there is still a dearth of information about mental health status among middle and older aged immigrant women. This study aims to investigate whether racial disparities on diagnostic mental disorders exist among immigrant women aged 50 and older living in the US.
Method: This cross-sectional study was restricted to 818 Asian, Latino and Black immigrant women aged 50 and above by using The National Institute of Mental Health Collaborative Psychiatric Epidemiology Survey (CPES). The main outcomes were any diagnostic lifetime anxiety disorder, mood disorder, eating disorder, and ever seriously thought about suicide. Demographic variables and self-reported physical and mental health status were controlled. Descriptive, bivariate and multivariate analyses were conducted.
Result: 14.7%, 15.2%, 2.1% and 7.3% of middle and older aged immigrant women experienced any lifetime anxiety disorder, mood disorder, eating disorder and ever seriously thought about suicide respectively. After controlling for confounders, significant racial disparities were found in any lifetime mood disorder (p=0.008) and ever seriously thought about suicide (p<.0001). Compared with Asian immigrant women, Latina immigrants were 0.14 times less likely to have mood disorder and Black immigrants were 6.9 times more likely to think about suicide seriously before.
Conclusion: Racial disparities on the mental disorder exist among immigrant women aged 50+ and the factors that account for these differences should be further researched and addressed in the future intervention.
A Community-Engaged Research Approach to Improve Mental Health Among Latina Immigrants: ALMA Photovoice
Georgina Perez, MSW, Duke University Medical Center, Division of Community Health; Rachel Page, MPH, The University of North Carolina at Chapel Hill, Department of Health Behavior and Health Education, Chapel Hill, NC; Laura Cubillos Braswell, The University of North Carolina at Chapel Hill, Department of Health Behavior and Health Education, Chapel Hill, NC; Anh N. Tran, PhD, MPH, Duke University Medical Center, Division of Community Health; Melissa Green, MPH, The University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research; Michelle J. Lyn, MBA, MHA Duke University Medical Center, Division of Community Health; Giselle Corbie-Smith, MD, MSc, The University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research
Background: Recent Latina immigrants are at increased risk of poor mental health due to stressors associated with adapting to life in the United States. Existing social and healthcare policies often do not adequately address mental health concerns of new Latino populations. Amigas Latinas Motivando el Alma (ALMA), a community partnered research project, seeks to improve immigrating Latinas' mental health outcomes. Using Photovoice methodology, ALMA promotoras shared insights about their communities' strengths and mental health concerns through a series of three public photography exhibits in order to reach local policy makers and increase community awareness.
Methods: ALMA Promotoras reflected on community factors impacting mental health through photography and guided discussion. Discussions were audio recorded, transcribed, and coded using content analysis to identify salient themes. Promotoras reviewed codes for verification and development of themes that they presented in a community forum.
Results: Twenty-one Promotoras participated in Photovoice. This project culminated in three local forums which displayed the promotoras' photographs and discussed action steps to address community concerns. Discussion themes included adaptation to American culture, the importance of positive parent-child relationships, education, impact of perceived racism, and the significance of lay health programs to address Latina mental health issues. Over 100 stakeholders attended the community forums and proposed responses to promotoras' photographic themes.
Conclusions: Photovoice provides an opportunity for Latinas and the larger community to identify issues they find most important and to explore avenues for action and change by creating sustainable partnerships between the community and forum attendees.
The Cultural and Linguistic Adaptation of the SHOWED Method Leading to the Implementation of ALMA VENCER
Rachel Page, MPH, The University of North Carolina at Chapel Hill, Department of Health Behavior and Health Education, Chapel Hill, NC; Laura Cubillos Braswell, The University of North Carolina at Chapel Hill, Department of Health Behavior and Health Education, Chapel Hill, NC; Georgina Perez, MSW, Duke University Medical Center, Division of Community Health; Anh N. Tran, PhD, MPH, Duke University Medical Center, Division of Community Health; Melissa Green, MPH, The University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research; Michelle J. Lyn, MBA, MHA Duke University Medical Center, Division of Community Health; Giselle Corbie-Smith, MD, MSc, The University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research
Background: Photovoice is a well regarded method for social and policy change that engages participants in defining and developing solutions to issues of concern and maybe especially important in socially and linguistically isolated populations. Non-English adaptations, however, are difficult to find in the existing literature to implement Photovoice. Amigas Latinas Motivando el Alma (ALMA), developed a cultural and linguistic adaptation of the SHOWED method, ALMA VENCER, to explore Latinas' acculturation experiences and mental health concerns in the context of access to local policy.
Methods: The ALMA VENCER was collaboratively developed with promotoras who had been trained to address disparities in mental health. We adapted SHOWED through an iterative process with 3 cohorts of 4-6 promotoras. The SHOWED method was modified based on feedback during Photovoice sessions and through supplemental information obtained by research staff. Culturally relevant questions were added throughout the two-year period and the process resulted in a bilingual handout.
Results: ALMA created a culturally and linguistically tailored method of implementing Photovoice with Latinas. This method used the Spanish acronym VENCER (to overcome): Ver (See), Explica que sucede (Happening), Nuestras vidas (Our lives), Causas (Why), Empoderar (Empower), Resolver(Do). The final model consisted of six general guidance questions, one for each letter of the acronym and twenty-six detailed questions distributed across the six sections of ALMA VENCER.
Conclusions: ALMA VENCER is a culturally tailored Photovoice tool involving community perspective and engagement and provides a method for marginalized populations to express their perceived issues, opening the door for dialogue and solutions with key stakeholders.
Previc, Stephanie T. BA Health & Society, Beloit College
Introduction: Hispanic women have the highest incidence of HPV-related cervical cancer in the United States. While the PAP smear has been successful in decreasing its overall prevalence, medically underserved populations comprise sixty percent of new cases reported each year; implicating a disparity in access to, or use of, the PAP smear in at-risk communities. Visual Inspection with Acetic Acid is regarded as an effective, low cost alternative to the PAP in developing countries, but is not currently widely recognized within the United States.
Methods: A focus group comprised of twenty women from the Southside of Tucson, Arizona, coupled with thirty surveys and fifteen in-depth interviews with stakeholders and key informants were conducted during Summer 2011. Using the Health Belief Model and Community-Based Participatory Action Research, VIA was assessed as an alternative to the PAP for Hispanic women in the border region.
Results: Among this population, the risk of cervical cancer is compounded by sociocultural beliefs, lack of resources, and immigration status. Participants in the study identified shame as the greatest barrier to seeking preventive care, followed by cost and transportation. As an inexpensive approach, VIA was regarded favorably among participants, including both women and their providers.
Conclusion: This study addressed health disparities by applying known interventions and integrating them into a new environment. While VIA may challenge infrastructural barriers, combining access to screening with resources and education for Hispanic women to make informed decisions about their health is ultimately needed to reduce the burden of cervical cancer in this community.
Reuland, Daniel S., MD, MPH, Associate Professor, Department of
Medicine, UNC Chapel Hill; Braswell, Laura Cubillos, Graduate Research
Assistant, NC TraCS Institute, UNC Chapel Chapel Hill*; Hall, Megan E.,
MPH, Research Assistant, NC TraCS Institute, UNC Chapel Hill; Miller,
Cheryl J., MSG, Community Coordinator, NC TraCS Institute, UNC Chapel
Hill; Mooneyham, Rachel A., Research Assistant, NC TraCS Institute, UNC
Chapel Hill; Perreras, Lexie, Graduate Research Assistant, NC TraCS
Institute, UNC Chapel Hill
Introduction: Problems with patient-provider communication for limited English proficient (LEP) Latinos in healthcare are well-documented. However, few studies have specifically explored communication challenges during the patient registration process for these populations.
Methods: We conducted Spanish-language surveys (quantitative items with open-ended prompts) in a community sample of LEP Latinos in Greensboro, NC. Items focused on perceived confidentiality in handling of registration information, discrimination, identification requests, accuracy in recording of surnames, language service provision, and general treatment by registration staff
Results: Among n=20 respondents, 18 (90%) trusted that their information would not be shared outside of the healthcare system; however, 11 (55%) reported being treated unfairly in the past 12 months by registration staff because of their race/ethnicity. Five (25%) reported discomfort with identification request processes. Nine (45%) reported problems with accurate registration of surnames. Open-ended responses reflected perceived rudeness on the part of registration staff; lack of help with filling out English forms; patients being asked to sign English forms they could not read; perceptions of being misunderstood by registration staff; "never getting [the] last names right"; and being told they "needed to bring an interpreter".
Conclusion: This exploratory study suggests multiple problematic aspects of patient registration processes for LEP Latinos. Further research is needed to better characterize the scope and frequency of these problems and to implement appropriate structural solutions, such as the training of registration staff regarding federal standards for providing language services and modifying electronic health record system inputs to accommodate diverse naming traditions.
Shen, Mary, BSPH Candidate, Department of Nutrition, University of North Carolina at Chapel Hill; Nezami, Brooke T., PhD Candidate, Department of Health Behavior, University of North Carolina at Chapel Hill; Crane, Melissa M., PhD Candidate, Department of Health Behavior, University of North Carolina at Chapel Hill; Tate, Deborah F., PhD, Associate Professor, Department of Health Behavior and Department of Nutrition, University of North Carolina at Chapel Hill
Research shows perceived stress (PS) is related to weight gain, but few studies have examined PS during a weight loss attempt. We hypothesized that higher PS would be associated with lower treatment adherence and less weight loss and we explored how change in PS during treatment is associated with weight loss.
This data is from a 4-month weight loss RCT intervention delivered via Internet and monthly in-person sessions (N=192, 46.3±10.8 yrs, BMI 37.9±8.5, 91% women, 51% African-American). Percent weight loss (WL) was calculated from measured weight and PS by the Perceived Stress Scale (range 0-40) at baseline and 4 months. Adherence was defined as website logins and group attendance. Intent-to-treat analyses (BOCF) controlled for group, race and education.
Overall, PS decreased over time (17.1±5.8 to 14.3 ±6.7). Among women (n=175), baseline PS did not predict WL (p=.56) but decreases in PS were associated with greater WL (p<.01). In an exploratory analysis of men (n=17), baseline PS predicted WL (p<.01) but there was no association between PS change and WL (p=.80). Adherence was associated with WL (p's.20).
Baseline PS was associated with WL among men while reductions in PS were associated with WL in women. It is unclear how PS changes affect WL as PS was not associated with adherence. These results suggest that the relationship between PS and WL may vary by gender.
A Working Group for Reproductive Justice: Using social movements to invigorate traditional public health theories on sexual and reproductive health
Arianna Taboada, MSW, MSPH, Project Manager UCLA Art|Global Health Center; Laura Villa Torres, PhD(c), Department of Health Behavior, Gillings School of Global Public Health; Chelly Richards, MS, MPH(c), Department of Health Behavior, Gillings School of Global Public Health
The intersection of immigrant status and health is a topic wrought with issues of social inequity in all regions of the world. Due to the difference in development between North America (USA and Canada) and the rest of the Americas, immigration is typically conceptualized as movement from the south to the north of the continent. Nevertheless, Latin American countries also present diverse levels of economic growth and human development among themselves, a context that leads to other, often understudied, migration patterns and social determinants that affect health. An interdisciplinary working group started by graduate students used a Reproductive Justice framework, developed in the USA by a social movement led by women of color, to develop a critical research agenda for sexual and reproductive health of migrant women across the Americas. While examining current theories used in reproductive health, we recognize the nuances of migrant women's experiences, and how such theories are often inadequate in capturing complex structural determinants of reproductive justice such as trade agreements and migration policies. This poster highlights how our community and academic activities critically examine typical theories for studying reproductive health that are based in legal and life-course perspective in order to understand what reproductive justice means for women whose reproductive rights and overall health are often neglected by countries of origin, transit, and/or destination. We propose that migration be considered a structural determinant for health, and a critical factor in achieving health equity. Research, policy and practice implications are addressed.
Tiffany H. Williams, DNP, APRN, CPNP, College of Nursing Faculty, Heart Health Program Nurse Practitioner, Department of Pediatrics, Medical University of South Carolina; Sarah Stein, BS, Heart Health Program Research Coordinator, Department of Pediatrics, Medical University of South Carolina; Melissa Henshaw, MD, Heart Health Program Medical Director, Department of Pediatrics, Medical University of South Carolina; Janet Carter, RD, Heart Health Program Manager, Department of Pediatrics, Medical University of South Carolina
Introduction: Vitamin D deficiency and insufficiency is a growing national problem for children and adolescents in the United States. There is a suggested relationship between BMI and serum vitamin D levels. Racial and ethnic differences in the degree of adiposity and distribution of body fat are well documented. The aim of this study is to examine an association between body mass index (BMI) and vitamin D status in a convenient sample from an obese pediatric cohort, and to assess for racial and gender disparities.
Methods: Data from 240 obese children and adolescents, ages 4-20, were analyzed for this project. Data was derived from laboratory values of serum 25(OH) Vitamin D and Dual-energy X-ray absorptiometry (DXA) scan. Using DXA BMI results, BMI z-scores were calculated using CDC standards for weight, age, and gender.
Results: Using the Wilcoxon analysis for a two-sided sample there is a significant difference between Vitamin D within race, p=<.0001. As confirmed by T-test, whites (n=87, = 26.8) had higher vitamin D levels compared to our black population with (n=120, =17.86) with a p-value<.0001. Race was significant in predicting vitamin D status, R2=.36, F (4,207) =39.20.
Conclusion: Consistent with previous studies, as BMI z-scores increased as vitamin D decreased. BMI and body fat are believed to influence the appearance of vitamin D insufficiency in children. Black children have higher rates of vitamin D deficiency than white children. BMI may play a role in vitamin D deficiency affecting health disparities.
An Examination of Racial Differences in Timeliness of Colorectal Cancer Care among Users of the Veterans Affairs Healthcare System
Leah L. Zullig, MPH, Predoctoral Fellow, Department of Health Policy and Management, UNC; George L. Jackson, PhD, MHA, Investigator, Health Services Research & Development, Durham VA Medical Center; Morris Weinberger, PhD, MS, Distinguished Professor, Department of Health Policy and Management, UNC;Dawn Provenzale, MD, MS, Investigator, Health Services Research & Development, Durham VA Medical Center;Bryce B. Reeve, PhD, MA, Associate Professor, Department of Health Policy and Management, UNC; William R. Carpenter, PhD, MHA, Assistant Professor, Department of Health Policy and Management, UNC
Introduction: The Veterans Affairs (VA) healthcare system is the largest integrated healthcare system in the United States. While quality of VA colorectal cancer (CRC) care is well chronicled, there is a paucity of literature describing racial differences in VA CRC care timeliness. The objective of this analysis was to examine potential racial differences in CRC care timeliness.
Methods: Data were from the VA External Peer Review Program (EPRP), a nationwide VA quality-monitoring program. Included patients must have been Caucasian or African American (AA), diagnosed with non-metastatic CRC between 2003 and 2006, and received definitive CRC surgery. We examined 3 timeliness metrics – time from: 1) surgery to initiation of adjuvant chemotherapy (Stage II-III), 2) surgery to surveillance colonoscopy (Stage I-III), and 3) surgery to death (Stage I-III). Unadjusted analyses used Log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models.
Results: In adjusted Cox regression there were no racial differences in time to initiation of chemotherapy (HR 0.82, p=0.61) or surgery to death (HR 0.94, p=0.0.49). In adjusted Cox regression, white race was protective for shorter time to surveillance colonoscopy (HR 0.63, p=0.02). The median time to colonoscopy was 367 and 383 days for Caucasian and AA patients respectively.
Conclusion: While Caucasian patients receive follow-up colonoscopies in a timelier manner than AA patients in VA, the difference between median times by race is 16 days. Though statistically significant, this potential racial difference in time to surveillance colonoscopy receipt is not clinically meaningful; there is no scientific evidence suggesting that surveillance colonoscopy benefits vary monthly.
Camila A Pulgar, BS, Clinical Studies Coordinator, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine; Joseph G. Grzywacz, PhD, Professor, Department of Human Development and Family Science, Oklahoma State University; Thomas A. Arcury, PhD, Professor, Department of Family and Community Medicine, Wake Forest School of Medicine; Cynthia Suerken, MS, Biostatistician II, Department of Biostatistics Sciences, Wake Forest School of Medicine; Grisel Trejo, MPH, Project Manager, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine; Edward Ip, Professor, Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine; Sara A. Quandt, PhD, Professor, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine.
Introduction: Farmworker family members are at risk for poor mental health due to stressors common to their lifestyles, including discrimination, documentation status, poor housing, frequent relocation, exploitative work arrangements, and poverty. Previous mental health research has focused primarily on male farmworkers. More research is needed to understand the factors associated with depression among women, particularly those responsible for childrearing.
Methods: Site-based sampling was used in North Carolina to recruit 248 mothers of children aged 2-3 from households with at least one adult engaged in farm work. By design, one-quarter were migrant farmworker families and the remainder seasonal. Participants completed a fixed-response interview in Spanish. Variables (measures) included depressive symptoms (Center for Epidemiologic Studies Depression Scale), farmwork-related stressors (Farmworker Stress Inventory), and economic hardship (USDA Household Food Security Survey Module). Analyses tested the hypothesis that greater depressive symptoms would be associated with greater farmwork-related stress.
Results: Bivariate analyses indicated greater depressive symptoms among mothers who reported more farmwork-related stressors, were older, were unmarried and reported economic hardship. In multivariate logistic regression, economic hardship remained the only factor associated with depressive symptoms (OR 2.2; 95% CI 1.2, 4.2).
Conclusion: Economic hardship, but not general farmwork-related stress, is associated with depression in these women. Maternal depression can have consequences for both mothers and families. Mental health services for women in farmworker families should be targeted to those with the greatest economic challenges. Further research should test whether food insecurity is the best measure of such hardship.