APHA 2015 - Chicago, IL

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Student Presentation Schedule

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Student Presentation Abstracts

Listed in order of student last name

Neighborhood Social Cohesion and Obesity among Latinos: A Novel Approach to Reducing Health Disparities

Stephanie Albert, MPA, PhD Student
Hector Alcala, MPH, PhD Candidate
Mienah Sharif, MPH, PhD Candidate

Background: Latinos bear a disproportionate burden of obesity and obesity-related chronic diseases. Novel approaches are needed to reduce the disparities of obesity among Latinos. Perceived social cohesion, a neighborhood level factor associated with positive self-rated health and health behaviors, is an understudied topic in obesity. This study will also assess whether physical activity helps explain this relationship.

Methods: Data were analyzed from the 2009 California Health Interview Survey (CHIS), a random-digit dial cross-sectional survey, representative of the California adult population. The sample was restricted to adults who completed the social cohesion module and reported being Latino/Hispanic (N=4,461). Logistic regression models were used to assess the relationship between social cohesion, measured by a 16-point scale, and obesity. Models will be developed to measure the mediating role of physical activity.

Results: 23.7% of the sample was obese. After controlling for age, gender and education, results suggest lower odds of being obese with a 1-unit increase in social cohesion (OR= 0.94; p-value= 0.04). Social cohesion is also positively associated with higher odds of physical activity (OR= 1.13; p-value= 0.001). Analyses will be expanded by building models that test physical activity as a potential mediator explaining the relationship between social cohesion and obesity.

Conclusion: Future obesity prevention efforts among Latinos may be more effective by focusing on public health and community level policies and programs that include strategies to improve levels of social cohesion. An individual’s perception of neighborhood social cohesion may increase levels of physical activity, which may in turn decrease their obesity risk.

Physical, Sexual and Emotional Child abuse and Cancer: Not Just Another Adverse Childhood Experience

Hector Alcala, MPH, PhD Candidate 

Background: A burgeoning body of literature has linked experiences of child abuse to increased risk of cancer in adulthood. The goal of the present study was to examine if each child abuse subtype (i.e. physical, sexual and emotional) impacted odds of cancer, while accounting for the other abuse types and other adverse childhood experiences (ACEs).

Methods: Data from the 2011 BRFSS (N=120,586) were used. The sample included adults, age 18 and over, from nine different states. Dichotomous measures of physical, and emotional abuse, indicated whether or not a respondent experienced that type of abuse as a child. Similarly, dichotomous measures of ACEs captured experiences that included having parents that were separated or living in a home with an adult drug user. A logistic regression model predicting a lifetime diagnosis of cancer was run. Independent variables included all abuse subtypes, ACEs, age, gender, race and state of residence.

Results: After controlling for ACEs, age, gender, race and state of residence, physical (AOR=1.23; 95% CI: 1.09-1.40), sexual (AOR=1.37; 95% CI: 1.23-1.53) and emotional abuse (AOR=1.10; 95% CI: 1.00-1.21) were independently associated with increased odds of cancer. Among ACEs, only living with a mentally ill adult (AOR=1.17; 95% CI: 1.02-1.33) and living with someone who was jailed (AOR=1.25; 95% CI: 1.00-1.57) increased odds of cancer.

Discussion: All childhood abuse subtypes appear to increase cancer risk. As such, research should avoid treating abuse and ACEs as interchangeable experiences. Current cancer prevention efforts may benefit by targeting child abuse survivors.

Associations Between Exchange Sex and Substance Use among a sample of Homeless Youth in Los Angeles

Catherine Branson, MPH, PhD Student

Homeless youth are at high risk for HIV and other STDs. One sexual risk disproportionately reported by homeless youth is exchanging sex for money, food, drugs, or a place to stay.  Previous estimates of exchange sex among homeless youth have ranged widely from 3% to 43%, indicating that continued research on this practice is needed. This study investigated the associations between exchange sex and specific substance(s) used among 154 homeless youth recruited from a drop-in center in Los Angeles in 2010.  Twenty percent reported ever having traded sex, and more commonly exchanged sex for drugs (14%) than for money (12%) over the previous 30 days. Exchange sex was practiced equally by each gender and was significantly correlated with recent use of crack, amphetamines, cocaine, and heroin.  It was also significantly more common among youth who had ever injected drugs or who had ever been in foster care. Preliminary OLS regression results indicate that practicing exchange sex increased with age (p=.002) and with greater amphetamine use over the previous 30 days (p=.036). While information about the gender of the exchange partner was not collected, instances of exchange sex increased along with having more same sex partners (p=.004) only among males, which is consistent with previous research indicating that predominantly males engage in transactional sex with homeless youth. Harm reduction interventions targeting homeless youth should teach ways they can protect themselves from victimization and minimize sexual risk while engaging in exchange sex.

Parental Disapproval and Difficulties Accessing Routine Health Care Influence Contraceptive Choice and Pregnancy Outcomes

Catherine Branson, MPH, PhD Student

Prescription birth control is more effective than over-the-counter (OTC) methods like condoms, but a need for secrecy or difficulties accessing medical care may contribute to the reasons teens more commonly use OTC birth control. Young women using OTC methods may be more likely to experience first pregnancies while still in adolescence than those using prescription methods.               

Methods: Limited access to health care services and perceptions of disapproving parental attitudes toward sex and birth control use were examined as barriers to use of prescription birth control with 1,625 sexually active females who participated in National Longitudinal Study of Adolescent Health. Bivariate logistic regression was used to determine if these barriers affected the choice of birth control methods. Time from sexual initiation to first pregnancy was analyzed using Kaplan–Meier survival curves and Cox proportional hazards models. All analyses used self-report data from adolescents’ first sexual experience and the most recent sexual experiences reported at Wave I and II.

Results: Experiencing barriers to healthcare access and perceiving parent disapproval resulted in less frequent use of prescription birth control relative to OTC. Users of prescription methods reported a significantly longer time to first pregnancy.

Conclusion: These results indicate that increasing young women’s access to basic preventative medical care is likely to encourage use of prescription birth control, but that taking full advantage of these more effective methods is likely to depend on their ability to access them independent of parental consent. 

Prioritizing Alcohol and Drug Abuse Prevention Efforts Using Spatial Analysis

Catherine Branson, MPH, PhD Student 

This project used spatial analysis to identify areas throughout Los Angeles (LA) County where there are high concentrations of factors known to be associated with adolescent substance use.  Predictors of adolescent substance use include delinquency, school problems, abuse/neglect, availability of alcohol and marijuana, prevalence of drug and alcohol abuse in the community, and crime. Cross-sectional, de-identified address data from multiple LA County agencies were combined to create a data set of 9,244 data points of indicators known to be positively correlated with adolescent substance use. Location data included addresses of: arrests for drunk driving or alcohol/drug use offenses; juvenile probation clients; child/abuse and neglect arrests; and marijuana dispensaries. Geographic information systems (GIS) was used to geolocate addresses to create point layers, perform spatial joins of each point layer to a census tract polygon layer, and then merge point layers into one layer, using census tract ID as the unifying variable. Point density analysis created circular neighborhoods with a 1 mile radius and calculated a magnitude per unit area from point features that fall within a neighborhood around each cell. A raster image color-coded by concentration of points is produced, preventing identification of any one point used in the analysis. The Getis-Ord statistic established that clustering of risk indicators was statistically significant. This data will be compared to community assessment data on substance use prevalence among 2,837 youth ages 12-17 located throughout LA County to determine the accuracy of predicting adolescent substance use by mapping the location of risk factors. 

Understanding Medical Care Decision-Making Among Ethnically Diverse Older Adults with Multiple Chronic Conditions

Rosana Leos Bravo, MPH, PhD candidate 

Patient-centered care involves assessing patient preferences. However, studying preferences alone will not ensure patient engagement in the decision-making process. This study identifies typologies of decision-making among older adults in comprehensive geriatric programs. We specifically focus on decision-making processes related to the patient’s reported medical encounters. methods: Forty older adults with multiple chronic conditions (MCC) were recruited from advanced care geriatric programs in Northern and Southern California. Researchers conducted three rounds of in-depth qualitative interviews in English and Spanish, completing 113 interviews over a 13-month period. The first interview was conducted face-to-face and lasted one hour on average. The second and third interviews were conducted over the phone and ranged in length from 20 – 90 minutes. preliminary findings: There were demographic differences between participants from the two health care sites. Notably, 50% of the Southern California cohort was Spanish-speaking and 25% was bilingual, with lower levels of formal education than the entirely English-speaking Northern California cohort. The Southern California cohort was less medically informed and less inclined to use technology or medical information sheets. The Northern California participants report being more proactive and engaging during the medical encounter and their decision-making process as compared to their Southern California counterparts. conclusion: Understanding how geriatric patients with MCC wish to be involved in medical care decision-making process requires tailored communication and assessment. Study findings can inform health care policy, including the development of decision-making tools to assist practitioners and patients during the decision-making process, and improve the geriatric medical care experience. 

Examining Racial Disparities in Cognitive Ability over Time Among Older U.S. Adults: Does Stress Play a Role?

DeAnnah Byrd, MS, PhD Student 

Objective: Racial differences in cognitive functioning have been widely documentedFurther, a growing body of research suggests that stress is associated with poorer cognitive functioning, particularly among older adults.  Yet, few studies have specifically considered the possible influence of stressful life events and discrimination on cognitive ability and whether the effect of these stressors differs by race. This study longitudinally examines disparities in cognitive ability among older U.S. black and white adults.

Methods: Participants consisted of aging black and white adults enrolled in the Americans' Changing Lives study (ACL; N =3,617). Data were drawn from waves 4 and 5, which are 10 years apart. Cognitive impairment was assessed at both waves such that change in cognitive status was examined over time, and cognitive status as well as predictor and demographic variables were controlled at wave 4.

Results: Whereas there was no main effect of stressful life events or discrimination on cognition, there was a significant race effect, β = -.195, p = .013, such that whites have significantly lower wave 5 cognitive impairment scores compared to blacks, adjusting for demographics and depressive symptoms.  Inconsistent with predictions, there was no significant interaction between stressful events, discrimination and race, β = -.004, p = .950 and β = -.004, p = .908, respectively.

Conclusions: Race, rather than social stressors, appears to influence cognitive ability among aging adults.  In particular, blacks experience greater rates of cognitive decline over time compared to whites.  This finding highlights the importance of addressing racial disparities in cognition. 

Examining psychosocial links between discrimination and behavioral risks for HIV among Asian Pacific Islander and Latino Men who have Sex with Men

Pornsak (Paul) Chandanabhumma, MPH, PhD Student 

Background:  Asian Pacific Islander (API) and Latino Men who have Sex with Men (MSM) are emerging high-risk groups for HIV transmission, with high frequencies of unprotected sexual contact in these groups.  Studies have found racism and homophobia to predict risky sexual practices, yet the specific psychosocial mechanisms have not been well established.  This study aims to apply the framework of intersectionality to describe psychosocial responses to gender and to racial discriminations that are associated with risky sexual behavior among API and Latino MSM. 

Methods:  Systematic review of published literature in the U.S. was conducted on major journal databases, including Pub Med and Science Direct.  Key search terms included: MSM, gay, Asian, Latino, discrimination, racism, sexual risk, and HIV. 

Results: The review found that API and Latino MSM responded to discriminations in two distinct but non-mutually exclusive ways: 1) responses to racism included perceived exclusion, separation from racialized settings, self-modification, and adherence to stereotypes 2) responses to homophobia included suppression of gender identity, dismissal of discrimination, seeking support from social network, and direct confrontation.   Race-based responses, such as conforming to stereotypes, may place API and Latino MSM at greater risk for HIV transmission than gender-based responses, such as finding social support. 

Conclusion: API and Latino MSM exhibit psychosocial responses to racism or homophobia depending on the context of discrimination. These responses may promote or inhibit the risk of HIV transmission. Findings highlight the importance of providing culture-centered prevention strategies that address racism and homophobia experienced by MSM of Color. 

Using boundary-work to understand the dynamics of community-based participatory research

Pornsak (Paul) Chandanabhumma, MPH, PhD Student 

Background: Community-based Participatory Research (CBPR) has been advocated as an approach to eliminate health disparities among communities of color.  Yet, when the key principles of CBPR are followed, implementation issues related to participation and power sharing among CBPR partners may still occur. With origins in sociology, boundary-work describes the creation of symbolic characteristics to draw boundaries between social groups.  The purpose of this systematic review is to apply the elements of boundary-work to explain issues of academic-community participation in CBPR.

Methods: Systematic review of literature focused on CBPR project implementation was conducted on major databases, including PubMed and Science Direct.  Key search words included: CBPR, implementation, academic, community, and participation.  Commonly identified issues were classified according to the processes and functions of boundary-work.

Results: The systematic review identified three key issues related to academic-community participation in CBPR 1) unintended exclusion of stakeholders from the symbolic domains of research and of community 2) shifting boundaries of tasks and responsibilities among CBPR partners to protect institutional autonomy 3) delineation of culture-centered boundaries to advance community priorities and values.

Conclusion: Increased attention to boundary-work may help understand implementation challenges in CBPR.  The proliferation of boundaries that distinguishes the domains of research from that of the community may complicate the working relationship among CBPR stakeholders.  On the other hand, the production of community-centered moral boundaries may help CBPR partners resolve ethical dilemmas in CBPR.  Future studies should further examine how perceptions of symbolic boundary affect partnership processes and outcomes. 

Childhood Maltreatment, Risk of Intimate Partner Violence and Inflammation in Young Adults

Elinam Dellor, MPH, PhD Candidate 

Maltreatment in childhood may leave individuals vulnerable to further victimization in the form of intimate partner violence (IPV), and to poor mental and physical health in adulthood.  Victims of maltreatment have a higher risk of developing chronic medical conditions in adult life, including heart disease. Differences may arise through changes in physiological functioning—due to the trauma of maltreatment—that result in higher levels of systemic inflammation over the life course. One biomarker used to detect elevated inflammation levels – C-reaction protein (CRP) - predicts future cardiovascular disease and stroke independent of other cardiovascular risk factors. Examining the relationship between maltreatment, IPV and inflammation is essential to understanding the precursors of chronic disease.

            The purpose of this study is to compare the effects of childhood maltreatment on CRP and 2) To examine to extent to which IPV in adulthood explains the effects of child maltreatment on CRP. Data for this study come from The National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of over 15,000 respondents first interviewed in 1994 (grades 7-12) and followed through young adulthood (ages 24-32). Analyses are conducted using Structural Equation Models (SEM). Preliminary results indicate emotional and physical maltreatment are both associated with higher levels of CRP.  Young adults reporting childhood maltreatment show an increased risk of physical IPV such that IPV mediates the association between maltreatment and CRP. This study supports the role of childhood experiences of violence in further victimization and poor physical health in adulthood. 

Introducing Technology in Child Welfare Referrals for Health and Social Services

Elinam Dellor, MPH, PhD Candidate 

Child maltreatment is a major health problem that carries serious consequences over the life course. Abused or neglected children have an increased risk of depression and anxiety, substance use, engaging in sexual activity at a young age, obesity, cancer and heart disease. The child welfare system is charged by state and federal law to protect children from abuse and neglect. When children are removed from caregivers, the child welfare system is also mandated to address the specific needs of each family. Oftentimes, this means facilitating access to services related to mental and physical health as well as basic needs. Access to health and social services is critical for the wellbeing and safety of children and ultimately for reunification of families. Linking families to services however, varies by caseworker and can be cumbersome and time-consuming. Internet-based technology, with its inherent interactive nature may be particularly effective for improving the linkage process in the child welfare system. 

Here, the implementation of the DCFS Needs Portal, an internet-based intervention to improve the timing and quality of health and social service referrals in Los Angeles County is described and analyzed. In-depth interviews were conducted with ten service providers and caseworkers to determine perceived benefits and barriers to adopting the Needs Portal. We also analyzed feedback obtained from users of the Needs Portal to examine how the flow of information between users and developers is used to adapt to user needs. Our analyses revealed four major themes: 1) caseworker apprehension over new technology, 2) lack of communication between caseworkers and service providers, 3) lack of technological infrastructure and 4) competing workplace demands. Our findings suggest a need to embrace the internet as a timely and efficient way to link families to much needed health and social services in real time.

Retooling the master's tools: Translating the theory of intersectionality into methods for empirical health disparities research

Anne Fehrenbacher, MPH, PhD Candidate 

In 2003, the Institute of Medicine released a pivotal report entitled Unequal Treatment, which documented vast and long-standing inequalities in the health status of racial minorities compared to non-Hispanic whites. Although the report was influential in bringing the issue of health disparities to the front of the public health agenda, disparities have continued to widen. Crenshaw's theory of intersectionality has the potential to transform health disparities research by providing a framework for understanding the interlocking, cumulative effects of multiple inequalities on health. However, there is a lack of clearly defined intersectional research methodology in the field of public health. The process of translating intersectionality theory into study designs, measures, and analytic techniques poses three key challenges for public health researchers. First, researchers must be reflexive about their positions within the social hierarchies in which their projects are embedded and aware of the potential for their actions and instruments to reify structures of dominance. Second, researchers must determine how to ask questions about interdependent, mutually-constitutive identities without relying on additive models, which assume that identity categories are independent of one another. Third, since intersectionality is a relatively novel theoretical approach in public health, researchers must establish baselines for empirical intervention research. New forms of "popular methodology” are challenging current practices in the collection, use, and deployment of health and social data. Emerging methods using social network analysis, geographic information systems, and data visualization of digital information hold great potential to enhance the practice of intersectional health research. The field of descriptive sociology seeks to link narratives, numbers, images, and geocodes in ways that engage with and analyze daily social transactions (e.g., Sociological Images). With the proliferation of computer-assisted analysis software for mixed methods research (such as Dedoose, formerly EthnoNotes) and open-access visualization tools (such as Gephi), methods that were once the domain and expertise of the academy are becoming increasingly democratized. Intersectional methods may be the key to addressing persistent inequalities and improving the health of the most marginalized populations in our society. 

Examination of a chronic disease self-management curriculum and self-efficacy among Latino adults

Angela Gutierrez, MPH, PhD Student 

Background: Culturally tailored and low-cost self-management programs are a cost-effective way to decrease chronic disease self-management disparities among Latinos. An application-based self-management session based on recently identified Latino-coping strategies (Rutledge et. al, 2013) was added to the Tomando Control de Su Salud (Tomand) self-management curriculum (Lorig, et. al, 2003) to evaluate self-efficacy among Spanish-speaking Latinos with chronic illnesses.

Method:Twenty Spanish-speaking Latino adults with chronic health conditions (e.g., diabetes, arthritis) were enrolled in a 7-week self-management program. Participants were randomly assigned to the intervention group (7 sessions) or the control group (6 sessions). The seventh-session curriculum involed an application-based self-management strategies via role-playing and resource-sharing to facilitate self-management application in real world settings. Self-efficacy was obtained at baseline and the 7-week mark (Time 2). Ethnographic interviews were collected at Time 2. Data were analyzed using descriptive statistics and paired t-tests. 

Results: Mean self-efficacy improved among the intervention group from baseline (M = 52.5) to Time 2 (M  = 59.5); self-efficacy remained constant among the control group for baseline (M = 52.6) and Time 2 (M = 52.2). Paired sample t-tests indicate no significant improvements within the treatment (p = .423) or control  (p = .316) groups, largely due to small sample size. Improvements in self-efficacy within the intervention group lend support to the seventh-session curriculum.

Discussion: An increase in mean self-efficacy among the intervention group was observed. This warrants further examination of the application-based self-management session curriculum among a larger sample size.  Implications of this study involve understanding and evaluating a novel approach in self-management among Latinos. 

Caregiver Burden in Frontotemporal Dementia Compared to Early-Onset Alzheimer's Disease

Elvira Jimenez, MPH, PhD Candidate 

Behavioral variant frontotemporal dementia (bvFTD) is a debilitating illness that has particularly profound effects on caregivers because of the socioemotional impairment of the patients who are typically under age 65.  We studied 48 caregivers of the two most common neurodegenerative early onset dementias, bvFTD and early-onset Alzheimer’s disease (EOAD).  Individuals with bvFTD exhibit severe impairment in socioemotional behavior, which impacts their relationships with their caregivers.  In contrast, EOAD sufferers exhibit  memory-related impairments that have a different impact on caregivers. Compared to the EOAD patients, the bvFTD patients had more socially-impairing psychiatric symptoms on the Neuropsychiatric Inventory and more emotional blunting on the Scale of Emotional Blunting.   Compared to EOAD caregivers, bvFTD caregivers reported greater burden on the Zarit Burden Interview with some of the most burdensome items involving social relationships.  Hence, in bvFTD caregiving, the burden goes beyond the usual tasks of caring for a dementia patient and includes coping with the impact of the characteristic social and emotional disturbances of bvFTD.  The findings of this study have implications on how to target effective support for the profoundly burdened caregivers of patients with bvFTD.  Support strategies for this disease need to be considered to address the differences in patient characteristics and caregiver need. 

Sexual Identity Concordance and Mental Health

Evan Kreuger, MPH, PhD Student 

Background: People who identify as lesbian, gay, or bisexual (LGB) are at higher risk for experiencing psychological distress compared to heterosexual individuals. However, sexual orientation consists of sexual identity, romantic or sexual attraction, and sexual behavior, which do not always align. Due to the stigmatized nature of holding a non-heterosexual identity, people with same-sex attractions or behaviors may fail to take on an LGB identity. Little work has measured concordance between identity, attraction, and behavior (concordance defined as matching identity and attraction/behavior), and examined its relationship to mental health.

Methods: Data are drawn from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (n=12,068).   Weighted OLS linear regressions, suitably transformed, were performed to examine the effects of identity-attraction (heterosexual identity, same-sex attraction) and identity-behavior (heterosexual identity, same-sex behavior) discordance on key mental health outcomes, including perceived stress, depression, and mastery. Results were stratified by self-reported gender.

Results: Compared to concordant respondents, identity-attraction discordant women and identity-behavior discordant men and women reported significantly higher perceived stress and depression, and significantly lower mastery (all p-values <0.05).

Conclusions: Sexual identity discordance may play an important role in shaping stress and mental health outcomes among sexual minorities. LGB-identified individuals experience elevated mental health hardship. Our results suggest that these disparities persist, and are amplified among identity discordant sexual minorities. Identity development occurs throughout the life course, and the disparities observed here may be partly explained by the stressors inherent to reconciling an LGB identity with same-sex attractions or behaviors. 

A Campus-Community Partnership to Narrow the Health Care Access Gap for Los Angeles' Undocumented Population

Jacqueline Leon, MPH Student
Rakhi Varma, MPH Candidate 

Issue: An estimated 700,000 undocumented immigrants in Los Angeles County were excluded from the Affordable Care Act, leaving them without access to affordable health care services. In October 2014, LA County launched the My Health LA program to provide free primary care services for those who continue to be ineligible for health coverage.

Description: In order to reach its intended participants, My Health LA must be promoted beyond just the clinic setting through a community-integrated campaign. Students of Color for Public Health (SCPH), an organization at the UCLA Fielding School of Public Health, created a campus-community partnership to identify high-need areas in LA County with low enrollment in My Health LA and to subsequently develop targeted outreach and communication strategies.

Lessons learned: SCPH has leveraged the breadth of public health disciplines represented by its members (e.g. community health sciences, health policy/management, and environmental health sciences), linked with existing campus resources (i.e. UCLA Global Media Center for Social Impact), and established an ongoing collaboration with community groups including LA Health4All Coalition and Community Clinic Association of LA County. This poster will describe the successes and challenges of participating in a multi-partner collaborative effort, and explain the process of jointly developing appropriate outreach and communications tools.

Recommendations: SCPH’s contributions to expand healthcare access for undocumented Angelenos can provide a framework for similar collaborative approaches. Establishing formal relationships between university student groups and their surrounding community maximizes the resources of contributing partners, reaches across academic and sector silos, and improves student learning. 

Role of paternal periconception exposures and lifestyle factors in the development of children with orofacial clefts in Democratic Republic of Congo, Honduras, Morocco, Philippines and Vietnam

Stephanie Ly, MPH, PhD Student 

A growing body of evidence has implicated the potential of paternal exposures to affect birth outcomes in future offspring. In particular, certain occupational and chemical exposures are linked to increased risk of birth defects and other morbidities in their children. In a partnership between Operation Smile, University of Southern California and Children’s Hospital Los Angeles, an investigation was conducted with fathers from global, multi-ethnic groups through an interviewer-based questionnaire. A total of 377 fathers of cleft case children and non-cleft controls were recruited in a hospital-based sampling from the Democratic Republic of Congo (34 cases, 6 controls), Honduras (50 cases, 8 controls), Morocco (26 cases, 9 controls), Philippines (70 cases, 66 controls) and Vietnam (96 cases, 12 controls). Statistical analyses are underway, using logistic regression, Chi-square analysis and t-tests to compare paternal case and control reports within and between each country. Odds ratios and risk determination will be calculated in the analysis. Variables being analyzed include self-reported demographic characteristics, occupational history, chemical exposures, health conditions and family history. Particular emphasis is placed on the periconception period, defined as 12-18 months before the birth of the child. Results from our study will contribute information from an understudied, diverse and resource-poor paternal population to encourage awareness and potential interventions in periconception. 

Disproportionate Exposure to Hazardous Heavy Metals Among Asian Americans: Findings from the 2011-12 National Health and Nutrition Examination Survey  

Brittany Morey, MPH, PhD Candidate

Prior studies suggest that Asian Americans suffer disproportionate exposure to several environmental toxicants. Some of these exposures stem from food sources, such as arsenic in rice, and mercury in fish. Others stem from industrial sources that may be particularly evident among immigrant Asian Americans. For example, cadmium is produced heavily in China and Japan.

Despite strong evidence to suggest greater exposure among Asian Americans, there have been no nationally representative studies to document these claims.

Objectives/Purpose: The purpose of this study is to evaluate the hypothesis that Asian Americans show disproportionate bodyburdens of mercury, cadmium, arsenic and lead.

Methods: Data come from the 2011-12 National Health and Nutrition Examination Survey (NHANES), with large samples of African Americans (n=2,683), Asian Americans (n=1,282), Mexican Americans (n=1,355), and Whites (n=2,973). This is the first time that NHANES has conducted an oversample of Asian Americans. 

Mercury, cadmium, arsenic and lead were obtained from urine or blood samples. Preliminary analyses estimated weighted descriptive characteristics by race. Future analyses will employ regression with additional covariates (e.g. nativity, occupation, diet).

Results: Preliminary results suggest that Asian Americans have higher bodyburdens of these metals compared to other racial groups. The medium blood mercury level for Asian Americans was 2.31 ug/L compared to 0.63 ug/L for Blacks, 0.63 ug/L for Whites, and 0.48 ug/L for Mexican Amerians. Similar patterns emerged for urinary arsenic (15.84; 8.17; 5.05; 6.9 respectively), blood lead (1.14; 0.91; 0.96; and 0.78 respectively), and cadmium (0.39; 0.26; 0.25; 0.20, respectively). All estimates are reported in units of ug/L. After controlling for age and sex, Asian Americans showed significantly higher levels of all 4 compounds compared with whites.

Discussion/Conclusions: Preliminarily, this study provides the first nationally representative data with objective biomarkers that show disparities in exposure to heavy metals among Asian Americans. This potentially serious environmental justice issue deserves further investigation. 

Systematic Review of Reproductive Health Services Provision for Nomadic Populations

Subasri Narasimhan, MPH, PhD Student 

Background: Nomads are among the most geographically isolated, socially marginalized, and educationally disadvantaged populations worldwide.  Logistical challenges keep them off the radar of government health ministries and public health planners.  This systematic review assesses current literature related to health service provision for nomadic populations, with special focus around issues of reproductive health.

Methods: Electronic databases including PubMed and Web of Science were reviewed for key terms including “nomads”, “pastoralists”,  “health services”, and “reproductive health”. The review included quantitative and qualitative studies published between 1980-2014, and excluded studies of displaced persons and refugees. Information was then analyzed to identify recurrent themes, services and theoretical applications.

Results: The review yielded approximately 100 studies.  A large proportion of studies focused on Sub-Saharan Africa contexts.  Analysis of these studies identified commonalities in theoretical frameworks and the types of health services provided. Studies revealed very little information on reproductive health in this population.  A significant amount of work was concentrated on three main areas, 1) identification of specific negative health outcomes 2) affect of changes in ecological or pastoral environments 3) gendering of health resources.  

Conclusion: Nomads are an underserved and understudied population due to logistical challenges. Yet as a group they are faced with some of the most pressing public health concerns of modern times.  This review indicates that services provided to nomads are minimal, leaving people at risk for complications not present in their non-nomadic counterparts.  Gaps in the literature of health services provision, specifically for reproductive health must be addressed. 

Emergency Access and Decision Making in Rural Northwest Nicaragua

Erik Pena, MPH Student 

Background: Little is known about barriers and decision-making processes rural communities experience when attempting to access emergency medical care in developing countries, such as Nicaragua. Nicaragua has no formal EMS system and rural communities struggle to access emergency services.

Aims: We aim to understand barriers to obtaining emergency care from the perspective of rural Nicaraguan communities. We seek to 1) describe current means of accessing emergency care employed by laypersons in Northwest Nicaragua living outside the vicinity of a hospital, 2) explore knowledge of emergencies and decision making regarding the use of emergency medical care, 3) describe perceived barriers to access.

Methods: In-depth interviews were conducted with 41 laypersons from 6 communities outside the vicinity of a hospital in Northwest Nicaragua. The interviews were approximately 30 minutes, and coded using qualitative software. Themes and categories were identified and grounded theory was used to develop a theoretical framework.

Results: The study identified three main categories of barriers to accessing emergency medical care for laypersons in Northwest Nicaragua living outside the vicinity of a hospital: 1) transportation availability, 2) lack of resources to pay for care-related expenses, 3) perceptions of public quality of care. An individual's decision to access emergency medical care is related to their risk-benefit calculation with regards to these barriers.

Conclusion: The findings will inform efforts in the development of a national EMS service. Decision makers must consider the strengths, challenges and cultural perceptions. Similar assessments should be undertaken in other countries striving to improve pre-hospital care. 

Trends in child obesity by severe housing cost burden among WIC preschool children in Los Angeles

Tabashir Z. Nobari, MPH, PhD Candidate 

Nearly 41 million households in the United States live in unaffordable housing (i.e., spending > 30% of income on housing costs). While unaffordable housing is a risk factor for health, little is known about its impact on child obesity. It may influence child obesity through decreased financial resources for healthy food and for living in safe neighborhoods, and through parental stress. We examine the association of severe housing cost burden and child obesity among low-income families participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) from 2005 to 2011, a time period that includes the 2008 economic recession. Data were from triennial surveys conducted on random samples of approximately 5500 WIC families in Los Angeles County. We used logistic regression to examine the association between obesity status among 2-5 year olds (BMI-for-age-and-sex ≥ 95th percentile) and severe housing cost burden (respondent answered that it was “very difficult” to pay for housing). The percentage of families severely burdened with housing costs decreased from 20.4% in 2005 to 17.9% in 2011. Adjusting for child’s age and gender, and mother’s education, race and BMI, severe housing cost burden significantly increased the odds of child obesity [OR (95%CI) = 1.44 (1.06; 1.96) for 2005, 1.17 (0.84; 1.61) for 2008, 1.34 (1.01; 1.77) for 2011]. Increasing the availability of affordable housing for low-income populations should be considered in the fight against obesity, and in maternal and child health policies aiming to promote children’s health and well-being. 

Liberation Medicine & Public Health Praxis: Reflection, Theory and Action of Doctors for Global Health

Sarah Smith, MPH-MA Latin American Studies Student 

Liberation Medicine is defined as, “The conscious and conscientious use of health to promote human dignity and social justice.” The framework of Liberation Medicine was born in the early 1990’s when doctor Lanny Smith, who was invited by refugees in rural El Salvador to help rebuild their communities soon after the civil war ended, sought to define the type of “medicine” he was practicing alongside community members. Years later, Smith founded Doctors for Global Health (DGH), a non-profit organization made up of hundreds of volunteers from all over the world who work on a variety of international health projects. DGH practices Liberation Medicine, a framework that has it’s roots in liberation psychology, social medicine, liberation theology, human rights, and participatory research.

This presentation will explore how liberation medicine can inform public health praxis with a special emphasis on the essential, but often neglected component of “Reflection.” The “Theory” of Liberation Medicine is best understood by analyzing its historical roots. We will describe the “Action” of how liberation medicine functions in the context of global public health work by utilizing several case studies.  Finally, we will argue that what sets DGH with its framework of Liberation Medicine apart from other international relief organizations and models is its particular process of “Reflection” where intimate, long-term relationships with community members inform decision making, problem solving and future planning for the organization’s public health projects.

Dive-ing Into Healing: Theater for Mental Health Awareness in the Filipino Community

Heidi Tuason, MPH, PhD Student 

This film portrays a creative method of exploring and talking about mental health issues in the Filipino American community and provides a space for community healing by depicting the grassroots theater performance "Dive", which strings together stories of mental health issues from the performers themselves. This film highlights MEnD Dance Theater Company in the San Francisco Bay Area and its founder Grace, a community organizer, educator, and art activist.

Rates of depression and suicidal thoughts in the Filipino American community are higher than the national average, yet due to cultural stigma, this is not talked about or addressed by the larger community. Studies have reported a steady and consistent pattern/increase that Filipino Americans obtain the highest percentage of depression using the Center of Epidemiological Studies--Depression Scale (CES-D). Based on the low rates of Filipina/o Americans seeking mental health services, mental health in the Filipina/o American community continues to remain in the margins (Gong, Gage, & Tacata, 2003; Ying & Hu, 1994). 

Due to this MEnD Dance Theater began to explore these issues with the seven women in their company through a dance theater piece developed over the course of two years.  Four members are Filipina American, one is African American, and another is mixed heritage of British and African American descent.  

This film displays one of their productions and shows how company members found healing through movement expression.  Through the performance piece, company members were able to uncover larger systems that may explain why Filipina/o Americans are struggling with depression and refuse to seek mental health services.  

In partnership with San Francisco’s Filipino Mental Health Initiative as part of the panel at the end of each of the four runs of the shows, dialogue was generated with audience members and the community on alternative ways to address these issues and provide care.  Utilizing both dance, public health, and critical pedagogical theories connected to how this project manifested, this film pushes viewers to see a creative method of mental health stigma reduction and healing, and revert back to indigenous ways of healing as a viable possibility to improve the well-being of individuals, especially the Filipina/o American community where their voices have been silenced by pushing to re-engage ourselves as human beings:  mind, body, and soul. 

Targeting policies to address the changing nature of housing insecurity over space and time in Los Angeles

Jenna van Draanen, MPH, PhD Student 

Background. Housing is considered to be a key social determinant of health, and policies that enable precarious housing for individuals can have a harmful effect on health outcomes and well being. Little is known about geographic distribution of housing insecurity and in Los Angeles and the way neighborhoods are uniquely impacted by financial recessions.

Objectives. This study assesses the impact of the 2008- 2009 economic recession on the spatial distribution of housing insecurity in Los Angeles.

Methods. Spatial data were mapped using QGIS software to visually represent the proportion of renters and owners spending more than 30%, 40% and 50% of their income on rent for the years 2006, 2007, 2008, 2009, and 2010 across Los Angeles county. Demographic data were added to analyze how these trends vary by race, gender, and age. This study uses data from the American Community Survey by census tracts for five years to show trends over time in the distribution of precariously housed individuals and neighborhoods.

Results. Results indicate that particular neighborhoods in Los Angeles county were more substantially impacted by the 2008-2009 market collapse than others and this study visually portrays the burden of risk given to systematically vulnerable neighborhoods in the county. Finally, a range of policy solutions are presented and discussed in terms of their potential efficacy to meet the challenges of unequal geographic and demographic risk of homelessness during and after recessions in Los Angeles. 

What is the health impact of federal immigration enforcement policy? An examination of deportations under Secure Communities in California

Maria-Elena Young, MPH, PhD Student 

Background: Evidence suggests that undocumented immigrants and members of mixed-status families experience psychosocial stressors and barriers to health care when federal immigration enforcement policies are implemented in their communities.  The executive action announced by President Obama in November 2014 will shield some immigrants from deportation, but will shift enforcement priorities such that significant levels of deportation will likely continue.  Research is needed to understand the relationship between health and deportations under these policies.  Objective: This study examines the associations between the level of deportations under the Secure Communities (SComm) program and health outcomes among undocumented immigrants and individuals in mixed-status families in California.  Methods: A multi-level data set with health outcomes and rate of deportations in California counties was created and analyzed.  The health outcomes, including indicators of health behaviors, mental health, and access to care, came from the 2011-2012 California Health Interview Survey.  The number of SComm deportations by county, converted into a rate, came from the Department of Homeland Security.  Moderator variables were undocumented status and residence in a mixed status household. Covariates included individual socio-demographic characteristics and county political characteristics.  Hierarchical linear regression models tested the associations between level of deportation and health outcomes by undocumented status and residence in a mix-status household, controlling for covariates.  Results: The rate of deportation varied by county.  Models showed how deportations under SComm are associated with differences in mental health and access to care.  Results provide evidence of the detrimental health impact of ongoing federal immigration enforcement.