APHA 2016 - Denver, CO

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Student Presentation Schedule

Presentation schedule

Student Presentation Abstracts

Listed in order of student last name. Bolded names denote first author.

Comprehensive Social Marketing Campaign Associated with Improved Perceptions of the Nutrition Environment and Eating Behaviors 

Stephanie Albert, PhD Student

Introduction: Interventions to improve the nutrition environments of underserved communities are popular, despite limited evidence of their effectiveness at improving nutrition outcomes. One approach has been to convert corner stores to become healthy food outlets. Proyecto MercadoFRESCO, a corner store conversion study in East Los Angeles, aimed to increase the availability of fresh and affordable produce. The intervention included a comprehensive community-wide social marketing and education campaign to attract new customers, build demand for fruits and vegetables, and improve eating behaviors. The objective of this analysis is to determine how exposure to the social marketing campaign is related to an array of measures of program effectiveness.

Methods: Data come from 1,052 household surveys. Households around converted and comparison stores were randomly selected and the primary food purchasers/preparers were interviewed. Participants reported exposure to nine marketing campaign components (e.g. posters, cooking demonstrations, coupons). Exposure was dichotomized into high versus low. Logistic regression models were run with exposure to social marketing as a predictor of perceptions of the food environment and corner stores, store patronage, purchasing, and fruit and vegetable consumption, controlling for intervention status.

Results: High exposure to the campaign was associated with increased odds of having improved perceptions of the food environment and corner stores, shopping at corner stores, and consuming more fruits and vegetables as compared to low exposure.

Discussion: Evidence on the effectiveness of corner store conversions remains equivocal. These findings suggest the importance of including a comprehensive social marketing campaign as a key intervention component.

Closeted City: Barriers to LGBTQ-inclusive Sex Education in Atlanta, Georgia

Amy Alterman, MPH and PhD (World Arts and Cultures) Student

According to the Centers for Disease Control, adolescent men who have sex with men are one of the most at-risk groups for HIV in the United States. In Atlanta, men who have sex with men represent a staggering 63% of newly diagnosed HIV infections. Comprehensive sex education, which includes explicit LGBTQ-inclusive messaging and safer sex barrier usage skills, is a key strategy for HIV prevention efforts.Yet, most states lack legislative policy and community capacity to mandate comprehensive sex education. In fact, only a median rate of 5.5 % of schools nationally, and 1.3% in Georgia, use LGBTQ-inclusive curricula. Through a close review of local policies and analyses of interviews with community health nonprofit professionals, health teachers, and parents, this paper examines sex education implementation in Atlanta, paying particular attention to Fulton County's recently renewed abstinence-centered (and non-evidence-based) “Choosing the Best” curriculum series. Integrating lessons from performance studies and public health, I analyze sex education implementation to inform methods for community capacity building toward policy change. In revealing current systems of communication that surround sex education implementation, and challenging how sex education advocacy is currently framed in Georgia, this paper offers insights for LGBTQ-inclusive comprehensive sex education advocacy in regions, such as the US South, that present particularly intransigent cultural barriers.

Multiculturalism in Action: Examining the Effects of Demographic Diversity and Multiculturalism on Partnership Functioning in Community-based Participatory Research 

Paul Chandanabhumma, PhD Student

Background: The field of public health has embraced the use of community-based participatory research (CBPR) to engage demographically diverse communities in eliminating health disparities. Concurrently, greater emphasis is placed on multiculturalism -- the perspective that affirms cultural differences along such lines of race, ethnicity, gender, and social class -- as strategies to enhance group diversity. Understanding how partnership demographic composition and multiculturalism impact the processes and outcomes of CBPR partnerships is needed.

Methods: A survey of literature was conducted to review current evidence on i) diversity and group functioning ii) multicultural ideology and intergroup relations. Subsequently, a conceptual model was created to theorize pathways among demographic diversity of partnership constituents, multiculturalism, and collective functioning in CBPR partnerships.

Results: The model hypothesizes that greater demographic diversity in CBPR partnerships could enhance their collective functioning by a) promoting the benefits of information sharing and multiple perspectives. Conversely, increased partnership diversity could compromise collective functioning by b) increasing bias against perceived outgroup members leading to elevated conflict and c) decreasing attraction among overall group members leading to limited cooperation. Greater support for multiculturalism, as shaped by relative power of individuals, is predicted to enhance the positive pathways and mitigate the negative pathways between diversity and collective functioning.

Discussion: The integrated model may help CBPR partners identify elements of group dynamics that could enhance or hinder the benefits of demographic diversity on partnership functioning. Empirical testing of this model could help stakeholders maximize the potential of diverse CBPR partnerships in achieving health equity.

Systematic review on the use of decolonial framework in public health   

Paul Chandanabhumma, PhD Student, Subasri Narasimhan, PhD Student, and Sarah Jane Smith, MPH-MA Latin American Studies Student

background: Within the social justice vision of public health, there is a need to address a history of systematic exploitation of marginalized communities by dominant groups. This study aims to examine the use of a decolonial framework in existing public health literature, particularly in addressing health disparities. method: Electronic databases, including PubMed, Google Scholar, and Web of Science were reviewed for key search terms among studies conducted globally: health, decolonization, and decolonial framework. Articles on bacterial decolonization were excluded. We examined the framing of decolonization, the population and health condition of focus, and the potential social justice implications of using a decolonial framework to address health disparities. results: The review yielded approximately 30 studies. A large portion of the articles focused on the contexts of Indigenous Peoples or on populations of previously colonized countries. The majority of articles framed colonialism as the root causes of health disparities among these groups. A minority of articles recommended decolonizing strategies, such as the integration of indigenous knowledge, as redress for the long-term health effects of colonization. conclusion: The findings indicate that the existing public health literature view decolonization as contextual explanations for health disparities among indigenous or previously colonized populations. There is a gap in the literature that advocates for decolonization as a social justice strategy to eliminate health disparities. We recommend that public health practitioners direct greater attention towards highlighting colonialism as structural determinants of health disparities and elaborating on the utilization of a decolonial framework to achieve health equity.

Neighborhood Characteristics, Local-Area Assaults and Market Segmentation among Medical Marijuana Dispensaries: Evidence from a Pilot Study

Alexis Cooke, PhD Student

Objective : As medical marijuana legislation becomes more common, concerns arise about the overconcentration of dispensaries, raising questions about the number of medicinal marijuana dispensaries (MMD) needed to serve medicinal users. Additionally, little is known about the relationship between spatial distribution of MMDs and neighborhood characteristics or the spatial distribution of MMD and concentration of local-area incidents of assault.

Methods: Data were collected in 2011 from MMDs in Long Beach, CA. Information about MMD clients was collected via exit surveys with patients at four dispensaries in Long Beach, CA. A total of 132 patients were surveyed regarding demographic data, purchase information, medical condition, and nearest cross street for their home address. Crime data was supplied by the Long Beach Police department, and Census tract information was obtained at the block group level.

Results: Chi-squared tests show significant associations between dispensary visited and race and significant associations between medical condition and dispensary visited. We found that all four of the dispensaries had patients who were different from community residents in some characteristics. Dispensaries also exhibit differences in regards to neighborhood characteristics and security measures as well as neighborhood characteristics and crime.

Conclusions: There were significant differences relating to race, medical condition, and distance traveled across dispensaries. Results suggest MMD clients do not necessarily reside in the same area in which dispensaries are located and do not necessarily reflect the local population. Research supports the idea that crime is concentrated in areas adjacent to dispensaries.

Convenience without Disclosure: Perceived benefits and challenges of integrated methadone and antiretroviral therapy in Dar es Salaam, Tanzania

Alexis Cooke, PhD Student

Background: Integration of HIV and methadone services is a vital component of effective HIV prevention, care and treatment. This research examined perceived benefits and challenges to, and recommendations for, integrating HIV services into a methadone clinic in Dar es Salaam, Tanzania.
Methods: We conducted in-depth interviews with 12 providers and 20 HIV-positive clients (10 women and 10 men) at a methadone clinic in Dar es Salaam in January and February 2015. We used thematic content analysis to identify perceived benefits and challenges to and recommendations for an integrated service model.

Results: Patients were interested in receiving HIV care and treatment within the methadone clinic, and felt it would allow them to receive care and lab results more timely. Patients identified potential challenges including: added provider workload, stigma regarding HIV status, and logistical constraints that may impede adherence. Providers felt that integrating care would help improve efficiency and allow for more comprehensive care to patients. Factors identified by providers as challenges include: limited space in the clinic, technological issues regarding the laboratory database and CD4 testing machine, and need for provider training. Patient recommendations included: improvements to privacy within the clinic, dispensing HIV medication separately from methadone, and giving clients options regarding ART dispensing. Provider recommendations included: added staff training, maintaining a reliable power source, and creation of new treatment spaces.

Conclusions: This integrated care model provides opportunities to improve quality of care and HIV clinical outcomes. Understanding potential challenges and recommendations regarding care integration early on helps create an integrated care model that meets the needs of HIV-positive methadone clients.

Identifying Novel Approaches to Reduce Sugar-Sweetened Beverage Intake Among Adolescents

Monique Gill, PhD Student

Background: Sugar-sweetened beverages (SSBs) are the primary source of added sugar in adolescents' diets and are associated with greater obesity risk. There are limited studies on the determinants of adolescent SSB consumption. This study elucidates novel correlates of adolescent SSB consumption to inform future health promotion efforts.

Methods: A cross-sectional survey was administered among 4,734 7th graders from 16 public schools in Los Angeles, California. Preliminary analyses were conducted to assess the following relationships: 1) self-rated SSB consumption (“just right/too little” or “too much”) and self-reported weekly SSB intake; and 2) reading the nutrition facts label (NFL) on a drink item (“always” or “never”) and weekly SSB consumption. Subsequent analyses will account for potential confounders.

Results: 33.5% of the students reported drinking 4+ sodas a week. There were differences between self-rated SSB consumption and SSB intake (p<0.001). 64.5% of students who drink 4+ sodas a week, reported drinking “the right amount.” SSB consumption also varied by utilization of the NFL (p<0.001). Specifically, 48.3% of students who “always” read the NFL reported drinking no soda at all. Yet, 46% of students who “never” used the NFL reported drinking 4+ sodas per week.

Discussion: Adolescents are regularly consuming high amounts of SSBs but do not rate their habits as unhealthy. Increasing awareness of the health risks of SSBs may decrease levels of consumption. Reading the NFL is associated with less SSB consumption. Health promotion efforts to increase utilization of the NFL may be an effective strategy to reduce SSB intake among adolescents.

Understanding and Addressing Social Norms around Eating Behaviour: Findings from a University Residential College in Singapore

Shelley Jung, PhD Student

Eating behaviors formed by young adulthood often correspond to those later in life, which is why the university-aged group is of considerable interest for health education and campus-based intervention purposes. Residential colleges provide communities where students live and learn together— an ideal platform to apply the social norms approach. The social norms approach was used to investigate the role of norms on eating behaviors in an undergraduate residential college in Singapore. This approach states that behaviors are influenced by misperceptions of the attitudes and behaviors of other members of that social group. 453 university residential college students completed an online, self-reported survey (response rate= 76.8%) on questions about their own attitudes towards, and intake of, fruits, vegetables, wholegrain foods, and sugar-sweetened beverages (SSBs), along with their perceptions of their peers' attitudes, and intake of, the above-mentioned. Misperceptions were calculated from differences between individual perceived norms and the median of self-reports (actual norms). Generally, respondents overestimated unhealthy attitudes and behaviors of their peers, and underestimated the healthy ones. These perceptions were predictive of respondents' diet. The perceptions of peers' dietary intake, not how the social group actually behaved, appeared to be associated with respondents' own intake. Based on the findings, a short two-week intervention incorporating strategies to correct misperceptions about social norms was implemented to decrease sugar-sweetened beverage consumption. During the duration of intervention, sugar-sweetened beverage consumption decreased among university-aged students. Long-term, sustainable interventions incorporating strategies to correct misperceptions have the potential to improve university-aged students' dietary behaviors.

Chemical pollutants and allergies: Trends and risk factors for older adults

Melissa Kelley, PhD Student

While the exact burden of disease from pollution is unknown, the World Health Organization estimates up to a 25% of all diseases today are from prolonged exposure to environmental pollutants. The aim of this study is to determine whether two chemical pollutants, polyfluorinated compounds (PFCs) and phthalates, are associated with allergies, and whether older adults were more susceptible to immunomodulation from these chemicals. Data from the National Health and Nutrition Examination Survey were utilized to conduct analysis that examined whether concentrations of PFC and phthalate congeners, respectively, were associated with allergies, net controls for key sociodemographic, health behavior, and health status covariates. On all measures, adults self-reported having more allergies than adolescents. However, when examining blood titers of allergen antibodies, adolescents tended to have a higher percent of persons clinically sensitized and a higher mean antibody titer compared to adults. Analyses also examined the association between PFCs and sensitization to a specific allergen. As a whole, many of the statistically significant associations between PFC congeners and allergen sensitization were inversely related in adolescents. In adults however, PFC concentrations were positively associated with allergen sensitization as a whole, and increasing PFC concentrations were generally associated with sensitization to animal and insect allergens. Similarly, phthalate exposure was positively associated with allergen sensitization in adults, in particular to animal allergens, but this was not seen in adolescents. Thus, preliminarily findings indicate older adults are more susceptible to immunomodulation from PFCs and phthalates compared to adolescents, which could contribute to increased morbidity from allergies.

HIV Disclosure in Rural China

Chiao-Wen Lan, PhD Student

Background: HIV disclosure is a critical component of HIV/AIDS prevention and the treatment efforts for both individual and public health outcomes. The decision to disclose one’s HIV serostatus is complex and challenging due to potential stigma, blame, and fear associated with HIV infection.

Methods: This study used the baseline data from a randomized controlled intervention trial for HIV-affected families in China. In addition to demographic and HIV-related clinical characteristics, we collected information about the extent of HIV disclosure to members of the community. The data were collected between late 2011 and early 2013.

Results: A total of 522 people living with HIV were included in the study. The results indicated that the level of HIV disclosure to members in the community differed between groups with increased levels of disclosure to village leaders and neighbors and reduced levels of disclosure to people in the village and co-workers. More disclosures of HIV status to members of the community were observed among the older age groups and people with lower family incomes. People with no formal education and lower levels of education were more likely to disclose their statuses than those who had received more years of education.

Conclusion: There is a need to explore HIV disclosures to the community to help realize the public health and personal implications of disclosure. Our results underscore the potential benefits of age- and socioeconomic status-specific interventions in the efforts to dispel barriers to HIV status disclosure to the community.

Evaluating an Arts-Based, Multiple Intervention, Peer-education HIV/AIDS Prevention Program for Adolescents

Chiao-Wen Lan, PhD Student

Introduction: It’s estimated that half of all new sexually transmitted infections (STI) are among young people under the age of 24, including 26% of new HIV infections. Adolescents are especially vulnerable given the asymptomatic nature of some STI and inexperience in negotiating safer sex behaviors. The purpose of this study is to analyze the efficacy of the live, theater-based intervention for high school students in increasing the knowledge of HIV/STI, building HIV/STI screening self efficacy and safer sex behaviors, and reducing stigma toward HIV-positive individuals.

Methods: The arts-based sexual health program is a HIV/STI prevention model designed for high school students. The undergraduate students are trained in HIV/STI, health education, and interactive theater to deliver theater-based sexual health intervention to “near peer” high school students. The program utilizes personal narrative, humor, and vulnerability to promote HIV/STI prevention knowledge and strategies. The program aims to provide a non-heteronormative and non-stigmatizing space for the high school audience.

Results: Student in the intervention group acquired knowledge about HIV/STI and reproductive health messages through the program. Students in the intervention condition felt more confident about discussing safer sex with their partner and felt more compassionate toward people living with HIV compared to those in the control condition.

Conclusions: Theater-based peer health education interventions have been shown to be effective for health promotion. The results from the program suggest the potential benefits of incorporating theater-based peer health education in the development of future HIV prevention interventions targeting adolescents.

A Collective Impact Framework in College Health and Wellness: The UCLA Healthy Campus Initiative

Hannah Malan, PhD Student

The University of California Los Angeles (UCLA) Healthy Campus Initiative (HCI) is in its third year of uniting and integrating health and wellness efforts across campus. HCI utilizes a collective impact framework to work collaboratively toward improving UCLA health and wellness. First, HCI has a shared vision of making UCLA the healthiest campus in America. Second, HCI serves as the backbone support organization for health and wellness efforts at UCLA with dedicated staff in the Chancellor's Office and several executive administrators and faculty serving in key leadership positions. Third, HCI supports and encourages mutually reinforcing activities by engaging with diverse campus stakeholders, promoting and supporting existing efforts, and creating new programs and projects. In addition, HCI is organized into five primary health and wellness working groups that harness topic-specific expertise to operate independently and also build collaborative efforts. Fourth, HCI is continuously refining a shared evaluation system to measure progress over time, including the establishment of a research and evaluation group. Finally, HCI maintains ongoing communication across its leadership and stakeholders through regular steering committee and working group meetings, an annual campus-wide event, progress reports and highlights, and a communication unit that manages social media and other outreach efforts. Through its collective impact approach HCI has become a driving force of UCLA health and wellness efforts and has expanded its reach beyond campus including partnerships with other universities. The lessons and successes of the HCI model can be used to inform other health and wellness initiatives in higher education.

Citizenship as Privilege and Social Identity: Implications for Psychological Distress

Brittany Morey, PhD Candidate

BACKGROUND/SIGNIFICANCE: Citizenship often shapes the immigrant narrative, as many immigrants prepare for years to apply for their naturalization test. These efforts are for good reasons: citizens have many rights, privileges, and opportunities that are denied to non-citizens. These rights suggest that citizenship is a fundamental status within U.S. society as well as a marker of social identity. In general, greater privilege is associated with improved mental health, and we would expect the same pattern with regards to citizenship.

OBJECTIVE/PURPOSE: We test two hypotheses: First, we hypothesize that citizens will show better mental health than non-citizens. Second, we hypothesize that associations between citizenship and mental health are mediated by socioeconomic disadvantage, discrimination, subjective social status.

METHODS: Data come from the Asian subsample of the National Latino and Asian American Study (n=2095). Weighted analyzes regress the Kessler Psychological Distress Scale (K-10) on citizenship. Mediation by discrimination, subjective social status, and socioeconomic status (education, income, employment) was evaluated with Sobel tests.

RESULTS: The data show that noncitizens report greater psychological distress compared with naturalized citizens and native-born citizens after accounting for sociodemographics (e.g., age, gender, Asian subgroup), health care visits, and immigration factors (e.g., interview language, years in the United States, acculturative stress). Education, employment, and poverty did not mediate this association. However, preliminary evidence suggests that subjective social status may explain some of the disparities between naturalized citizen and noncitizen Asian Americans.

DISCUSSION/CONCLUSIONS: Studies of immigrants should evaluate the role of citizenship as a key dimension of health inequities.

A Classification Framework for Quality of Life Technologies

Helene Riess, PhD Student

In recent years, a wide array of quality of life (QoL) technologies has been developed and studied by multiple scientific disciplines, resulting in inconsistent concepts, labels, and definitions. The goal of this study was to identify a comprehensive classification scheme that enables comparisons between various types of QoL technologies. The authors performed a systematic review of studies that evaluate QoL technologies for older adults 65 years and above. Quantitative and qualitative studies were retrieved from MEDLINE and other databases, and reviewed for factors of technology acceptability, usability, and adoption. More than 50 studies were included in the study. In addition to previously reported dimensions such as life domain and function, analyses identified a previously unreported dimension: the placement of technological devices either on a person or in a person's physical environment. While environmental devices can be perceived as invasive and more complicated to install and handle, mobile or wearable devices are often accompanied by a fear of stigma, especially when devices are visible to others. Given these distinct perceptions of technologies, placement is an important dimension to assess QoL technologies in terms of their acceptability and adoption. The study identified at least one additional dimension to classify technologies. When comparing and evaluating QoL technologies, it is useful to not only consider characteristics of the technology itself, but also take into account the meaning and impact they have in people's lives.

Perceived barriers and benefits to physical activity among urban middle school students

Sarah Roth, PhD Student

Background: Physical activity (PA) improves cognitive development and well-being (physical and mental). Appropriate interventions to address declining rates of PA during the critical period of adolescence are important to chronic disease prevention. Few studies have examined the perceived barriers (e.g. lack of equipment) and benefits (e.g. build-up muscular strength) of regular PA among minority youth. This study examines factors that promote and inhibit PA among an ethnically diverse population.

Methods: Data were collected in a cross-sectional survey of 4,734 7th grade students recruited from a large, urban school district in Los Angeles. Logistic regression models tested the associations between self-reported PA and perceived benefits and barriers. The three primary outcomes were: 1) exercising every day during the past week for at least 60 minutes, 2) performing exercises to strengthen muscles every day during the past week, and 3) participating in at least one sports team in the past year.

Results: Students who reported more perceived benefits to PA had higher odds of exercising daily (p<0.001), strength training (p<0.001), and sports team participation (p<0.001), after controlling for gender and race/ethnicity. Conversely, perceiving more barriers was associated with lower odds of three outcomes (p<0.01). Additional analyses employ hierarchical modeling and will control for body mass index, fitness level, and perceptions of built environment.

Discussion: Exploring youth perceptions around PA can advance our understanding of current trends and disparities. These results may facilitate the design of effective interventions to increase PA among minority adolescents, to leverage their right to health across the lifecourse.

“We Gon' Be Alright: Addressing Racism and Anti-Black Violence as a Public Health Crisis” - A Student-Led Course grounded in an intersectional approach to inform Public Health Praxis

Sarah Jane Smith, MPH-MA Latin American Studies Student and Saron Selassie, MPH Student

Issues of anti-black violence and racism have permeated the United States for hundreds of years, yet it seems that in our increasingly digital society the rates at which we encounter these narratives is almost a daily occurrence. Public health students at the University of California, Los Angeles, called on administration to address anti-black violence as a public health crisis. During our first year as students, numerous incidents of anti-black violence emerged and community uprising throughout the nation unfolded. These events forced us as aspiring public health practitioners to grapple with how racism, anti-black violence, white supremacy and privilege, as well as institutional complacency play a fundamental role in the health disparities we study. Methods: A student-led course was proposed and approved after challenging administration to address anti-black racism as a public health issue. Students collaborated in the development of the course pedagogy and syllabus. Course content was developed through a literature review of interdisciplinary materials, with a primary focus on intersectionality, racism and health disparities. Anti-black racism is explored in the course through the following topics: historical legacies, food justice, mass incarceration, police brutality, reproductive justice, and the built environment. Conclusion: The development of this course presents a critical step forward in the necessity of public health institutions to address the legacy and current reality of racism and the ways in which it continues to manifest in health disparities.

Creating Space: Supporting Breastfeeding on the UCLA Campus

Sally Saleh, MPH '16, Jasmine Uysal, MPH student, Subasri Narasimhan, PhD student and Sarah Jane Smith, MPH student

Background: Breastfeeding on University campuses is an understudied topic. Proper lactation accommodations and understanding of campus-based experiences are often lacking. The University of California Los Angeles’ Reproductive Health Interest Group (RHIG) engaged in a project assessing University respondents’ lactation experiences and current lactation accommodations on the UCLA campus for employees, faculty and students.

Methods: The project had three main arms. An electronic survey was administered during the 2015-2016 academic year to students, faculty and employees regarding their experiences with lactation on the UCLA campus. Questions included those on feelings and experiences of UCLA lactation accommodations and recommendations for improvement. The survey information was then utilized to enhance existing lactation accommodations and develop spaces where none existed. A digital map of lactation rooms was created and shared across campus to promote campus-wide knowledge of available resources. An advocacy plan proposing the university contract with a Lactation Consultant was developed and delivered to the UCLA Arthur Ashe Health Center to increase access to professional support.

Results: Results showed a substantial need for improved lactation accommodations, education, and support on campus. Although the medical wing had the most and best resourced lactation rooms, even these spaces lacked expressed milk storage areas, privacy, and a comfortable atmosphere. Other areas of campus reflected an inadequate designation of space for lactation.

Conclusion: RHIG worked to improve lactation accommodations and experiences on the UCLA campus. Lactation accommodations are an important tool in increasing exclusive breastfeeding rates and improving the experience of breastfeeding individuals in academic environments.