APHA 2020 - Virtual

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Student Presentation Schedule

Presentation Schedule

Student Presentation Abstracts

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

Key predictors of past-year dental visits among older adults from the Mexican health and aging study (MHAS)

Jennifer Archuleta, PhD Student

Annual dental check-ups are essential preventive care practices that support positive oral health and quality of life. This study assesses the number of past-year dental visits among older Mexican adults, and presents how various health conditions and contextual factors are associated with oral health-seeking behaviors. 
Objective. To analyze predictors of dental visits among participants ages 50 and older from the Mexican Health and Aging Study (MHAS). 
Methods. MHAS is a national prospective cohort study of adults 50 years and older from Mexico that collected data on health, aging, and sociodemographic characteristics. The 2001 baseline survey gathered information from a nationally representative sample of 15,186 adults who were born before 1952. Follow-up interviews for this cohort were conducted in 2012. Key independent variables included age, sex, education, insurance status, depressive symptoms, chronic conditions, and mobility limitations. Chi-square tests and logistic regression analyses will be performed. 
Results. Results will indicate significant predictors of dental visitations among participants. Potential differences in these relationships between 2001 and 2012 will also be shared. 
Conclusions. Dental visitations are important for supporting the oral health status, especially among vulnerable aging populations. This study highlights how social determinants of health and co-morbidities impact oral health-seeking behaviors in Mexico. At the policy-level, these results could inform and re-evaluate public health and dental insurance programs in both Mexico and the U.S to better support the oral health needs of older adults from Mexico.

Exploring the intersection of alcohol use/abuse and risk of sexual violence at the University of California

Claire Amabile, MPH-MSW Student, Dallas Swendeman, PhD, Stoddy Carey, Stephanie Sumstine, MPH, Jennifer Wagman, PhD

Background: Alcohol use on college campuses is a major risk factor for sexual violence, associated with 50-70% of campus sexual assaults. The college student experience provides an environment where experimentation with alcohol may be facilitated by density of youth in highest risk 18-24 year old populations, peer group socialization risk factors, and cultures of partying. In 2019, more than half of undergraduate students reported past 30 day alcohol use at the three campuses in this study, UCLA (59%); UC San Diego (54%); UC Santa Barbara (68%). The National Institute on Alcohol Abuse and Alcoholism estimates 40% of American college students binge drank in the past month. This study aimed to learn students’ perceptions of relationships between alcohol use and violence on campus.
Methods: 25 focus group discussions (FGDs) and 71 in-depth interviews (IDIs) were conducted with undergraduate students from UCLA, UC San Diego, and UC Santa Barbara. FGDs and IDIs were transcribed verbatim and coded using iterative thematic content analysis.
Results: Students overwhelmingly felt alcohol created “gray areas” of sexual violence, when negative sexual experiences brought on feelings of harm but confusion over whether consent was given. “Gray areas” of consent were associated with not reporting incidents because of concerns about the experience being minimized or invalidated. Available online sexual violence prevention trainings were deemed unengaging and felt to insufficiently address how alcohol increases risk for assault. Students recommended in-person trainings and bystander interventions that addressed intersecting alcohol use and violence.
Conclusion: Findings emphasize the need for integrated approaches on campus where: (1) existing violence prevention programs address the role of alcohol in increasing risk for abuse; (2) existing alcohol policies/programs address violence as a correlate/outcome of drinking; and (3) more research is done to comprehensively understand alcohol and drug use on campus.

Student-athletes', coaches' and administrators' perspectives of sexual violence on three campuses with ncaa division I and II athletic programs 

Claire Amabile, MPH-MSW Student, Jennifer Wagman, PhD, David Stoddard Carey, Stephanie Sumstine, MPH, Dallas Swendeman, PhD, Eunhee Park, PhD Student

Background: Sexual violence (SV) is pervasive on college campuses and rates of SV are higher on campuses with athletic programs regulated by the National Collegiate Athletic Association (NCAA). More SV has been reported on NCAA Division I campuses, relative to NCAA Division II and Division III campuses and those with no athletic programs.
Methods: From January to June 2019, we conducted 7 focus group discussions and 19 in-depth interviews with Division 1 and Division II student-athletes, Athletic Directors and coaches. All notes were transcribed verbatim and data were analyzed to develop coding frameworks and identify themes.
Results: Student-athletes recognized SV as an important campus problem, including within the sports system. While athletes were proud to represent their school, they felt socially and academically isolated from the overarching campus, and beholden to their athletic scholarships and team placements. This limited their agency to report SV or seek SV services. Student-athletes felt available SV prevention training was ineffective and only offered to protect the University. Athletic staff and administrators were disconnected from the lives of student-athletes who did not feel comfortable disclosing personal information to staff. Despite widespread promotion of coach-led training to prevent SV among college athletes, student-athletes disapproved of this approach.
Discussion: While college athletics provide an ideal platform for preventing sexual violence, work is needed to prioritize the well-being of student-athletes over the success of the athletic program. Student-athletes should be involved in all steps of designing, implementing and monitoring sexual violence prevention and response programs for athletes.

What factors explain the self-rated health advantage among migrants pre- and post-migration?: Results from the health of philippine emigrants study

Adrian Bacong, PhD Student, Anna Hing, PhD Candidate, Brittany Morey, Arnold de Castro, PhD, RN, Gilbert Gee, PhD

Background: Many studies note a “healthy migrant effect” that is often explained by health selection. However, what factors account for health differences between migrants and non-migrants?
Objective: Using self-rated health (SRH), this study examines how five domains of health account for health differences between migrants and non-migrants pre-migration and one year post-migration.
Methods: We examine pre-migration baseline and year 1 follow-up data of the Health of Philippine Emigrants Study, an ongoing longitudinal study on the health of Philippine migrants to the U.S. Using ordinary least squares regression, we examine the association between migration status and self-rated health at baseline and year 1 accounting for five domains: demographic factors, socioeconomic status, physical and mental health, psychosocial factors, and health behaviors.
Results: Accounting for these five domains, migrants report better SRH compared to non-migrants both at baseline (B=-.43; 95% CI = -.57, -.29) and follow up (B=-.92; 95% CI= -1.09, -.76). Physical and mental health in addition to health behaviors account for most of the difference in SRH among migrants versus non-migrants. The SRH advantage among migrants compared to non-migrants remains, even after accounting for covariates.
Conclusions: Differences in SRH between migrants and non-migrants are largely accounted for by both physical and mental health. However, the persistence of a migrant health advantage, despite accounting for these different health domains, could be the result of selectivity, attrition, or one's self-evaluation in light of the migration context. Future work should further examine the utility of SRH in how migrants and non-migrants evaluate their health.

Undoing the master's foundation: Faculty and student challenges to institutionalizing health justice courses

Adrian Bacong, PhD Student, Anna-Michelle McSorley, PhD Student, Erin Manalo-Pedro, PhD Student

Background: In 2016, the Council for Education on Public Health amended accreditation requirements in an effort to ensure that training institutions "[d]iscuss the means by which structural bias, social inequities and racism undermine health and create challenges to achieving health equity at organizational, community and societal levels." Despite this call, courses addressing these topic areas are in short supply. As a way to reconcile this gap, faculty and students may propose experimental courses; however, few of these experimental courses become institutional requirements offered to graduate students.
Purpose: Examine processes and challenges of introducing and later institutionalizing both faculty- and student- initiated courses addressing health justice.
Methods: Key informant interviews will be conducted with both faculty and student instructors of experimental courses addressing racism and health justice. Results will be analyzed using manual thematic coding of transcribed interviews.
Results: Results from qualitative interviews will highlight the premises for introducing and institutionalizing courses based on addressing racism and health justice. Emerging themes, as well as institutional lessons learned will be discussed.
Discussion: Describing the processes and challenges to implementing experimental courses on racism and health justice offers guidance on how to change curriculum to reflect accreditation requirements and address health equity. Uplifting perspectives from faculty and students will highlight institutional opportunities to address the needs of stakeholders. We will also explore how institutional support and sustainability ultimately affect the quality of public health graduate education.

Factors associated with psychosocial resiliencies among older men living with HIV in Palm Springs, California

Alejandra Cabral, PhD Student, Jeff Taylor, Christopher Christensen, Brandon Brown, PhD, Michael Plankey, PhD

Introduction: There is a paucity of published evidence of psychosocial resiliencies among aging people living with HIV (PLWH). We conducted a community-based survey in Palm Springs, CA, which has the highest prevalence of older PLWH in the U.S., to identify and characterize psychosocial factors.
Methods: PLWH who were 50 years or older; male identifying; and resided in Palm Springs, CA for at least 6 months were recruited from 2018 Palm Springs Pride and community meetings in November 2018. A questionnaire measuring emotional state, symptoms of anxiety, companionship, and post-traumatic stress disorder (PTSD) was self-administered. A score of less than 32 out of 75 on the perceived PTSD scale score was defined as having resiliency. Univariate logistic regression was performed to test the association of resiliency with 3 outcomes: symptoms of anxiety, companionship, and emotional state.
Results: A total of 107 people participated, with 61.2% older than 60 years. The average time living with HIV was 30 years (range 10-40 years) and the majority of respondents had an undetectable viral load (95.3%). More than 40% were single and half lived alone, with 70% reporting graduating from college. Around 65% had resiliency which was positively associated with lower symptoms of anxiety (OR=6.14, 95%CI: 2.57-14.65), less loneliness (OR=7.51, 95%CI: 3.09-18.28), and higher emotional state (OR=8.57, 95%CI: 3.46-21.20) compared to those with higher anxiety, more loneliness, and lower emotional state.
Conclusions: Implementing healthcare interventions to decrease anxiety and loneliness and increasing emotional wellness are needed to mitigate PTSD (essentially promote resiliency) among aging PLWH.

Voicing health concerns of Women aging with HIV: “I really am aging with this”

Alejandra Cabral, PhD Student, Griselda Ruiz, Fidel Chagolla, Logan Marg, Marjorie Martin, Bridgette Picou, Christopher Christensen, Jeff Taylor, Brandon Brown, PhD

Background: By 2016, women comprised over 22% of all persons aged 50 or older living with HIV in the United States. Little research examined women’s experiences aging with HIV.
Methods: In 2019 in Palm Springs, California, women living with HIV (WLWH) aged 50 and older were recruited to participate in a focus group. Questions encompassed three main areas, including major health issues, sources of resilience that promote healthy aging with HIV, and priority research topics related to HIV and aging. The focus group was audio-recorded and facilitated by two trained community members. Data were transcribed and analyzed using the rigorous and accelerated data reduction (RADaR) technique.
Results: There were 9 participants, 8 cis-women and one trans-woman. Three participants identified as white, three as Black, one Hispanic, one Asian, and one multiracial. The average age of participants was 57 years. Participants’ main health concerns centered on mental health and related psychosocial issues—namely, social isolation and stigma linked to living with HIV as a woman—as well as other common HIV comorbidities. Participants also described structural barriers that inhibited healthily aging, such as medical costs and lack of access to recreational and social activities. Participants most frequently cited social support as a major source of resilience.
Conclusion: These results illustrate the health concerns and barriers faced by older WLWH. As the population of older WLWH continues to grow, more research is needed to understand their challenges, and sources of resilience in order to develop effective, tailored, and comprehensive care and treatment.

The influence of intersecting institutional policies on the lived experiences of Mexican and Chinese immigrants in California: Impacts on health

Iris Guzman-Ruiz, PhD Student, Maria-Elena Young, PhD, Michelle Nakphong, PhD Student, Lei Chen, MSP, Brenda Morales, MSW, Reyna Campos, Kathryn Kietzman, PhD, Steven Wallace, PhD

Immigrant policies implemented at the state level have implications for healthcare access; however, little is known about the differential influence of policies on Asian and Latino immigrants, two of the largest immigrant groups in the United States. As part of a larger investigation of how immigrants in California experience exclusion across the institutions of health, social services, education, labor, and law enforcement, this in-depth qualitative study identified policy-related barriers and opportunities experienced by 28 Chinese and 32 Mexican immigrants purposefully sampled in two counties in California. In-depth interviews were conducted and analyzed using an iterative, modified grounded theory approach. While both immigrant groups described experiences of discrimination that affected access to healthcare, Mexican participants provided specific examples of exclusion from policy arenas such as employment and social services, while Chinese participants more frequently discussed experiencing stigma and barriers related to language or cultural identity within the sectors of education and employment. Emerging patterns indicate that type of legal status aspired to or attained make a difference in the lived experiences of immigrants, with additional variations observed between Mexican and Chinese participants. Undocumented Mexican participants described wanting to belong and largely sought to achieve full integration within the US; paradoxically, many documented Chinese participants felt treated as outsiders, and actively sought to maintain ties with their country of origin. Efforts to improve healthcare among immigrant populations need to account for the diversity of immigrant experiences and interactions with multiple institutions that either facilitate or impede the attainment of health equity.

Racial Inequality in Voting and Health

Anna Hing, PhD Candidate

Background: Few studies have identified how voting inequality is related to health. This study investigates how racial inequality in voting, as a form of structural racism, is connected to life expectancy (LE).
Objective: Using Robert Wood Johnson Foundation County Health Rankings Data 2019, this study examines how voting inequality is related to community conditions (segregation, air pollution, income inequality, and black child poverty) and if these community conditions mediate the relationship between voting inequality and LE (both black and white) at the county-level.   
Methods: Ordinary least squares regression was used to examine the relationship between voting inequality (black voter turnout/white voter turnout) and community conditions, controlling for demographic and socioeconomic factors. Baron and Kenny’s method was used to test mediation of voter suppression on white and black LE through each community condition.
Results: In bivariate analyses, voting inequality was significantly associated with segregation, air pollution, and child poverty. With covariates added, significance remained for air pollution (B=-0.25; 95% CI=-0.439, -0.067) and black child poverty (B=0.02; 95% CI =0.003, 0.035). Voting inequality significantly predicted white LE (B=.49; 95% CI =0.134, 0.854) but not black LE. Air pollution significantly mediated 20% of the relationship between voting inequality and white LE and 41% of the relationship between voting inequality and black LE.
Conclusions: Voting inequality by race is related to both community conditions and life expectancy. Voting inequality influences health by shaping the built environment (i.e. air pollution). Future work should consider how voting inequality impacts other health outcomes and through which mechanisms.

Emergency medical service (EMS) use among Latino older adults in California during the COVID-19 pandemic

Esmeralda Melgoza, PhD Student, Hiram Beltran-Sanchez, PhD, Arturo Vargas Bustamante, PhD

Background: In California, the COVID-19 pandemic has disproportionately affected Latino older adults (65+) who represent 21.8% of the state's population, but 41.2% of confirmed cases and 44.7% of deaths in the state. Use of emergency medical services (EMS) is a vital response to the COVID-19 pandemic; however, pre-COVID-19 studies have found that Latino older adults are less likely to use EMS compared to other racial and ethnic groups.
Methods: A four-year comparative retrospective cohort analysis from 2017 to June 2020 examines trends in overall EMS activations among Latino older adults using data from the California Emergency Medical Services Information System (CEMSIS). EMS data from March to June 2020 is compared to pre-March 2020 data and the same time periods in the three previous years.
Results: Based on previous research, our findings show that Latino older adults in California are less likely to use EMS compared to other racial and ethnic groups during the COVID-19 pandemic. Several factors may contribute to the disparities in EMS activations among Latino older adults, including fear of COVID-19 infection, fear of deportation, immigration policies, language barriers, and lack of or inadequate health insurance.
Conclusion: Understanding EMS activations among Latino older adults may serve to inform and modify policies that address existing health disparities, which disproportionately affect this population. 

Experiences of exclusion in employment and impacts on health care access among Latino and Asian immigrants in California

Michelle Nakphong, PhD Student, Iris Guzman-Ruiz, PhD Student, Brenda Morales, MSW, Lei Chen, MSP, Kathryn Kietzman, PhD, Steven Wallace, PhD

Employment is a major driver of immigration to the United States; however, little research has explored how experiences of exclusion in employment impact health care access and health across immigrant groups. We examined how experiences of exclusion, discrimination, and stress in employment were associated with barriers to health care access in a sample of Latino and Asian immigrants in California. We conducted a mixed-methods study with surveys of 1,060 Latin American and Asian immigrants and in-depth interviews with 32 Mexican and 28 Chinese immigrants. We surveyed participants on six types of exclusion in employment: work authorization at risk, inability to apply for a job, settling for a job, wage theft, dangerous jobs, and injury at work. More than half of survey respondents (57%) reported at least one form of employment exclusion. Participants in the qualitative interviews described challenges acquiring work due to language barriers or discrimination. Once employed, many experienced disrespect in the workplace, and some reported violations of their workers’ rights, such as physical or financial exploitation. In the most extreme cases, employment was described as a form of “bondage”, and participants reported staying in sub-optimal work situations to obtain income, immigration status sponsorship, or health insurance coverage. Participants who found work through co-ethnic communities were frequently unable to obtain employer-sponsored health insurance, had difficulty obtaining health insurance due to legal status or cost, and sometimes experienced work-related injuries. These findings indicate a need to improve work conditions for immigrants, including access to adequate health insurance and coverage.

Student-athletes', coaches' and administrators' perspectives of sexual violence on three campuses with ncaa division I and II athletic programs