2013 - Boston, MA

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Student Presentation Abstracts 

Assessing and Addressing the Needs of the Most Vulnerable of Older Adults in California

Charlene Chang, MSPH Student, Panel Moderator

America is graying rapidly. Between 2011 and 2029, we will see the greatest growth in the 65+ population as the “boomers” turn 65. While many older adults are living longer and healthier lives, the prevalence of chronic disease in the older population remains high. For those of limited economic means, the challenges associated with accessing care and managing complex health conditions are heightened. In California, the elderly population will double to nearly 8 million by 2026. Currently, 1.1 million Californians are “dual-eligibles” – those who qualify for both Medicaid and Medicare and are typically the most medically and financially vulnerable. This panel examines how the physical, psychological and social care needs of vulnerable California seniors are being assessed and addressed. The first presentation highlights differences in mental health need among older subgroups in California and identifies their characteristics. The second presentation provides details about the Elder Index -- an alternative to the Federal Poverty Level that better gauges poverty among the elderly, particularly in states such as California where living costs are high. The third paper assesses older adult “dual-eligibles” utilization of care as compared to other Medicare beneficiaries and examines whether cost-sharing is associated with their utilization of health services. The final presentation offers “lessons learned” from the Helping Older-adults Maintain independencE (HOME) study, which is following older adult “dual-eligibles” over time, and evaluating how they have managed a fragmented network of informal and formal care, along with unlinked medical care, to continue to live independently at home.

Nov 6, 2013, 10:30 - 12 PM

Successful advocacy for condoms in adult films: Using social and traditional media and marketing to convince voters to support Measure B

Adam Carl Cohen, PhD Student

The adult film industry (AFI) in Los Angeles (LA) County publicly ignores the required use of barrier protection on set. As a result, workplace-acquired sexually transmitted infections (STIs) are at epidemic levels and have on numerous occasions caused the industry to shut down entirely due to outbreaks of HIV and, most recently, syphilis. Despite industry-wide monthly testing, STI transmissions persist. In a recent LA County Department of Public Health sponsored study, one in three performers were found to be infected with gonorrhea and/or chlamydia despite industry testing protocols. To effect change in industry practices, proponents gathered voter signatures to put Measure B, known as the Safer Sex in the Adult Film Industry Act, on the LA County ballot. In this presentation, the panelist will first describe the use of Twitter, Facebook, YouTube and additional new media to promote Measure B messages and interact with pro- and anti-B commentators online. The panelist will also discuss the importance of traditional media, particularly newspaper advertisement stickers and county-wide billboards, to stay on the message of workplace health and safety. Second, the panelist will analyze the campaign contributions of both traditional media and social media. Third, the panelist will discuss the decision to include in the campaign former adult film performers who contracted HIV while in the AFI, to bring faces to the issue. Finally, the panelist will assess the social marketing tactics of addressing the anti-Measure B arguments without directly debating AFI lobbying groups and producers.

Session: Successful Advocacy for Condoms in Adult Films

Nov 5, 2013: 2:30 PM - 4:00 PM

Colorado River and climate change: Averting social and environmental disaster

Melissa Kelley, PhD student

In the semi-arid west, having a reliable water source has been a fundamental limitation to life. For centuries, the Colorado River has been the lifeblood of southwestern U.S. and northwestern Mexico inhabitants providing not only an essential nutrient for life, drinking water, but economic security with jobs in farming and fishing as well as environmental sanctuary for numerous plant and animal species. Given the system is already under water stress and climate change could reduce the flow further, the future of the river, however, is uncertain. Preliminary findings show annual runoff is expected to decrease, but to what level is level unknown. Estimates predict that a 10% reduction in flow could to yield a 50% shortage probability by 2040 and a 20% reduction could yield a 50% shortage probability by 2025. Yet, a 5% reduction is expected to cause shortages that violate legal allocation agreements furthering political tensions and environmental degradation in the United States and Mexico. Thus, it is necessary to determine what consequences such reductions will have on the Colorado River, and what measures should be implements to improve our capacity to cope with potential impacts. This analysis will explore the challenges climate change could create for water security in the Colorado River Basin with a focus on the social and environmental ramifications for the U.S. and Mexico. Environmental consequences will be explored using GIS and remote sensing, and social dimensions, such as political, legal, economic and cultural issues, with literature reviews and meta-analysis.

Session: Spirit of 1848 Social Justice & Public Health Student (Poster)

Nov 5, 2013: 12:30 PM - 1:30 PM

Youth Violence, Suicide, and Homicde in the U.S Urban Cities: Changing Trends in Rates and Risk Factors

Melissa Kelley, PhD student

Background: While youth violence has generally decreased, it is still at unacceptably high levels. Nationwide, homicide is the second leading cause of death for 15–24 year olds, and suicide the third leading cause of death. This analysis examines trends in youth violence rates and risk factors before and after the inception of the UNITY Initiative, a comprehensive strategy aimed at youth violence prevention.

Methods: Secondary data actors were obtained from the National Center for Health Statistics (NCHS) and Youth Risk Behavior Surveillance System (YRBSS). NCHS data on homicide, suicide, and firearm deaths as well as YRBSS data on violence, school violence, and suicide measures were assessed.

Results: The overall 5-year average homicide and firearm frequency for UNITY cities decreased between 1999-2003 and 2005-2009, however, the 5-year average homicide rate per 100,000 people increased slightly. For all UNITY cities, the 5-year average suicide frequency and the 5-year average annual suicide rate per 100,000 for 15-24 year olds decreased between 1999-2003 and 2005-2009. In terms of violence risk factors, the majority of cities were below the national average in the number of youth electronically bullied, and those that reportedly carried a weapon. All UNITY cities were below the national average for youth that seriously considered attempting suicide.

Discussion: While all UNITY cities have seen a decrease in suicides and suicidal behavior since the initiative's inception, violence rates and risk factors have only improved for some cities. More research is necessary to understand what city-level factors can help prevent youth violence.

Session: ICEHS Latebreaker (Poster)

Nov 4, 2013 12:30 PM - 1:30 PM

Laying the groundwork for an intervention to address partner violence among young men who have sex with men

Katrina Kubicek, PhD Student

Research examining intimate partner violence (IPV) within the relationships of young men who have sex with men (YMSM) is scarce. The limited research has focused primarily on providing estimates of the rates and types of violence that occur, which indicate that YMSM experience IPV at rates similar to those of heterosexual females. In spite of this, evidence-based interventions targeting IPV in YMSM relationships are nonexistent. More in-depth research on the covariates of IPV in YMSM relationships is necessary to develop interventions. Methods: This mixed-method study included multiple data collection activities: survey administered to 101 YMSM ages 18-25; 6 focus groups; and 24 one-on-one interviews. Results: Survey data indicate high rates of IPV. About a quarter (24%) reported an injury in the past year as a result of a fight with their partner and a similar percent reported causing an injury to their partner; 29% reported making their partner have sex without a condom and a third reported their partner making them have sex without a condom. Qualitative data indicate that issues such as internalized homophobia, power, normalization of violence in same-sex relationships and limited access to positive relationship role models are important to understand for intervention development. Conclusion: The relationship between IPV and HIV risk behaviors makes this an issue that should be of concern for public health professionals. Findings are discussed in relationship to intervention development so that YMSM communities can be better prepared to advocate for themselves in order to promote a safe and healthy community.

Session: Understanding the diverse dimensions of intimate partner violence (IPV) (Poster)

Nov 5, 2013: 8:30 AM - 10:00 AM

Intimate partner violence among young men who have sex with men: Implications for HIV prevention

Katrina Kubicek, PhD Student

HIV rates among young men who have sex with men (YMSM) are among the highest – indicating that current prevention efforts are not fully effective. Understanding YMSM's relationship dynamics is crucial for effective intervention development. Research examining intimate partner violence (IPV) among YMSM is limited but suggests that YMSM experience IPV at rates similar to heterosexual females. Additionally, there is evidence suggesting that IPV is linked to HIV risk. More in-depth research on the covariates of IPV in YMSM relationships is necessary to develop effective interventions. Methods: This mixed-method study included multiple data collection activities: survey administered to YMSM ages 18-25 (N=101); 6 focus groups; and 24 one-on-one interviews. Results: Survey data indicate high rates of IPV- including behaviors that would be considered sexual abuse. Twenty-nine percent reported making their partner have sex without a condom and a third reported their partner making them have sex without a condom; 36% reported insisting on sex when their partner did not want to and about 10% reported being forced to have sex. These behaviors are related to other HIV risks (e.g., substance use, unprotected sex) at the bivariate level (p<.05). Qualitative data indicate that issues such as internalized homophobia, power, and normalization of violence are important to understand for intervention development. Conclusion: Given that the majority of HIV transmission occurs in primary partner relationships, understanding the relationship dynamics of YMSM is imperative for intervention development. Developing evidence-based interventions addressing IPV among YMSM may be an innovative approach for HIV prevention.

Session: Sex, violence, and HIV

Nov 4, 2013: 2:30 PM - 3:30 PM

Evidence of the impact of California's 2007 smokefree vehicle law

Minal Patel, PhD Student

Background. Four states (including California) and Puerto Rico have banned smoking in vehicles when minors are present. Proponents assert that such laws will reduce child exposure to secondhand smoke but evidence for this claim is wanting. If these laws are effective, then children in states with these laws should report significantly reduced exposure to smoking after implementation of the law. Methods. Using data from the biennial California Student Tobacco Survey (CSTS), we investigated the impact of California's smokefree vehicle law. California adopted the law in October 2007 and fully implemented it on January 2, 2008. Since 2001, the CSTS has been surveying 6th-12th graders about exposure to smoking in a car in the last 7 days. Evidence from the National Youth Tobacco Survey (NYTS) indicated a secular trend towards reduced child exposure to smoking in cars. We hypothesized that the corresponding trend in California accelerated after the 2005 CSTS administration. Results. The proportion of California students reporting exposure to smoking in cars in the last 7 days declined 1% per year from 2001 (24.7%) through 2005 (23.8%), but declined 5.8% per year from 2005 through 2009 (18.3%). The corresponding declines for the NYTS were a 4.8% decline per year from 1999 to 2004 versus a decline of 3.2% per year between 2004 through 2009. Conclusion: The decline in California student-reported exposure to smoking in cars accelerated after California enacted a smokefree car law, significantly exceeding national trends. Results may encourage other states to adopt similar laws.

Session: Smokefree Workplaces and Beyond: Cars, the Military, and Private Clubs

Nov 4, 2013: 4:30 PM - 6:00 PM

Effect of women's decision-making power on the use of skilled birth attendants at childbirth in Tanzania

Kyoko Shimamoto, PhD Student

Maternal mortality remains unacceptably high in developing countries, especially in sub-Saharan Africa, where more than half of live births are unattended by Skilled Birth Attendants (SBA). This study assesses the ways in which women's status and decision-making power are related to the use of SBAs at most recent births among married women in Tanzania. Data and Methods. The 2010 Tanzania Demographic and Health Survey (weighted n = 4,516). Multivariate logistic regression analysis was used, including mediation and moderation analyses. Results. Women's household decision-making power (scored 0-6) has a positive significant association with the use of SBA (OR=1.096), after controlling for sociodemographic characteristics. Additionally, women's age, household wealth, and urban residence show significant, positive associations with the use of SBAs, while parity is negative. Relative to women with primary education, women with no formal education have 34.3 % lower odds of using a SBA (OR=0.657); women with high education have 1.97 times higher odds (OR=1.968). Also, this relationship between women's education and SBA use appears to be mediated by decision-making power, especially among women with no formal education (OR=0.98, Sobel test statistic=-1.95, p=0.05). Conclusions. Further understanding of the mechanisms linking socioeconomic determinants to SBA use is needed for prioritizing program and policy interventions targeting the most vulnerable groups. Maternal health programs may have the potential to accelerate maternal mortality reduction by focusing on women's empowerment, especially among women with little formal education.

Session: Maternal and Child Health (Poster)

Nov 6, 2013: 8:30 AM - 9:30 AM

Identifying and overcoming challenges in promoting mental wellbeing for Asian & Pacific Islander immigrants in San Francisco: A CBPR approach

Heidi Tuason, DrPH Student

Background: Though Asian & Pacific Islanders (APIs) may have similar rates of mental health issues as the general population they tend to underutilize mental health (MH) services due to various socio-cultural and ecological factors. Developing community-based, culturally competent and language-specific MH interventions is critical in improving the mental well-being of API communities.
Objective: To examine six API communities' (Cambodian, Cantonese, Laotian, Samoan, Filipino and Vietnamese) perceptions of mental health and barriers to MH services and to assess the collaborative process in developing culturally-relevant and community-oriented interventions.
Methods: In the 1st phase, coalition organizations conducted community-based participatory research (CBPR) to understand perspectives of six API communities on mental health (12 focus groups, N=139 participants), and in the 2nd phase, conducted 15 workgroup meetings with 36 community partners to develop culturally-appropriate programs based on resulting recommendations. Ongoing process evaluation was conducted through semi-structured interviews to assess coalition organizations' experience in both phases.
Results: Stigma and various socio-cultural and ecological factors influencing mental wellbeing were identified as barriers to MH services. Recommendations on how to develop programs that leveraged community assets and culture emerged, including: (1) building community-based organizations' (CBOs) capacity to address mental wellbeing, (2) integrating MH promotion in CBO programming (e.g. cultural festivals), and (3) developing a bicultural/bilingual MH workforce. Filipino, Southeast Asian, and Samoan working groups formed to collaboratively develop 3-year program plans based on recommendations. Collaboration increased community awareness of MH issues, fostered co-learning, and increased capacity of CBOs to address mental wellbeing of their communities.
Discussion: Understanding API ethnic-specific cultural perspectives on mental wellbeing is crucial in developing MH interventions that are culturally-appropriate and build upon existing community assets. Utilizing a CBPR approach through collaboration with community organizations at all stages not only creates awareness and buy-in, but also builds their capacity to plan and implement effective interventions.

Session: Social-ecological context of Asian and/or Pacific Islander health (Poster)

Nov 4, 2013: 4:30 PM - 5:30 PM

Student Contributors


College student sexual health educators comment on their participation in an arts-based intervention for high school students: A qualitative analysis


Adriana Romero-Espinoza, MPH Student

Sexual health interventions often focus on social cognitive and behavioral health outcomes for participants; however, effects may also be observed among those who deliver the intervention. This paper documents the impact of an arts-based sexual health program on the college students who deliver the intervention. AMP! is a multisite trial of an arts-based sexual health intervention that relies, in part, on a Sex(Ed) Squad (SES) to disseminate information about sexual health to high school students. The SESs are groups of college students at each site who create performance pieces on sexual health for local high schools. Focus group discussions with SES members from each AMP! site (N=45) were conducted before beginning the program and again following the creation of the sexual health performance piece. Semi-structured focus group guides focused on the ways in which SES participation affected members' knowledge, attitudes, and behaviors regarding sexual health. Discussions were recorded, professionally transcribed and analyzed using Atlas.ti. Results indicate increased sexual health knowledge, more favorable attitudes toward HIV testing, and increased sexual health communication among SES members. Participants also described increased confidence in their ability to effectively communicate sexual health information in their personal lives. Through involvement in the AMP! program SES members became opinion leaders to their friends, families and sexual partners regarding matters of sexual health. Beyond the effects of the AMP! program on high school students, this study shows promising results for training popular opinion leaders who can be agents for sexual health communication in their social and sexual networks.

Session: Population, Reproductive and Sexual Health

Leadership development strategies to engage nail salon workers in policy advocacy to improve their health, safety and rights

Tina Duyen Tran, MPH Student

For long hours a day on a daily basis, nail salon workers use many products and are exposed to a variety of toxic chemicals present in their workplace environment. Workers have reported health issues linked to chemicals in their environmental workplace, including respiratory illness, allergies, cancer, and neurological and reproductive harm. Despite the increasing documentation of environmental health and justice issues that workers face, federal and state regulatory oversight of the ingredients in nail products continues to be weak and largely ineffective. As a result, the burden of toxic environmental exposure and poor health outcomes falls upon those who are exposed to the most – low-income immigrant salon workers, owners, their families, and communities. With up to 80% of California nail salon workers being Vietnamese low-income immigrant women who are of reproductive age, lack access to health care, and with limited English proficiency, there has been a clear need to develop the community's leadership to address the systematic and institutional inequalities impacting their environmental health. To promote environmental health and justice among the nail salon workforce, the California Healthy Nail Salon Collaborative established an innovative culturally appropriate leadership development program focused on empowering nail salon workers and owners to: 1) Implement health and safety best practice strategies in the workplace, 2) Develop their organizing and leadership skills, and 3) Advocate for federal and state policy solutions that positively impact their environment. This session will describe how developing a leadership program that supports behavior change while empowering workers to advocate for their communities is a powerful tool to address the root causes of the environmental injustices that they experience.

Session: Environmental justice: New approaches to screening, response, practice, and politics