1.  The Race of Space: Can Racial Residential Segregation Effect Birth Outcomes of African Americans?

Author: Sharese N. Porter, MPH

Introduction: Numerous studies have focused on individual factors as they relate to health disparities. A growing body of literature indicates that racial composition of neighborhoods and their degree of segregation may be more of a predictive factor contributing to health disparities among African Americans in urban areas. It is suggested that social inequalities, stemming from racism and segregation affect a community's economic, social, and political capital therefore influencing health outcomes.

Methods: This paper examined published literature between 1988 and 2008 to determine the relationship between racial residential segregation and maternal and infant health outcomes among African American women. Literature within the context of low birth weight, preterm births, and infant mortality was reviewed.

Results: The literature supports the thesis that racial residential segregation contributes to adverse birth outcomes and maternal health. The findings support Krieger's Ecosocial Theory which posits that health outcomes are an embodiment of the biological, environmental, and internalized societal conditions among African American women.

Conclusion: It is proposed that a comparative analysis of African American and other racial and ethnic groups of women residing in racially and ethnically concordant neighborhoods, within the same city, be conducted to further explore the dimensions of segregation (dissimilarity, isolation, clustering, centralization, and concentration) and identification of risk or protective factors for health. Examination of health disparities within a social and environmental context can offer insight into ways health disparities can be addressed in the social and political arenas beyond individual based interventions.

 2.  Telling Our Stories: Using Photovoice to Bridge Equality for Black men at a Predominantly White Institution

Authors: Warner L. McGee, MPH, Robert E. Aronson, DrPh, MPH, Robert Strack, PhD, MBA

Introduction: Social and economic factors increase the vulnerability of low socioeconomic communities to a cadre of health issues including hypertension, obesity, and HIV. In all these public health concerns, Black males experience greater proportions of morbidity and mortality. Subsequently, educational attainment plays a major role in health disparities particularly for Black males. Therefore, the purpose of this project is 1) to examine those factors that facilitate and/or inhibit Black males from successfully completing their college education at a predominantly white institution 2) inform the development of policies and practices that improve student retention and graduation.

Methods: The study used a grounded participatory design where photovoice methods elicited information regarding participants' lived university experiences including barriers to educational success.

Results: A representative set of images with captions provided a springboard for informing the larger university community about the salient issues articulated by the men in this project. Participants described lack of social space, intimidation from campus police at Black events, misconceptions and racial stereotypes from other students, difficulties in communicating with professors and navigating the college financial system as barriers to educational success.

Conclusion: Efforts to increase retention and graduation must address communication barriers from student and faculty perspective, cultural awareness and diversity, and integrating Black males into the campus community. These findings will be shared via a photo exhibit with key stakeholders in order to inform the development of policies and practices that encourage student health and success.

 3.  Healthy Living/Healthy You: A Diabetes Prevention Program

Authors: Maria L. Dupree, B.S.,CPhT, Patricia A. Clubb, PhD, & Dorothy C. Browne, MSW,MPH, DrPH

Introduction: The prevalence of diabetes in the US, particularly among minorities, has increased over the past two years (CDC, 2008). Risk factors for diabetes have been identified, including obesity, inactivity, and poor dietary habits. Diabetes prevention programs have been developed, including those for college students, particularly at the undergraduate level. However few programs exist for undergraduate students attending HBCUs (Owens, 2008). The Healthy Living/Healthy You program is a lifestyle modification program designed to prevent diabetes among HBCU students.

Methods: Students enrolled at two HBCUs were recruited to complete an online survey including questions regarding risk factors for diabetes and related factors. African-American students who indicated at least one risk factor for diabetes (overweight/obese, low physical activity, consumption of less than five fruits/vegetables per day, and/or a family history of diabetes) were recruited to participate in a 6-week lifestyle modification program. Each week included three sessions, two led by a certified fitness instructor and one led by a nutritionist. A pre-post design with a baseline and 6-month follow-up will be implemented to determine the effectiveness of the program.

Results: Findings will include the prevalence of risk factors among HBCU students who completed the online survey and the results of multivariate models investigating the covariates of risk factors for diabetes. Also, the approach and components of the Healthy Living/Healthy You program will be described.

Discussion: This poster will discuss the prevalence of risk factors for diabetes among HBCU undergraduates and the implications of not addressing diabetes risk factors during the college period.

 4.  Perspectives of Policymakers Regarding the Quality of Family Planning Services Received by Women Who Have Had Terminated Pregnancies in Argentina

Author: Bita Emrani

The purpose of the study was to examine the perspectives of policymakers regarding the quality of family planning services received by women who have had terminated pregnancies in Argentina through and interview process. Eight policymakers and leaders who are working in the field of reproductive, women's and child's health were interviewed. Overall, the policymakers whom I interviewed felt that although the quality of these services received by these women had improved much over the past few years it still is not where it should be.

 5.  Preventing Transmission of Chagas Disease in the U.S. Blood Supply: A Cost Effectiveness Analysis of Testing Blood Bank Donations

Author: Danielle Doughman, BA

Introduction: Chagas Disease is a parasitic infection that affects people living in poor, rural areas of the Americas. Though Chagas is not endemic to the U.S., increased attention on immigration from Latin America to the U.S. coupled with the availability of a highly effective assay highlight the need for testing of the blood donations for Chagas, which may be transmitted through transfusion. Currently, blood banks are not required to test for Chagas.

Methods: To estimate incremental cost-effectiveness of blood bank testing and screening strategies for Chagas, a cost-effectiveness analysis with a decision tree model with a 20-year time horizon is used. Data is taken from peer-reviewed literature. The interventions include: 1) testing all blood donations, 2) verbal screen with ELISA testing for those with a positive screen, and 3) testing new donors only. Base-case and sensitivity analyses are conducted.

Results: In the base-case analysis, Test All averted 20 additional cases over Screen and Test, but at a cost of $3.6 million per additional case averted. Test New Donors resulted in an additional 14 disease cases compared to Screen and Test and with had the lowest costs of all alternatives. The sensitivity analysis is most sensitive to whether or not a negative verbal screen was obtained and slightly sensitive to the probability for high risk of transmission.

Conclusion: Both Screen and Test and Test All improve over the standard of Test New Donors in the number of cases averted, however, both are cost-prohibitive at thresholds of $1 million per case averted.

 6.  Protecting microfinance clients from health related emergencies: Health loan program in one of the fastest growing microfinance organization in India

Author: Somen Saha

Introduction:

The growth of microfinance as an effective tool for poverty reduction provides an excellent scope to extend health services to the poorest and needy. Several microfinance institutions (MFI) have ventured into health programs sensing sound business rationale, apart from social causes. This paper analyzed the effectiveness of health loan as a health protection instrument in a MFI in India.

Methods:

Qualitative research tools, adopted from AIMS-SEEP manual of USAID, were developed to measure the performance of health loan. In-depth interview were conducted with 57 members who have availed health loan and 30 members whose loan applications were rejected in Howrah district of West Bengal, India.

Results:

Health loans range from 1000 to 5000 INR (~24 to 119 USD ) and bear an annual interest rate of 10 per cent (which is 2 per cent less than normal business loan). Members prefer visiting private providers. However, referral system for members seeking treatment with health loan is not well laid out, with lack of systemic effort to demarcate qualified versus unqualified providers. There are instances of selection bias in offering health loan with an intention to keep low loan defaulter rate.

Conclusion:

There is a strong case for removing financial barrier in health loan and need to create a discounted preferred provider network. Better referral linkages, networking with public health systems and proper communication in case of loan rejection, can enable the program to work as a model health protection scheme in India and elsewhere.

 7.  Building Bridges to Healthy Communities: The Sandhills Family Heritage Association Youth/Senior Project

Authors: Semra Aytur and Ammie Jenkins

Introduction:

Residents of Spring Lake, NC (aged 16-70) completed a participatory research project to learn about diabetes and health behaviors within the context of community values, such as preservation of African American land, economic self-sufficiency, and cultural heritage.

Methods:

Community members (n=7) partnered with a UNC epidemiologist to learn skills (e.g., interviewing and PhotoVoice) and explore barriers and enablers to community health. Four 2-hour sessions were held during the summer of 2008. Participants interviewed other residents (n=8) and took photographs to explore beliefs, knowledge, and attitudes relating to diabetes and the community environment.

Results:

Participants identified many health-promoting assets, such as a local Farmers Market, 'Gardening and Gleaning' program, senior center, parks, and youth dance programs that allow residents to pursue healthier lifestyles while empowering one another. However, the proliferation of fast food restaurants, inadequate exercise facilities, lack of public transportation, and limited access to diabetes educators were identified as barriers to community health. To address these barriers, participants discussed working with town planners, parks/recreation and transportation departments, and establishing a diabetes education training program. Better advertising for the Farmer's Market was also discussed, as participants viewed the Farmer's Market as a means of developing the local economy, encouraging sustainable use of natural resources, while promoting healthy behaviors.

Conclusion:

Participants learned new skills and established partnerships for diabetes prevention. Results are being used to develop an ongoing youth/senior health partnership. Projects that empower African Americans to create healthier community environments and support local economies are needed to eliminate health disparities.

 8.  Knowing and Learning: A Three-City Study of Knowledge and Perceptions regarding HIV/AIDS within Nigerian Undergraduate Students' Social Networks

Author: Ebun Odeneye, BA

Introduction:

Nigeria is one of the countries predicted to suffer the greatest hit from HIV/AIDS by 2010. Thousands of Nigerians migrate internationally to such destinations as the United States and the United Kingdom, making it crucial to evaluate HIV/AIDS within a trans-national context. The study, which assesses students' knowledge of HIV/AIDS, examines their risk perception and evaluates socio- cultural elements that may help mold effective HIV/AIDS prevention measures.

Methods:

Its sample was drawn through the snow-ball sampling method, and includes twenty-four Christian undergraduates in the US and the UK. Through qualitative data analysis of twenty-four in-depth interviews with students and their social network partners in London, Leeds (UK) and Houston, Texas, this research study confirmed how ethnicity and religion shape the creation of social networks in the three communities, how social networks influence HIV-related risk perceptions, and the type of knowledge these students have and share with their network partners regarding HIV/AIDS.

Results:

Students were found to rely on national-, ethnic-, and religion-based identities to form social networks and use these networks to cope with migration-specific difficulties; their social networks therefore have a strong impact on their interpretation of the HIV/AIDS pandemic and affirm conditional silence surrounding the subject.

Conclusion:

Since study participants draw on academic arenas as the primary source of their HIV/AIDS-related knowledge, there exists a self-other (personal-professional) dichotomy relating to exposure to HIV and potential contraction of the virus which explains the perceived low risk regarding HIV in this populace.

 9.  Making heart health a priority for women: What African American women in North Carolina are saying about cardiovascular disease.

Authors: Avia G. Mainor, MPH, Maihan B. Vu, DrPH, MPH, Carmen D. Samuel-Hodge, PhD, MPH, RD, Sonya F. Sutton, MA, Thomas C. Keyserling, MD, MPH

Introduction:

Cardiovascular disease (CVD) is a leading cause of adult mortality and morbidity, with disparities in underserved populations. As rates of CVD are very high for African American women, it is important to understand these women's perception of risk for CVD and barriers to decreasing risk.

Methods:

To better understand these issues, we used qualitative methods as part of our formative research to inform a Cardiovascular Health Intervention Research and Translation Network. A total of ten focus groups were held with 115 African American women, over age 40, who reside in urban and rural North Carolina. Women were recruited from community contacts and churches.

Results:

The mean age of participants was 60. Overall, participants associate CVD with risk factors. Having a family history of the disease, eating habits, and being stressed were common themes identified as factors that increase risk for heart disease. Likewise, participants considered themselves to be highly susceptible for heart disease compared to other women like them. Having heart disease was viewed to be devastating, primarily because of the loss of independence and the inability to take care of their family. Despite these recognitions, participants expressed the tendency to neglect their heart health because of competing priorities.

Conclusion:

Participants acknowledge that certain cultural beliefs regarding food preparation and eating habits and the woman's role as caregiver for the family are barriers, making it difficult to place their health as a priority. These findings suggest the importance of developing culturally appropriate strategies to help African American women reduce heart disease and stroke.

10.  Using the Intervention Mapping Approach to Develop a Community-Based Intervention to Increase Rural Racial and Ethnic Minority Enrollment in HIV/AIDS Clinical Trials

Authors: Bahby Banks, MPH, Malika Roman Isler, MPH, Margaret Miles, PhD, Sohini Sengupta, PhD, Giselle Corbie-Smith, MD, MSc

Introduction:

Minorities are disproportionately affected by the HIV/AIDS epidemic in the rural Southeast, therefore, it is important that targeted culturally appropriate interventions support enrollment and participation in HIV/AIDS research. Intervention mapping (IM) provides a structured, theory-based approach for intervention development.

Methods:

We collected qualitative data from three data sources: people living with HIV/AIDS (PLWHA), community leaders (CL), and service providers (SP). Eleven focus groups and 35 individual interviews were conducted; this data was used to develop matrices of behavioral outcomes, environmental outcomes, and performance objectives. Each performance objective was mapped with changeable, theoretically-based determinants in a complete matrix. Methods and strategies were developed to reflect the influencing factors and desired outcomes in each matrix.

Results:

The outcomes and objectives varied by target group to produce a total of five matrices (three behavioral and two environmental). The three behavioral outcomes included: 1) Eligible PLWHA will enroll in clinical trials, 2) Service Providers will refer eligible PLWHA to clinical trials, and 3) Community leaders will support HIV/AIDS research. The environmental outcomes included: 1) Decreasing HIV stigma and 2) Increasing HIV testing and care. Resultant methods and strategies used constructs from the Theory of Reasoned Action, Social Cognitive Theory, and Social Support Theory.

Conclusion:

This intervention was developed using IM and resulted in a comprehensive community-based program. This theoretically driven intervention, that is potentially replicable, can assist rural PLWHA with recruitment and participation in HIV/AIDS research.

11.  Emotional Suffering and Mental Health Issues: An Unaddressed Health Disparity Issue for Rural HIV+ African Americans

Authors: Margaret Miles, PhD, RN, Bahby Banks, MPH, Michelle Hayes and Giselle Corbie-Smith, MD, MSc

Background

The diagnosis of HIV is an emotionally charged experience. Concern about confidentiality, stigma, and discrimination is especially difficult for African Americans living in the rural South where negative perspectives about HIV remains high. Emotional distress and mental health issues in the context of HIV are an added health disparity that is largely unaddressed.

Methods:

Thirty semi-structured individual interviews were conducted with African American people living with HIV/AIDS (PLWHA). Interviews were audio-taped, transcribed and entered into Altas.ti for thematic coding and analysis. Transcripts were independently analyzed by six team members in a back/forth approach between discovery and verification of findings.

Results:

At diagnosis, emotional distress was the most salient response and also one of the most difficult aspects of living with HIV, especially for men. A major source of distress was fear of discrimination and being treated like a 'bad' person. Participants indicated the need for mental health and supportive services as higher than the need for health care. A major barrier to sharing was fear of losing confidentiality about the diagnosis and the concerns about how they would be treated if their diagnosis were known. Women were especially concerned about being ostracized.

Conclusion:

This study adds to the body of literature indicating the need for mental health services, especially in rural areas. In addition, health care providers, as well as case managers and others, need to listen to the concerns of HIV+ persons and help them deal with fears of discrimination and issues related to disclosure.

12.  Community Based Research Infrastructure: An Exemplar of Community Engagement

Authors: Malika Roman Isler, MPH, Tiffini Williamson Canty, MS (presenter), Alicea Lieberman, BA, Molly De Marco, MPH, PhD, Sam Cykert, MD, Nettie Coad, Kay Doost, Jennifer Schaal, MD, Brandolyn White, MPH, Deborah Young, MHA, MS, RD, LDN, Giselle Corbie-Smith, MD, MSc

Introduction:

The NC TraCS Community Engagement Core (CEC) seeks to improve the process of conducting community-based research in order to address health disparities. Physically locating a research infrastructure in the community, staffed by persons familiar to and trusted by the community and working collaboratively with local agencies may help to engage community members in research, demonstrate trustworthiness, and in turn lessen health disparities.

Methods:

The CEC, in partnership with the Greensboro Area Health Education Center, created a Regional TraCS Campus (RTC) - an infrastructure to conductt community- and university-initiated research. A local infrastructure provides a venue to facilitate community-academic interaction that sets research priorities, informs study design, assists in developing a useful and practical dissemination plan, participation in tailored research education, and increases geographic and cultural accessibility to the University. For university researchers, the RTC alleviates the need to recreate community linkages and partnerships with each study, and provides a means to build trust and collaboration.

Results:

The RTC facilitated a pilot research program to investigate the effects of physician/patient communication and healthcare outcomes - how peoplle of different races and incomes are given prescriptions. Through the RTC, a local community coalition and UNC researchers collaborated to implement community and physician forums to share findings and are currently working on practice recommendations for clinical providers on doctor-patient communication regarding prescription drugs and personalized medicine.

Conclusion:

Community-based research infrastructures can be vital to facilitating community engagement, developing locally-driven research initiatives, and informing the dissemination of culturally appropriate health-related information and the provision of culturally sensitive health services programs.

13.  Hope Works and Threads of HOPE: Addressing women's health and poverty through Community Participatory Research

Authors: Katie Barnes, BRE; Salli Benedict, MPH; Marci Campbell, PhD; Patricia Peterson; and Imani Rivera

Introduction: We will describe the participatory process that lead us from HOPE Works, a women's obesity prevention and empowerment project, to Threads of HOPE NC, a woman-owned business and entrepreneurial training laboratory.

Method: HOPE Works focuses on goal setting, weight management and increasing hope among lower income rural women by addressing social/economic determinants and healthy behaviors. The Community Advisory Committee (CAC) planned, implemented and evaluated the project with the UNC research team. Community women receive training and lead Hope Circles of women in their social networks to set and achieve health and life goals. Evaluation included qualitative, quantitative, and bio-measures. During our decade long community-university partnership, the relationship of jobs, poverty and health has been emphasized repeatedly, culminating in the decision, during the HOPE Works project funding period, to start a business. The result is Threads of HOPE NC, a successful sewing enterprise.

Results: Preliminary results from the first four years of the HOPE Works study indicate that HOPE Works is a successful model: reaching mostly minority women (over 67 % African American). Women in HOPE Circles experienced significant weight loss and increases in physical activity, fruit and vegetable intake and hope compared with non-participants. To address the loss of jobs and the relationship between poverty and health, women in the project started a business.

Conclusion: Using a CBPR process can lead to sustainable community programs that address health within the context of women's lives by improving their economic condition.

14.  Racial/Ethnic Group Differences in Child Maltreatment Outcomes

Authors: Jon M. Hussey, PhD, MPH, Quynh C. Nguyen, MSPH

Introduction: Evidence on racial/ethnic differences in maltreatment outcomes is limited and findings are mixed. Past studies have largely focused on a single exposure (physical abuse) and a limited set of outcomes (externalizing behaviors) and have relied on non-probability samples of uncertain generalizability. We extend past research by examining an expanded set of maltreatment exposures (neglect, physical assault, and sexual abuse) and a broader range of outcomes, including alcohol, cigarette, and illicit drug use; externalizing behaviors; and depression.

Methods: We use data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of more than 15,000 young adults first interviewed in 1994-95. Using logistic regression and controlling for socio-demographic characteristics, we estimate the association between four types of self-reported childhood maltreatment and twelve health risk outcomes measured during early adulthood (ages 18-26). To examine whether associations between maltreatment and health differ by race/ethnicity, we estimate separate models for Non-Hispanic Whites, Non-Hispanic Blacks, Latinos, Asian/Pacific Islanders, and Multiracial participants.

Results: Across all racial/ethnic groups, maltreatment tended to be most strongly associated with illicit drug use, externalizing behaviors, and depressive symptoms. While many associations differed by racial/ethnic group, no clear patterns (by maltreatment type or health risk outcome) emerged.

Conclusion: When an expanded set of exposures and outcomes is considered, racial/ethnic group differences in the consequences of child abuse and neglect appear to be less consistent and more complex than previously reported.

15.  Implementation and Analysis of the Short Supplemental Youth Tobacco Survey focusing on North Carolina's American Indian Youth (Grades 6-12)

Authors: Nicole Standberry, Scott Proescholdbell, MPH, Shannon Fleg, BS

Introduction: Although North Carolina (NC) is among states with the highest Youth Tobacco Survey response rates and has the largest American Indian (AI) population east of the Mississippi, there are no data regarding the prevalence of tobacco use among AI youth in this state. The Short Supplemental Youth Tobacco Survey (SSYTS) was created to address this information gap in NC.

Methods: The SSYTS contains 29 questions, 24 from the statewide YTS and 5 created specific to AI youth regarding tribal affiliation, commercial vs ceremonial/traditional tobacco use, frequency of participation in AI events, and traditional use among family members. Schools with an AI population of at least 10% were invited to participate. 140 second and third period classes of 6th-12th grade students were randomly selected for a target sample size of 2860, to obtain point estimates and narrow confidence intervals.

Results: Approximately 4,532 students from 271 classrooms in 24 schools from 7 counties were surveyed. We will present data on tobacco use prevalence by region, gender, age, tribal affiliation, type of use (ceremonial vs commercial), family member use, AI event participation. We will also present lessons learned in fielding the NC SSYTS.

Conclusion: Data obtained from this study will be beneficial for tailored prevention and control interventions and for seeking funding opportunities. Lessons learned will be used to expand the current methods and improve representation from the 8 NC AI tribes.

16.  Racial/Ethnic Disparities in Asthma in North Carolina

Author: Winston Liao

Introduction: Racial/ethnic minorities are disproportionately affected by asthma in North Carolina. This descriptive study investigates the disparities between whites and African Americans with respect to asthma prevalence, selected asthma-related outcomes and management behaviors, and asthma mortality.

Methods: We analyzed asthma data from the 2007 North Carolina Behavioral Risk Factor Surveillance System and the 2007 Child Health Assessment and Monitoring Program to examine differences in asthma prevalence, attacks and symptoms; emergency room and healthcare visits; activity limitation; and disease management. Vital statistics from 1999-2007 were used to determine racial differences in asthma mortality.

Results: Among adults, Native Americans had the highest lifetime and current prevalence rates (16.4%, 10.0%) followed by African Americans (14.8%, 9.9%), and whites (12.1%, 7.9%). More whites than African Americans reported asthma attacks, symptoms, days unable to carry out usual activities, using an inhaler, and having an asthma management plan. African Americans had more emergency room and healthcare visits, difficulty sleeping, and asthma medication usage. African American children had significantly higher lifetime and current prevalence rates (23.2%, 17.4%) than their white counterparts (14.5%, 8.3%). They reported more ER visits, missed school days, and using emergency asthma medication at school, while more white children used daily and rescue asthma medications and had an asthma management plan. African Americans had a significantly greater asthma mortality rate (3.28/100,000) than whites (1.23/100,000).

Conclusion: Racial/ethnic disparities are notable among adults and children with asthma in North Carolina. These findings provide ongoing surveillance data that complement current local, community-based activities supported by the North Carolina Asthma Program.

17.  How does having Medicaid as an individual's primary insurance affect the type of surgical hysterectomy procedure chosen for uterine fibroids?

Author: Donovan Anderson

Introduction:

Uterine fibroids are benign tumors that can negatively affect the female's reproductive system. Their two distinct surgical procedures are the abdominal and vaginal hysterectomy. Abdominal hysterectomies are the more invasive surgical procedures when compared to vaginal hysterectomies. Thus, they lead to more complications, render slower hospital recovery time, and cause greater physical pain. The study proposes that (1) Medicaid insured patient's are more likely to receive abdominal hysterectomy as a surgical procedure for uterine fibroids and (2) Black women are more likely to receive the abdominal hysterectomy procedure than White women while sharing the same insurance.

Methods:

This paper will use National Hospital Discharge Survey data from 2004-2006. It will analyze the data using Ordinary Least Squares (OLS) regression, and three types of propensity score matching (PSM) techniques-Mahalaanobis matching with and without replacement, and Kernel matching.

Results:

All techniques conclude with statistical significance that Black women with uterine fibroids are more likely to receive abdominal hysterectomies than vaginal hysterectomies. White women in contrast are more likely to receive vaginal hysterectomies than abdominal ones under PSM techniques. The secondary hypothesis was not proven with statistical significance in three out of the four techniques used.

Conclusion:

Medicaid is an indicator of surgical procedure choice. Future research should include data over a longer time period (1997-2006) since here significance was only slightly missed. Although statistical significance is not proven in this case, the study illustrates that more research is required to render more equitable health outcomes across race.

18.  A Community Garden Initiative for Inner City Minority Youth and Families to Learn about Gardening, Entrepreneurship and Healthful Eating

Authors: A. Fisher, Nicolette Warren-White (presenter), C. Mitchell, M. Dunn, B. Williamson, M. Floyd and R. Moore

Introduction:

Encouraging children to grow their own fruits and vegetables may make them more receptive to eating fresh products. The purpose of this community garden initiative was to increase the number of youth who report eating at least 5 servings of fruits and vegetables per day, reduce the proportion of school age students who engage in no leisure-time physical activity, and promote eating behaviors consistent with managing body weight of all family members.

Methods:

The garden had plots available to children, individuals, families and community groups. Children aged 10-13 were paired with children aged 4-9. Specifically, the gardening project sought to examine the knowledge gain in science, nutrition, the environment and the personal skill areas. Methods included systematic observation of educational sessions, pre and post surveys, and interviews.

Results:

Surveys conducted after the completion of the growing season showed that children who participated in the garden consumed the recommended servings of fresh fruits and vegetables and increased their physical activity. The children connected with the gardening experience which encouraged them to eat the vegetables that they grew. During grocery store tours, the children demonstrated recognition and retention of knowledge about fruits and vegetables grown in the garden. The gardening experience provided a basis for lifelong knowledge and appreciation of good vegetables and good taste.

Conclusion:

The community garden initiative improved community health by building community capacity. The garden helped established links between plants, gardening, food and health. The gardening initiative can be applied across a variety of settings and audiences.

19.  Use of Psychosocial Support Services at Diagnosis among Patients with Colorectal Cancer in the VA

Authors: Natia S. Hamilton, BA; George L. Jackson, Ph.D., MHA; David H. Abbott, MS; Bryan Paynter, BS; Leah Z. Conner, MPH; Diana L. Ordin, MD, MPH; Dawn T. Provenzale, MD, MS

Objectives: Psychosocial support among colorectal cancer patients (CRC) has potential to improve quality of life. We examined factors, including race, potentially associated with the use of VAMC patient's receipt of psychosocial support within 3 months of diagnosis.

Methods: Analysis included 396 veteran patients with CRC treated at 28 participating VAMC. We calculated proportion of veterans receiving psychosocial care (i.e. social work, chaplain, psychology, psychiatry, mental health nurse, other) within three months of CRC diagnosis. Logistic regression was used to examine association between receipt of psychosocial support and: 1) marital status, 2) age, 3) determined stage, 4) hospital complexity, 5) race, 6) service connected status, 7) cancer type, and 8) gender.

Results: Approximately 81% of patients received some form of psychosocial support. Patients often received more than one form. 50% social work services, 62% chaplain services, 6% psychologist services, 8% psychiatry services, 4% other mental health nurse services, and 1% some other form of service. Bivariate analysis indicate cancer type [colon vs. rectal] [OR=1.76, 95% CI=1.04- 2.98]; marital status (married vs. unmarried) [OR=0.60, 95% CI =0.35- 1.03], and stage at diagnosis (I vs. IV) [OR=0.49, 95% CI=0.23- 1.05] were significantly associated with receiving psychosocial services.

Conclusion: About 2/3 of VA patients with CRC received psychosocial service support around the time of CRC diagnosis. Patients in the VA are less likely to receive psychosocial support services if they had rectal vs. colon cancer, married, or had a lower stage. Race was not associated with receipt of psychosocial support.

20.  Cross-Program Evaluation of Peer-Led HIV Prevention at a Minority-Serving Institution

Author: Danielle Laborde, PhD, LaVerne Reid, PhD, Tanya Bass, MS and David Jolly, DrPH

Since 2003, we have received funding from the Office on Women's Health to develop and evaluate culturally-sensitive peer-led HIV education programs to address the health needs of women attending a minority institution. Working with campus organizations and departments, we implement student-led projects including HIV prevention serial sessions, one-time events, and a campus-wide HIV conference. Methods: For each program event that was evaluated, students completed evaluation questionnaires that included a core set of items. This allowed for comparison of immediate outcome indicators across subsets of programs. IRB approval was obtained for all student data collection linked to program evaluation.

Results: The response rate across all events in 2007-2008 was 78% (N=336). Reported condom use at last intercourse (60%) was higher than what we have seen in previous years among participants across all our programs on this campus (30-40%). Within a subset of 161 participants asked about confidence in their communication and condom negotiation skills before and after certain HIV educational events, we found statistically significant increases in levels of confidence.

Conclusion: Overall, results indicate that the majority of peer-led activities are well-received by students on campus and increase participant knowledge of HIV/STD risks, self-efficacy for condom use and negotiation, and behavioral intent to lower risk behaviors. Despite design limitations, i.e., combining data collected over time from students attending different campus HIV prevention programs, results provide useful information on the effects of our HIV prevention efforts.

21.  The Latino Health Promotion Partnership: A model for community-based needs assessment

Authors: Ellen Bailey, MA; Danielle Arias, BA; Althea Gonzalez, BA; Amy Lanou, PhD; Alphie Rodriguez, MA

Introduction: The Latino population in Buncombe County is projected to reach 4.2% of our population by 2010, with actual numbers doubling since 2000. Over one-third of Latinos surveyed reported fair or poor health in a 2005 Community Health Assessment. In order to help guide health promotion programming and services for this growing population, The Latino Health Promotion Partnership, funded by the NC Center for Health and Aging, is an academic and community collaboration that formed to assess the needs of the local Latino community and of the organizations and providers who serve them.

Methods: We collected primary data by way of surveys (of local agencies who serve Latinos, interpreters, physicians, and individual Latino community members), a community provider forum, and three focus groups with Latino youth and families. This data collection was designed to identify health promotion and health care desires and needs. A needs assessment and gap analysis were performed on the qualitative and quantitative data.

Results: Both providers and Latino community members identified significant linguistic, cultural and environmental barriers to access and a need for better outreach and access to information about available services and programs. Support for parenting skills, nutrition and opportunities for family physical activity were high priorities for community members.

Conclusion: Community members, providers and agencies need to continue to collaborate to develop a centralized resource network and community-based health promotion programming to better meet the health and wellness needs of Latinos in Buncombe County. Specific recommendations based on our findings will be presented.

22.  Tetanus Immunization Initiative: Tafi Atome, Ghana

Author: Delali O Blavo. B.S., M.B.A., Second Year Medical Student. Isaac Tam, Cyril Blavo, M.S., D.O., M.P.H &T.M., FACOP., Erica Burch (presenter)

Introduction:

Tetanus is a serious disease of the nervous system caused by ubiquitous spores of the bacteria Clostridium tetani. When infected the patient suffers a significant illness, which may lead to death in 10 - 20 % of casess. A 1999 World Health Organization (WHO) report established that while substantial progress has been made toward the elimination of tetanus globally limited progress has been made in Africa. In a recently published profile of Ghana by the WHO, tetanus deaths account for four percent of total neonatal deaths in Ghana.

Methods:

In three phases vaccinate women of childbearing age in the Tafi Districts, according to implemented guidelines by the Ghana Health Service.

Results:

Phase One: 12/19/07 - 12/ 20 /07 (Vaccinated 1170) Phase two: 6/22//08 - 6/23 /08 (Vaccinated 1136) Phase three: 12/ 21/08 - 12 12/22/08 (Vaccinated 1150). Over 90 % of the vaccinees received the full complement of the vaccinations.

Conclusion:

The goal of this initiative is to advance the WHO's aim toward the Global elimination of Neonatal tetanus and maternal tetanus. The target date for worldwide elimination was set for 2005, however neonatal and maternal tetanus continue to be significant problems. Ghana is one of eighteen Class B countries who according to the WHO have between 11% - 50% of their districts are high risk. The goal of the initiative is to identify gaps in immunization coverage in rural Ghana, and implement immunization campaigns to close those gaps.