Poster Presentation Abstracts

Introduction: The University of North Carolina Asheville and the YWCA of Asheville collaborated to implement a culturally competent family- and community-based program to address the nutritional and physical activity needs of Latino families in Buncombe County, NC. The primary objective was to improve the knowledge and adoption of habits leading to better nutrition and increased physical activity. The secondary objective was to evaluate the effectiveness and sustainability of an academic and community partnership in prevention of childhood obesity.

Program Design: An existing nutrition and physical activity curriculum for Latinos, Salsa, Salud y Sabor (SSS), was adapted for local families and student interns. Participants were recruited through networking with community organizations. In summer 2010, families participated in eight SSS sessions held at the YWCA. In fall 2010, summer participants decided on follow-up activities to be held in the community to support participant and program goals. Methods of evaluation included tools to measure behavior change, one-on-one interviews with adult participants, attendance records, and program self-evaluation.

Outcomes: Nine families (26 participants) participated in our summer program (88% participation). Thirteen events were held in the fall (25% participation). The interviews indicated positive knowledge gain and behavior change, and the important role of social support. Self-evaluation of the program indicated success and areas for improvement. Program design with a regular time and location can result in greater attendance. Building trust between the program leaders and the Latino participants can contribute to program success. Program sustainability through an academic-community partnership needs further exploration.

Examining the Relationship between Geographic Proximity and HIV Clinical Trial Knowledge among Rural, African-American People Living with HIV/AIDS

Adina Black, BA; Bahby Banks, PhD, MPH; Malika Roman Isler, PhD, MPH; Giselle Corbie-Smith, MD, MSc

Introduction: Geographic proximity to academic medical centers (AMCs) conducting clinical trials and lack of knowledge about clinical trials (CTs) have been cited in the literature as barriers to clinical trial enrollment for African-American people living with HIV/AIDS (PLWHA). This study examines the association between geographic proximity of five community based organizations (CBO) to four major AMCs and baseline knowledge of CTs among African American PLWHA in central and eastern North Carolina.

Methods: We administered a 57-item questionnaire to 85 PLWHA receiving services from the five CBO’s, with seven of those items assessing PLWHA knowledge of CTs. These items were derived from existing surveys and items created de novo by the research team. Composite scores were calculated as the total number of items scored correctly divided by the total number of items. Geographic data, to determine the distance of CBOs from academic medical centers, were obtained by entering addresses for each location into geospatial software. Distances were measured and recorded in miles.

Results: Linear regression analyses will be conducted to examine the association between geographic proximity and baseline knowledge among PLWHA participating in a CT outreach effort at each CBO. Comparisons will be made by region (eastern and central). We expect a positive correlation between the two variables.

Conclusion: The association between geographic proximity and CTs knowledge, if present, could inform intervention efforts for researchers and practitioners related to outreach--particularly in communities distant from medical academic centers. Efforts may need to include alternative forms of dissemination of CT information (e.g. peer outreach, video, brochures).

Formative Research for Dissemination of the Seeds of HOPE Intervention

Loneke T. Blackman, MA, RD, LDN

Introduction: In eastern rural North Carolina, social determinants are negatively impacting community health, particularly obesity. This study reports on formative research conducted to enhance dissemination of Seeds of HOPE (Health, Opportunities, Partnership, and Empowerment), a community-based research study to improve the economic understanding, empowerment and health of women in rural communities.

Methods: In March 2011, 23 local organizational leaders were recruited to participate in four focus groups across rural counties of eastern North Carolina (Sampson, Duplin, Robeson, Lenoir). Using a semi-structured interview guide, a trained facilitator asked questions regarding community health, program implementation, and women’s needs. Discussions were digitally recorded and transcribed verbatim. Qualitative data analysis included exploration, reduction and interpretation to identify relevant codes and themes.

Results: Participants were mostly female (90%) and averaged 49.6 years of age. The sample was 40% African American, 28% Caucasian, 28% Native American and 4% Latino. Emergent community issues were unemployment, financial illiteracy, low income, lack of education, awareness of resources, and low social support. Health barriers and issues specific to rural living were distance, lack of transportation, and cost of transportation. Discriminatory practices, historical trauma, and cyclical poverty were also barriers. Grassroots efforts, use of natural helpers, and empowerment of women were favorable characteristics of future programs.

Conclusions: Financial illiteracy, unemployment, and social support were major issues for all counties. Future implications include amendment of the intervention curriculum and recruitment strategies. Involving organizational leaders prior to intervention dissemination to help identify barriers and needs may enhance intervention effectiveness.

**ALMA (Amigas Latinas Motivando el Alma) Promotoras as Photovoice Participants: From Intervention to Community Advocacy**

Laura Cubillos Braswell; Rachel Page, MPH; Connie Blumenthal, MPH; Melissa Green, MPH; Sarah Paraghamian; Georgina Perez, MSW; Anh N. Tran, PhD, MPH; Michelle J. Lyn, MBA, MHA; Giselle Corbie-Smith, MD, MSc

Introduction: As Latino immigrants navigate their transition to the United States, they face unique mental and physical stressors. Employing participatory methods to engage community members in the identification of these stressors and potential solutions can develop sustainable approaches to improve community health and reduce health disparities. ALMA is a stress reduction intervention with Latina promotoras (lay health advisors) in North Carolina. In Phase I, ALMA conducted an intervention addressing mental health concerns, stress coping strategies, and knowledge of local resources. Phase II introduced promotoras to photovoice, a process using photography and guided discussions to identify community concerns impacting mental health, engage community members and stakeholders, and promote community advocacy.

Methods: Eight promotoras in Chatham County participated in photovoice, which consisted of training sessions, forum planning meetings, a community forum, and post-forum debriefing. Through photography, promotoras recorded and reflected on their community’s strengths and concerns pertaining to mental health; they identified and discussed mental health issues, stimulated self-empowerment, and proposed action steps. The process culminated with a community forum.

Results: Promotoras identified three emergent themes which were presented at the forum: 1) Impact of Latinos’ social isolation and the role that programs like ALMA play in reducing isolation and improving access to resources; 2) Parenting and education; and 3) Racism and discrimination toward Latinos.

Conclusion: Photovoice provides an opportunity for promotoras and the larger community to identify issues which they find most important and to explore avenues for action and change by addressing policy and community barriers to mental health parity.

Project SAFE (Seeking Answers for Flu Education): An Examination of African American Participation in Influenza Vaccination Efforts in Hampton, Virginia

Dorothy C. Browne, MSW, MPH, DrPH; Patricia A. Clubb, PhD; Jackie Copeland-Campbell, BA, MA Vonda Johnson, BSW

Introduction: National studies indicate that African Americans are less likely to obtain the influenza vaccine than other ethnic groups (Uscher-Pines, Maurer, & Harris, 2011). In an effort to increase African American influenza vaccination, the Hampton Health District conducted a study of residents using a mixed method approach.

Methods: African American adult residents of Hampton, Virginia were recruited via flyers distributed at community events, businesses, churches, community centers, and other venues. Twenty-seven focus groups were conducted with 288 adults. Trained facilitators led a discussion of: knowledge, attitudes, and perceptions about influenza vaccination; reasons for vaccinating or not; perceived barriers of vaccination; and effective vaccination messages. Focus group transcripts were coded for central themes. An additional 248 African Americans answered up to 92 questions regarding influenza vaccination and related constructs using Audio Computer-Assisted Self-Interviewing (ACASI). Multivariate logistic regression was used to identify factors related to vaccination in the past year.

Results: Four out of ten ACASI participants reported receiving a flu vaccination in the past year. Being older, having a regular health care provider, and having a positive attitude toward the vaccine were related to vaccination status. These findings are consistent with focus group themes, the most common one being that the vaccine causes illness and/or has negative side effects. Other common themes pertained to: perceptions of the vaccine as unnecessary due to good health, financial barriers, medical mistrust, vaccination content (virus), and a fear of shots.

Conclusion: The results provide information that could increase the vaccination rates among African Americans.

Work Conditions and Organization of Work Create Occupational Health and Safety Hazards for Immigrant Chicken Catchers

Lourdes Carrillo, BS; Antonio Marín, MA; Thomas A. Arcury, PhD; Alice E. Arcury-Quandt; Emma Lawlor; Sara A. Quandt, PhD

Introduction: Minority workers are over-represented in dirty, dangerous and difficult (3-D) jobs. Chicken catching, gathering and caging chickens in confined animal feeding operations, is one 3-D job. This study uses data from a qualitative, exploratory study to (1) describe the tasks performed by chicken catchers, (2) describe their organization of work, and (3) identify health and safety hazards they encounter. Such data are essential for developing occupational safety and health strategies.

Methods: Data come from 21 immigrant Latino chicken catchers from three poultry companies in North Carolina. Catchers were recruited by word of mouth in the community. The data were collected using 10 in-depth interviews (recorded, transcribed, and translated into English) and 11 shorter interviews with chicken catchers.

Results: Chicken catchers described their job as difficult and physically demanding because of work speed, weight of the chickens, repetitiveness, and awkward postures. They described their work place, chicken houses, as being dusty, muddy, and noisy, with a strong odor and limited lighting. Safety risks include slips and falls, as well as being hit by forklifts. Workers display hand deformities, which they consider an embarrassing mark of their work. Catchers are organized as teams paid a set amount per 1000 chickens caught per day, creating collective pressure to work as quickly as possible.

Conclusions: Occupational health hazards identified were environmental (dust, ammonia, noise, biohazards), physical (posture, hand deformities), and mental (embarrassment, drug use) occupational health hazards. Occupational safety hazards were identified (machinery working in low light, mud on flooring, pace of work).

Experiences of the US Health Care System: A Comparison Study between Asian-Indian Immigrants and Korean Immigrants in the US

Jennie C. De Gagne, PhD, RN-BC, CNE; Suk-Sun Kim, PhD, RN; So Aeyoung, PhD, MPH

Introduction: Asian Americans are one of the fastest growing minority populations in the U.S. In the last decade, the Asian population in NC grew by 131%, and the majority of those immigrants are foreign-born (73.5%). The purpose of this study was to examine the differences and similarities in experiences and satisfaction with the U.S. healthcare system (HCS) between Asian-Indian Immigrants (AIs) and Korean Immigrants (KIs).

Method: We measured the experiences and satisfaction with the HCS in 125 KIs (47 males and 78 females) and 125 AIs (71 males and 54 females) living in the NC Triangle area. T-test and Chi-square statistics were used for data analysis.

Results: Most participants (52.0%) reported that they were not satisfied with the U.S. HCS. KI respondents (62.4%) reported a more significant dissatisfaction than AIs (41.6%). Such dissatisfaction was related to high cost, long waiting time to get an appointment with a doctor, complexities and difficulties to access the HCS, and the language barrier. There was a significant difference in the language barrier between KIs and AIs; KI respondents (34.7%) more often reported that the language barrier was the main reason for their dissatisfaction with the HCS than did AIs (8.0%). Also, the difference in knowledge about the HCS and health insurance between the two groups was significant; AIs were more likely to have health insurance than were KIs.

Conclusion: In light of the related factors between AIs and KIs, health equity programs should be prepared. A language supportive program should be considered for KIs with limited language skills.

A Community-Wide Initiative to Combat Obesity and Type 2 Diabetes: The Brooklyn Partnership to Drive Down Diabetes (BP3D)

Kimberly S. George, MIA; Calpurnyia B. Roberts, PhD; Stephen A. Beasley, MFA; Margaretta Fox, BA

It is well known that rates of obesity and type 2 diabetes (T2D) are the highest among low-income minority communities. Interventions targeting individual-level factors associated with obesity and T2D are effective. However, in order to reduce the disproportionately high rates of obesity and T2D in low-income areas, more interventions are needed that also address social determinants of health (e.g. access to healthy foods) and barriers to adequate healthcare.

The Brooklyn Partnership to Drive Down Diabetes (BP3D) is a multi-faceted, community-based participatory research driven intervention that functions with the support of community members, community-based organization leaders, and researchers to reduce obesity and T2D in Central Brooklyn and East New York, Brooklyn. In collaboration with community stakeholders, over the past 12 months, BP3D has 1) implemented programs focused on individual-level factors, such as: a 24-week behavior-change intervention, a six-week course on fitness and nutrition, and a six-week T2D self-management course; 2) designed a culturally-tailored social marketing campaign based on a community needs assessment and focus groups to advocate for healthier options, which appeared on bus tailgates and shelters and subway platforms over a two-month period; 3) built strategic partnerships with 50+ partners offering various services, including insurance coverage, job training/placement, and mental health; and 4) engaged stakeholders in a strategic planning process.

Over three years, BP3D is expected to reduce hemoglobin A1C levels, T2D-related emergency room visits, and hospital stays in participants. The methods, challenges, and recommendations for building a multi-disciplinary community-wide health intervention in an urban setting will be presented.

**On Target: Minority Outreach Strategies of the Let’s Move! Campaign**

Stephanie L. Gillam, BM, MA Candidate 2012

Introduction: Michelle Obama’s Let’s Move! campaign is a national initiative aimed at eradicating childhood obesity within a generation. As the epidemic of childhood obesity disproportionately affects African-American, Hispanic and American Indian populations, this study aims to uncover the ways in which the campaign has targeted these groups in its strategic communication efforts. The study’s purpose is to elucidate strategies for targeting minorities with health messages, and ultimately to expand the literature in the area of minority health communication.

Methods: The author is utilizing the case study method to explore how the campaign has tailored both the crafting and delivery of health messages to African-American, Hispanic and American Indian audiences – including parents, children, communities and the media. In-depth interviews will be carried out with Chicago-based Burrell Communications and California-headquartered Casanova Pendrill – the communications firms engaged by the White House to target African-American and Hispanic audiences, respectively – to gain deeper insight into the strategies employed in reaching these audiences.

Results: Research thus far shows that the campaign has employed specific tactics for targeting and engaging each of these minority groups, including the utilization of well-known minority spokespersons and targeted multimedia initiatives. Further research will uncover the strategy behind the campaign’s messaging and dissemination tactics.

Conclusion: The minority outreach strategies will be analyzed in their entirety and evaluations will be made of the campaign’s success thus far. These analyses will be used to recommend and highlight best practices in minority health communication, specifically as it relates to childhood obesity.

Racial Disparities in HIV Testing among High-Risk Individuals: Where You Live Matters!

Andrew W. Goodwin, MA; Cara V. James, PhD

Introduction: Thirty years into the US HIV/AIDS epidemic, racial disparities persist. Reducing new infections is a goal of the National HIV/AIDS Strategy, and testing is an important step in achieving that goal because people who know their status are less likely to transmit the disease. Many studies have focused on populations at an increased risk for HIV/AIDS, but few studies have examined the effect of race and geography on testing behavior among high-risk individuals.

Methods: This study used data from a 3-year merged file of the 2008-2010 Behavioral Risk Factor Surveillance System (BRFSS). Analyses were restricted to 21,044 adults who engaged in at least one of four risky behaviors in the past year. The main outcome was whether the individual had an HIV test in the past year, and the main independent variables were metropolitan statistical area (MSA) group and race. Analyses were stratified by gender and controlled for sociodemographic characteristics.

Results: Nearly 40% of high-risk adults had been tested in the past year. Regardless of sex, MSA city and MSA non-city residents had a greater odds of testing than non-MSA residents. With the exception of Asian men and women, people of color were more likely to have been tested than whites, and there was a significant interaction between race and MSA.

Conclusion: Many high-risk individuals have never been tested, and significant racial and ethnic and geographic differences were observed among high-risk men and women. Prevention efforts may benefit from approaches that combine geography and race in determining the population’s needs.

Overcoming Barriers to Care Among Latino Migrant Seafood-Processing Workers in North Carolina

Leah A. Gordon, MPH Candidate; Clare Barrington, PhD; Mary Rockers, MSW

Introduction: Given the lack of data on Latino H2-B migrants working in the North Carolina seafood-processing industry, local farmworker health organizations and county health departments are currently unable to adequately serve this community. The purpose of this study was to conduct formative qualitative research exploring the utilization of US medical services and barriers to accessing care among Latino seafood-processing workers in Eastern North Carolina. Additionally, the author examined workers’ social networks in order to identify strategies for future health outreach activities.

Methods: In-depth semi-structured interviews were conducted with 12 migrant seafood-processing workers in Eastern North Carolina during 2011 by the researcher. Participants were purposively sampled to capture a range of US work experience. Interviews were then transcribed verbatim by native Spanish speakers and coded by the researcher. An inductive analytical approach was used to identify emergent themes related to workers’ experience with the US health care system.

Results: Workers attempt to manage both acute and chronic conditions while working in the US. Obstacles to accessing health care in the US included transportation, interpretation, and lack of knowledge about clinic locations and hours. Analysis also revealed that workers who overcome barriers and obtain clinical care utilize a complex web of formal and informal networks, including their employer, other workers, permanent Latino residents, and family in Mexico.

Conclusions: Workers’ pre-existing formal and informal networks are a leverage point for health-related organizations seeking to increase clinical access among this population. The findings have direct implications for how organizations can effectively extend health care and outreach services to this previously underserved community.

CBPR Charrettes: A Problem-Solving Approach for Community-Academic Partnerships

Christina Hardy, Alexandra Lightfoot, Alice Ammerman, Kristin Z. Black, David Caldwell, Nettie Coad, Giselle Corbie-Smith, Barbara Council, Molly DeMarco, Danny Ellis, Eugenia Eng, Barbara Harris, Melvin Jackson,
Jimmy Jean-Baptiste, Bonnie Jones, Nora Jones, William Kearney, Mac Legerton, Tony Locklear, Melvin Muhammad, Naeema Muhammad, Donald Parker, Florence Siman, Mysha Wynn

Introduction: Equity is a core principle undergirding community-based participatory research (CBPR), but it is hard to achieve given funding mechanisms and institutional structures geared towards the needs of academic partners. The last decade has seen growing support for CBPR and increased demand for relevant skills, knowledge, training, and strategies to enhance partnership equity. This poster will highlight a model for transforming the way community partners are engaged and compensated to provide training and consultation to new and on-going CBPR partnerships.

Methods: UNC’s community engagement consulting model has been developed through a collaboration between NC TraCS, home of UNC’s CTSA (Clinical and Translational Sciences Award), the CBPR Core at the UNC Center for Health Promotion and Disease Prevention, and Meharry-Vanderbilt’s Community Engaged Research Core and community partners at our respective institutions. Our model uses “CBPR Charrettes” as a problem-solving approach to address challenges facing community-academic partnerships at different stages of development.

Discussion: This poster will present three aspects of UNC’s model: 1) new positions for community partners to co-lead project activities and provide CBPR expertise; 2) CBPR Charrette guidance sessions to troubleshoot challenges for research partnerships; and 3) the Multidimensional Assessment of Partnerships (MAP), a new tool designed by a community-academic team to measure changes in partnership capacity and equity.

Conclusion: Ongoing evaluation suggests that our model provides a valuable resource in the development of effective and mutually beneficial research approaches for communities and academic investigators.

Beliefs about Diabetes and Medication Adherence among Lumbee Indians Living in Rural Southeastern North Carolina

A. Jacobs, RN, BSN; J. Kemppainen, PhD, RN; J. Taylor, PhD, RN; C. Hadsell, MA, MSN, PhD

Introduction: Few studies have examined illness perceptions about having diabetes and medication adherence among Lumbee Indians living in rural North Carolina. Study aims include: 1) identifying personal perceptions about the cause of diabetes, 2) examining relationships between demographic characteristics and diabetes beliefs, and 3) determining personal perceptions about the efficacy of diabetes medications.

Methods: Leventhal’s self-regulatory model provided the theoretical framework for this study. A total of 42 participants (21 males and 21 females) in this descriptive, cross-sectional study completed the validated Illness Perception Questionnaire-Revised (IPQ-R), based on Leventhal’s model, and the Morisky Medication Adherence Survey. Data on living with diabetes and perceptions about medication efficacy were also collected through open-ended questions.

Results: Ninety percent of the participants reported a family history of diabetes. The mean length of time since diagnosis of diabetes was 9.82 years. The average body mass index (BMI) for females was 34.76 (range=24.21-55.44) while the average BMI for males was 35.10 (range=22.71-59.71). Hemoglobin A1c levels for males were above the American Diabetes Association recommendation (7.0) at 7.67; levels for females were slightly below at 6.91. While the majority of participants held beliefs that the course of diabetes was amenable to personal control, they described difficulties in persevering with treatment expectations. They also reported more comfort adhering to prescribed medication regimes than making long term lifestyle changes.

Conclusion: In this cohort, the average BMI exceeded 30, which is diagnostic for obesity. Study findings highlight the potential for targeting illness perceptions in patient education programs.

Racial Disparities in Receipt and Comparative Effectiveness of Oxaliplatin for Stage III Colon Cancer in Older Adults

Christina D. Mack, MSPH; William Carpenter, PhD, MHA; Anne-Marie Meyer, PhD; Hanna Sanoff, MD, MPH; Til Stürmer, MD, MPH

Introduction: African Americans (AA) in the United States have higher rates of colon cancer (CC) mortality than other races. This study examines the use of oxaliplatin, a novel chemotherapeutic agent approved in 2004, among AA and Caucasian Americans (CA) patients with stage III colon cancer to understand whether differential receipt or differential effectiveness of the drug may explain the racial disparity in CC mortality.

Methods: We conducted a population-based retrospective cohort study of stage III CC patients age 65 and older treated from 2004 through 2006 who initiated chemotherapy within 90 days of surgical resection (N=1162) using Surveillance, Epidemiology and End Results (SEER)-Medicare data. Patients receiving oxaliplatin (n=477) were compared with those receiving 5-Fluorouracil (5-FU) without oxaliplatin (n=685). We estimated prevalence ratios (PR) and hazard ratios (HR) using multivariable binomial regression and Cox models to evaluate racial differences in oxaliplatin receipt and survival.

Results: AAs were as likely as CAs to receive oxaliplatin (40.5 vs. 41.1%; PR=0.90; CI:0.71-1.13). Oxaliplatin was associated with lower mortality compared with 5-FU (HR=0.76; CI:0.58-1.00). This benefit appeared stronger among AAs (HR=0.31; CI:0.09-1.05) than CAs (HR=0.80; CI:0.60-1.06).

Conclusion: In Medicare-insured patients receiving chemotherapy, we observed no meaningful racial disparities in receipt of oxaliplatin and, among those receiving it, potentially better survival among AAs. Differential receipt and effectiveness of oxaliplatin-containing regimens does not appear to contribute to the previously documented racial disparities in colon cancer survival. Understanding reasons for potentially enhanced effectiveness among AAs may inform efforts to resolve racial disparities in colon cancer outcomes.

The State of Diversity in North Carolina’s Health Care Workforce

Victoria McGee, Jessica Carpenter Lyons, Katie Gaul, Erin P. Fraher, PhD, MPP

Introduction: Racial and ethnic diversity among health care professionals is vital to maintaining high quality health care that is accessible, equitable, and culturally competent 1,2,3 . The provision of culturally competent health care requires not only a health care workforce that is prepared to interact with the wide variety of cultures represented in NC’s population, but also requires a workforce that represents the population and the communities they serve 4,5,6,7,8.

Methods: To assess the diversity of North Carolina’s health care workforce, descriptive and cartographic analyses of health professional licensure files were conducted. Data for 15 professions were compared to the racial/ethnic makeup North Carolina’s population at the state and county levels.

Results: The racial/ethnic diversity of NC health professionals is short of matching state population diversity (33% nonwhite9 in NC vs. 19% nonwhite among the professions). Despite the lack of diversity, there are a few professions that could be considered “best practices”: licensed practical nurses (31% nonwhite), primary care physicians (27% nonwhite), and respiratory therapists (17% nonwhite). Longitudinal trends indicate that North Carolina’s health care workforce is slowly diversifying although significant disparities still exist.

Conclusion: The lack of diversity among health professionals in NC is problematic on multiple fronts, and barriers to health workforce diversification need be systematically addressed to facilitate the entry of diverse health professionals into the workforce10.

Cohen, J. J., Gabriel, B. A., & Terrell, C. (2002). The case for diversity in the health care workforce. Health Affairs (Project Hope), 21(5), 90-102.
Smedley B.D., Stith A.Y., Nelson A.R., eds. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press.
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Laveist, T. A., & Nuru-Jeter, A. (2002). Is doctor-patient race concordance associated with greater satisfaction with care? Journal of Health and Social Behavior, 43(3), 296-306.
Saha, S., Arbelaez, J. J., & Cooper, L. A. (2003). Patient-physician relationships and racial disparities in the quality of health care. American Journal of Public Health, 93(10), 1713-1719.
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“Nonwhite” refers to those who self-identify racially as African American/black, Asian/Pacific Islander, American Indian/Alaska Native, and ethnically as nonwhite Hispanic/Latino.
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Factors related to the Performance of Mammography Screening among Women with a Family History of Breast Cancer in Korea

Jina Oh, RN, PhD; Taehyun Kim, MD, PhD

Purpose: Breast cancer has occupied the first rank among cancers in Korean women for the last ten years. Early diagnosis is the primary method aimed at controlling breast cancer. The purpose of this study was to analyze factors affecting the performance of mammography screening among women with a family history of breast cancer in Korea.

Method: This study applied a descriptive design method through structured self-report questionnaires. The Care Seeking Behavior Theory [CSBT] provided a theoretical framework for the study. Factors measured in this study represent demographic, clinical, and psychosocial variables including anxiety, barriers, utility, habits, perception, and facilitators, based on CSBT. A total of 212 participants, of at least 20 years old, were sampled from April 8, 2010 to March 31, 2011. The data was analyzed by a logistic regression method using the Statistical Package for the Social Science (SPSS) 18.0 software.

Results: Of the 212 participants, 122 women (57.5%) went through a mammography screening. The results of the analysis showed that (a) age (Odds Ratio [OR] =1.10, p<.001), (b) facilitating influences (OR=1.83, p=.008), (c) perception of mammography importance (OR=1.92, p=.011), (d) barriers to mammography (OR=0.60, p=.031), and (e) utility of mammography (OR=2.01, p=.050) significantly affect mammography screening.

Conclusions: The results underscore the impact that psychosocial variables in obtaining mammography have on adherence to screening. Women with a family history of breast cancer should be given accurate information and recommendation about mammography by healthcare provider and a regular source of healthcare.

Disparities In Vitamin D Status Among Obese Children and Adolescents

Jennifer N. Paige, BS; Janet R. Carter, MS; Melissa H. Henshaw, MD

Background: Vitamin D deficiency and obesity are becoming increasingly prevalent in the United States. Obesity has been identified as a potential risk factor for developing Vitamin D deficiency. Race may also be a factor in Vitamin D deficiency. Information is needed about disparities in vitamin D status among obese children and adolescents.

Objective: To examine a convenience sample from an obese pediatric cohort for the prevalence of Vitamin D deficiency and to assess for racial disparities.

Methods: Data from 157 obese patients ages 4-21 was analyzed for this project. Data was derived from laboratory values of serum 25(OH)Vitamin D. Deficiency was defined as < 20 ng/mL, insufficiency was defined as > 20 ng/mL and < 30 ng/mL, and sufficiency was defined as > 30 ng/mL.

Results: 63% of obese Black pediatric patients were found to be deficient, compared to 11% of obese White patients. 31% of obese Black patients were found to be insufficient, compared to 50% of Whites. Only 6% of the Black patients contained sufficient amounts of serum 25(OH)Vitamin D, compared to 39% vitamin D sufficiency in the White patients.

Discussion: Vitamin D deficiency and insufficiency are common in childhood obesity, affecting a combined 94% of Black and 61% of White patients studied. Obese Black children and adolescents had significantly higher instances of Vitamin D deficiency compared to Whites. Vitamin D deficiency may play a role in the development of cardiovascular health disparities.

The Brothers' Opinion: America’s Sick-care System Can(not) be Turned into a Health-care System?

Rogers, Charles R., MSAS; Shaw, Mary, PhD, MEd, MCHES; Sherman, Ledric, MA; Saldivar, Isaac, BA;
Grande, Stuart, PhD, MPA

Introduction: There is national consensus that the existing health disparities between racial and ethnic groups must be eliminated. Specifically, African-American men live approximately 6.0 years less than White men and are less likely to have a usual primary care provider, as compared to their White counterparts (CDC, 2006; AHRQ, 2008). The significance of these and other findings suggests that substantial gains must be made to improve the health status and communication relationship between health care providers and African-American men in the United States. This investigation explores the active process of becoming aware of and making choices toward a more successful existence within the understudied social phenomenon called Brotherhood. Franklin (2004) asserts that Brotherhood has a quantifiable and describable impact upon the health of African-American men.

Methods: Interpretive interactionism was the primary mode of critical qualitative research for this study. Twenty semi-structured interviews were conducted with African- American men ages 18-35 years old, enrolled in two HBCUs in southeastern Texas.

Results: Brotherhood appears to be both contemporaneously and historically influential on dimensions of social support which influence help-seeking behaviors, decision-making skills, and patient-provider communication associated with the utilization of health related services - both preventive and primary.

Conclusions: The opinions of the Brotherhood can be translated to address health disparities which are a result of America's broken health care system. These findings also advance the understanding of the help seeking behaviors of young African-American men and their lived experiences with the health care system as influenced by the field of social support networks.

Acknowledgements: The study was conducted by the Social and Health Disparities Research Lab at the Center for the Study of Health Disparities where Dr. Mary Shaw served as the PI. It was supported through funding awarded by Indiana University and Texas A&M University.

Community-Based Participatory Research (CBPR) to Assess the Acceptability of Self-Sampling for HPV among Haitian Women

Hira Shabbir; Erin Kobetz, PhD, MPH; Jonathan Kish, MPH; Ian Bishop, BA; Sheila Kaupert; Lacey Greathead; Hannah Lipshultz, BA; Sarah Marsh, CM, MPH; Maxi Raymondville, MD

Introduction: Cervical cancer is one of the leading causes of death in developing countries and is the primary cause of mortality among Haitian women. Globally, Haitian women bear a disproportionate burden of cervical cancer incidence and mortality. Many factors contribute to this disparity, including limited access to health care resources, low levels of health literacy, and low socio-economic status. These barriers inhibit Haitian women from accessing preventive screening, such as routine Pap smears to test for the Human Papilloma virus (HPV), the primary cause of cervical cancer. Self-sampling devices may serve as a viable and accessible alternative to in-clinic Pap smear testing and can successfully detect the presence of HPV, thus leading to the early detection of cervical cancer. This study aims to assess the acceptability of self-sampling devices as a possible alternative to the Pap smear among women in rural Haiti.

Methods: Under the facilitation of Zanmi Lasante/Partners in Health, community health workers (CHWs) recruited 493 women 18 years and older with no prior history of cervical cancer. Women were approached at their homes and instructed by the CHWs on how to use the self-sampling device. They were also asked to answer a series of questions about their experience using the HPV self-sampling device.

Results: The vast majority of participants (97.4%) were either comfortable or very comfortable using the cervical self-sampler at home and most (99.4%) would recommend it to friends or family members. A large proportion (78.7%) of participants would prefer to use the self-sampler at home as opposed to the in-clinic test (82.6%).

Discussion: The facilitation of this project through the CHW network helped overcome many of the barriers involved with accessing preventive cancer screening, including the general distrust of the formal healthcare system. In addition, the high level of acceptability indicates that self-sampling has the potential to serve as a feasible alternative to the Pap smear for HPV detection, and is an efficient and cost-effective method of screening women in resource-poor regions or when cultural barriers exist to the use of traditional sampling methods. This data may inform future large-scale initiatives to address the high cervical cancer rates in Haiti utilizing the CHW network and the self-sampling device.

The Relationship of Caregiving for a Child with Special Care Needs and Caregiver Health

Pamela L. Shields

Introduction: This analysis looks to identify the relationship between caregiver physical health and caring for a child with special health care needs (CSHCN). The study also analyzes the relationship between the health of Latino and non-Latino caregivers.

Methods: This study used secondary data from the 2010 National Health Interview Survey (NHIS). It is a cross-sectional, household survey conducted yearly to obtain current information on the effects of illness in the United States.

Results: The binary logistic regression showed that caregivers of CSHCN were significantly more likely (OR=1.78, 95% CI: 1.37, 2.33) to experience an adverse health condition as caregivers of non-CSHCN. These figures were still significant when adjusting for Latino origin, age of the caregiver, and the number of adults living in the household ages 18-64 (OR=1.66, 95% CI: 1.26, 2.18). The study found that Latino caregivers have a reduced chance of having a doctor tell them they had a previous health condition (OR=0.79, 95% CI = 0.72, 0.87). As the number of adults living in the household ages 18-64 increases, the odds of a health condition decrease (OR=0.84, CI = 0.79, 0.89). Finally, as age increases, caregivers are 1.04 times more likely (p<.01) to have a health condition as opposed to younger caregivers.

Conclusion: Findings indicate that there is a significant relationship between caregiver health and caregiving for CSHCN. Also, Latino caregivers are less likely to report having a health condition which could be as a result of differences in access to care as compared to non-Latino caregivers.

Examining HIV/AIDS Stigma and Knowledge among Students at an HBCU in a Southeastern University

Amber C. Simmons, BSHCM- 2012; Vanessa Duren-Winfield, MS, PhD; Elijah O. Onsomu, MPH, PhD, CHES

Background: In the past decade, HIV/AIDS stigmatization has decreased. However, it still remains a barrier to individuals receiving preventive care and treatment. African American (AA) college students are at a higher risk of contracting HIV, and social stigmas create significant hindrances towards HIV/AIDS initiatives.

Purpose: To explore whether there is an association between HIV/AIDS knowledge and stigmas among AA students at an HBCU in a Southeastern university.

Methods: A mixed method design integrating qualitative and quantitative analyses was used. Ten students were recruited to participate in two focus groups to design a 15-item survey about HIV/AIDS knowledge and stigmas. Survey questions were developed, validated, and assessed by students and implemented in three phases: survey development, pilot testing and survey assessment. A convenience sample of sixty three students participated in the survey. Stata version 10.1 was used for data analyses, p<0.05.

Results: Ninety-nine percent of the participants were knowledgeable about HIV/AIDS. However, 65% (n=44) had stigma compared to 4% (n=3) who did not have stigma – a counterintuitive finding. In the bivariate analysis among students who were knowledgeable about the disease, 66% (n=27) of those in the Allied Health major had HIV/AIDS stigma compared to those who did not [100% (n=2)], X2(N=63, df=2)=1.87, p=0.392.

Conclusion: The prevalence of stigma among students was found to be high – a hindrance to HIV testing. The feeling of discomfort towards those infected with the disease should be addressed as an imperative public health policy because they are the most vulnerable.

Baseline Characteristics of Participants in Live Well, a Weight Gain Prevention Study Among New Immigrants

Alison Tovar, PhD, MPH; Rebecca J. Boulos, MPH; Emily Kuross Vikre, MS; Sarah Sliwa, MS; Heloisa Galvao; Christina D. Economos, PhD

Introduction: The rise in weight experienced by immigrants with increased length of residence in the US may be caused by numerous stressors of transitioning to a new country and exposure to an “obesogenic” environment.

Methods: Mother-child dyads (n=375) were recruited for Live Well, a community-based participatory, randomized intervention to prevent weight gain among new immigrants. Anthropometric data were collected from dyads, and socio-demographic information from the mother. For children, BMI was transformed into z-scores using age-and sex-specific CDC standards and categorized as overweight (85th–94th) and obese (≥95th). Maternal BMI was classified into overweight (25–29.9) and obese (>30).Chi-squares and correlations were computed.

Results: Mothers are 35% Brazilian, 31% Latin-American, and 35% Haitian, and have been in the US for an average of 6.0±3.0yrs. Their children are 6.2±2.8yrs. Overall, mothers are 34% overweight and 38% obese, while 20% of their children are overweight and 24% are obese. Significant ethnic differences are seen by weight for mothers but not children: 45% of Haitian mothers are obese vs. 24% Brazilian and 31% Latina (p<0.001); while for children, 33% of Haitians are obese vs. 28% Brazilians and 39% Latino (NS). Child BMIz-score, however, is significantly and positively associated with maternal BMI (p<0.001).

Conclusions: Maternal anthropometric characteristics vary between immigrant groups living in the same geographic area, but these differences are not evident in their children. Maternal and child BMIz-score, however, are significantly related across groups. Further exploration is needed to understand how transitioning into an “obesogenic” environment differs for mothers and children.

De Mujer a Mujer: Using the Familial Value to Engage Latinas in Sexual Health Care

Veronica Tovar, MPA; Rosalinda Cano-Hays; Monica Leon, BS; Rita Melendez, MS, PhD; Sharon Morrison-Velasco, PhD; Alfredo Velasco, PhD;

Issues: Latinas face HIV prevention barriers due to sexual silence. Sexual silence in Latino culture leaves Latinas uneducated about issues relating to healthy relationships, sex, and reproductive anatomy. Although HIV rates in Latinas are underreported, the proportion of HIV cases in Latinas is more than twice that of whites.

Description: De Mujer a Mujer is an innovative seven-session HIV prevention program. Topics covered include: cultural factors related to safer sex behaviors, gender roles, healthy relationships, anatomy, HIV knowledge, and effective communication. The program is successful because it offers childcare, is culturally specific, and provides a safe environment where women can openly discuss personal matters.

Lessons Learned: To date, 107 women have completed the program. Preliminary evaluation suggests that women benefit in the areas of increased HIV testing and condom use. The family-like connection creates an environment where women are comfortable discussing issues of sexual health as it relates to their communities. Many women report the desire to share their newly acquired knowledge with their children and other family members. Prevention programs should mirror the familial system that Latinas feel comfortable with in order to share HIV prevention and other sexual health information; breaking the cycle of silence and stigma.

Educating Farmworker Families about Pesticide Safety: Evaluation of an Intervention to Translate Research to Practice

Grisel Trejo, MPH; Thomas A. Arcury, PhD; Joseph G. Grzywacz, PhD; Maria C. Mirabelli, PhD, MPH; Jennifer W. Talton, MS; Janeth Tapia, Ralph D’Agostino, Jr., PhD; Sara A. Quandt, PhD

Introduction: Latino farmworker families are exposed to pesticides through occupational and paraoccupational pathways. The EPA Worker Protection Standard mandates pesticide safety training for farmworkers; however, family members are not required to receive training. This project translates an effective intervention to improve farmworker family knowledge of pesticide safety to a broader public health context.

Methods: This demonstration project was based on a community-university partnership. Six public health agencies in eastern North Carolina recruited promotoras from farmworker communities. Promotoras recruited Latino families with at least one child ≤ 12 years. They taught participants a culturally and educationally appropriate pesticide safety intervention using a six-lesson curriculum. Independently conducted pre- and post- tests evaluated knowledge and behavioral change.

Results: 610 families completed the study over 18 months. Knowledge of long-term consequences of pesticide exposure increased (20% to 90%), how pesticides enter home from work (24% to 89%), protecting family from pesticide drift (5% to 68%), integrated pest management (1% to 56%), convincing others to adopt pesticide safety behaviors (8% to 52%), and minimizing exposure of unborn babies and children (52% to 99%). Significant increases in knowledge occurred across all 17 learning objectives and their combined summary scores increased from a mean (SD) of 4.2 (2.7) correct to 12.5 (2.9) (p<0.0001).

Conclusions: This curriculum improves knowledge of ways to protect farmworker families from agricultural and home pesticide exposure, pesticide related skills, and safety and hygiene behavior. Women from the farmworker community, with limited training, can effectively carry out this program and reach marginalized populations.

Infant Oral Health: The Role of Caregivers’ Oral Health Literacy

W.F. Vann, Jr., DDS, PhD; J.Y. Lee, DDS, MPH, PhD; D. Baker, MBA; K. Divaris, DDS, PhD

Introduction: To investigate the association of caregiver oral health literacy (OHL) with infant oral health (IOH) care practices, oral health (OH) knowledge, and IOH status in a low-income WIC population.

Methods: This study relied on data from structured interviews with 1,214 child/caregiver dyads from the Carolina Oral Health Literacy (COHL) Project. Information was collected on IOH practices, OH knowledge (6-item score), caregiver-reported IOH status (NHANES item), health literacy, and socio-demographic characteristics. OHL was measured using REALD-30, a validated word recognition test. Overall summary measures for OHL and knowledge were calculated. Analyses included descriptive, bivariate, and multivariate methods.

Results: Caregivers’ median age was 25 years; children’s mean age was 1.5 years (range=birth-4 years, 9 months); 88% reported brushing their child’s teeth/gums daily, and 30% reported putting their child to bed with a bottle, either currently or in the past. Eighty-three percent of caregivers of dentate children rated their child’s IOH status as very good/excellent. The mean OH knowledge score was 4.73 (range 1-6). Caregivers in the lowest quintile (<13 REALD-30) had lower OH knowledge scores versus those in the higher quintiles (mean difference=-0.49; 95% CI=-0.62,-0.35). Caregivers reporting good/fair/poor IOH status had a 2-point lower (95% CI=1.0, 3.0) OHL score versus those reporting excellent/very good. Independent of age and education, low OHL was associated with decreased OH knowledge (OR=0.47; 95% CI=0.35, 0.62).

Conclusions: Lower OHL levels were consistently and independently associated with worse caregiver-reported IOH status and lower OH knowledge.

Raising our Tweens to be Queens: A Mother-Daughter Pilot Intervention Program

Shanda Vereen, BS; Lillian Maddox-Whitehead, MS; Kimberlee Wyche-Etheridge, MD, MPH

Purpose: The mission of the Metro Public Health department is to protect and improve the health and well-being of all people in Nashville. The 2007 Nashville Youth Risk Behavior Survey reported that Black students were more likely to report having sexual intercourse than white students; of the black students, 23% reported having four or more sexual partners. A pilot-intervention was developed to encourage mother daughter preconception health communication.

Methods: Girls aged 8-12 from two predominantly African American middle schools in Nashville, TN were identified by school nurses to attend a two day preconception health symposium at Fisk University with their mothers. To assess baseline levels of communication, the participants completed a pre-survey. Participants attended seminars on communication, self-esteem, risk behaviors, and healthy relationships. In addition, participants completed interactive communication building exercises such as verbal gifting. In separate groups, participants attended sessions on reproductive and preconception health. At the conclusion of the program, participants completed a post survey. The data was analyzed using SPSS to determine differences in reported communication among mothers and daughters.

Results: Mothers were more optimistic about preconception communication ability. Daughters were pessimistic about communication ability and comfort in preconception discussions. Mothers and daughters reported having little conversation about preconception health topics. All participants reported a willingness to increase the frequency of preconception health discussions.

Conclusions: The ability of parents and children to communicate about sensitive topics can influence adolescent decision making. Interventions to encourage effective communication could potentially delay the onset of risky behavior among youth.

Equity in an Equal Access System: The Effect of Race on Receipt of Guideline-Concordant Surveillance Colonoscopy

Leah L. Zullig, MPH; Dawn Provenzale, MD, MS; Rebecca McNeil, PhD; David Abbott, MS; George L. Jackson, PhD, MHA

Introduction: Colorectal cancer (CRC) accounts for ~9% of cancer cases treated within the Veterans Affairs (VA) system. For stage I-III post-treatment CRC patients without an obstructing lesion, guidelines recommend surveillance colonoscopy within one year of surgery. Only 44% of VA CRC survivors undergo surveillance colonoscopy within 7-18 months of surgery. This analysis aimed to determine the effect of race on the odds of receiving surveillance colonoscopy.

Methods: The initial data consist of all incident invasive CRC cases diagnosed at VA hospitals between 10/1/2003 and 3/31/2006 (n=2,896). After applying exclusion criteria, 1,038 non-metastatic male Veterans remained for analysis. A generalized estimating equations model with VISN-level clustering was used to analyze patient characteristics potentially associated with receiving surveillance colonoscopy.

Results: In multivariable analysis, non-white Veterans had marginally significant, reduced odds of receiving surveillance colonoscopy (OR=0.67, 95% CI 0.45-1.00). Marital status and region were not significantly associated with colonoscopy receipt. However, patients with early stage (i.e. stage I or II compared to stage III) at diagnosis were more likely to receive surveillance colonoscopy (OR=1.30, 95% CI 1.02-1.65).

Conclusion: Non-white CRC patients were approximately one-third less likely to have a colonoscopy within 7-18 months of surgery compared to white patients. VA patients diagnosed with early stage disease were approximately one-third more likely to receive surveillance colonoscopy, perhaps because of improved perceived long-term prognosis. Only 44% of eligible VA CRC patients receive guideline concordant surveillance colonoscopies. While this rate is better than the private sector, strategies should nevertheless focus on improving this rate.