APHA 2017 - Atlanta, GA

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Student Presentation Schedule

Presentation Schedule

Student Presentation Abstracts

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

Healthcare Decision-Making Among Older Dual-Eligible Immigrants: Implications from Cal MediConnect

Adrian Bacong, PhD Student, Kaitlyn McBride, MS Candidate, Ana Reynoso, Steven P. Wallace, PhD and Kathryn G. Kietzman, PhD, MSW

The CHOICE study documented dual-eligible consumers’ health-care decisions and experiences with California’s duals demonstration program in Los Angeles County. Between April 2014 and March 2015, dual eligible consumers were enrolled into a Cal MediConnect managed care plan unless they actively opted out. The current study explores decision-making processes among dual-eligible immigrants compared to similar US born individuals. State-level data show that uptake rates differ among immigrant populations. However, the effects of immigration status on this trend are unknown. We conducted in-depth interviews with dual-eligible consumers (n = 53), including 14 immigrants. Interviews were coded and analyzed using a constructivist grounded theory approach and constant comparison analysis. We found that dual-eligible immigrants were less likely than non-immigrants to utilize formal community-based resources when making decisions about their health care. Perceived advantages of managed care also varied between these two groups, depending on previous health plan experiences and length of time having lived in the US. Within our immigrant subgroup, Latinos were more likely to be enrolled in Cal MediConnect than were other ethnic minorities (i.e. Armenian, Filipino, and Chinese). They were also less likely to ask questions, seek more information about health care options, or request changes to existing health services. These findings suggest that Latino immigrants may feel less empowered to exercise their healthcare choices when compared to other adult immigrants. Understanding how diverse perspectives of dual-eligible immigrants influence health care decision-making has implications for new health reform strategies aimed at ameliorating disparities for vulnerable immigrant populations.

Exploring academic researchers’ perceptions on promotora-academic partnerships

Angela Gutierrez, PhD Student

Promotoras have been increasingly involved in research; however, the academic literature has widely overlooked promotoras’ role as community partners. Additional literature exploring the perceptions of promotora-researchers indicates patterns of inequity, labor injustice, and lack of training opportunities. Recent calls to promote equal partnerships between promotora-academic relationships and recent findings challenging some of the conceptualizations of promotora-researchers indicate the current practices of promotora-academic partnerships must improve. The purpose of this study is to explore academic researchers’ perceptions of promotoras in research. Data collection includes: (1) semi-structured interviews with 15 academic researchers from diverse disciplines and institutions to explore academic researchers’ perceptions of promotoras’ roles in research and (2) document analysis of promotora-based training curriculums and certifications. Findings include (1) academic researchers’ perceptions and meaning of successful collaborations with promotores vary on a spectrum from distinct hierarchical roles to collaborative partnerships; (2) challenges in including promotoras in all facets of research collaborations, such as promotoras’ scope of training and practice; and (3) benefits in increasingly including promotoras in research processes, such as research benefiting from the inclusion of community members’ voices in data interpretation. Findings from this study identify assets and barriers to the promotion of equitable partnerships between academic researchers and promotoras. Ultimately, the formation and practice of equal partnerships will empower research partners who represent voices of communities served. Empowering community partners, such as promotoras, to have equal roles in research collaborations can develop diverse teams that can uniquely work to promote health and minimize existing health disparities.

Sexual Identity Discordances: Implications for Alcohol, Tobacco, and Cannabis Use Disorders

Evan Krueger, PhD Candidate, MSW Student, Jessica Fish, PhD, MS

Background: Sexual minorities display higher rates of substance use than heterosexuals. Increased exposure to minority stressors (e.g., stigma, discrimination) is thought to underlie this disparity. Yet, sexual orientation is multidimensional, including identity, attraction, and behavior. Discordances between sexual orientation domains (e.g., heterosexual identity, same-sex attraction) have also been linked to substance use disparities, though the mechanisms driving these differences are poorly understood. Methods: Using the National Epidemiologic Survey on Alcohol and Related Conditions III (N=35,744), logistic regressions assessed differences in lifetime DSM-5 alcohol, tobacco, and cannabis use disorders between sexual majority (concordant heterosexuals) and minority (concordant LGBs, discordant heterosexuals) subgroups. Next, among sexual minorities, negative binomial regressions assessed differences in minority stress experiences, and logistic regressions assessed associations between minority stress and each disorder. Analyses were weighted, adjusted for sociodemographic characteristics, and stratified by gender and discordance (identity-attraction, identity-behavior) type. Results: Attraction and behavioral LGB concordant men and women reported higher odds of alcohol, tobacco, and cannabis use disorders, compared to concordant heterosexuals (men: aORs=1.41-1.71; women: aORs=1.89-3.39). Heterosexual discordant women reported higher odds for all disorders (ORs=1.45-4.79). However, attraction discordant heterosexual men had lower odds of alcohol and tobacco use disorders than concordant heterosexuals (aORs=0.71-0.73). Compared to concordant LGBs, all attraction and behavioral discordant heterosexual men and women experienced less minority stress. Finally, minority stress was associated with increased odds of both alcohol (aOR=1.28) and tobacco (aOR=1.13) use disorders among men, but not women. Conclusions: Both concordant LGBs and discordant heterosexuals reported greater odds of alcohol, tobacco, and cannabis use disorders compared to concordant heterosexuals, though risk varied by type of discordance and gender. Despite positive associations between minority stress and substance use disorders among sexual minority men, findings suggest lower rates of substance use disorders among discordant heterosexual men may be partly explained by less exposure to minority stress.

Association of Problematic Alcohol Use And Risky HIV Behavior Among Chinese Adults: A Systematic Review

Chiao-Wen Lan, PhD Candidate

China has one of the highest rates of alcohol consumption and is experiencing one of the fastest-growing HIV epidemics in the world. Given these co-occurring health problems, we systematically reviewed the association of problematic alcohol use and risky HIV behavior among Chinese adults. Search strategies were used to obtain studies meeting the inclusion criteria. Studies were retrieved from ten electronic database (e.g., PubMed) using Boolean search strategies with no date limits. Studies were included if they (a) sampled people living in China, (b) assessed both problematic alcohol use, and (c) assessed sexual risk behaviors. Studies that fulfilled selection criteria and were available through December 2016 were included. These searches yielded 825 studies, of these, 4 were included. The studies show that problematic alcohol use is associated with increased sexual risky behaviors among Chinese. These findings support the need and potential benefits for alcohol and HIV interventions among Chinese, and suggest directions for public policy.

Student perspectives on food literacy in higher education settings

Hannah Malan, PhD Student, Tyler Watson, MPH

Introduction: Although research is nascent, food literacy is increasingly considered an important concept for health promotion and disease prevention, as it is more comprehensive than nutrition literacy and encompasses a broader range of both critical awareness and practical knowledge and skills. Given that college is a critical time for developing personal identity and lifelong habits, it is important to consider the role of universities in promoting food literacy to support healthful and environmentally responsible relationships with food. Methods: Eleven focus groups were conducted with students at the University of California, Los Angeles (UCLA). Students were recruited from three subpopulations and assigned to appropriate focus groups: undergraduates living on campus; undergraduates living off campus; and graduate and professional students. Focus groups were transcribed and analyzed based on a priori and emergent themes. Results: Preliminary analysis suggests the following themes: students perceive several barriers and benefits to obtaining food knowledge and skills; students currently utilize several strategies to navigate their physical (access and availability) and social (interpersonal, culture, media) food environments; the university is well positioned to help students navigate conflicting priorities and information around food. Conclusions: Findings illuminate the simultaneous and multilevel influences on student food literacy. In addition, we identify opportunities for advancing food literacy and provide a student perspective on the current discourse about the role of the university in ensuring students develop practical life skills for lifelong health.

Lessons from the West Africa Ebola Outbreak and Recommended Strategies for Effective Healthcare Volunteerism on Medical Missions

Ezinne Nwankwo, PhD Student, Robyn R. Gershon, DrPH, Liza A. Dernehl, MS, Manu V. Venkat, ScB, Kristine A. Qureshi, PhD, RN, FAAN, CEN, APHN-BC and Qi Zhi, MPH

Background: Infectious disease outbreaks are increasing in frequency and severity. This is in part due to better reporting, population growth, and climate change. An example of this was the 2013–2016 West Africa Ebola epidemic that plagued Guinea, Liberia, and Sierra Leone. This qualitative study assessed US healthcare volunteers’ experiences with their deployment to the West Africa Ebola epidemic and identified strategies for mitigating psychosocial risks at all phases of deployment. Methods: Sixteen US healthcare volunteers who returned from West Africa in 2014-2015 were recruited to participate in semi-structured interviews. Transcripts were thematically categorized into three phases of deployment: pre (before), peri (during), and post (after). Following this categorization, strategies and recommendations were made for reducing the risk of adverse psychosocial effects in US healthcare volunteers at each deployment phase. Results: To mitigate psychosocial risks at all deployment phases, emphasis should be placed on: 1) providing quality and standardized pre-deployment and on-site training; 2) ensuring that volunteers are prepared for the environment to which they will deploy and adequately resourced to do the most good with the tools that they have. Rest periods should be mandatory and volunteers should be informed about the possibility of quarantine upon their return home; 3) ensuring psychosocial support is provided to volunteers at all phases and that communication channels are available for volunteers and their families. Further research and improvements in PPE technology are also warranted. Conclusion: Sponsors of high-risk medical missions are responsible for protecting the physical and psychosocial safety of their volunteers.

Association of Poverty and Sexual and Reproductive Health Among Brazilian Adolescent Students

Natalia Woolley, PhD Student,  James Macinko, PhD

Purpose: Although poor adolescents in low and middle-income countries suffer from higher rates of adverse sexual and reproductive health outcomes, evidence on the association between poverty and sexual risk behaviors has been less consistent. This study investigates the association between adolescent poverty, and sexual risk behaviors and outcomes in a middle-income country using a nationally representative sample of Brazilian students. Methods: Cross-sectional analysis of the Pesquisa Nacional de Saude do Estudante (PENSE), a nation-wide school-based survey of 102,301 adolescents attending 9th grade, carried out in 2015. Analyses include descriptive statistics, and multivariate logistic models that control for individual, interpersonal and environmental factors. Preliminary Results: Sexually experienced students comprised 28.14% of the survey sample, and within this group 63.74% were males. Median age of first sexual intercourse was 13 years old, yet 6.29% of sampled students reported sexual debut at age 9. Bivariate analysis results show that while there were no household asset differences in reported condom and contraceptive use at last intercourse (p=0.3413 and 0.1441 respectively), pregnancy odds for females in the bottom quintile were 1.99 (p<0.001) times those in the top household asset quintile.

Bullying Involvement and Substance Use Among Brazilian Adolescent Students

Natalia Woolley, PhD Student,  James Macinko, PhD

background: Substance use is one of the leading preventable causes of mortality and morbidity in adolescents. Although bullying involvement has been associated with substance use among adolescents, most of the evidence comes from high-income countries. Studies in low and middle-income countries have focused on risk factors associated with bullying victimization-only, and little is known about substance use among bullying perpetrators, and perpetrator-victims. This study investigates the relationship between types of bullying involvement and adolescent substance use (i.e. alcohol, cigarettes and marijuana) in Brazil. methods: Data for this cross-sectional analysis was obtained from the 2015 PENSE, a nation-wide school-based survey of 102,301 adolescents attending 9th grade. Substance use was analyzed in two ways: any substance use (i.e. use of alcohol, cigarettes or marijuana in the previous 30 days), and substance co-use (i.e. use of all of three substances). Logistical regression analyses were conducted for each of the two outcome variables, and odds ratios (aOR) were calculated adjusting for demographic characteristics and mental health. Analyses were also adjusted for the survey’s complex sample design. results: Odds of any substance use for bullying perpetrators-only, and perpetrator-victims were significantly higher compared to no bullying involvement (aOR= 2.89, 95% CI=2.62, 3.19; aOR=2.37, 95% CI=2.17, 2.59, respectively). Adjusted odds of substance co-use were also significantly higher among perpetrators-only, and perpetrator-victims (aOR= 3.76, 95% CI= 2.84, 5.00; aOR=3.18, 95% CI= 2.46, 4.12, respectively). Victimization-only was associated with a 9% increase in the odds of any substance use (AOR=1.095% CI=1.03, 1.17) but odds were not significantly different for substance co-use (aOR=0.93, 95% CI= 0.71, 1.20). conclusions: The results underscore the complex relationship between bullying involvement and substance use among adolescents. Results are in line with findings from high-income countries, and indicate type of bullying involvement should be taken into consideration when assessing health-risk behaviors and bullying among adolescents.

Measuring the social determinants of immigrant health at the state level: An approach to identifying and assessing state immigrant policy

Maria-Elena Young, PhD Candidate, Steven P. Wallace, PhD

In the last twenty years, immigration-related policy-making has increasingly been conducted by states. State immigrant policy may harm health by creating discriminatory social environments or protect health by supporting immigrant integration. There is a growing literature on the impact of immigrant policy, but it is hindered by lack of a framework and methods for measuring immigrant policy. We, therefore, developed a theoretically- and legally-grounded framework for identifying state immigrant policies and conducted a systematic scan of 20 policies enacted prior to 2014. We developed continuous composite measures of state policy contexts, scoring states by the inclusiveness or restriction of their policy context. Through regression analyses we assessed sensitivity of the measures and their association with related state measures drawn from the American Community Survey. We found that within current legal frameworks, states have enacted immigrant policies within sectors of public health, social welfare, education, labor, drivers’ licenses, and enforcement. There was significant variation across states in the levels of inclusiveness and restriction of their policy contexts. Measures were associated with state political, but not economic characteristics. Measures of state immigrant policy can be created through a theoretically- and legally-grounded approach that captures the variation in contexts in which immigrants live. Immigrant policies influence critical social and economic factors. Standardized approaches to measuring policy will advance knowledge of their impact on immigrant health.