Western Partners Trainee Spotlight: Alyssa Thomas

Alyssa is a second year MPH student in Nutrition/Dietetics at the Colorado School of Public Health and will begin a dietetic internship in the fall. She completed an undergraduate degree in Psychology at Stanford University and currently works in public health consulting. These experiences, along with that as a MCH nutrition trainee, have all informed her desire to reduce nutrition-related health disparities for underserved mothers and families.

As an MCH trainee this past year, I have had the great experience of supporting a technical assistance project aimed at advancing MCH nutrition initiatives for childhood obesity. This project began in fall of 2018 and works with four teams throughout the Western states. It aims to reduce disparities in obesity by focusing on populations disproportionately affected by the condition: low-income, American Indian/Alaskan Native, and rural women and children. On monthly community of practice calls, the teams discuss healthy eating and active living initiatives they are implementing that include individual, policy, systems, and environmental approaches. By participating in the calls and completing related modules on Systems Approaches for Healthy Communities from the University of Minnesota, I have gained valuable insight into working with communities on interdisciplinary teams to affect system and policy change. This insight will be invaluable in my future career as a public health dietitian.

As a future dietitian, I hope to work with mothers and families in a community setting, with the ultimate goal of helping to reduce disparities in nutritional health. Last month, I had to opportunity to improve skills relevant to this goal at the Western Maternal and Child Health Nutrition Leadership Network Conference. The second day of the conference featured a leadership workshop presented by Dr. Niki Steckler from Oregon Health Sciences University. The workshop included practice in articulating a vision, mapping networks of stakeholders, listening actively, and opening conversations powerfully. These communication and negotiation/conflict resolution skills will help me develop and strengthen coalitions and partnerships once I enter the field.

Recap of the Western Maternal and Child Health Nutrition Leadership Network Conference

The Western Maternal and Child Health (MCH) Nutrition Leadership Network (NLN) is an annual conference of public health and nutrition professionals among 13 western states. In February 2019, as part of our training, the trainees of Arizona State University, including myself, had the pleasure of attending the 11th NLN meeting in Redondo Beach, California. Over two days, we attended sessions including updates of federal programs such as SNAP, utilizing PSE (policy, system, environment) concepts in rural communities, a leadership workshop, and more. We also had several networking opportunities in which state leaders discussed accomplishments and challenges specific in their respective states. Five trainees (three from ASU) also had the opportunity to share their research work with conference members.

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Marisa Gutierrez is a first year Master’s student in Nutrition, dietetic intern, and MCH trainee with Arizona State University. After graduating with a Bachelor’s degree in Nutrition from ASU in 2016, she worked in WIC for 2 years providing nutrition education to mothers and caregivers of infants and children. She has returned to ASU to complete her Master’s degree as well as a dietetic internship to become a Registered Dietitian and further serve the MCH population.

Throughout these sessions, we discussed topics such as understanding your journey map and ‘why’ for the work you do, building coalitions and partnerships, and how rural and tribal communities experience challenges that might not be experienced among urban communities. For me, discussing my ‘why’ for the work I do has helped to reaffirm my passion for both nutrition and maternal/child health. While we know our fellow trainees and coworkers have a shared goal in our current positions, this activity was the first time I had discussed this topic with my fellow trainees. Understanding unique perspectives will  help strengthen our team and identify unprecedented partnerships. I look forward to being able to continue these conversations and begin new ones with trainees from other states at our MCH Nutrition Grantee meeting later in March.

I highly encourage everyone to take a few minutes to ask yourself or someone you work with: what journey has brought you to where you are now? Why do you do the work you do? How might your passion shape your future?

 

For more information on the NLN conference, please visit http://www.mchnutritionpartners.ucla.edu/

UCLA Trainee Spotlight: Karen Meacham

Karen is a first year MPH student in Community Health Sciences at UCLA’s Fielding School of Public Health. She received undergraduate degrees in Dietetics and Biology at Texas Woman’s University in Denton, TX, and will be completing her Dietetic Internship through a combined program with UCLA and the Greater Los Angeles VA.  She plans to focus on food insecurity and young child nutrition, especially in those with disabilities.

As an MCH trainee, I serve in a leadership role in our Public Health Nutrition Club. This club allows students from across the spectrum of public health to come together under a common interest of nutrition. One of our main activities is providing food demonstrations around campus. This past fall, we coordinated with the medical school to offer lunchtime demonstrations for their students. We prepared Kale Walnut Quinoa Salad with Honey Dijon Vinaigrette and Apple Chai Energy Balls, made with oats, almond butter, honey, and dried apples. The space we used allowed the attendees to follow along at their own stations as we prepared the recipes. At the end, they had created their own healthy lunch to go!

Our food demonstrations have the aim of promoting healthy eating among students using fresh, local, and seasonal produce. We show students how to use kitchen equipment while providing nutrition information about the foods being prepared. This activity empowers students with new culinary skills while encouraging them to make healthy choices for their meals and snacks. Many of our students face some level of food insecurity, so knowing how to cook simple healthy meals using local, seasonal produce can help them to stretch their food dollars while supporting their own health.

UTK Trainee Spotlight: Rachel Klenzman

Rachel

Rachel Klenzman is a first year dual Master of Science in Public Health Nutrition and Master of Public Health student and an MCH Nutrition trainee at the University of Tennessee. She will also be completing a dietetic internship through UT in 2021. Rachel received her Bachelor of Science degree in Dietetics from Ashland University in Ashland, OH in May 2018. She hopes to use her education and training to improve health outcomes for mothers and infants.

In January, I attended the first general East Tennessee Childhood Obesity Coalition (ETCOC) meeting of the year. The Childhood Obesity Coalition, as it was previously known, began under the East Tennessee Children’s Hospital in 2008. In the Spring of 2018, our University of Tennessee MCH Nutrition Leadership and Education Program faculty, Drs. Marsha Spence and Betsy Anderson Steeves, and funded trainees have assumed facilitating the coalition and it has been renamed ETCOC. The Coalition’s mission is to prevent and reduce childhood obesity by promoting healthy, active lifestyles through family, community and interprofessional collaborations. The vision is to see that all children in East Tennessee have access to nourishing foods, opportunities for physical activity, and community resources to support healthy weight. ETCOC’s overall goal is to facilitate collaborations that maximize funding to reduce childhood obesity in East Tennessee.

There are currently three active committees – policy, assessment, and outreach – each with unique goals and objectives in efforts to support the coalition’s mission and vision. During the meeting, we reviewed the direction of ETCOC with the coalition members and committee chairs. Next, each committee brainstormed specific ways to meet their respective goals during breakout sessions. As a coalition, we decided to reach out to more community members and organizations in order to increase participation and commitment. I am very excited to be a part of ETCOC and see how we are able to amp it up and make an impact in our very own community!  As a member of the outreach committee, I am especially excited because we already have so many great ideas about how to maximize resources and make them attainable for families, teachers, and the community, for the benefit of children in Knoxville and in East Tennessee.

 

For more information, check out our website at https://etncoc.org

ETCOC
ETCOC Assessment Committee Members

Dr. Anderson Steeves
Dr. Anderson Steeves

Using Conceptual Models to Tackle Complex Public Health Problems Affecting MCH Populations

 

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This post is contributed by Junia Brito, MCH Nutrition trainee and PhD student in epidemiology at the University of Minnesota, Twin Cities

An Example of How Structural and Intermediary Determinants of Health Affect Breastfeeding Rates among African American Women

Despite the many known benefits of breastfeeding, a persistent discrepancy exists between African American mothers and mothers of other races who breastfeed. According to the Centers for Disease Control and Prevention (CDC), among all children born during 2010–2013, 64.3 percent of African American women initiated breastfeeding, compared to 81.5 percent for Whites, and 81.9 percent for Hispanics. The percentage point difference in the rate of exclusive breastfeeding through 6 months and breastfeeding at 12 months between African American and White infants was 8.5 and 13.7, respectively. Multiple factors influence a woman’s decision to start and continue breastfeeding. However, certain barriers are disproportionately experienced by African American women.

Using the Word Health Organization’s (WHO) Conceptual Framework for Action on the Social Determinants of Health, I attempt to show you in a simplified manner how structural and social determinants of health shape these lower breastfeeding (BF) rates (i.e., initiation, exclusivity up to 6 months, and duration up to 12 months) among African American women. Following the proposed conceptual model, I briefly explain each construct and how they interact to shape BF rates among African American women.

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Structural determinants of low BF rates among African American women include (1) the U.S. Federal Employment and Labor Laws (e.g., Family and Medical Leave Act -FMLA), (2) social norms (e.g., embarrassment/ fearful of being stigmatized when they breastfeed in public, sexualizing women’s breasts as objects of male desire, the cultural belief that the use of cereal in a bottle will prolong the infant’s sleep), (3) discrimination, racism, and harassment (e.g., race, religion, appearance), and (4) sexual division of power and labor (e.g., sexual division of labor reduces women’s economic status by distributing wealth in ways that disadvantage caregiving relative to specific forms of productive work, role differentiation leads to unequal parental role expectations and economic opportunity). These structural determinants affect not only occupation and income, but also the following intermediary determinants: (1) material circumstances (e.g., earlier return to work, unsupportive work and childcare environments), (2) psychosocial factors (e.g., poor partner, family and social support, commercial pressures to not breastfeed or stop BF via aggressive marketing campaigns of formula producers), and (3) healthcare system (e.g., inadequate delivery of BF information by providers, lack of access to professional BF support, provision of supplemental feeding to healthy full-term breastfed babies during the postpartum stay, separation of mothers from babies during their hospital stay). Together, these social determinants of health inequities and health shape BF rates in African American women.

Using the WHO’s Framework for Action on the Social Determinants of Health, can you think about any other public health problem that affects MCH populations?

References:

Anstey EH, Chen J, Elam-Evans LD, Perrine CG. Racial and Geographic Differences in Breastfeeding — United States, 2011–2015. MMWR Morb Mortal Wkly Rep. 2017;66(27):723-727. doi:10.15585/mmwr.mm6627a3

Solar O, Irwin AA. A Conceptual Framework for Action on the Social Determinants of Health: Determ Heal Discuss (Policy Pract. 2010:1-79. doi:ISBN 978 92 4 150085 2

Ethics in Research: The Power of Collaboration

Most, if not all, scientists are familiar with the Nuremberg Code, the Belmont Report, and the famously inhumane experiments that made ethical guidelines for conduct of research necessary (for background information on these topics, please see links at the end of the post). And most, if not all, researchers are familiar with the process of submitting the plan for a study to their local Institutional Review Board (IRB) for approval of ethical treatment of study subjects. However, what about situations in which the ethical course of action is unclear?

One of our most recent discussions as trainees in the ASU program was on research ethics. Our group discussed several case studies with a wide variety of ethical dilemmas, including the best way to obtain parental consent in research involving adolescents; working with populations involved in risky health behaviors; what exactly constitutes appropriate incentives for participating in research; and conducting research with participants that may be untrustworthy of researchers. NEP_1350

Each of the situations we discussed was uniquely complex, with many different angles, yet with each case, there was a point where a decision had to be made. Whether it was to intervene with adolescents taking serious health risks (even though it was an observational study) or allow an incentive to remain unchanged (even though some researchers may argue that it is high enough to be coercive), researchers in each of these situations had to pick a course of action and deal with the consequences. Discussion among the group allowed class members to see issues from various angles and brainstorm solutions that would not have been apparent if a single person was trying to make that decision on their own.

Researchers have the opportunity to work with a wide variety of populations. It is their responsibility to those populations to be not only good scientists, but good ethicists as well. This includes not just ensuring that literature searches, methods, analyses, and conclusions are of high quality, but that reasoning, motives, and contingency plans are also sound. In nearly every case we considered, the ethical dilemma faced would have been greatly reduced by involving someone with relevant expertise in the research process—such as a consulting psychologist or a respected community member who understood local customs. Including the right people in a study can help improve the design and ensure that ethics are sound.

What are some of the ethical dilemmas you have faced in research? How have you overcome them?

If you would like real-life examples of research ethics in action, please visit the following website: https://ethicsresearchcore.org/education/case-studies/

For further reading on ethical guidelines in science, please visit the following links:

  1. https://history.nih.gov/research/downloads/nuremberg.pdf
  2. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/
  3. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html

UTK Former Trainee Spotlight: Ruth Wooten

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Ruth Wooten, an alumnus of the Maternal and Child Health Leadership traineeship, is a registered dietitian nutritionist and completed her Master’s program in Public Health Nutrition at the University of Tennessee. This blog post describes her recent publication/thesis research.

Upon entering graduate school, I was not convinced that I wanted to pursue the thesis track for my degree. I certainly found research interesting but was not positive that I wanted to tackle such a daunting task and bury myself in one specific topic. My major professor, Dr. Betsy Anderson Steeves, had a project for our research lab that was to assess food insecurity rates on campus to contribute to a regional wide survey being administered by members of the Southeastern Universities Consortium on Hunger, Poverty, and Nutrition. I was assigned as the lead on the project and became more invested in the research. Eventually, I decided to take this research project and form it into my thesis research. Instead of only assessing food insecurity rates at our campus, I decided, with the assistance of my committee, that it would be advantageous to assess rates at the three other campuses in our university system to capture a larger population. During my first semester as a MCH Nutrition trainee (spring 2017), I attended our annual MCH grantees meeting and had several conversations with fellow trainees and directors who were assessing similar information at their universities. I was thankful to have a network of researchers pursuing a topic that could unveil information beneficial to the public health nutrition community. The MCH training grant exposed me to a community of graduate students and nutrition professionals from across the country that added value to my research process.

During the fall semester of 2017, an online survey was administered to over 38,000 students to assess their food insecurity rates as well as factors that related to their food insecurity status. We had a fairly good response rate (12.5%)1 for online surveys and resulted in a large amount of data to analyze. I analyzed data and wrote my thesis during the spring semester of 2018. After successfully defending in April 2018, I began finalizing my thesis for publication. The various tasks that I completed as a trainee were helpful in developing my skills to research, write a manuscript, and complete the publication process. Just a few months ago, we were told that the manuscript was accepted for publication. I realized that this research was important and could make an impact on a larger scale than just my department or university.

Without providing too many spoilers, the study revealed that 36% of students were food insecure, meaning that they did not have adequate access to food to live a normal life.1 Several factors were significantly associated with an increased likelihood of experiencing food insecurity, including previous food insecurity before attending college, financial factors, and self-reported grade point average.1 The full study can be found at the citation at the bottom of this post.

Since the completion of this project, several exciting things have happened on campus at the University of Tennessee, including: an on-campus task force for student hunger and homelessness, an interview with Dr. Anderson Steeves on NPR, and the implementation of the 2-item food insecurity screener on intake forms at the student health center.

1Wooten R, Spence M, Colby S, Anderson Steeves E. Assessing food insecurity prevalence and associated factors among college students enrolled in a university in the southeast USA. Public Health Nutrition. 2018. https://doi.org/10.1017/S1368980018003531

https://www.cambridge.org/core/journals/public-health-nutrition/article/assessing-food-insecurity-prevalence-and-associated-factors-among-college-students-enrolled-in-a-university-in-the-southeast-usa/C7CBF2D99C7E2A0F568334554787D031