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