Sa’Nealdra is a 4th year doctoral student at the University of Tennessee pursuing a degree in Nutritional Sciences in hopes of impacting women and girls of color as it pertains to dietary quality. She currently holds a degree in Health Education-Public Health from Middle Tennessee State University.
This summer I completed a 7-week internship with a Partnership for a Healthier America (PHA) as a part of our nutrition program requirements. PHA is a non-profit organization that was created by Michelle Obama to partner with the private sector while improving our nation’s food systems, in a larger effort to improve childhood obesity rates. As I reflect on this experience, I am reminded of how important it is as a future professional to embrace opportunities and to explore unfamiliar territory. I have always been comfortable embracing those familiar opportunities that are similar to what I aspire to do as a professional; however, I learned this summer that sometimes it is more beneficial to get your feet wet in other fields.
I interned with PHA’s Fruit and Vegetable campaign (initiative) which seeks to encourage the world to consume more fruits and vegetables: fresh, frozen, dried, or canned. Although I had no prior experience with non-profit organizations, I found this to be a fulfilling experience. It was different than the usual public health and community research I have been involved in. I was instead doing things such as assisting companies in improving the nutritional quality of their food products. I developed many new skills that I will continue to use throughout my career; however, my main takeaway was the reminder to always immerse myself in opportunities that are outside of my normal scope. This internship was definitely a highlight in my graduate career and I would encourage others to seek opportunities that are outside of their field!
This blog post highlights the work and experiences of two funded MCH trainees from Oregon Health and Sciences University (OHSU), Georgia Brown (left) and Nicole Thelan (right).
Georgia is a 1st year trainee at OHSU in Portland, Oregon. She is currently completing her Masters of Science degree in Human Nutrition in combination with her dietetic internship at OHSU School of Medicine, with a thesis focus in fatty acid oxidation disorders. She received her Bachelor of Science in Nutrition at Arizona State University in 2016. Georgia has a variety of interests including inborn errors of metabolism, disorder eating in adolescents and adult women, behavioral health and food insecurity.
From Georgia: “During the Winter 2019 term at OHSU I took a Maternal Infant Child nutrition course, which emphasizes the growth and development of a fetus during pregnancy up until young adulthood. In this time, I completed two presentations which included a focus on adolescent girls and body image with the use of social media, and another on pregnancy in bariatric surgery patients. Both presentations provided unique opportunities for learning about two distinct populations, all while still learning about maternal and child health. I felt these in-depth presentations afforded me the opportunity to continue building off my MCH competencies while exploring topics of interest to me, including disordered eating behaviors and pregnancy.”
Nicole is a 1st year trainee at OHSU and is finishing up her second year of her Master of Science in Human Nutrition. Nicole obtained her Bachelor of Science in Nutrition at Seattle Pacific University where she participated in the Community Kitchen program. This program aims to provide affordable meals to community members while teaching meal planning and cooking skills. As part of her graduate experience, Nicole spent 4 weeks interning at the Multnomah County WIC department and 2 weeks rotating in the Pediatric Metabolic Clinic at OHSU. Nicole’s nutrition related interests include gastrointestinal disorders, community nutrition, public policy and food insecurity.
Highlights of MCH Nutrition Traineeship
As MCH trainees, we have had the pleasure of immersing ourselves in a variety of maternal and child nutrition related opportunities, including attending weekly Leadership Education in Neurodevelopmental and Related Disabilities (LEND) seminars which is a traineeship that provides graduate level interdisciplinary training and education. This traineeship focuses heavily on interdisciplinary work among a multitude of disciplines including Registered Dietitians, Speech Language Pathologists, Audiologists, Psychologists etc. with the goal of improving health outcomes in infants, children, and adolescents with disabilities. As attendees we were able to observe seminars with guest lecturers from both providers and patients/families, along with participating in a healthy discussion on how we can improve the health care experience for families. This opportunity has provided the unique experience of working specifically with families and children with disabilities, providing exposure and training on how to work with this commonly underserved population.
We also had the opportunity to attend the Western MCH Nutrition Leadership Network conference in February. The conference afforded us the chance to listen to the activities and accomplishments of the other trainees in our network and enhance our understanding of policy, system and environment concepts. We both walked away with a significantly deeper grasp of how to incorporate these ideas into our future practice as dietitians. Furthermore, the conference included a full day of education on building and further cultivating our leadership and communication skills — both of which will be key as they will allow us to go forward and make a meaningful difference in the lives of women and children, and really all people we work with.
We are currently working with the Multnomah County WIC office to develop a continuing education presentation for their providers. After hearing from the providers regarding a list of topics they would be interested in, we chose to focus on fad dieting for mothers and children. We plan to present on a range of diets including the ketogenic diet, veganism/vegetarianism, and the gluten free diet. Our goal is provide education the providers may apply in their practice and to help them answer questions they may receive from families about the practicality of these various diets for young children and pregnant or lactating mothers. Finally, we will be providing some online educational materials for the OHSU Hemophilia clinic and will specifically be focusing on topics families may find useful or interesting.
Laura is a 1st year trainee at the University of Minnesota – Twin Cities. She is pursuing a PhD in Nutrition and a doctoral minor in Epidemiology at UMN. Her research is focused on the intersection of obesity and disordered eating in children and adolescents. She is interested in understanding how external factors such as weight stigma and food insecurity impact health outcomes in these populations.
I was thrilled to learn that I would have the opportunity to work as a research assistant on the Positive Deviance Child Obesity Supplement for the MCH Nutrition Training Program here at UMN. What is Positive Deviance you ask? Positive Deviance is an innovative approach to public health research. Traditional research approaches investigate the sick, focusing on a particular disease. They focus on identifying risk factors associated with a particular disease, reducing modifiable risk factors, with the goal to mitigate the population’s risk for developing that disease. Positive Deviance uses a different approach. In Positive Deviance, instead of studying the “sick,” researchers study the “well.” Within an at-risk population, they ask who does not develop the disease? They aim to identify protective factors or protective behaviors within the “well” population. Finally, they aim to promote those protective behaviors within the at-risk population.
For the Positive Deviance Child Obesity Supplement, the condition we are studying is child obesity. We will be looking at 2- to 5-year-old children who are at risk for developing obesity. Our goal is to identify the characteristics that are associated with (and possibly responsible for) not developing obesity. For example, which children do not have accelerated weight gain and what characteristics do they share?
Why am I so excited about this approach, you ask? Well, before I returned to graduate school to purse a PhD, I worked as a MS, RDN for 10 years in child and adolescent obesity clinical programs at Seattle Children’s Hospital. We used a strengths-based approach to clinical care. We partnered with children, adolescents, and their families to help them to see what they were already doing well, then we built upon those strengths as we set SMART goals (Specific, Measurable, Agreed-Upon, Realistic, and Time-Oriented). I saw firsthand how helpful it was to patients and families when our clinical team was able to empower them to feel good about what they were already doing and then make changes based on those strengths. When I was first being trained in this approach to clinical care, one of my mentors used this analogy: “You don’t teach a child to read by listing off all the things they are doing wrong. You start with what they are doing well and then build from there.”
Even though the strengths-based approach to clinical care is not the same thing as Positive Deviance research, they both focus on investigating what is going well rather than investigating what is going wrong. Child obesity is such a complex, multifaceted, layered problem, and previous research approaches have not been able to adequately prevent the condition from developing. It is a puzzle that has yet to be solved. Our research team is currently recruiting participants, and we will be collecting qualitative data this summer. I am very excited for the opportunity to participate in this innovative approach to research and eager to see what we discover!
The Promoting Healthy Weight (PHW) Colloquia are a biannual series, held each spring and fall, that highlights the latest research in maternal and child health nutrition. The Colloquia are for practitioners, health agency employees, students, faculty, researchers, families, and the community. Viewers can attend the event onsite or view the live or archived webcast remotely.
On Friday, March 29, 2019, The University of Tennessee’s MCH Nutrition Leadership team along with the Department of Nutrition hosted the Promoting Healthy Weight Colloquium. The event, which launched our 3rd PHW Colloquia series focused on illustrating how policy is used to promote healthy weight in the MCH population at all levels of the Socio-Ecological Model (SEM) by Urie Bronfenbrenner.
The Spring 2019 colloquium featured five speakers, which included distinguished faculty from the Departments of Child & Family Studies and Public Health at UT, Dr. Hillary Fouts and Dr. Carole Myers, who introduced the Socio-Ecological model as a framework for promoting healthy weight and discussed how policy can influence healthy weight promotion at all levels. The next speaker, Dr. Karla Shelnutt, from The University of Florida provided an overview of the extension program and SNAP-Ed interventions from the individual level to a Policy, Systems, and Environmental (PSE) approach. Our fourth speaker, Jennifer Russomanno a DrPH student in the Public Health Department, presented on ways to connect participants in the Women, Infants, and Children (WIC) program with local farmers. To conclude, Leslie Lewis, from the Louisiana Department of Health spoke about the Collaborative Improvement & Innovative Network (CoIIN) and its role in implementation of state-level policies for the promotion of children’s healthy weight.
Yetunde is a 2nd year trainee at the University of Minnesota – Twin Cities. She is currently finishing up her MPH and dietetic internship at the UMN School of Public Health. She earned her Bachelor in Science in Nutrition – Dietetics at Auburn University in 2017. Her interests include maternal and child health, mental health, and nutritional counseling. She hopes to primarily work with women and children of color.
Community health workers (CHWs) are public health workers that typically come from the same culture, ethnicity and/or socioeconomic background, and speak the same language as the communities they serve. Because they often have similar life experiences as those they assist, they are able to build trusting relationships with their communities and are therefore an important link between health services and the people. CHWs are also involved in a number of other activities that seek to increase the health knowledge of both individuals and the community such as informal counseling, education, support, advocacy, outreach, and providing resources (1).
The Minnesota CHW Curriculum cancer course focuses on the role of the CHW when working with patients with cancer and their families. It places emphasis on understanding cancer, its risk factors, screening for detection and diagnosis, and the types of cancer treatments. It also seeks to understand the emotional factors involved when a cancer diagnosis is made, its treatment, and cultural considerations that must be addressed. Lastly, it helps CHWs in identifying resources and ensuring client access to those resources, as well as aid and support clients and families (2). However, the literature still reveals gaps in cancer training among CHWs in Minnesota.
The goal of my culminating experience (Master’s project) was to better understand the needs and barriers of CHWs and their health care employers as it relates to cancer detection, treatment, and survivorship of clients and their families across the state of Minnesota. Understanding these barriers could improve CHWs’ role in the spectrum of cancer care. I had the privilege of completing this project under the direction of the Program Coordinator of the Comprehensive Cancer Control at the Minnesota Department of Health, the Minnesota Cancer Alliance, and the Cancer Health Equity Network.
After completing a literature review, planning for data collection, and conducting 8 key informant interviews (2 more written responses to the interview questions were received totaling 10 participants), 9 top themes were discovered after thematic analysis: 1. Enrolling clients in screening programs; 2. Providing education; 3. Involvement in the community; 4. Providing culturally appropriate care; 5. Care coordination; 6. Transportation for clients; 7. Integration into the healthcare team; 8. Training for CHWs and 9. Defining the scope of the CHW. Based on the results of the interviews, there are a few recommendations that could be made to help elevate the work that CHWs do in the spectrum of cancer care in Minnesota: 1.Further formal training for CHWs, 2. Integration of CHWs into the primary care team, and 3. Clear scope of practice for CHWs.
CHWs have been shown to play a beneficial role on any interprofessional team, and this also applies to serving clients on the spectrum of cancer care. With further research and implemented recommendations, CHWs have the ability to enhance their work in the spectrum of cancer care in the state of Minnesota.
Through my research project, I acquired the Critical Thinking, Communication, Cultural Competency, and Working with Communities and Systems MCH Competencies.
Alicia is a 2nd year Master of Public Health candidate at the University of Washington, Seattle. She holds a degree in Food and Nutritional Sciences from Seattle Pacific University and completed her dietetic internship at Golden Gate Dietetic Internship. She worked in outpatient care and nutrition research as a registered dietitian before returning to school. Her interests include the intersection between social determinants of health and the public sector, and their impact on women’s health and nutrition.
Highlights of the MCH Nutrition Conference 2019 in Washington, DC
The MCH Nutrition Conference was a fortuitous opportunity to connect faces to many names and voices I had seen in e-mails and heard on Zoom calls. Many I had met at the Nutrition Leadership Network Conference in February (a networking conference of the MCH grantees and trainees in 13 Western states). However, this weekend in Washington D.C. had a different purpose. In addition to meeting each other and giving updates of our programs, trainees participated in cultural competency and policy trainings.
We started our day with updates on a federal, regional, state and program updates. In short:
Federal: Update and Q&A with Michael Warren and Lauren Raskin Ramos from the Maternal and Child Health Bureau (MCHB).
Regional: Obesity Enhancements led by University of Minnesota (Jamie Stang) and University of California, Los Angeles (Leslie Cunningham-Sabo)
Regional Leadership Programs
Emerging New Leaders in PH Nutrition
Western MCH Nutrition Leadership Network
Association of State Public Health Nutritionists: Children’s Healthy Weight Coalition
Trainee Peer Mentoring Network Update
Thoughts on Cultural Competency: Reflection on a Training from
After lunch, we received valuable training from Tawara Goode, MA director of Georgetown University’s National Center for Cultural Competence. Her training on cultural competency noted the multiple dimensions of culture that “affects how we work, parent, love, marry, understand health, mental health, wellness, illness, disability and end of life.” As public health practitioners and professionals we are responsible for not only understanding how organizational cultural affects us, but also doing the work to recognize and seek understanding of the multiple cultural identities of the persons and populations we serve. Further, these individuals and populations interact with multiple systems at once. The convergence of multiple cultural contexts is illustrated below.
I asked Dr. Goode about the connection between cultural
competency and equity, diversity and inclusion (EDI), which I hear more often
now than the former. (UW Seattle has a clear EDI initiative and the School of
Public Health recently created.) She distinguished that they are acutely
different. EDI, when it is clearly and specifically defined, aim to address
external factors that negatively influence the diversity of individuals and/or
I interpreted this to mean that cultural competency is the internal, personal work this is required of us in order to truly address the systemic barriers to equity, diversity and inclusion. Future food for my personal thought: How can I bring cultural competency to the spaces I learn and work in, which are primarily focused on systemic and institutional EDI?
Policy Training: A Vital Component to the Nutrition Profession
Currently, (as of March 2019) only two dietitians work on The
Hill, as stated by Alison Hard, MS, RDN, staffer of the House Labor and
Education Committee. In the photo above, Ms. Hard (right) speaks with Nancy
Chapman, MPH, RDN, who has years of experience advocating for nutrition policy
in Washington. Ms. Chapman organized four speakers to give us a glimpse of
nutrition policy in the non-profit, immigration policy, and federal government
Jen Holcomb, US Advocacy and Outreach Manager for 1,000 Days
Renato R. Rocha, policy analyst for The Center for Law and Social Policy
Alison Hard, MS, RD, House Labor and Education Committee
Robert Rosado, Senate Committee on Agriculture, Nutrition, and Forestry
This was probably my favorite part of our two-day conference,
mainly because I have had the least exposure to policy. Renato Rocha discussed
how public comments can impact rulings on policy. Specifically, when it was
proposed to add WIC to public charge, CLASP rallied several organizations and
thousands of public comments to delay the public charge ruling. We discussed
how public health practitioners and researchers can best contribute to public
comments. Both Renato and Jen agreed a combination of personal stories from the
field of how rulings can directly affect (or have already affected)
individuals, families and communities in addition to compelling data are most
We learned from Ms. Hard and Mr. Rosado about their roles and
the process of writing and passing the Farm Bill as well as their role in
education Congresswomen and Congressmen about it. Because so many Congress
members are freshman, which requires a substantial amount of their time to
educate them and their staffers in order to make informed decisions about the
Farm Bill. Following, after a training on how to speak with our
Representatives, we went to our respective state Congress members.
Congresswoman Primila Jayapal was on break back in Washington
State, so I spoke with Stephanie Kang, her staffer working on health and
nutrition issues. Unlike many Legislative Assistants, Stephanie is a fellow for
Congressional Progressive Caucus Center. She is a Doctor of Public Health at
Harvard University working on the Medicaid for All Bill. Because we are not
allowed to advocate under as Title V recipients, my fellow trainee Alyssa
Thomas (from Colorado State) and I spoke to Stephanie about the MCH Traineeship
in developing nutrition leaders and how we could be a potential resource to
Congresswoman Jayapal in the future. We continued to chat about the role of
public health in federal policy; Stephanie shared that public health
practitioners/students rarely stop in to speak with the Congresswoman or her
LAs. She emphasized the need for public health students to experience the
operations of developing policy.
The end of Day 2 involved grouping up to discuss and strategize
future steps for trainees and grantees. Trainees discussed the future of this
blog as well as how to continue to create connections and to make our group
Overall, this conference offered a plethora of
information vital to our professions, regardless of the specific job. It was
helpful to feel more involved in the traineeship through meeting other
trainees, faculty and other grantees face-to-face. I would say it has been a
highlight of the traineeship so far and would encourage any future trainee to
make it a point to attend.