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.
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.
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.
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?
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
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.
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?
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
Kalia is a second year MPH Nutrition student, MCH nutrition trainee, and a MNLEND trainee. She completed her undergraduate degree in Nutritional Science from Northeastern State University in Tahlequah, OK and her dietetic internship through Iowa State University. She is currently working as a Nutrition Educator for WIC. She has found a passion in helping underserved populations as well as learning more about individuals with neurodevelopmental disorders and helping them with their needs.
As the semester began in September, I was fortunate enough to have been selected as a trainee in MN LEND which also falls under the MCH bureau. What exactly is MN LEND? MN LEND stands for Minnesota Leadership Education in Neurodevelopmental and Related Disabilities. When I first heard about it, I didn’t know exactly what I was signing myself up for. With my experiences so far as a LEND trainee, it really has allowed me to view things differently from other disciplines outside of nutrition for individuals who may have neurodevelopmental disabilities. During undergrad, one topic that I felt I lacked most in was with those individuals who could possibly a disability and always wondered why their nutrition choices were so limited or why they tend to be so “picky” when it came to meal times. With what I’ve learned so far, I can see a small glimpse of what these individuals see – how their daily activity is affected by their surroundings, what their lens is on their surroundings and their thought process on their surroundings, early signs of developmental delays and more. Being a fellow and with the year continuing, I only hope to continue to learn more about individuals with neurodevelopmental or related disorders.
As a LEND fellow and working with WIC, I am fortunate enough to be able to work on a project for both organizations. With the project, we hope to identify issues that WIC staff may have in addressing delays with families. We also hope to find partnerships with other programs and helping families find interventions in helping families with identification of possible developmental delays in their young children, often times these delays can be overlooked. This could be as simple as making a referral for other programs that are here in Minnesota known as Help Me Grow or Learn Now, Act Early. With the knowledge I have gained from being a LEND fellow, I have found that the education I learn from MN LEND and working with young children have many benefits and how important this could be in helping families.