MPH - Project Abstracts

ABSTRACT

Background/purpose: The two most common occupations for Latina women in the U.S. are maids and housekeeping cleaners, representing 6.4% of all Latinx workers nationally. Hotel Housekeepers (HHS) are predominately immigrants and women of color with the majority being Latinas, African American and Asian. Latina HHS experience injury twice as much as their non-Latina counterparts, and are exposed to poor working conditions that increase risk for CVD and poor management of chronic illness. In addition, Latina immigrant HHS have unique experiences of inequity related to socioeconomic status, anti-immigration policy, housing inequity, food insecurity and health care accessibility. Job strain represents one of the main areas of study among Latina immigrant HHS and the impacts on chronic disease, stress, and musculoskeletal health. However, little is known about the implications posed by job strain on dietary practices in the workplace. The purpose of this research project is to understand how factors produced through hotel practices, policies and procedures like stress and time pressures impact dietary practices and what is the overall workplace dietary experience among Latina immigrant HHS. Methods: Research project utilized a Community Participatory Action Research approach to work with a Hotel Housekeepers Community Advisory Board (HHSCAB) to guide in partnership the design and implementation of the project. In collaboration with researchers and graduate students at Northern Arizona University, Center for Health Equity Research (NAU-CHER), a total of 10 Key Informant interviews were conducted and thematically analyzed. Results/outcomes: Key Informant interview participants included Mexican immigrant women (31-50 yrs. of age) who had worked as HHS for an average of almost 14 years. Qualitative analysis results describe hotels producing structural forces such as formal and informal rules and employer strategies that materialize in Latina immigrant HHS skipping meals, eating while cleaning, working long hours without eating, and hiding to eat. Latina immigrant HHS identified policy recommendations to sustain adequate dietary intake in the workplace, which include: provision of lunch and breakfast at no cost, allowing HHS to eat and hydrate as needed, respect HHS lunch breaks and use food as an opportunity for hotel management to engage and listen to HHS’ needs. Conclusions: Latina immigrant HHS work within a structural entity being the hotel, which deprives them from the opportunity to engage in practices that support the self-reproduction of immigrant workers; for instance, adequate eating and hydration. This research project focused on the experiences of Mexican immigrant HHS, and provides a microscopic example of the structures impacting the livelihoods of immigrant low-wage workers in the U.S. Therefore, further research is needed to fully understand how hotel practices, policies and procedures have shifted during the COVID-19 pandemic and the implications on workplace dietary practices.

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Objective: To assess the impact of health literacy on mental health services utilization in individuals 18 + seeking health services in Flagstaff, AZ

Methods: Health literacy level assessed through Newest Vital Sign (0-3pts = Limited health literacy; 4-6pts = Adequate health literacy) Mental health services utilization assessed through 7-item section of SAMHSA’s NSDUH. Telephone administration.

Results: 30% of individuals with limited health literacy utilized mental health services when needed. The type of services used varied (support group, chiropractor, doctor’s office, outpatient clinic). Individuals with adequate health literacy were .75 times as likely as individuals with limited health literacy to have seeked out mental health services in the past 12 months.

Conclusions: There are numerous factors that impact whether or not an individual seeks out needed mental health services. More research is needed to understand the true impact of health literacy on an individual’s mental health services utilization.

Policy Implications: Considerations should be made with regard to providing support to individuals with limited health literacy when seeking out health services. Future research can inform organizations that provide healthcare support (governmental supplement).

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Introduction: Comprehensive sexual education (CSE) has shown its efficacy in preventing negative sexual outcomes form occurring, however, most sexual education is taught through a heterosexual lens, making it difficult for individuals who identify as LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual, or other) to relate. Objectives: To identify the true perceptions of CSE among LGBTQIA+ students at Northern Arizona University (NAU) in order to fill the gender- inclusivity gap. Methods: This was a qualitative study design that collected information through one-on-one interviews between the researcher and participants who met eligibility requirements. Interviews were conducted and guided with an interview guide based on prior literature. With permission, interviews were recorded for transcriptions. All transcriptions were uploaded and coded through the NVivo software. Initial codes were then organized into overarching themes that encompassed the answer to the research question. Results: Eleven undergraduate, LGBTQIA+ students were included. Three overarching themes emerged from the narratives of interviewees: 1) Abstinence- promoted, 2) Lack of gender and sexual diversity, and 3) Need for inclusive topics. Participants also expressed that the information provided in their classes were either somewhat relevant or not relevant at all. As a result, were left to seek relevant information through the internet or from conversations with friends. Conclusions: The study’s results indicated that the CSE curricula participants were exposed to were taught through a heterosexual framework, and as a result, participants desired topics about the LGBTQIA+ community. Students of minority communities, including the LGBTQIA+ community, are often underrepresented- therefore, more research is needed to understand their perceptions in order to provide a more inclusive environment.

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Background: Sources of sex information include exposure to any form of sexual education. Common sources include friends, family, and the media. Sources of sexual health information and education have varying influences on sexual behaviors and outcomes. Methods: In this cross-sectional study, students are asked about how much they have learned from various sources of sexual information and education and their engagement or non-engagement in various sexual behaviors. The sample population includes undergraduate students aged 18 to 24 who are currently attending the NAU Flagstaff campus. A randomized sample of 7,500 students were emailed and asked to participate through the Qualtrics email feature. Results: A total of 918 students responded and completed the questionnaire. Responses indicate students learned a lot from the internet. Statistically significant data shows that students who learned a lot or some from their romantic partners were more associated with engagement in risky sexual behaviors. Conclusion: This study serves as a beginning step toward more extensive and conclusive research regarding the effect of sources of sexual information and education on sexual health behaviors and outcomes of college students.

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Background: The Navajo Epidemiology Center (NEC), developed the Navajo Nation Health Survey (NNHS), a tribe-specific Behavioral Risk Factor Surveillance Survey (BRFSS) to gain insight on health behaviors among Navajo Nation residents. This paper summarizes physical activity and nutrition behaviors collected from the NNHS in 2013, 2015 and 2016. Methods: The NNHS followed the CDC BRFSS methodology with adaptations to Navajo sociocultural conditions. Questions regarding physical activity, nutrition, and weight control were analyzed. Results: Of the 2,346 survey participants, 73.7% reported being physically active 3 times a week for at least 90 minutes. Respondents reported consuming 4.30 servings/day of fruits and vegetables. A total of 45.6% of men and 32% of women reported drinking soda daily. Almost half of residents reported they tried to lose weight, with approximately 4 of 5 people utilizing exercise and reduction of caloric and fat intake to do so. Conclusion: Participants attained the recommended physical activity and fruit consumption; however, sugar-sweetened beverage consumption was high and vegetable intake was low. This information can help identify benchmark objectives for chronic conditions influenced by health behaviors.

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Background: The association between wholesome nutrition and improved health status is well documented; however, nutritional commodities provided to individuals incarcerated, one of the more vulnerable populations in the US, is significantly understudied. Compared to the general US population, the prevalence of vitamin deficiency (particularly fat-soluble vitamins) is thought to be more substantial among incarcerated individuals, as the enforcement of quality nutritional standards is voluntary. Moreover, the majority of individuals incarcerated come from underserved communities that struggle with addressing social determinants and reducing health disparities.

Objective: The purpose of this research is to describe the fat-soluble vitamin content of a 7-day cycle menu at Coconino County Detention Facility and compare these findings to the national dietary reference intake (DRI). Methods: Fat-soluble vitamin provisions were estimated for each food item and its respective portion size from the 7-day cycle menu using NutritionCalc Plus and ASA24. Daily and total averages of vitamins D, E, A, and K were calculated over the 7-day menu period. Nutritional adequacy of each vitamin was calculated as the daily average vitamin provisions divided by the Dietary Reference Intake (DRI) recommendations. Results: The menu provisions met 32% and 39% of the DRI recommendations for vitamin D and vitamin E, respectively. For vitamins provided in excess, the menu met 112% for vitamin A and 142% for vitamin K of DRI recommendations for men and 145% for vitamin A and 190% for vitamin K of DRI recommendations for women. Conclusions: With reference to DRI recommendations, the menu provided adequate provisions of vitamin A and vitamin K. However, vitamins D and E were substantially underprovided. Studies have linked low or deficient vitamin D and E levels with an increased risk of chronic disease and decreased autoimmunity. Given the functional roles of fat-soluble vitamins in promoting optimal health, jail administration and food distributors should serve more vitamin dense foods and supplements to increase fat-soluble vitamin intake among individuals incarcerated.

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Objectives: Individuals incarcerated have higher rates of chronic diseases. These inequities are partially driven by the nutrition environment in correctional facilities. The objectives were to determine the macronutrient distribution and caloric composition of a 7- day menu and commissary items. Methods: The 7-day menu and commissary list were obtained from a jail in Arizona. Daily carbohydrate, protein, fat, and calories was assessed using NutritionCalc Plus® for each of the seven days. Commissary items included four gift packs which were assessed for macronutrients and calories using NutritionCalc Plus. Daily intake of macronutrients and calories was averaged and compared to the Acceptable Macronutrient Distribution Range (AMDR) and 2015-2020 Dietary Guidelines. Four scenarios were created to understand the effect of commissary items in addition to the menu. Results: All macronutrients met AMDR recommendations. Caloric provisions exceeded Dietary Guidelines recommendations. Commissary items and menu exceeded AMDR and caloric recommendation. Conclusion: Exceeding macronutrient and caloric recommendations for at risk populations may worsen disease status. Recommendations include increasing the amount of fresh foods on the 7-day menu to meet macronutrient and caloric recommendations.

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Objectives: To determine the estimated daily sodium intake in 7-day cycle menu provisions and commissary provisions at a county jail and compare it to Dietary Reference Intakes (DRI) and Dietary Approaches to Stop Hypertension (DASH) recommendations for sodium intake. Methods: We obtained a 7-day cycle menu and commissary food list from a Southwest rural county jail. The cycle menu included 3 daily meals and commissary items included 4 purchasable, pre-bundled food packs. NutritionCalc Dietary Analysis software was used to determine sodium content for each meal and commissary pack. All estimates were converted to a daily average and compared to DRI and DASH recommendations. Results: The daily average sodium from menu provisions was 167% of the DRI and 256% of the DASH recommendations. The determined average sodium content for commissary packs ranged from 173% to 292% of DRI and 265% to 447% of DASH diet recommendations. Conclusions: Commissary items make up a substantial portion of dietary sodium intake within jails. Small changes to one meal within the cycle menu and the inclusion of fresh or frozen produce could reduce sodium content to align with DRI and DASH recommendations.

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Introduction: In the United States, unemployment rates increased amid the COVID-19 pandemic in levels similar to those of the Great Recession; in times of high unemployment, childhood food insecurity increases. Childhood food insecurity can result in physical and psychological consequences later in life. This study will fill the research gap observed between household size, unemployment, and food insecurity during the COVID-19 pandemic in Flagstaff, AZ. Methods: Flyers that linked to a questionnaire were distributed to parents at Flagstaff Unified School District summer meal sites. The questionnaire recorded demographic data and how a household’s food security had changed throughout the COVID-19 pandemic. Results: Marginal significance was found between the number of children in a household and how a household’s food situation had changed, and between number of children in a household and how many food resources a household utilized. Conclusion: The COVID-19 pandemic and related increased unemployment has the potential to increase food insecurity in the United States. This study’s marginally significant findings showed that larger households experienced greater difficulty in obtaining food and utilized more food resources in Flagstaff, AZ.

ABSRACT

Abstract: Introduction: A nutrient-dense plant-based diet or the Nutritarian diet may be an important nutrition intervention for pregnant women for a number of factors. Factors include possible decreased risk for gestational diabetes and excess weight gain, and how excess meat consumption may negatively impact the health of adult offspring. Methods: This study performed qualitative interviews to understand the in-depth personal experience of women who aimed to eat a plant-based diet while pregnant. The interviews were held over the phone on Northern Arizona University campus from June to August 2020. Results: Three main themes emerged from the interviews. First, family and social influence played an important role for women to follow the Nutritarian diet. Second, women who had previous pregnancy experience felt they had fewer pregnancy complications on the Nutritarian diet. Lastly, the participants may have experienced low milk supply on a Nutritarian diet. Conclusions: Future research should consider family conflict as a barrier to plant-based dietary patterns, investigate the link between plant-based diets and less symptoms of nausea and vomiting in early pregnancy, and if plant-based diets lead to decreased breast milk production.

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Background: Latina immigrants represent 46% of the total housekeeper workforce in the US and face several occupational risks including lower lumbar injury, chronic diseases, and high stress environments. The occupational risks faced by Latina immigrant housekeeper has been well documented from an economic and systems level perspective, yet descriptions of the daily experiences of these workers is limited. This project describes the daily experiences of Latina immigrant housekeepers in Flagstaff, Arizona within a framework of Everyday Violence (EV) to better understand practical and effective policy recommendations to reduce occupational risks among housekeepers. Objectives: To describe and understand how immigrant Latina housekeepers interpret and cope with structural and intrapersonal forms of violence for the purposes of developing policy recommendations to reduce occupational risks. Methods: Key informant interviews were coded and analyzed using Atlas.ti to describe the semantic relationships between described forms of EV and root causes. Results: Semantic relationships point to intrapersonal conflicts, hotel mismanagement, retaliation, and discrimination as root causes of risks. Policy implications: Policy recommendations should include EV as a framework to target nuanced risks that operate daily.

ABSTRACT

Background: Latina immigrants represent 46% of the total housekeeper workforce in the US and face several occupational risks including lower lumbar injury, chronic diseases, and high stress environments. The occupational risks faced by Latina immigrant housekeeper has been well documented from an economic and systems level perspective, yet descriptions of the daily experiences of these workers is limited. This project describes the daily experiences of Latina immigrant housekeepers in Flagstaff, Arizona within a framework of Everyday Violence (EV) to better understand practical and effective policy recommendations to reduce occupational risks among housekeepers. Objectives: To describe and understand how immigrant Latina housekeepers interpret and cope with structural and intrapersonal forms of violence for the purposes of developing policy recommendations to reduce occupational risks. Methods: Key informant interviews were coded and analyzed using Atlas.ti to describe the semantic relationships between described forms of EV and root causes. Results: Semantic relationships point to intrapersonal conflicts, hotel mismanagement, retaliation, and discrimination as root causes of risks. Policy implications: Policy recommendations should include EV as a framework to target nuanced risks that operate daily.

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Objective: The overall objective of my graduate research project is to assess and improve the knowledge of acid fracturing among Northern Arizona University (NAU) undergraduate students in various academic disciplines. Methods: This study aims to provide a brief educational intervention on helium extraction in Arizona. The study will be conducted on NAU students assessing knowledge on acid fracturing in 15 students from geology, environmental science, and public health undergraduate programs. A pre/post test with a comparison group will measure outcomes including costs and benefits of extracting oil and gas including, economic impact, public health implications, community effects, political policies and affiliations. The educational intervention will be a pre-recorded lecture on the topic given via zoom. Students will be given the pre-test before the lecture is provided and will be asked to follow up with the post after the intervention is given. Results: The study has not been conducted yet due to complications with COVID-19, but will be conducted in Spring 2021. Using the data collected from the pre and post test, a paired t-test will be done in SPSS for the analysis.

ABSTRACT

Background: The purpose of this study is to evaluate a one-week summer education program is known as the Indigenous Summer Enrichment Program (ISEP) from June 21 – June 26, 2020. Methods: For this study, we compared the difference between a pre- and post- test using the Self-in-School (SIS) measurement. A virtual focus group asked 6 questions on communication strategies. The sample consisted of 12 AI/AN high school students. Due to COVID-19, both methods had to be conducted through Zoom.

Results: Data was exported from Qualtrics. We used SPSS to conduct a signed-rank test. We calculated a P-value of 0.75, higher than 0.05, which was not significant. The virtual focus group failed, questions were emailed instead. Five qualitative themes emerged using Excel. 75% of respondents suggested using social media to promote ISEP. All students agreed Instagram was the best method to communicate.

Conclusion: The observed difference between the pre- and post-test is not significant. Useful data was gathered from the qualitative themes. This study has expanded on new methods to use for evaluation and communication for summer education programs.

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Background: The objective of this study was to describe arrest outcomes among sexual assault suspects in Coconino County overall and by race/ethnicity. Methods: Administrative arrest records were used to create a retrospective cohort of individuals who were charged with sexual assault/abuse from January 1, 2009 through May 31, 2018. Demographic information on age, sex, and race was obtained from arrest records. Results: We identified 265 sexual assault or sexual abuse charges during 169 arrests among 155 individuals. All charges were felonies among males. Only 47 (28.3%) were convicted of their charges and served time in a correctional facility. Compared to White men, American Indians, Latinos, and Black men were convicted for their charges more often. Conclusions: Results indicated that individuals with sexual assault/abuse-related charges have a high likelihood of being booked in the county jail at time of arrest, yet only a small proportion are found guilty and serve time for those charges. Additionally, racial/ethnic minorities are overrepresented within the group that is convicted compared to White men.

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Objective: To examine the impact of (3-5 minute) pre-recorded food demonstrations and an intuitive eating worksite wellness program on fruit and vegetable consumption and self-efficacy to cook meals at home. Methods: A 6-week experimental pilot intervention was conducted at Northern Arizona University’s worksite wellness program. This weekly intervention occurred from February 5th - March 10th in 2020, and included 28 participants. Results: Results showed significant increases in intuitive eating (t = 4.317; df = 5, p = 0.008). Vegetable intake, participants showed non-significant changes (t = -1.581; df = 5, p = 0.175). Participants indicated close to significant changes in the number of servings of fruit they consumed a day (t = -2.236; df = 5, p=0.076). The averages of participant’s confidence to cook at home over the course of the program was 3.88, 4.33, 4.38, 5, and 4.6. Conclusions: This pilot intervention demonstrated improvements in intuitive eating and self-efficacy to cook at home. No significant changes were seen in fruit and vegetable consumption. Policy Implications: Implementing nutrition education for employees can be beneficial for worksite wellness programs.

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Introduction: Food insecurity in the United States is a growing problem which disproportionately affects low-income children. The biggest risk factors for food insecurity are household income and job loss. These risk factors are exacerbated by economic downturns such as the current COVID-19 pandemic. This study will assess parental education level and household income as they relate to unemployment and food insecurity during the COVID-19 pandemic in Flagstaff, AZ. Methods: Flyers linking to a questionnaire were distributed to parents at Flagstaff Unified School District meal distribution locations. Demographic data and how a household’s food security had changed throughout the COVID-19 pandemic were obtained through the questionnaire. Results: There were no statistically significant data pertaining to the relationship between education level and the effect COVID-19 had on food security, or the relationship between household income and food security. Conclusion: The COVID-19 pandemic has affected all families utilizing the FUSD meal distribution program similarly, not discriminating on education or income. More government assistance and food resources are needed in order to help families who are struggling with food insecurity during this economic and public health crisis.

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Objective: To determine whether a rural Southwest County Jail meets the Dietary Reference Intake for pregnancy for Folate, Iron, Vitamin D, and Calcium based on the 7-day cycle menu.Methods: The study design is descriptive and based on a rural Southwest county jail located in Arizona conducted in the year 2020. The exposure is the 7-day cycle menu and the outcome is excess or deficiency of the given four micronutrients analyzed and the likelihood of benefit or harm. The 7-day cycle menu was manually inputted into NutritionCalc® Plus, a dietary assessment tool. Results: Of the four micronutrients analyzed, 75% did not meet the DRI for pregnancy. The average daily amounts of each micronutrient from the menu were 577 mcg Folate, 21 mg Iron, 5 mcg Vitamin D, and 1,155 mg Calcium, and percentages were 96.2%, 76.0%, 32.3%, and 107.7%, respectively. Conclusion: Although Calcium provisions were appropriate for pregnancy, Folate, Iron, and Vitamin D did not meet the DRI. Policy Implications: County jails should consider providing prenatal supplements to reduce risk of pregnancy-related health complications.

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Objective: Determine whether food/nutrition competences in American Indian and Alaskan Native (AIAN) college students can improve health and higher education outcomes. Methods: Northern Arizona University students were assessed in a cross-sectional assessment of eating competence. Data was analyzed using SPSS v27 and validated questionnaires were recorded in Qualtrics. Descriptive statistics evaluated variables using SPSS. Statistics included frequencies and central tendencies (mean, median, median) as well as measures of variability or dispersion (range and deviation). Results: 62 percent (n= 67) were eating incompetent with a mean score 29 (ecSI 2.0 score <32) (n=108). Within subscales, eating attitudes, 10.49 + 0.31 on a scale of 15, contextual skills, 4.82 + 0.21 on a scale of 9, food acceptance, 5.23 + 0.22 on a scale of 9, internal regulation 5.24 + 0.24. All areas exhibited need for improvements.

Conclusions: Low food/nutrition competencies exist among AIAN college students and target food/nutrition intervention could emphasize cultural significance among these students. Policy Implication: Coordination with community, state, federal partners to advocate for support of food/nutrition education interventions to increase higher education initiatives and achievement.

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None provided.

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Objective: To determine whether an Arizona county jail’s seven-day cycle menu met the 2015-2020 USDA Dietary Guidelines for Americans. Methods: A seven-day menu was provided from an Arizona county jail. Daily sodium, cholesterol, added sugars, saturated fats, and trans fats were analyzed using nutrition software. Daily estimates were averaged over seven days and compared to the 2015-2020 USDA Dietary Guidelines for Americans. Results: Sodium was 67% higher than the guidelines (<2,300 mg/day). Cholesterol was 9% higher than the guidelines (<300 mg/day). Added sugars met the guidelines (<10% of cal/day) for males and females. Saturated fats met the guidelines (<10% of cal/day) for males but was 30% higher for females. Trans fats met the recommendations (limiting and <1% of cal/day) for males and females. Conclusions: While the menu met the guidelines regarding added sugars, trans fats, and saturated fat intake (males only), the meals provided exceeded the guidelines for sodium, cholesterol, and saturated fats (females only) if consumed in their entirety. Policy implications: Jails should consider meeting sodium, cholesterol, and saturated fat guidelines, which may improve the health of individuals incarcerated.

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Introduction: It has been proven that combining nutrition and fitness is necessary to sustain long-term health. However, research on the relationship between nutrition and exercise, physical activity takes precedence over nutrition education for intervention exposure variables. Objective: To develop online nutrition education materials that will increase knowledge and emphasize the importance of nutrient-dense foods of those engaged in physical activity challenges. Methods: A pilot feasibility study design is being proposed to determine if online nutrition education materials are accepted among adults over the age of 18 who are enrolled in nutrition and health science courses at a university. Discussion: The long-term goal of this pilot study is to improve the nutrient-dense eating behaviors of individuals who are members of health clubs. The overall hypothesis of this pilot study is that the nutrition education intervention materials will be accepted and implemented in a future 60-day physical activity “fitness”challenge at a health club in Scottsdale, Arizona to increase participant’s Healthy Eating Index (HEI) score from pre- to post-assessment.