NPHW Research Symposium

“We were like general practitioners for planes”: The Environmental Health Impacts from Military Bases

Author(s): Camila Alvarez

Military sites across the world have marred the air, water, and land with toxins. Consequently, this affects the health of military personnel and civilians on the frontlines. This talk will discuss social theories to provide a framework for understanding the role of the U.S. Military, specifically domestic military sites, towards environmental health injustices. Then discusses current research applying this framework to understand the trajectory of domestic military sites, from active operation to decommission, and their corresponding environmental health injustices.

Hmong Farmers, Farmworkers, and Healers’ Knowledge of Pesticide-related Illnesses and Education

Author(s): Chia Thao, Nancy J Burke

Background.
Pesticide-related illnesses are associated with adverse health impacts in farming populations, including farmers and farmworkers. However, the Hmong farmers and farmworkers subgroup is an under-study population. This study explores small-scale Hmong farmers, Hmong farmworkers, and Hmong healers’ perceptions of pesticides and the health risk associated with pesticide-related illnesses.

Methods.
This is an in-depth qualitative interview study. The data collection was conducted between September 2022 through January 2023.

Results.
The study explored pesticide-related illnesses among small-scale Hmong farmers, farmworkers, and healers in the Central Valley. The primary preferred language was Hmong (83%). The majority (70%) of participants had no formal education, 13% had completed college, and 10% had completed high school. The existing pesticide illnesses training was in English, dismissing the pesticide educational need for Hmong farmers. The study found that 50% of the participants have limited knowledge of pesticide-related illnesses. All the participants were interested in receiving culturally and linguistically appropriate pesticide-illnesses training and education in Hmong.

Conclusions.
Farmers and farmworkers are at increased risk of pesticide-related illnesses due to their pesticide exposure vulnerabilities. Understanding where Hmong farmers and farmworkers seek services when dealing with the health effects of pesticide exposure is key to addressing care services in this community. Additionally, understanding perceptions of pesticide-related illnesses in this community is crucial in developing culturally and linguistically appropriate training for this community and other groups with language barriers and difficulties in the Central Valley and perhaps elsewhere.

Essential labor, disposable bodies: How the agricultural workplace shaped farmworkers' COVID-19 safety

Author(s): Fabiola M Perez-Lua, Maria-Elena De Trinidad Young, Alec Chan-Golston, Nancy J Burke

Farmworkers in the US experienced disproportionately high rates of COVID-19 infections and deaths during the COVID-19 pandemic. Their workplace may have been a significant place of exposure to the novel coronavirus. Through the lens of political economy theory, this study examined how organizational aspects of the agricultural industry shaped farmworkers’ COVID-19 workplace safety during the pandemic. Fourteen in-depth, semi-structured phone interviews with Latinx farmworkers living in three agricultural counties in California between July 2020 and April 2021 were analyzed using a Grounded Theory approach. This study identified organizational aspects of the agricultural industry that shaped farmworkers’ access to COVID-19 workplace protections and their individual agency to enact COVID-19 preventive practices at work. Organizational practices and arrangements normalized unsafe working conditions and the worker – rather than employer – responsibility for workplace safety. These workplace conditions uniquely shaped farmworkers’ risk to potential exposure to COVID-19 infection and negatively impacted workplace camaraderie. Study findings draw attention to how the organizational aspects of the agricultural industry can shape workplace safety and health inequities that negatively impact workplace camaraderie, potentially reducing farmworkers’ individual and collective agency to achieve safe working conditions. Occupational safety interventions should extend beyond worker education and address organizational factors that produce workplace health and safety inequities and disempower farmworkers to protect themselves from COVID-19 and other existing and emerging occupational health risks.

"Self-efficacy for writing in Health Communication"

Author(s): Lindsay K. Crawford, PhD

This study explores the self-efficacy for writing in an undergraduate writing-intensive Health Communication course at University of California, Merced. In order to measure how students' self-efficacy for writing changes over the course, the Self-Efficacy for Writing Scale (SEWS) was administered to students at the beginning of the semester and will be administered once more at the end of the semester. Additionally, a focus group will be conducted to gain insights into how students' self-efficacy for writing was affected by the class content, assignments, and instructor feedback. Preliminary findings indicate that self-efficacy for writing among the population (majority female, upperclassmen, Hispanic, non-native English speakers, and first-generation college students) is generally low. However, the post-assessment data has not yet been collected to make comparisons. Implications of low self-efficacy on writing performance and strategies for enhancing self-efficacy for writing among this population will be discussed.

Dietary Patterns in Mexican-origin Adults in the U.S.

Author(s): Aime Arreola; Kimberly Sanchez, MPH, MSPH; Karina Diaz Rios, PhD

Mexican-origin adults in the U.S. have the highest prevalence of diabetes (14.4%) in comparison to other Hispanic subgroups like Puerto Ricans (12.4%) and Central/South Americans (8.3%). Improving diet quality in Mexican-origin populations can help reduce their risk of diet-related chronic diseases, including diabetes. This study aims to describe the state of evidence on dietary patterns of Mexican-origin adult populations in the U.S. A systematic review was conducted with searches in four databases (i.e., Google Scholar, PubMed, Web of Science, and ProQuest) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were included if their primary focus was diet quality among Mexican-origin populations in the U.S. Findings of peer-reviewed articles focusing on Mexican-origin adults were systematically extracted and narratively summarized by 2 researchers. The initial search rendered a total of 1,383 articles. After title and abstract review, 91 articles were included; 22 articles were retained and summarized upon full-text review. Findings revealed that Mexican origin populations have a poor diet quality. Specifically, Mexican origin individuals consume more refined grains and sodium and do not meet the recommended amount of unsaturated fat. U.S.- born Mexicans who are the most acculturated consume more sodium, saturated fats, and sugars, than Mexicans who are the least acculturated. This research provides insight into the dietary patterns of Mexican-origin populations that may contribute to an increase in the risk of chronic diseases such as diabetes. Given the increased risk of diet-related chronic diseases among individuals of Mexican origin, the poor diet quality of this group unveiled in this study indicates a critical need for interventions to improve eating choices, particularly around limiting the consumption of refined grains, sodium, and saturated fat, with a targeted focus among those who are more acculturated.

EFFECTS OF DUST ON HOSPITALIZATIONS IN EL PASO AND LUBBOCK, TEXAS, USA

Author(s): Estrella Molina-Herrera, Thomas E. Gill, Gabriel Ibarra-Mejia, Karin Ardon-Dryer, Soyoung Jeonnone

The Southwestern USA has been identified as one of the most persistent dust-producing regions of North America, where exposure to dust events or their fine or coarse particulate matter can increase risks to human health. We investigated whether dust exposures (DE) in two dusty cities of Texas, El Paso and Lubbock, are associated with significant increases in hospitalizations on the day of the exposure and up to seven days afterward. Using a quasi-Poisson regression, it was found that relative risks of hospitalizations for multiple conditions were positively associated with DE in both cities between 2010 and 2014. Moreover, the associations and temporal lags for Lubbock were largely different than those for El Paso. In El Paso, valley fever, coronary atherosclerosis, genitourinary diseases, neurodegenerative diseases, injury and poisoning, septicemia, circulatory system diseases, respiratory system diseases, births, Associated Diseases (aggregation of all causes each associated with at least 5% of hospitalizations), and all ICD-9 admissions were significantly positively associated with dust exposures, indicated from higher to lower significant risk, at different lag periods. In Lubbock, we found increased relative risks for mental disorders, neoplasm, asthma, diseases of the blood, cerebrovascular, ischemia, and musculoskeletal system diseases at various lags. The highest relative risks in Lubbock were neurodegenerative diseases on the day of exposure. As climate change increases water stresses on dryland agriculture and land cover, dust exposures are likely to increase for residents of dryland cities. Additional investigations are needed for other dust-prone cities to investigate the health effects of dust exposures.

Investigating the Spatio-Temporal Clustering of Self-Harm in California, 2009-2013

Author(s): Jordan Jensen, MSPH, Alec M. Chan-Golston, Ph.D., Jennifer Howell, Ph.D., Sidra Goldman-Mellor, Ph.D.

Approximately 500,000 people present to the emergency department every year in California with injuries due to deliberate self-harm. Previous research has indicated that deaths from suicide can cluster in space and time. There is currently a paucity of research on whether cases of self-harming behavior can present in a similar way. Using Statewide emergency department data and census information from 2009-2013, this study aimed to identify if, where, and when clusters of self-harm related emergency department visits occurred in California. Kulldorff’s spatial scan statistic was employed to detect spatio-temporal clusters of self-harming behavior at the zip code level and CAR modeling techniques were utilized to identify risk factors associated with total visits in each zip code. 14 distinct clusters of self-harm related emergency department visits occurred within the study window, with zip code level predictors of clustering including standardized median income among others. Large clusters were identified in all regions of California. These findings may be used to increase the geographic specificity of prevention efforts and can inform future studies on the topic. Future studies will focus on evaluating clusters using a variety of different detection methods with more recent data.

Evaluating the Acceptability of Mobile Health Clinics Among Men Who Have Sex with Men

Author(s): Justin J. Naidu, Andrea N. Polonijo, PhD, MPH, Department of Sociology and the Health Sciences Research Institute, University of California, Merced

Mobile health clinics (MHCs) are vehicles that aim to provide healthcare services and maximize health equity in underserved populations. Though MHCs can close the distance between communities and healthcare providers, they may not be acceptable for all populations. This study evaluates the acceptability of MHCs among men who have sex with men (MSM) in California. As part of a community-based research project, we conducted six focus groups with English-speaking MSM in California to assess: (1) general attitudes toward mobile health clinics, (2) willingness to receive vaccines, pre-exposure prophylaxis (PrEP), and information about these disease prevention tools from MHCs. Data were analyzed using the rigorous and accelerated data reduction technique. The sample (N=24) was diverse (50% Hispanic, Black, or other non-White/mixed race/ethnicity; 46% HIV+) and captured participants from across the socioeconomic spectrum. Forty-five percent of participants reported having used an MHC. Participants had generally positive attitudes toward accessing MHCs for vaccinations and/or PrEP, provided the MHC was physically accessible, well-integrated into the community, endorsed by trusted organizations, and designated as LGBTQ+ friendly. Participants who had regular healthcare providers recognized the utility of MHCs for some populations (e.g., students, people experiencing homelessness) but preferred to access disease prevention tools via their regular providers due to established trust and the desire for care continuity. Some participants reported concerns surrounding privacy and confidentiality that would need to be addressed before they would be willing to access an MHC. Findings will be used by the project’s community partner to inform local health promotion interventions.

Exploring the cessation needs of San Joaquin Valley tobacco users: A community-engaged pilot study to inform cessation interventions involving rural and isolated communities

Author(s): Vazquez, K; Garcia, M; Naidu, J; Durazo, A; Burke, N; Song, AVNCPC, UCSF, CHC

Abstract
Background. California’s San Joaquin Valley (SJV) has a higher percentage of smokers as compared to urban centers like Los Angeles and San Francisco. In 2020, many SJV communities reported smoking rates up to 20%, whereas the rest of the state’s smoking rate dropped under 9% (CDC, 2021). In partnership, NCPC researchers, a SJV community-based organization, and UCSF cancer/tobacco control researchers, this community-engaged qualitative pilot study focuses on SJV’s racial/ethnic tobacco users, including Spanish speakers, and virtual cessation aids.
Methods. We explored their views and perspectives about tobacco use, cessation, and products designed to help people quit tobacco use. In two phases, we are conducting focus groups with 30 participants and 10 follow-up interviews to examine acceptability of a novel mHealth cessation product. Interns (MG, JN, KV) led development of recruitment materials and observed focus group sessions.
Findings. In phase one, participants described their history of tobacco use, as well as considered quitting behaviors, and knowledge of resources to aid tobacco cessation. Our findings suggest tobacco use occurs in the context of poly-use, particularly alcohol and cannabis use. Participants described their motivation to quit or decrease their tobacco use. Moreover, they reported past quit behaviors and interest in testing cessation support services based on mHealth and social media platforms.

Social and Economic Inequities Impact San Joaquin Valley Latino Parents During COVID-19

Author(s): Kesia K Garibay, MSPH, Maria-Elena De Trinidad Young, PhD, Nancy J Burke, PhD Department of Public Health School of Social Sciences, Humanities and Arts, University of California

Background: Despite the disproportionate rates of COVID-19 infection among Latino individuals in the United States, accessing resources during the COVID-19 pandemic within the San Joaquin Valley (SJV) has been largely unexplored.
Objective: To report findings describing the relationship between accessibility to food, transportation, COVID-19 vaccinations, and financial assistance among SJV Latino parents’ during the pandemic.
Methods: We conducted a survey with SJV parents/caregivers/legal guardians of a child/children between the ages of 0 to 18 between July 2022 to August 2022 in English and Spanish. A total of 493 SJV parents responded to the survey, of these 188 identified as Latino. Only Latino respondents were included in this preliminary analysis.
Results: Among Latino parents, 25% reported their family experienced food insecurity during the pandemic. 22% of Latino parents reported they were worried about not being able to pay for their rent or mortgage during the pandemic. A total of 12% of Latino SJV parents reported their immigration status prevented them from applying for additional resources during the pandemic. 5% of Latino SJV parents reported their immigration status prevented them from receiving or vaccinating their family.
Conclusions: Latinos in the SJV experienced social and economic inequities when trying to apply for resources during the COVID-19 pandemic.

Water? Food? Shelter? What about air? The San Joaquin Valley Center for Air Injustice Reduction (SJV-CAIR)

Author(s): Kimberly Valle, MSPH, Kate DeMarsh, Tim Tyner, MS, Jermaine Reece, Estrella Herrera, PhD, Alec Chan-Golston, PhD, MS, Sandie Ha, PhD, MPH, Sidra Goldman-Mellor, PhD, MPH, Trevor P. Hirst, LL.B (Manc), Asa Bradman, PhD, MS School of Social Sciences, Humanities and Arts, University of California, Merced, School of Engineering, Department of Life and Environmental Sciences, University of California, Merced, Central California Asthma Collaborative, Little Manila Rising, Health Sciences Research Institute, University of California, Merced

The San Joaquin Valley (SJV) of Central California (CA) is a broad, uniform valley that extends south to Bakersfield and is bounded by the Sierra Nevada mountains to the east and coastal ranges to the west. This topography, combined with local and regional air pollution sources, create an environment for air pollution formation and retention.1 The SJV experiences high levels of air pollutant exposure that often fails to meet Environmental Protection (EPA) Standards for Particulate Matter (PM) 2.5.1 Pollution sources in the SJV include agricultural production and agricultural transportation.2 Increasing traffic on the interstate I-5 and CA-99 highway transportation corridors also contribute to increased traffic-related air pollutants (TRAP) observed in the SJV. The San Joaquin Valley Center for Air Injustice Reduction (SJV-CAIR) at the University of California, Merced is partnering with community-based organizations to better understand air pollution in the SJV.3 Specifically, we are deploying a large network of air quality monitoring in Fresno, Stockton, and other areas in the SJV to increase citizen-science based air monitoring to better characterize air pollution trends and spatial variability. We will also evaluate the relationship between air pollution levels and hospital emergency department visits for respiratory, cardiovascular, and other TRAP related health outcomes. Through this work we will assess TRAP exposures and health impacts in some of CA’s most disadvantaged communities. We also aim to inform policies to improve CA’s air quality.

Farmworker Health Study (FWHS): Language Barriers in Utilizing Health Care Among Farmworkers in California

Author(s): Lisette I. Muñiz, Paul Brown, PhD.

For farmworkers to access healthcare, it must be affordable, readily available, and delivered in a manner that is appropriate to their needs and culture. This project examines the extent to which farmworkers report facing language barriers when accessing healthcare, and the issues that healthcare providers face when providing translation services to farmworkers and their families. This mixed-method study combined information from the recently completed Farmworker Health Study (n=1199), the largest study regarding farm workers in California, with qualitative data from interviews with healthcare providers. Results from the quantitative analysis were examined based on the various California regions from the FWHS. The results from a search of the literature and the interviews with healthcare providers identified a number of barriers and facilitators that farmworkers face, including language proficiency and the need for appropriate translations. Taken together, these results put forward an introduction to current language barriers among farmworkers and the healthcare providers who assist these individuals.

Distinguishing features of Valley fever relative to community acquired pneumonia and other San Joaquin Valley lung diseases

Author(s): Maria Pimentel, Anh Diep, Samuel Arda, Katrina K. HoyerOscar Davalos, Nadia Miranda, Susana Tejeda-Garibay, Katrina K. Hoyer

Coccidioidomycosis, also known as Valley fever, is a respiratory fungal infection caused by Coccidioides immitis and Coccidioides posadasii. Coccidioides is found in the soil of endemic regions like the San Joaquin Central Valley. After exposure to the fungal pathogen, 40% of individuals will have cold like symptoms that are common in many respiratory infections leading to its misdiagnosis and the use of ineffective treatments such as antibiotics. We performed a retrospective analysis of published data to identify commonalities and differences between respiratory diseases with similar symptoms to Valley fever. Published reviews, case studies and primary research articles from asthma, pneumonias, smoke exposure, tuberculosis, cancer, and COVID-19 were analyzed to determine the key diagnostics, symptoms, and the immune features. To compare disease symptoms, diagnostic methods, and key immune features between respiratory diseases we performed a multiple factor analysis, providing an analysis of potential correlation between and within diseases. As expected, symptoms were most similar between bacterial pneumonia and coccidioidomycosis, but many symptoms are similar in all respiratory diseases assessed. Diagnostic methods varied significantly between diseases although newer, more rapid diagnostics are needed in several respiratory infections and cancers. Immune features were variable between diseases, but more studies are needed to enhance this comparison. Published immune studies each focus on different populations and comparisons were not always comparable. The analysis in this project examines the similarities of common respiratory diseases to aid in better understanding and distinguishing them. The identification of unique markers in symptoms, immune characteristics, and diagnostic testing can help yield proper diagnostics that would result in better patient outcome and treatment options.

Immigrant political participation and health in Asian American neighborhoods

Author(s): Shaina Sta. Cruz, PhD(c), MSPHR. David Rebanal DrPH, MPH; Danielle Coquia-Guzman, MPH; Kami Yamamoto, MPH; Irene Yen PhD; Alec M. Chan-Golston, PhD (San Francisco State University and University of California, Merced)

Racial and ethnic minoritized groups that are the least politically engaged also experience the poorest health outcomes and struggle to access health care. Racial/ethnic minoritized groups’ political participation has been identified as a potential mechanism through which residents living in segregated neighborhoods can overcome structural and interpersonal inequities affecting multiple health outcomes. Few studies have examined the potential pathways between racial residential segregation and health among Asian Americans, despite the fact that Asian Americans are increasingly more residentially segregated. Using participatory community mapping and focus group methods, we examined civic and political attitudes, perceptions, and actions of Southeast Asian American residents of ethnic-segregated neighborhoods in California, as well as structural promoters and barriers to political participation. Common themes include systemic and individual-level discrimination, generational differences, intersectional solidarity, and recommendations toward fostering civic engagement. Findings highlight the importance of examining the role of political participation on health outcomes in segregated communities. Community mapping exercises indicate ethnic-specific health and faith-based organizations as promoters, and lack of centralized spaces as well as fear of political persecution as barriers. Isolated communities, including residents from immigrant neighborhoods, can participate in collective political participation (e.g., protests, identity-based coalitions) as a means to work toward better health and well-being. Results can inform place-based health inequity indicators, and identify public health interventions to promote political engagement as a mechanism to mitigate the effects of neighborhood isolation and discrimination, including the violence in Asian American neighborhoods recently amplified through the COVID-19 pandemic.

Developing tailored interventions for San Joaquin Punjabi Population with Type 2 Diabetes

Author(s): Shaista Afzal and Palwinder Kaur, Harmanpreet Chauhan, PhD student and Dr. Mariaelena Gonzalez. School of Social Sciences, Humanities and Arts, University of California, Merced

Diabetes is a worldwide issue that has impacted over 400 million people in 2017 and has various factors for Type 2 Diabetes (T2D), where physical activity and unhealthy diet are the main contributing factors. South Asian Indians have the highest prevalence amongst other races and ethnicities as each differ in risk of acquiring this disease. Specifically for Punjabi South Asians, there are only 1 intervention set to combat T2D. The objective for this study is to identify the major health issues among the San Joaquin Punjabi community, recognize previous strategies to address T2D as well as identify opinions on T2D management interventions. Many literature related to South T2D interventions are taken in consideration to develop an intervention specifically for Punjabi residing in the United States. In addition, many interviews are conducted with health professionals that serve San Joaquin Valley (SJV) Punjabis to gather knowledge about their experience and their perception on cultural tailored interventions. The aim of the research is to determine meaningful intervention that is specific to the Punjabis in the United States to reduce Type 2 Diabetes prevalence. We are working directly with a PhD student, Harman under the supervision of Dr. Mariaelena Gonzalez’s Lab.

An Investigation Into Neuronal Activity Utilizing A Novel Optogenetic Device

Author(s): Supratik Nandi

Optogenetics is a research method that allows for “targeted, fast control of precisely defined events in biological systems as complex as freely moving mammals. By delivering optical control at the speed (millisecond scale) and with the precision (cell type–specific) required for biological processing, optogenetic approaches have opened new landscapes for the study of biology, both in health and disease.” (Deisseroth 2010). Classical optogenetic experiments traditionally utilize automated light microscopes and/or advanced illumination setups using LED strips mounted inside incubators. Issues arise, however, when one considers the limitations of these setups. Microscopes have proven to be a powerful approach, however, their low field-of-view (FOV) and high cost make them impractical for studying a large number of cells for long periods of time. Advanced illumination setups involving Arduino microcontrollers can be used as alternatives, but they often require a high degree of coding knowledge and access to special hardware, such as 3D printers. In other words, “a cheap, easy-to-assemble, user-friendly device that provides experimental flexibility is still missing in the optogenetic community” (Höhener et al. 2022). As a result, Thomas Höhener and colleagues tested and developed a tool called LITOS, which requires no prior coding knowledge and hardware. Since our lab is interested in using optogenetics to help us answer our own research questions, we obtained a LITOS system directly from them. Our lab is in the process of collecting preliminary data in order to investigate the differences in gene transcription between cells exposed to LITOS stimulation and those that aren’t.

Effects of Project-Based Learning in an Undergraduate Public Health Course at the University of California, Merced

Author(s): Lindsay K. Crawford, PhD and Rewanshi Kumar 

The use of active, collaborative, and project-based learning has increased significantly in college classrooms due their effective student-centered approaches. Compared to traditional teaching methods, active and project-based learning engages students in the learning process through collaboration on authentic problems. In an effort to better prepare students for careers in public health, we evaluated the efficacy of a collaborative project-based health promotion assignment in an upper division public health course. In order to measure learning, participants completed a pre- and post-assessment in order to measure both actual and self-reported content mastery. Paired-samples t-tests were utilized to examine differences among means. Results demonstrated an average increase of 24% for actual content mastery, with an average 26% self-reported increase. Survey results demonstrated that the group-based project served as a valuable tool for undergraduate learning, with the majority of students evaluating the project positively across all measures. 

Community-Informed Process to Explore the Feasibility of Increasing Nutrition Education Capacity in a Rural Native American Community

Author(s): Namitha Bhat, Karina Díaz Rios, Lenna Ontai, Mical Shilts

Health disparities with food insecurity and malnutrition affect many in rural California communities, especially in Native American youth, so increased access to services like health education may help to mitigate these issues. This project aims to determine the feasibility of connecting existing resources to improve nutrition-related preventive care capacity in these communities. A community participatory process was utilized to adapt traditional nutrition education offered by the Expanded Food and Nutrition Education Program to fit the cultural and contextual needs of the community. The classes were also adapted to be delivered remotely, via telehealth. The Tribal Board identified 3 community members to serve on the Community Advisory Board (CAB) for the project. Four monthly meetings were held with the CAB to discuss class logistics including telehealth delivery, schedule, space, equipment needs, and recipe selection. A partnership with the Outreach Department of the Indian Health Center was established to recruit participants into the classes. A community event was held to further explore recruitment and retention strategies with key informants within the community. A full series of 7 classes has been conducted to date. A total of 22 participants enrolled into the classes; 18 attended at least 4 classes. Dinner and take-home meal kits were provided each class. A local cafe prepared the meals for the classes and volunteers from the community helped with childcare. Participants provided feedback about the acceptability and appeal of the content and delivery mode by completing a survey at the end of each class and through a focus group interview after the last class of the series. Data is being compiled and organized using Excel spreadsheets for subsequent statistical and content analyses. Participants found the content useful to improve their eating practices at home and the telehealth format sufficiently engaging. A second series of classes will be conducted.