Challenging Issues in Community Health: The Role of Research

Friday, November 30, 2012
8:30 AM - 3:30 PM
Hoagland Pincus Conference Center
Shrewsbury, Mass.

The Community Engagement and Research Symposium is part of the five-campus clinical and translational science movement across the University of Massachusetts. It is sponsored by the UMass Center for Clinical and Translational Science (UMCCTS) Community Engagement and Research Section. This page features a collection of posters contributed by presenters at the symposium. The full agenda, the complete list of poster abstracts, and the full text of the keynote and breakout session presentations are also available.

Questions? Contact Phil Merriam or Amy Borg at CommunityEngagement@umassmed.edu.

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2012
Friday, November 30th
8:30 AM

A Parent Focus Group to Inform Improving Access to Adolescent Reproductive Health Services and the Prevention of Teen Pregnancy: A Community Participation Study

Dorothy Brewin, University of Massachusetts - Lowell
Ainat Koren, University of Massachusetts - Lowell
Angela L. Fortenbacher, University of Massachusetts - Lowell
Andrea Laskey, Lowell Community Health Center
Melanie Priestly, Lowell Community Health Center

8:30 AM - 10:00 AM

Background: In 2009, Lowell’s teen birth rate was 53 per 1,000 teens age 15-19 more than double the Massachusetts 2009 rate of 19.6. Teen births occur disproportionately to the most vulnerable teens, with racial and ethnic disparities being common.

Methods: A focus group qualitative methodology was used to capture the subjective experiences of parents of pre-teen and teen parents to explore adolescent utilization of reproductive health services and the issue of teen pregnancy. Focus group interviews (FGI) enabled the researchers to gather rich and detailed information. A diverse group of 10 women who met the selection criteria agreed to participate.

Results: Parents thought teen pregnancies occurred for a variety of reasons with peer pressure, lack of sex education and family discussion of sexuality, pressure from mate and cultural influences being the most common. When exploring barriers to accessing sexual health services, lack of transportation, teen invincibility, denial that they could get pregnant, misconceptions and faulty information were identified as contributing to teen pregnancies. Suggested solutions were: enhance parental communication with teens using techniques such as ―car talk‖ and ―backyard sharing‖; include preteen and teen sexual health discussions in pediatric visits; involve other community groups working with youth; normalize the discussion of sexual health and encourage absence.

Conclusions: The focus groups results will guide the building of teen programs that focus on specific characteristics of risk and resilience, the adolescent-parent relationships and youth development to build a community based intervention to prevent teen pregnancy and improve teen sexual health.

Healthy Homes Asthma Survey

John Corbacio, University of Massachusetts - Lowell
Amy Delgado, University of Massachusetts - Lowell
MaryAnn Ford, University of Massachusetts - Lowell
Nicole Giaquinto, University of Massachusetts - Lowell
Sandra Nabanja, University of Massachusetts - Lowell
Jayson-Ann Wright, University of Massachusetts - Lowell
Leland K. Ackerson, University of Massachusetts - Lowell

8:30 AM - 10:00 AM

Asthma is a serious health concern among older adults in Massachusetts, the age group with the highest number of deaths due to asthma. The objective of this research is to investigate the prevalence of asthma and respiratory illness as well as the presence of environmental respiratory irritants in public senior housing. A total of 57 survey participants were recruited from social events for senior citizens sponsored by the Lowell Housing Authority. A paper survey was used to collect data regarding respiratory health and the presence of respiratory irritants in the homes. The study found that a large portion of the study participants has one or more respiratory ailments, and the majority of the participants have respiratory irritants present in their homes. Seniors living in public housing may benefit from residential respiratory health interventions.

Innovations in Primary Care: Implementing Clinical Care Management in Primary Care Practices

Sai Cherala, University of Massachusetts Medical School
Jeanne Cohen, University of Massachusetts Medical School
Christine Johnson, University of Massachusetts Medical School
Judith Steinberg, University of Massachusetts Medical School

8:30 AM - 10:00 AM

The Massachusetts Patient Centered Medical Home Initiative (MA PCMHI) is a statewide, multi-payer demonstration that seeks to transform 46 primary care practices into PCMHs. Clinical care management of high-risk patients is a key element of the PCMH and a new service for most primary care practices. Training for practices in the MA PCMHI includes the clinical care manager (CCM) role, identification/tracking of highest-risk patients, care plan development/implementation, care coordination, and communications. Content is delivered through learning collaborative sessions, monthly webinars and practice-based transformation facilitation. Assessment of progress towards implementation is made through practice-based data on clinical care management measures and self-assessment of transformation. At year one of implementation, averages for measures such as percentage of patients who received timely follow-up after hospitalizations and ED visits range 37%-63% with 35-40 of 46 practices reporting. The challenges that have hampered implementation include lack of: (1) EMR/registry functionality, (2) hospital to practice notification systems, (3) clarity of the CCM role and workflow, (4) risk stratification criteria for high-risk patients, and (5) adequate resources to support this service. An important lesson learned is that engaged leadership is critical to successful clinical care management implementation. Next steps include refinement of the practice-based self-assessment that is used as a monitoring and QI tool, and a pilot to study the coordination of payer-based and practice-based clinical care management.

Lessons Learned in Conducting School Health Research in Massachusetts: A Massachusetts School Nurse Research Network (MASNRN) Project

Mary Jane O’Brien, Massachusetts School Nurse Research Network and Boston Public Schools
Marie DeSisto, Massachusetts School Nurse Research Network and Waltham Public Schools
C. Lynne McIntyre, Massachusetts School Nurse Research Network and Dotwell
Katherine O'Neill, Massachusetts School Nurse Research Network and Framingham Public Schools
Anne Sheetz, Massachusetts School Nurse Research Network and Massachusetts Department of Public Health

8:30 AM - 10:00 AM

The Institute of Medicine (2007) and the Robert Wood Johnson Foundation (RWJF) (2010) recognized that the school environment plays a role in shaping children’s health and health behaviors, and school health services are positioned to model these approaches. The majority of school health services are school nurse (SN) managed (RWJF, 2012; Schainker, 2005), but a research gap exists linking school health services with improved student outcomes (Hootman, 2002; Lear, 2007). In Massachusetts, the student health research question ideally has roots in the expertise of the SN. The researcher conducting a school-based student health study interacts with SNs and administrators in school districts that vary by the type and number of health staff , as well as district location and size. These variables confound the research design in terms of structure and process. IRB issues and permission for research conduction in the school district are particularly vexing. Consent of parents and assent of children are required, and SNs participating in the research must complete human subjects training. Massachusetts School Nurse Research Network (MASNRN) was founded in 2004 by a group of SN experts to conduct school based research. The 100 members of MASNRN have conducted studies across the state and within school districts on asthma, availability of epinephrine for anaphylaxis, bullying, immunizations, training modules and mental health. Particular lessons learned from the unique experience of conducting research in schools are presented.

Mobile Pantry of Lowell Survey

Krista Bobola, University of Massachusetts - Lowell
Kathleen McCabe, University of Massachusetts - Lowell
Antje Brisbin, University of Massachusetts - Lowell
Nancy Sok, University of Massachusetts - Lowell
Christine Soundara, University of Massachusetts - Lowell
Shawn Patterson, University of Massachusetts - Lowell
Leland K. Ackerson, University of Massachusetts - Lowell

8:30 AM - 10:00 AM

The Mobile Pantry (MP) program of the Merrimack Valley Food Bank in Lowell, Massachusetts provides supplementary food to ensure that their clients have a sufficient amount of appropriate foods for a nutritious diet. The purpose of this project was to assess the effectiveness of MP services and explore opportunities for providing more healthful foods. The project was a descriptive cross-sectional study surveying MP clients, who are homebound, low-income elderly and/or disabled individuals residing in Greater Lowell. The survey took place between October 10 and November 16, 2011. Participation was anonymous and voluntary. The primary client from each of 77 households out of 309 responded to the questionnaire. Most of the respondents were white, female, and over age 65. Most respondents agreed strongly that with MP’s aid they ate more fruits, vegetables, and healthy foods; ate a balanced diet; were more physically and socially active; and generally felt healthier. Most respondents also stated that they would skip more meals and spend less on other necessities if they did not have help from MP. The program may be essential for the health, nutritional well-being, and food security of the low-income elderly and/or disabled in the Greater Lowell community. The results of this study may be utilized to improve MP services and food variety.

Stressing the Hormone: Biological and Psychosocial Factors associated with Chronic Stress

Kymberlee M. O'Brien, University of Massachusetts Boston
Jerrold S. Meyer, University of Massachusetts - Amherst
Edward Z. Tronick, University of Massachusetts Boston
Celia L. Moore, University of Massachusetts Boston

8:30 AM - 10:00 AM

Chronic stress has been associated with a constellation of deleterious psychological and physical health outcomes. We collected cortisol from hair (CORT) to assess chronic stress retrospectively for 3 months’ time (3cms). Over two studies from the UMass Boston campus and the local community, we recruited in t1: 134 adults (ages 18-67; M = 29.49, SD = 12.48) and t2: 145 adults (ages18-30, M = 22.56, SD = 3.54) to participate on two studies assessing objective biological stress (via hair cortisol), subjective perceived stress (via self-reports), psychosocial factors, and health indicators. In follow-up Study 2, we also included indices of perceived discrimination, cardiovascular parameters, and affective vigilance.

Results: t1: CORT levels were positively associated with Total perceived stress and one health indicator: systolic blood pressure. An SES by Race interaction predicted both higher CORT and perceived stress, although higher SES did not always confer the expected benefit of higher SES: minorities in high SES had the greatest CORT, systolic blood pressure, and lowest self-rated health.

Results: t2: Perceived stress measures and new measures of discrimination were negatively associated with well-being and health. Higher racial/ethnic pride was associated with better health, but also increased daily discrimination and waist-to-hip ratio. The SES by Race interaction was again associated with Total perceived stress and minorities in higher SES reported greatest Total stress. Minorities also showed the greatest vigilance. Specifically, African-Americans had the longest latencies for social devaluation words during a modified Stroop, the greatest city stress, and the greatest pride/identity for heritage group.