Sharon D. Morrison

What Changes When We Move? A Transnational Exploration of Dietary Acculturation

This study aimed to explore Mexican dietary acculturation patterns among immigrants using a unique transnational photographic assessment. Participants (N = 10) were Latino mother and child pairs living in Mexico (1 pair) and in the United States (4 pairs). Data were collected in 2 phases: 1) participant observation and photography in Mexico, and 2) in-depth interviewing using photographic guides in North Carolina. Environment, daily activity patterns, shopping, and dietary patterns in Mexico were all documented. Acculturation resulted in poor dietary intake due to decreased availability, food displacement, and cost. Decreases in physical activity due to environmental and social barriers were also reported.

Violence against women symptom reporting and treatment for reproductive tract infections in Kerala State southern India.

In this article we examine factors associated with womens self-reports of reproductive ill health symptoms and factors associated with seeking and receiving treatment for the symptoms. We focus on indicators of womens societal position, especially empowerment (indicated by experience of and attitudes toward violence against women), autonomy, and education. We used data from the National Family Health Survey-2 from Kerala state in Southern India. Based on our results we suggest that violence against women, whether actually experienced or internalized as acceptance of its justification, is associated with increased ill health symptoms, and the acceptance of violence is associated with decreased chance of treatment. Womens higher formal education appeared to reduce treatment seeking for reproductive ill health, perhaps due to the stigma associated with sexually transmitted disease (STD) in this cultural setting. Womens work participation had no significant impact, nor did indicators of womens economic and personal autonomy.

Marital Violence and Women's Reproductive Health Care in Uttar Pradesh, India

OBJECTIVE Although the impact of marital violence on womens reproductive health is recognized globally, there is little research on how womens experience of and justification of marital violence in developing country settings is linked to sexually transmitted infection (STI) symptom reporting, and seeking care for the symptoms. METHOD This study analyzes data on 9,639 currently married women from Indias 2006-2007 National Family Health Survey-3 from the Central/Northern Indian state of Uttar Pradesh. The likelihood of currently married womens reporting STIs or symptoms, and the likelihood of seeking care for these, are analyzed using multivariate logistic regression techniques. RESULTS Currently married womens experience of physical, sexual, and emotional marital violence in the last 12 months was significantly associated with greater likelihood of reporting a STI or symptom (odds ratio [OR], 1.364 [95% confidence interval (CI), 1.171-1.588] for physical violence; OR, 1.649 [95% CI, 1.323-2.054] for sexual violence; OR, 1.273 [95% CI, 1.117-1.450] for emotional violence). Experience of physical violence (OR, 0.728; 95% CI, 0.533-0.994) and acceptance of any justification for physical violence (OR, 0.590; 95% CI, 0.458-0.760) were significantly associated with decreased chance of seeking care, controlling for other factors. CONCLUSION This study suggests that experiencing marital violence may have a negative impact on multiple aspects of womens reproductive health, including increased self-report of STI symptoms. Moreover, marital physical violence and accepting justification for such violence are associated with decreased chance of seeking care. Thus, policies and programs to promote reproductive health should incorporate decreasing gender-based violence, and overcoming underlying societal gender inequality.

Cultural Adaptation Resources for Nutrition and Health in New Immigrants in Central North Carolina

This paper presents results of a study that was conducted for the purposes of describing available human services resources relating to nutrition, physical health, and behavioral health for new and recent immigrants (predominantly Mexican immigrants, but groups from Southeast Asia and continental Africa as well) in Guilford County, NC. Sixty-five service providers were determined to represent cultural adaptation resources providing either direct and/or ancillary assistance to limited English proficient immigrants. Seventeen direct assistance providers specialized in food and nutrition programs, but only 2 had targeted programs for addressing food scarcity, insecurity, and nutritional deficiencies in immigrant households. Four of 15 direct physical health services providers had clinical care or specialty programs for immigrants. Finally, 5 of 16 direct behavioral health care providers offered mental health treatment and counseling services adapted specifically for targeted immigrant groups. These findings highlight the limited development of the existing human services network to increase its capacity to provide nutrition and health related services to a growing community of diverse immigrant groups. These descriptive results underscore a need for additional local level or community based resources to be directed towards increasing the community’s ability to provide essential human services to population groups not yet language proficient and acculturated to “American community standards.”

Lifestyle and Food-Related Challenges Refugee Groups Face Upon Resettlement: Do we Have to Move Beyond Job and Language Training Programs?

An exploratory qualitative study was conducted to assess lifestyle and food-related changes that refugees experience upon resettlement in the United States. A convenience sample including 18 refugee women and 5 refugees who were physicians prior to resettlement was interviewed. Overall, loss of social network, poor physical activity, and stress related to household expenditures were identified as major issues of resettlement lifestyle. Participants reported increase in intake of meat, soda/fruit drinks, and dairy after moving to the United States. Results also indicated that in contrast to daily, need-based food shopping, participants had to train themselves to do weekly or planned food shopping. In addition to job and language training, resettlement programs should focus on providing skills to adapt to nuances of the host countrys infrastructure.

TRUCE for Advocacy and Peer Education in Tobacco Prevention

In response to aggressive marketing of tobacco to college students, Floridas legislature allocated multi-settlement agreement dollars to fund tobacco prevention programming at state institutions of higher learning. The Student Tobacco Reform Initiative: Knowledge for Eternity (STRIKE) was one such program. Its purpose was to increase awareness and support college student advocacy for prevention. In this program note, we introduce Targeting, Resource Identification, and Unification for College Peer Education (TRUCE), the strategy used to facilitate implementation of STRIKE tobacco prevention programming by student advocates at a metropolitan university campus.

American-Indian diabetes mortality in the Great Plains Region 2002–2010

Objective To compare American-Indian and Caucasian mortality rates from diabetes among tribal Contract Health Service Delivery Areas (CHSDAs) in the Great Plains Region (GPR) and describe the disparities observed. Research design and methods Mortality data from the National Center for Vital Statistics and Seer*STAT were used to identify diabetes as the underlying cause of death for each decedent in the GPR from 2002 to 2010. Mortality data were abstracted and aggregated for American-Indians and Caucasians for 25 reservation CHSDAs in the GPR. Rate ratios (RR) with 95% CIs were used and SEER*Stat V.8.0.4 software calculated age-adjusted diabetes mortality rates. Results Age-adjusted mortality rates for American-Indians were significantly higher than those for Caucasians during the 8-year period. In the GPR, American-Indians were 3.44 times more likely to die from diabetes than Caucasians. South Dakota had the highest RR (5.47 times that of Caucasians), and Iowa had the lowest RR, (1.1). Reservation CHSDA RR ranged from 1.78 to 10.25. Conclusions American-Indians in the GPR have higher diabetes mortality rates than Caucasians in the GPR. Mortality rates among American-Indians persist despite special programs and initiatives aimed at reducing diabetes in these populations. Effective and immediate efforts are needed to address premature diabetes mortality among American-Indians in the GPR.

Reaching Latinas with Our Bodies, Ourselves and the Guía de Capacitación para Promotoras de Salud: health education for social change.

As the cultural and linguistic diversity of the United States continues to grow and population shifts transform the communities where we live and work, health care providers continue to face challenges to deliver health services in demographically redefined terrains. This report describes the development of a Spanish-language training guide for community health workers (Guía de Capacitación para Promotoras de Salud) based on the book Nuestros Cuerpos, Nuestras Vidas (NCNV), the Spanish-language translation and cultural adaptation of the classic womens health book Our Bodies, Ourselves. The guide aims to 1) provide a tool for addressing the health education needs of immigrant Latinas and 2) facilitate the use of the book NCNV as a health education tool in Latino communities. Thirty telephone interviews with individuals working in agencies and organizations serving Latinos and 2 focus groups with Latinas were conducted to select the topics included in the training guide, all of which were drawn directly from NCNV. The guide contains 11 modules organized into 6 workshops. The modules address 11 topics related to womens health, ranging from sexuality and pregnancy to domestic violence and mental health. An ecological framework is used to deliver the health information. The materials acknowledge the roles of history, environment, culture, economic conditions, migration history, and politics as key determinants of health and illness. The workshops are designed to train community health workers on the womens health topics contained in the guide and to equip them for the delivery of health education among immigrant Latinas.

Emerging Trends in Family Caregiving Using the Life Course Perspective: Preparing Health Educators for an Aging Society

Background: As life expectancy and morbidity related to chronic disease increase, the baby boomers will be called upon to provide care to aging members of their family or to be care recipients themselves. Purpose: Through the theoretical lens of the life course perspective, this review of the literature provides insight into what characteristics of baby boomers separate them from previous caregiving cohorts and how these characteristics will affect family caregiving. Methods: A systematic process to identify literature was completed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: Findings suggest multiple emerging trends related to caregiving, including (1) increasing use of digital technology for information gathering and support, (2) more diversity among caregivers and care recipients, (3) strained finances and loss of entitlements, (4) more complex care and care management, (5) demand for public policies related to caregiving, and (6) balancing work, family, chronic disease, and caregiving. Discussion: Examining the literature related to family caregiving and baby boomers through a life course perspective offers a unique and more complete understanding of emerging trends related to chronic disease management. Translation to Health Education Practice: These emerging trends offer health educators implications for strategies and best practices intended to support those involved in family caregiving.

Race, Socioeconomic Status, and Age: Exploring Intersections in Preterm Birth Disparities among Teen Mothers

Few studies have examined disparities in adverse birth outcomes and compared contributing socioeconomic factors specifically between African-American and White teen mothers. This study examined intersections between neighborhood socioeconomic status (as defined by census-tract median household income), maternal age, and racial disparities in preterm birth (PTB) outcomes between African-American and White teen mothers in North Carolina. Using a linked dataset with state birth record data and socioeconomic information from the 2010 US Census, disparities in preterm birth outcomes for 16,472 teen mothers were examined through bivariate and multilevel analyses. African-American teens had significantly greater odds of PTB outcomes than White teens (OR = 1.38, 95% CI 1.21, 1.56). Racial disparities in PTB rates significantly varied by neighborhood income; PTB rates were 2.1 times higher for African-American teens in higher income neighborhoods compared to White teens in similar neighborhoods. Disparities in PTB did not vary significantly between teens younger than age 17 and teens ages 17-19, although the magnitude of racial disparities was larger between younger African-American and White teens. These results justify further investigations using intersectional frameworks to test the effects of racial status, neighborhood socioeconomic factors, and maternal age on birth outcome disparities among infants born to teen mothers.