Tassy Parker

Reducing health disparities through a culturally centered mentorship program for minority faculty: the Southwest Addictions Research Group (SARG) experience.

Purpose Ethnic minority faculty members are vastly underrepresented in academia. Yet, the presence of these individuals in academic institutions is crucial, particularly because their professional endeavors often target issues of health disparities. One promising way to attract and retain ethnic minority faculty is to provide them with formal mentorship. This report describes a culturally centered mentorship program, the Southwest Addictions Research Group (SARG, 2003-2007), at the University of New Mexico (UNM) that trained a cadre of minority researchers dedicated to reducing health disparities associated with substance abuse. Method The SARG was based at UNM’s School of Medicine’s Institute for Public Health, in partnership with the UNM’s Center on Alcoholism, Substance Abuse, and Addictions. The program consisted of regular research meetings, collaboration with the Community Advisory Board, monthly symposia with renowned professionals, pilot projects, and conference support. The authors collected data on mentee research productivity as outcomes and conducted separate mentee and mentor focus-group interviews to assess the strengths and weaknesses of the SARG program. Results The SARG yielded positive outcomes as evidenced by mentee increase in grant submissions, publications, and professional presentations. Focus-group qualitative data highlighted program and institutional barriers as well as successes that surfaced during the program. Based on this evaluation, a Culturally Centered Mentorship Model (CCMM) emerged. Conclusions The CCMM can help counter institutional challenges by valuing culture, community service, and community-based participatory research to support the recruitment and advancement of ethnic minority faculty members in academia.

Psychological distress among Plains Indian mothers with children referred to screening for Fetal Alcohol Spectrum Disorders

BackgroundPsychological distress (PD) includes symptoms of depression and anxiety and is associated with considerable emotional suffering, social dysfunction and, often, with problematic alcohol use. The rate of current PD among American Indian women is approximately 2.5 times higher than that of U.S. women in general. Our study aims to fill the current knowledge gap about the prevalence and characteristics of PD and its association with self-reported current drinking problems among American Indian mothers whose children were referred to screening for fetal alcohol spectrum disorders (FASD).MethodsSecondary analysis of cross-sectional data was conducted from maternal interviews of referred American Indian mothers (n = 152) and a comparison group of mothers (n = 33) from the same Plains culture tribes who participated in an NIAAA-funded epidemiology study of FASD. Referred women were from one of six Plains Indian reservation communities and one urban area who bore children suspected of having an FASD. A 6-item PD scale (PD-6, Cronbachs alpha = .86) was constructed with a summed score range of 0-12 and a cut-point of 7 indicating serious PD. Multiple statistical tests were used to examine the characteristics of PD and its association with self-reported current drinking problems.ResultsReferred and comparison mothers had an average age of 31.3 years but differed (respectively) on: education (<high school: 47.4%, 9.1%), PD-6 mean scores (3.57, 1.48), current prevalence of serious PD (19.1%, 0.0%), and a current drinking problem (31.6%, 12.1%). Among referred mothers, those with a current drinking problem had a significantly higher mean PD-6 score. Having PD, serious PD, and 2 specific scale items significantly increased the odds that a referred mother would have a current drinking problem.ConclusionsPsychological distress among referred mothers is significantly associated with having a self-reported drinking problem. FASD prevention requires multi-level prevention efforts that provide real opportunities for educational attainment and screening and monitoring of PD and alcohol use during the childbearing years. Mixed methods studies are needed to illuminate the social and cultural determinants at the base of the experience of PD and to identify the strengths and protective factors of unaffected peers who reside within the same communities.

Healthy Children, Strong Families 2: A randomized controlled trial of a healthy lifestyle intervention for American Indian families designed using community-based approaches:

Background/Aims Few obesity prevention trials have focused on young children and their families in the home environment, particularly in underserved communities. Healthy Children, Strong Families 2 is a randomized controlled trial of a healthy lifestyle intervention for American Indian children and their families, a group at very high risk of obesity. The study design resulted from our long-standing engagement with American Indian communities, and few collaborations of this type resulting in the development and implementation of a randomized clinical trial have been described. Methods Healthy Children, Strong Families 2 is a lifestyle intervention targeting increased fruit and vegetable intake, decreased sugar intake, increased physical activity, decreased TV/screen time, and two less-studied risk factors: stress and sleep. Families with young children from five American Indian communities nationwide were randomly assigned to a healthy lifestyle intervention (Wellness Journey) augmented with social support (Facebook and text messaging) or a child safety control group (Safety Journey) for 1 year. After Year 1, families in the Safety Journey receive the Wellness Journey, and families in the Wellness Journey start the Safety Journey with continued wellness-focused social support based on communities’ request that all families receive the intervention. Primary (adult body mass index and child body mass index z-score) and secondary (health behaviors) outcomes are assessed after Year 1 with additional analyses planned after Year 2. Results To date, 450 adult/child dyads have been enrolled (100% target enrollment). Statistical analyses await trial completion in 2017. Lessons learned Conducting a community-partnered randomized controlled trial requires significant formative work, relationship building, and ongoing flexibility. At the communities’ request, the study involved minimal exclusion criteria, focused on wellness rather than obesity, and included an active control group and a design allowing all families to receive the intervention. This collective effort took additional time but was critical to secure community engagement. Hiring and retaining qualified local site coordinators was a challenge but was strongly related to successful recruitment and retention of study families. Local infrastructure has also been critical to project success. Other challenges included geographic dispersion of study communities and providing appropriate incentives to retain families in a 2-year study. Conclusion This multisite intervention addresses key gaps regarding family/home-based approaches for obesity prevention in American Indian communities. Healthy Children, Strong Families 2’s innovative aspects include substantial community input, inclusion of both traditional (diet/activity) and less-studied obesity risk factors (stress/sleep), measurement of both adult and child outcomes, social networking support for geographically dispersed households, and a community selected active control group. Our data will address a literature gap regarding multiple risk factors and their relationship to health outcomes in American Indian families.

The new 6-unit individualized curriculum for pediatric residents: the perspective of neonatology fellowship program directors.

Objective:Starting in 2013, all pediatric residents entering fellowship must be provided six educational units whose structure is to be determined by their individual career plans. We sought to determine whether (1) neonatology fellowship program directors (PDs) consistently identify certain weaknesses among incoming fellows and (2) neonatology fellowship PDs agree on the most beneficial activities in which pediatric residents should participate to improve preparation for entry into neonatology fellowships.Study design:We sent a 21-question survey focused on the structure and implementation of the 6-unit curriculum to all members of the Organization of Neonatology Training Program Directors.Results:Sixty-seven percent of PDs responded. Seventy-five percent cited insufficient procedural skills as the primary weakness of incoming fellows. More than 80% rated additional training in clinical neonatology, including procedural and resuscitation training, as ‘beneficial’ or ‘highly beneficial’. In contrast, fewer than 40% of PDs gave the same positive ratings to activities broadly focused on scholarship.Conclusions:The results of the survey may help guide pediatric residency programs as they undertake development of these new curricular initiatives for individual residents entering neonatology.

Organization of Neonatal Training Program Directors Council responds to the ACGME 2010 Proposed Standards

Organization of Neonatal Training Program Directors Council responds to the ACGME 2010 Proposed Standards

Overnight sleep duration and obesity in 2-5 year-old American Indian children: Sleep and obesity

Sleep has emerged as a potentially modifiable risk factor for obesity in children.

Predictors of Overweight and Obesity in American Indian Families With Young Children

Objective: To describe sociodemographic factors and health behaviors among American Indian (AI) families with young children and determine predictors of adult and child weight status among these factors. Design: Descriptive, cross‐sectional baseline data. Setting: One urban area and 4 rural AI reservations nationwide. Participants: A total of 450 AI families with children aged 2–5 years participating in the Healthy Children, Strong Families 2 intervention. Intervention: Baseline data from a healthy lifestyles intervention. Main Outcome Measures: Child body mass index (BMI) z‐score and adult BMI, and multiple healthy lifestyle outcomes. Analysis: Descriptive statistics and stepwise regression. Results: Adult and child combined overweight and obesity rates were high: 82% and 40%, respectively. Food insecurity was high (61%). Multiple lifestyle behaviors, including fruit and vegetable and sugar‐sweetened beverage consumption, adult physical activity, and child screen time, did not meet national recommendations. Adult sleep was adequate but children had low overnight sleep duration of 10 h/d. Significant predictors of child obesity included more adults in the household (P = .003; &bgr; = 0.153), an adult AI caregiver (P = .02; &bgr; = 0.116), high adult BMI (P = .001; &bgr; = 0.176), gestational diabetes, high child birth weight (P < .001; &bgr; = 0.247), and the family activity and nutrition score (P = .04; &bgr; = 0.130). Conclusions and Implications: We found multiple child‐, adult‐, and household‐level factors influence early childhood obesity in AI children, highlighting the need for interventions to mitigate the modifiable factors identified in this study, including early life influences, home environments, and health behaviors.

What If Medicine Disappeared

racial groups is far greater than diversity between socially recognized racial groups. He shows that the racial groupings commonly used in the medical profession are disturbingly imprecise and inaccurate (for example, the health status of African Americans is quite different from the health status of African immigrants) and that there is little research supporting racially driven medical decision-making. Barr offers health care providers a useful guide to determine when it makes sense to consider race in the medical decision-making process and when an emphasis on race obscures other more salient individual characteristics. In light of this nuanced approach, I find it somewhat surprising that Barr decided not to address gender in this book. He notes in the Preface that he chose to limit his discussion of health disparities to those that involve race, class and ethnicity because disparities based on gender (and age) “exist in a different context and stem from different causes, and they deserve their own examination and policy analysis” (p. xiii). Personally, I do not find this disclaimer persuasive. Gender disparities exist in exactly the same context as class, race and ethnic disparities—that context is what we call society. The pains and illnesses of racism and classism are always inscribed on gendered bodies—there are no other kinds of bodies in our social world. Barr cites a study that looks at gender and the impact of education on life expectancy in a North Carolina population. It turns out that white men with lower educational attainments lived 0.9 years longer than similarly educated black men. Regarding women, however, the authors found the opposite to be the case: Among women with lower educational attainments, whites lived 0.4 years fewer than blacks. The authors of this study (Gornick et al. 1996) conclude that “gender has a larger influence on life expectancy than race or education” (Barr, p. 148). By drawing attention to this particular study my intention is not to deflect attention from racial or economic disparities. They are real and they wreck havoc on the lives and health of millions of Americans. Rather, I hope to encourage exactly the kind of nuanced analysis that Barr advances in this book. Race, class, ethnicity and gender are intertwined moving targets that appear quite differently depending upon who is doing the looking. Good clinical practice, good medical research, and good policy-making rely on acknowledging these realities of our social landscape. To that end, Barr’s work makes a substantial contribution.