the impact of intervention strategies for overcoming barriers to
reproductive healthcare seeking for African American women residing in
the study’s setting (Hudson, New York). Primary intervention strategies
include a series of community health education events and a
transportation voucher program.
(by the end of the data collection period of the project, December
2012) by at least 25% the number of African American women in Hudson,
New York and environs who are receiving reproductive healthcare as
demonstrated by increased clinical attendance at the local publicly
funded reproductive healthcare provider, Upper Hudson Planned
Studies and Results
1. In 2011, through October 20th, the Project conducted 5 Community Health Education Events (one every two months) on topics related to women’s reproductive health. Venues and formats were varied to assess their effectiveness in engaging underserved women in the community. Assessment tools and measures included attendance numbers, pre- and post-event questionnaires measuring knowledge, attitudes, and behavioral intentions, qualitative interviews ascertaining participants’ reactions to events, and the number of
participants who signed up to receive services.
Project expanded the range of interventions it designed and conducted
to increase underserved women’s access to services related to
March 2011, the Project initiated monthly HIV/STD testing events out of
the Project’s field office in collaboration with the AIDS Council of
May 2011, the Project initiated weekly outreach sessions at the
subsidized housing complex in collaboration with Upper Hudson Planned
Parenthood, during which UHPP supplied free safer sex kits and emergency
contraception kits. Reproductive and sexual health information was
offered, and an opportunity to sign up for clinical services at UHPP and
taxi vouchers from the Project were available.
August, 2011 the Project began a peer outreach assistant initiative: 6
women from community were hired to assist with weekly
reproductive/sexual health outreach, and to assist with promoting and
carrying out monthly community health education events. The group is
receiving training on outreach techniques and reproductive/sexual health
facts (through UHPP). The group meets weekly for discussion and
Community Advisory Board met January 26 and May 19, and November 3.
Meetings provide a forum for discussing past events and planning future
events. The Board members are both advisory and represent community
partners who participate in the health resource fairs. As local
community members, the Board members have been a valuable source of
guidance about leveraging event participation around other community
events and groups.
research team continued to collect knowledge, attitude, and behavioral
intention data using and pre- and post-event questionnaires, and to
collect data on participants’ reactions to events through post-event
qualitative interviews, from UHPP clients, and from users of the Taxi
Voucher program to collect participants’ perceptions of its impact on
their reproductive healthcare seeking behavior. The team continued
qualitative data analysis of interview transcripts using NVivo, and
quantitative data analysis of pre- and post-interview questionnaires. We
added post-testing interviews in connection with AIDS Council testing
to collect participants’ perceptions of the importance of availability
of on-site testing. We conducted 3 focus group discussions with women in
the community on perceptions of women’s health needs, availability of
resources, and barriers to healthcare seeking.
15 will be Mammography Night at Columbia Memorial Hospital held in
partnership with the CMH Medical Imaging Unit and the Columbia County
Community Healthcare Consortium. In December the project will conduct a multiple CBO event including a health education/entertainment presentation.
9. Gather quantitative outcome data and qualitative process data on experiences of peer outreach assistants.
to collect and analyze qualitative (interview, ethnographic) and
quantitative (pre- and post-questionnaire; attendance) data.
the project’s third year, the Project has continued to explore new
venues and new formats for engaging underserved women in the community.
The 14 health education events and resource fairs conducted so far,
together with our more recent smaller scale interventions and analysis
of the data gathered from them, have helped the research team identify
effective strategies for planning and conducting community events. The
primary challenges the project faces are eliciting participation in
interventions and moving individuals who do participate to take the next
step to signing up to receive healthcare services. In the second half
of Year 3, and going forward into Year 4, the Project is shifting its
strategy to work more intensively and individually with organizations
whose missions most closely align with the Project’s central goals;
however, the Project will continue to maintain relationships with
community organizations and promote women’s reproductive health as part
of overall healthy lifestyle through at least 2 multi-organization
events in Year 4.
addition to encouraging underserved women to seek reproductive and
sexual health-related services at UHPP and other health service
organizations, the Project will continue to emphasize bringing the
services to the women, for example in weekly outreach sessions and
monthly on-site testing.
Continue to conduct community health education events every 1 to 2 months.
to work with peer outreach assistants on community activities and to
gather qualitative process data on their experiences.
to partner with agencies such as UHPP, Healthcare Consortium, and the
AIDS Council to bring services related to reproductive and sexual health
to underserved women in the focus community.
Continue to collect and analyze data for presentations and publication.
PUBLICATIONS AND PRESENTATIONS
|Golden, A. G., & Pomerantz, A. (2011). Intermediate
and behavioral health outcomes of community education events: Evidence
from interventions to increase reproductive healthcare seeking among
small town, low income African American women. Session presentation at the APHA Annual Meeting, Washington, DC, November.
Golden, A. G., Pomerantz, A., & Scott, M. (2011). Becoming
part of the environment of the underserved: An ecologically informed
intervention to increase reproductive healthcare seeking among low
income African American women. Session presentation at the National Conference on Health Communication, Marketing, and Media of the CDC, Atlanta, August.
Golden, A. G., & Pomerantz, A. (2011). Communicating in time: Temporal dimensions of community health promotion. Competitive poster presented at the D.C. Health Communication Conference, Fairfax, VA, April.
Curry, R., Golden, A. G., & Pluviose, C. (2011). Do you have “C.L.A.S.”?
Workshop presentation at the National Lesbian, Gay, Bisexual &
Transgender People of Color Health Summit, Albany, NY, October.
Project website www.albany.edu/womenshealthproject (established 2009 and updated before and after each event).
PROJECT 2: Environmental contaminants and reproductive health of Akwesasne Mohawk women.
The specific aims of the study are unchanged from original application.
They are summarized here:
1 is to determine the relationship between the body burden of PCB
congeners and specific measures of reproductive function in females,
specifically: a) pituitary function as indexed by gonadotropin levels,
b) gonadal function as indexed by estradiol (E2) and progesterone (P)
levels, and c) other characteristics of the menstrual cycle as reported
through diary and questionnaire.
2. Aim 2 is to determine the relationship between lead levels and measures of reproductive function as described in Aim 1 above.
3 is to determine whether there are moderating factors (includes
susceptibility factors) that influence effects of PCBs and lead on
measures of reproductive functioning.
Studies and Results
the third grant year, continued time and effort was focused on
maintaining a high level of effort in recruitment of potential
participants, and data collection.
In concert with this effort we
hire of an additional woman to facilitate data collection and conduct
interviews. A community member that is invested in the well-being of the
people of Akwesasne, she helps the Project staff on all participant
visits with anthropometric measurements and blood draws.
the Project staff in data collection techniques including conducting
interviews, phlebotomy (for certification) and anthropometry, research
ethics, and other data collection methods.
3. Development of the database has been completed, and data entry and checking is ongoing.
recruitment has expanded to women who seek care from the Canadian
Health Service, with permission and approval by the University at Albany
IRB, the Canadian Health Services Director, and the SRMHS Director. Our
pool of potential participants has increased.
5. Recruitment to date:
a. As of 9/30/2011, a total of 641 women have been approached. Of these, 188 were eligible, 453 were ineligible (on birth control, pregnant, nursing, on thyroid medications, or outside age range).
b. 128 women have signed informed consent forms. Of these 128, 27
withdrew before completing project requirements (either became
pregnant, decided to go on birth control, or were unable to be reached
to schedule appointments), 82 have completed all requirements of the study, 7 have yet to finish their saliva collection, and 12 are waiting for their next menstrual cycle to begin.
c. As of 9/30/2011, there is one
potential participant who is waiting to meet the eligibility criteria
(Completed time post-nursing, post-birth control, post-pregnancy).
6. Results as of 09/30/2011:
- Toxicant levels:
the 102 whole blood serums delivered to the Exposure Assessment
Laboratory, final toxicant levels on 41 have been received (includes
- Clinical chemistries:
the 109 bloods delivered to LabCorps Inc. for analysis of the clinical
chemistries, results on all 109 individuals have been received.
- Salivary estradiol and progesterone levels:
collected over the course of one menstrual cycle on 86 women has been
delivered to the Neurobehavioral Laboratory. Preliminary results on 82
women have been completed
significance cannot be assessed until more results are obtained, and
this cannot occur until data collection is complete for more
participants. The immediate and non-scientific significance is that the
work to date shows that there is substantial interest in the research by
the community, good participation from those women who are eligible,
and that the protocol for data collection and laboratory analyses is
workable. It also shows that the partnership between the Akwesasne
Mohawk Nation and the University at Albany is on solid footing.
Our plans for the near future are as follows:
1. Continue recruiting participants. We estimate an average of three to four participants a month.
2. Continue data collection and data entry; start preliminary analyses.
3. Continue meeting with the SRMHS director to discuss the project and future directions.
a CKON Radio (local station) interview with the PI (Schell) which will
be broadcast in both English and Mohawk (translated) to discuss the
5. Present results to the health providers and the project participants.
Publications and Presentations
Gallo MV, Schell LM, DeCaprio AP, Jacobs, A. Levels of
persistent organic pollutant and their predictors among young adults.
Chemosphere. 2011 May; 83(10):1374-82.
Behforooz B, Brooke GC, Fan W, Lee JE, Newman J, Gallo MV,
Schell, LM, Akwesasne Task Force on the Environment. The Influence of
Breastfeeding on the Cognitive Functioning of Children Raised in an
Environment Polluted with PCBs (Poster). Presented at Society for
Research in Child Development, Montreal, Canada in March-April 2011.
Burnitz KK, Schell LM, Gallo MV. The impact of early
exposure to PCBs and p,p’-DDE on adult BMI in the Akwesasne Mohawk
(Poster) Presented at the 2011 Human Biology Association, Minneapolis,
Minnesota, April 2011.
Karsten JK, Schell LM, Gallo MV. The impact of toxicants
and maternal cigarette use on sex steroid levels in pre-menarcheal
Mohawk females (Poster). Presented at the 2011 Human Biology
Association, Minneapolis, Minnesota, April 2011.
Nelder KR, Schell LM, Gallo MV. Persistent organic
pollutants and testosterone levels in a male adolescent Native American
sample (Poster). Presented at the 2011 Human Biology Association,
Minneapolis, Minnesota, April 2011.
Schell LM, Gallo MV, Ravenscroft J, Nelder KR , Burnitz
KK. Toxic foods: What shouldn’t be for dinner? (Podium Presentation).
Presented at the 2011 Human Biology Association, Minneapolis, Minnesota,
PROJECT 3: Decomposing Racial/Ethnic Disparities in Health
SPECIFIC AIMS (unmodified from original)
STUDIES AND RESULTS
The project team continues
to meet monthly as a large group, as well as weekly in smaller groups
that are convened to discuss particular tasks and papers.
complete drafts of the following three papers.
(1) Beware of being
unaware: racial/ethnic disparities in awareness of chronic disease
(Specific Aims 1 and 2) estimates racial/ethnic disparities in
individuals’ awareness of chronic disease using biomarker data from the
2006 Health and Retirement Study. We focus on
racial/ethnic differences in disease awareness since these differences
may be a critical factor underlying disparities in treatment and
adequate control of disease. The findings suggest that African-Americans
are more likely than non-Latino whites to have hypertension, but we
find no statistically significant differences in awareness of
hypertension between African-Americans and non-Latino whites. All
minority groups are more likely than non-Latino whites to have diabetes
but, among those with diabetes, African-Americans and Latinos are less
likely to be aware of their condition compared to non-Latino whites.
(2) Child health
inequality and its dynamics through adolescence (Specific Aim 3) applies
innovative methods from econometrics to estimate racial/ethnic
disparities in child health in U.S., and examine how disparities change
as children enter adolescence. Data come from the Panel Study on Income
Dynamics – Child Development Supplement. The results
indicate parental education and employment are important factors
underlying income-related health inequality among children in the US.
Especially for African-American children, effective policies to reduce
disparities would include policies that target family structure and
mother’s education and employment. Living in a large
metropolitan area (1 million+ population) in the US is associated with
higher levels of child health after controlling for other factors. Urban
residence is an important factor in the decomposition of child health
inequality both across and within racial/ethnic groups.
(3) Early health
conditions and disparities in academic achievement, uses data from the
Child Development (CDS) and the Transition into Adulthood (TA)
Supplements of the Panel Study of Income Dynamics (PSID) to examine the
role of health at birth and in early childhood as a contributor to
racial disparities in academic achievement and educational attainment
later in life. Our preliminary findings show that poor health at birth
and in childhood indeed is more prevalent among African-American
children compared to non-Latino white children. However,
the negative effects of poor health on academic outcomes appear to be
concentrated among non-Latino white children, and the effects of poor
health at birth on academic outcomes are small in magnitude. As a result, early health is not an important contributor to racial differences in test scores or educational attainment. Racial
differences in educational attainment, in fact, are fully accounted for
by racial differences in maternal SES at the time of the child’s birth.
All three papers were presented at the American Society of Health Economists (ASHE) biennial conference in July 2010. The third paper was part of a session our group organized on this topic. In
addition, the second paper was accepted for and presented at a
selective meeting on health and SES research hosted by the Panel Study
on Income Dynamics in Ann Arbor, MI in September 2010.
Project staff had training
opportunities, including taking on-line courses in STATA and attending a
selective Summer Institute on Health and Aging held at RAND in July,
The completion of these
analyses, particularly the analyses associated with Specific Aim 3, will
provide unique data on the magnitude and persistence of health
disparities along an urban-rural continuum. These results will identify
health disparities that may be especially important to address in the
smaller cities and towns comparable to the communities in which the
Center is developing its intervention research.
In the next year, we will
work to obtain community level data which can be merged to individual
records in these large secondary data sets. This will allow us to examine effects of community size and community attributes at a more disaggregated level.
PRESENTATIONS AND PUBLICATIONS
Chatterji P, Heesoo J,
Lahiri K. Beware of Being Unaware: Disparities in the Awareness of Major
Chronic Illnesses. American Society of Health Economists, 3rd Biennial
Conference, Ithaca, NY, June 2010.
Chatterji P, Lahiri K, Song J. Child health disparity analysis
and income gradient: evidence from PSID-CDS Data. American Society of
Health Economists, 3rd Biennial Conference, Ithaca, NY, June 2010.
Chatterji P, Lahiri K. Early Health Conditions and Racial
Disparities in Academic Achievement. American Society of Health
Economists, 3rd Biennial Conference, Ithaca, NY, June 2010.
Chatterji P, Lahiri K, Song J. Child health disparity analysis
and income gradient: evidence from PSID-CDS Data. Panel Study on Income
Dynamics Conference: Research on Connections between Health and
Socioeconomic Status Using PSID Data. Ann Arbor, MI, September 2010.
Chatterji P, Joo H, Lahiri K. Beware of being unaware:
Racial/ethnic disparities in awareness of chronic disease, National
Bureau of Economic Research (NBER) working paper, 2010.
Lahiri K, Pulungan Z. Health inequality and its determinants in
New York. Journal of Human Capital. Submitted for publication, 2010.