Health of Women, Children, and Families

The relationship between air pollution and asthma outcomes among students will be studied by deploying personal monitoring and novel wearable technologies. Outdoor and indoor low-cost sensor networks will be established throughout Tucson schools to characterize spatiotemporal patterns of air pollution and develop machine learning-based prediction models. This project was funded by the University of Arizona.

This study will evaluate the impact of a multi-site green playground renovation program on academic performance (test scores, absenteeism, graduation rate) and health outcomes (respiratory health, physical activity, body mass index) in New York City (NYC) students employing a quasi-experimental study design. This project was funded by the Robert Wood Johnson Foundation. 

The purpose of this project is to investigate the association between infertility and risk of postmenopausal breast cancer among women in the Women’s Health Initiative. This project was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. 

The overarching goal of this project is to inform parents, pediatricians, and eye care providers if prescribing spectacles for astigmatic toddlers will have a beneficial effect on their global development and will allow clinicians to make evidence-based, rather than consensus-based, recommendations regarding treatment of astigmatism in toddlers. Research area: Vision Science (Ophthalmology)

Firefighters are exposed to many harmful materials and conditions while fighting fires. These hazardous exposures put them at risk for damaging health effects, including those that may negatively impact female reproductive health. Anti-müllerian hormone (AMH) can be used as a measure of ovarian reserve, or the quantity of eggs in the ovaries. Exposure to harmful substances has been shown to decrease AMH. We will measure the AMH levels of female firefighters and compare them to the AMH levels of females who are not firefighters. The AMH measurements will be done using dried blood spots (DBS). We believe that the AMH levels will be lower in firefighters compared to non-firefighters. Also, we believe that those who have been firefighters for longer than others will have lower AMH. This project is receiving federal funding. 

The Title V legislation requires the state, as part of its Application, to carry out a statewide Needs Assessment every five years that identifies the need for preventive and primary care services for pregnant women, mothers and infants up to age one; children and adolescents; and children with special health care needs up to age 26. The University of Arizona College of Public Health is collaborating with Arizona Department of Health Services (ADHS) to contribute the qualitative components of the Title V needs assessment, including focus groups, community forums and dissemination of results to community partners. Our approach involves (i) participation at state-wide meetings; (ii) conduct of focus groups with selected communities not traditionally heard including African American, Hispanic, Refugees, LGBTQ, Farm Workers, Families with Children with Special Health Care Needs and Youth; (iii) facilitation of community forums with community members and providers to get feedback on preliminary findings; and (iv) dissemination of results to community partners. Results will feed into priority setting for Title V programming for the next five years 2020 – 2025.  This project is funded by the Arizona Department of Health Services (ADHS).

There is increasing evidence suggesting that women with endometriosis may have a greater risk of cardiovascular disease. This project overcomes limitations that have challenged previous studies of endometriosis and long-term health outcomes and leverages long-term longitudinal data from an established cohort, with detailed information collected on endometriosis, stroke, type 2 diabetes, and potential confounding and intermediate factors. Understanding the relation between endometriosis and cardiometabolic conditions may increase our understanding of disease etiology, influence screening recommendations, and ultimately reduce excess morbidity and mortality among the substantial proportion of women experiencing endometriosis worldwide. More information about this projet can be found here.  This project received funding from the Endometriosis Foundation of America. Stacey Missmer, ScD., from Michigan State University is a Co-Investigator for this project. 

The overarching aim of this study was to determine if the Nurtured Heart Approach® (NHA) can reduce the symptoms of inattentiveness, hyperactivity, and impulsivity, which are associated with attention deficit/hyperactivity disorder (AD/HD), among children ages six to eight years old. NHA is a six-week, online, behavioral intervention that trains parents on its three primary principles including: (1) completely refusing to engage in negativity, by moving toward the elimination of strong reactions such as reprimands, yelling, and hitting, (2) persistently creating and emphasizing positivity and success, and (3) being absolutely clear when using consequences and setting limits. We randomly assigned 104 parents to either the immediate or delayed NHA intervention. Data were collected and analyzed using surveys from parents at three time points. We expected NHA parent training would be associated with (1) reductions in their child’s AD/HD behaviors, (2) reductions in parental stress, and (3) improvements in parents’ sense of competency. Parents reported significantly improved AD/HD symptoms in their children as well as lower parental stress; however, improvements in parents’ sense of competency were not detected. Collaborators: Richard J. Wahl, MD Betsy C. Wertheim, MS Study Related Links: Study Infographic Study listing on ClincialTrials.gov Published study protocol U of A Alumni article

Child Care Factors that Influence Parental Engagement: Understanding Longitudinal Pathways to Children’s School Readiness. Secondary Analysis of Data on Early Care and Education. Admin. Of Children, Youth and Families. (Co-Investigator with Ann Mastergeorge, Texas Tech, Co-I, Melissa Barnett, UA, PI).

Research Brief: Women’s Work: Realities and Possibilities for Arizona. Women’s Foundation Southern Arizona. (Michele Walsh, FSHD, CALS, UA; PI)

This is a clinical trial pilot study to examine the feasibility of conducting a large multicenter trial of dispensing inhaled corticosteroids in the emergency department (ED) and supervising their use in the school setting in children with asthma. Kurt Denninghoff is co-principal investigator for this project. 

Our collaborative team is currently advancing a randomized controlled trial at five different sites in the United States with 12-36 month-old children, diagnosed with mild-to-moderate spastic cerebral palsy (CP) (N=110).  The study is designed to evaluate the effectiveness of an intense protocol of physical (PT) and occupational (OT) therapies versus the current standard of care.  The therapists are using the Perception-Action approach (P-AA), a child-driven, active, dynamic, task-oriented therapy.   P-AA is based on concepts of neuroplasticity and takes advantage of the young brain’s ability to reorganize and stimulate dormant neurons to influence the acquisition of motor skills and neurodevelopment. Previous work strongly suggests that a protocol of intense therapy is feasible and may substantially improve function in young children with CP (Duncan, Shen, Zou, Han, Lu, Zheng, et al., 2012; Pottinger, Rahlin, Voigt, Walsh, Fregosi, & Duncan, 2018).   The study employs a crossover design that provides all children an equal number of therapies over a 48-week period. Children are randomized to either early intense therapy (Group 1) or delayed intense therapy (Group 2). Children randomized to Group 1 receive PT and OT five days a week for 12 weeks followed by 36 weeks of PT and OT once a week (standard of care); children randomized to Group 2 start with 36 weeks of PT and OT once a week and finish with 12 weeks of PT and OT five days a week. The primary outcome measure is an assessment of clinical changes in motor function after 12, 24, 36 and 48 weeks using the Gross Motor Function Measure-66, the most widely used evaluation tool to assess the effectiveness of interventions for CP. Parental/caregiver-reported changes in function are captured with the Pediatric Evaluation of Disability Index-Functional Skills assessment at the same time points. Comparison of changes from baseline to 12 weeks will be used to evaluate impact of daily versus weekly protocols; 24- and 36-week evaluations will be used to determine whether gains made during the intense phase are maintained even after reverting to standard treatment; and 48-week evaluations will be used to assess whether intense therapy is equally effective independently of the time of administration, or if there is a greater benefit in earlier administration. In a subgroup of children with hemiplegia presentation (n=20), clinical findings will be correlated with magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) that assess white matter and high angular resolution diffusion imagining (HARDI). This will provide an objective analysis of anatomical changes that will be correlated with clinical functional changes. The results of this project will offer insight in the management of young children diagnosed with spastic CP, a highly limiting condition in which current standard of care delivers less than optimal results. We anticipate that our findings will significantly improve children’s functional independent abilities and in so doing will improve their quality of life and that of their families. We also believe that the identification of signature changes in neuroimaging will lead to recognizing MRI/DTI/HARDI as a clinical tool for evaluating the effectiveness of interventions of patients with CP.

This environmental epidemiology project is a mentored research award (K99/R00) from the National Institute of Environmental Health Sciences (NIEHS). The project's goals are to 1) create models of atmospheric dispersions of agricultural organophosphorus and pyrethroid pesticide applications over a 20 year period in Arizona, 2) to construct a case control study of ADHD in Arizona by applying a validated algorithm to Medicaid (AHCCCS) claim records, and 3) to examine associations between the modeled ambient pesticide concentrations during fetal/early life and ADHD. The project also employs the use of novel mixture methods, primarily Bayesian Kernel Machine Regression, to assess the potential for mixture effects of different pesticide exposures. Beate Ritz is a Co-Mentor for this project with Paloma Beamer. Avellino Arellano is a collaborator for this project as well. 

Female smokers often face unique barriers to quitting smoking. The purpose of this study is to examine how menstrual cycle/ female sex hormones may play a role in smoking outcomes. The study tests the feasibility of a menstrual-cycle timed smoking cessation program for female smokers between 18-40 years of age. Treatment consists of a six-week telephone-based behavioral counseling program along with provision of nicotine replacement therapy. Primary outcomes include determining acceptability and feasibility of the study by assessing the recruitment and retention rate and overall participant study satisfaction. Quit smoking outcomes are measured at end of the program and at 3 month follow-up. Dr. Alicia M. Allen from the Department of Family and Community Medicine is the Co-PI on this project with Dr. Nair. 

Saludable is a prevention intervention tackling the linkages of toxic stress and pediatric obesity in Latino youth populations. The Saludable curriculum focuses on three domains of health and well-being: (1) nutrition, (2) physical activity, and (3) mindfulness based stress reduction. The intervention is being delivered at community sites in both rural and urban contexts across Pima and Maricopa Counties.

This randomized controlled trial test was performed in collaboration with a statewide Medicaid health plan, building on a 10-year community partnership.  It tested the effectiveness of community health worker intervention that targets preventive services utilization among newly enrolled reproductive age women health plan members. To test this, community health care workers will be trained in a personal health education program and then asked to deliver the program information to female patients recently enrolled in Medicaid.This project was funded by the Patient-Centered Outcomes Research Institute. More information about this project can be found here.

While inhaled corticosteroids (ICS) are recommended for children with asthma, our experience suggests that Hispanic patients, particularly those of Mexican-origin, may be less responsive to ICS than non-Hispanic whites. To investigate this question, we used data from three Childhood Asthma Research and Education Network (CARE) multi-center trials that used ICS as a primary intervention, enrolled pre-school children with asthma-like symptoms, particularly severe wheeze, and whose Hispanic population was predominately of Mexican-origin. We harmonized data from three clinical trials by using the original data to construct comparable variables across the 3 studies. Data were available from 332 non-Hispanic white and 136 Hispanic white children. Our primary outcome variable, obtained from study diaries, was the fraction of asthma episode days.  The results of this analysis will help inform the treatment of pre-school children with asthma-like symptoms. This project was sponsored by the University of Arizona Health Sciences Health Data and Analytics Program. 

Prenatal exposure to organophosphorus pesticides (OPs) has been associated with a wide range of adverse childhood outcomes [1]–[7]. However, most of these studies rely on OP biomarkers in the general population. These biomarkers disproportionately reflect non-toxic dietary ingestion of metabolites and cannot distinguish between parent pesticides. Exposure metrics that use agricultural pesticide applications may overcome these limitations, but such studies are limited to California. We propose to prepare Arizona’s Pesticide Use Registry as a resource for future studies of exposure to pesticides and childhood health outcomes, and to enhance exposure assessment by incorporating birth certificate-reported farmworker occupation into analyses. Farmworkers are at higher risk of pesticide-associated health risks due to occupational exposures, but farmworkers are difficult to identify and are highly transitory. Thus, we also propose a pilot study of prenatal exposure to OPs and preterm birth among farmworkers to assess the feasibility of this approach for future studies. The National Institute for Occupational Safety and Health and the University of California, Davis fund this project. 

Although Benin has been making progress in reducing malnutrition problem, yet it still exists at a proportion of public health significance. Access to food and especially to high quality foods is limited in the region. Food insecurity is high and particularly related to a high incidence of poverty and food availability unevenly distributed across the country in the context of recurring rising prices of staple foods. In addition, food production is very dependent on erratic rainfalls, which often lead to precarious food harvests and chronic strain on national financial stability. On the back of this situation, in 2007, the Solar Electric Light Fund (SELF) began a pilot test of commercial-scale solar-powered drip irrigation (PVDI) systems in the Kalalé district of northern Benin. The Solar Market Garden (SMG) systems were installed in conjunction with local women's agricultural groups. Over the first two years of operation, these gardens were found to have a significant impact on the food security and economic well-being of the farmers and their households (Burney et. al 2010). However, there is no evidence base on their health and nutrition impacts in sub-Saharan Africa. Increased consumption, along with increased income, could all contribute to improvements in maternal and child health and nutrition outcomes. In addition, to date there has been limited understanding as to how these types of program can be optimized to maximize impacts on child health and nutrition outcomes. The goal of the present study is therefore to evaluate the impact of the SMG on child and women’s nutritional status, child and mother anemia status and measured indicators of women’s empowerment. The study was conducted in 16 villages in the Kalalé district of northern Benin at the same period (January –March) in 2014 and 2015. The study enrolled 774 households. Socio demographic information, household food insecurity, child and women’s anthropometry measurement, and information pertaining to women’ empowerment were obtained.  Jennifer Burney and Roz Naylor were contributors for this project. 

The Children’s Healthy Living Program for Remote Underserved Minority Populations in the Pacific Region (CHL) is a partnership among the remote Pacific jurisdictions of Alaska; American Samoa; Commonwealth of the Northern Mariana Islands (CNMI); the Freely Associated States of Micronesia (FAS) which includes the Republic of the Marshall Islands (RMI), Republic of Palau, Federated States of Micronesia (FSM); Guam; and Hawaii to study childhood obesity among Pacific children, ages 2 to 8 years. The program is sponsored by the United States Department of Agriculture (USDA), Agriculture and Food Research Initiative. To address the child obesity epidemic in the Pacific, the CHL Program has the following objectives: (1) Conduct program/data inventories and situational analysis; (2) Train 22 professionals and para-professionals in obesity prevention; (3) Develop a Pacific food, nutrition, and physical activity data management and evaluation system, using assessment data, and aggregate, display and communicate available data pertinent to young child obesity; (4) Develop and conduct a community-based environmental intervention to prevent, maintain, or reduce young child overweight and obesity; (5) Evaluate the environmental intervention; and (6) Incur at least one obesity prevention policy change per jurisdiction.

To date, no prospective, randomized, placebo-controlled clinical trials have been conducted to test the hypothesis that exposure to diindolylmethane (DIM), in combination with tamoxifen (TAM), can significantly modify breast cancer risk. The DIME Study tests the novel hypothesis that DIM will demonstrate an enhanced efficacy of TAM by modulating the breast parenchyma to a ‘low’ density, ‘low risk’ state and alternatively by favorably modulating steroid hormone metabolism. In fact, DIM has been shown to act on breast cancer risk through a variety of mechanisms, and as such, core breast biopsy tissue samples and blood for alternate hypotheses testing (e.g., COX-2, prolactin receptor, proliferation assays, AhR, inflammatory markers, oxidative stress, etc) are collected in the context of this trial. The recruitment portion of the study ended in September 2015. Study results will be available as of late 2016. This study was funded by the National Cancer Institute. 

Ovarian cancer accounts for over 18,000 deaths each year in the U.S. with disease progression rates estimated at 60-70% after 4 years. The efficacy of a physical activity + dietary intervention to increase progression-free survival (PFS) in this vulnerable population is currently being tested in a hypothesis-driven, randomized, attention-control study of 1070 women with prior invasive disease [(Gynecological Oncology Group (GOG) 0225 study (Lifestyle Intervention for oVarian cancer Enhanced Survival- (LIVES) Trial]. Here, we propose to take advantage of the trial infrastructure and capacity to collect repeat blood samples to evaluate the mechanistic underpinnings that might explain any changes in health indices by treatment arm over time. The overarching hypothesis is that change in metabolic and inflammatory status of participants, that is expected to demonstrate a reduction in inflammation and metabolic deregulation in the intervention group participants more so than the attention-control group, will be associated with increased PFS. A secondary focus of the proposed work will be the interaction with central adiposity. The Specific Aims include: To determine if the LIVES intervention alters biomarkers of metabolic deregulation in women previously treated for stage II-IV ovarian cancer; Aim 2: To determine if any effect of the intervention on biomarkers is mediated by change in central adiposity; and Aim 3: To determine if any effect of the intervention on biomarkers is modified by baseline central adiposity including exploration of central adiposity using Computerized Tomography (CT) scans. Our longer term goal is to determine whether change in central adiposity, insulin/lipid metabolism or inflammation is associated with progression free survival.

Residents of rural communities and Latinos continue to experience significant health disparities for chronic disease such as diabetes and cardiovascular disease.  The residents in these communities have significant disparities due to multiple social determinants of health including but not limited to a lack of access to opportunities for physical activity and other resources necessary to prevent chronic disease. Bike Ajo is a community-campus coalition with diverse membership including community health. Bike Ajo’s goal is to create a sustainable cycling hub that educates, trains, provides resources, and builds health-based partnerships within the Ajo community. The asset-based coalition includes community residents, Desert Senita Community Health Center, International Sonoran Desert Institute, Ajo Chamber of Commerce, Arizona Planning Association, Mel and Enid Zuckerman College of Public Health, UA Department of Mexican American studies, Pima County Parks & Recreation, Pima County Health Department, and Pima County Department of Transportation. The Bike Ajo works to increase access to environments promoting physical activity opportunities through the creation of the1) Bike Ajo Cycling Hub (ReaCH); and 2) expanding community-clinic linkages to chronic disease prevention resources for Desert Senita Community Health Center patients.  Successes, lessons learned, and process/implementation strategies will be shared through the Arizona REACH network as well as at local and national conferences.  Digital stories will be utilized to help community members tell their own compelling stories of the personal impact of inequities in public health. This project was funded by the National Center for Chronic Disease Prevention and Health Promotion and the Arizona Chapter of the American Planning Association. 

More than four million people with asthma live outside of urban areas, and most are seen in primary care settings where their asthma is often inadequately managed, representing a significant gap in care. Rural health disparities for children with asthma include poverty, limited access to care, and environmental challenges including high levels of outdoor and indoor particulate exposure. The Asthma Toolkit program has translated evidence-based asthma care into both rural and urban primary care practices. Although this program has produced evidence of increased guidelines-concordant care, much room exists for improvement. We believe that by deploying Asthma Toolkit training in a larger program that includes community, school, and family engagement, quality of care and health outcomes can be improved for rural children with asthma. This project will bring together investigators from the University of Arizona and National Jewish Health to 1) engage three communities on the Navajo Nation to build a successful collaboration (U34); and 2) conduct a randomized pragmatic trial of a community rural pediatric asthma program (U01). During the initial empowerment phase, we will solidify relationships with community stakeholders including patients, parents, community leaders, hospital administrators, schools, and providers. A group of stakeholder advisors will be created to inform and guide the subsequent study.  In the second (U01) phase, we will employ a step wedge, randomized trial design to test the capacity of the Community Asthma Toolkit program to improve care and outcomes.  The provider component will include comprehensive training in evidence-based pediatric asthma care. The school component will work to improve capacity to identify pediatric asthma and facilitate communication between school, family, and provider. The hospital component will help provide structured communication between hospital clinicians and primary care providers to improve outpatient management and prevent unnecessary urgent care utilization. Finally, the air quality component will assess community and provider concerns about indoor and outdoor air quality and determine potential methods to measure and reduce environmental risks to children with asthma. The final trial will be modified in accord with stakeholder input during the engagement phase. We believe that the intervention could serve as a model for implementation of strategies to improve asthma care in rural children.

The American Lung Association Airways Clinical Research Centers (ACRC) network is a network of asthma and airways experts with access to a nationwide and demographically representative study population, for the purpose of decreasing the prevalence, morbidity and mortality of asthma and COPD. The basic activities of the network and its data coordinating center include:  Developing a collective data base of well characterized patients with asthma and COPD who can serve as potential research participants;  Collecting core data from recruited participants;  Communicating information gained from network activities to local Lung Associations and the populations they serve;  Participating interactively in developing grant and contract proposals. Such proposals may be extensions of initial projects proposed in the applications of individual centers, or may involve emerging new priorities that arise as a consequence of developments within the field.  Participate in development of presentations and publications based on network research.

Asthma is a common chronic condition among children that is associated with significant morbidity. Because medication non-adherence is an important cause of excess morbidity, the National Asthma Education and Prevention Program guidelines have called for the development of more effective adherence programs.  Schools represent a logical setting where adherence programs could reach the inner-city, low-income, and ethnically diverse populations that have the highest morbidity and lowest adherence.  A recent clinical trial demonstrated that supervised therapy of daily controller medication at school increased medication adherence and asthma control among primarily African-American students in urban, low-income elementary schools.  This study aims to evaluate:  (1) the effectiveness of supervised therapy when administered by the community under real world conditions via a randomized controlled trial of 500 children with asthma in a large urban, predominantly Hispanic school system;  (2) the cost-effectiveness of supervised therapy from the societal perspective using dollars per quality-adjusted life year (QALY) gained; and 3) the program’s implementation fidelity, optimal delivery mechanisms, and construct validity via a comprehensive process evaluation.  Supervised therapy is hypothesized to be both an effective and cost-effective mechanism to improve population-level asthma control among students with asthma.  This project will provide critical information regarding the program’s value, feasibility, and sustainability within communities with large asthma burden.  In addition, it will provide important recommendations to accelerate the adoption of guideline-based care for students with asthma in urban, low-income, and ethnically diverse populations.  With this information, policymakers can optimize the use of scarce public health resources by adopting programs that efficiently maximize child health. Funding for this study came from the National Heart, Lung, and Blood Institute. Also, this study is supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp and product donation from Thayer Medical Corporation.

The goal of this project is to examine the association between stress and asthma morbidity, using our preliminary work from the Children’s Respiratory Study, and within the context of an ongoing school-base randomized clinical trial, to determine to what degree variations in asthma control and morbidity are associated with chronic school stressors. Eyal Oren was a contributor on this project but has since left the University of Arizona. 

  The objective of this project is to critically assess and summarize outcomes of home versus health facility births attended by midwives. The findings will guide ADHS in making evidence-based policy decision regarding the scope of midwifery practice in Arizona. The objective of this project is to critically assess and summarize outcomes of home versus health facility births attended by midwives. The findings will guide ADHS in making evidence-based policy decision regarding the scope of midwifery practice in Arizona.  

This project was evaluation research on the impact of a train the trainer leadership curricula on the activities of community health workers across the U.S. When the project began, we have gathered baseline data from the trainers. During the project, we gathered baseline data from the Community Health Workers and collected 3 and 6 month follow up data on leadership activities.

  This is a K25 application for a mentored quantitative research scientist. Much of my research effort this year was focused on developing the preliminary data, and working with my mentoring team which includes: Fernando Martinez, Duane Sherrill, Lynn Gerald, Eric Betterton, Anne Wright, and Andrew Comrie. We have submitted one paper and one abstract. Research: Epidemiological analyses of respiratory outcomes and traffic pollutant exposures. Training: This grant provide training for Dr. Beamer. She has been accepted to the AzCRTP program. I completed 5 courses last year. For this project I will serve as Ms. Sugeng's primary sponsor. The main objectives of this project is to quantify pesticides in farmworker homes, understand how they are getting into the home and what are important characteristics of the pesticides and the homes to assess in future studies. RESEARCH: Ms. Sugeng has collected samples from 21 farmworker homes. They have been analyzed by Battelle Laboratories and we are currently in the process of assessing which factors were most important to their detection in the homes. SERVICE: We collaborated with Campesinos sin Fronteras to recruit participants. Each household will also receive the results of the analyses in their homes. TRAINING: This grant is primarily a training grant for Ms. Sugeng as it is her MS and dissertation work.   This is a K25 application for a mentored quantitative research scientist. Much of my research effort this year was focused on developing the preliminary data, and working with my mentoring team which includes: Fernando Martinez, Duane Sherrill, Lynn Gerald, Eric Betterton, Anne Wright, and Andrew Comrie. We have submitted one paper and one abstract. Research: Epidemiological analyses of respiratory outcomes and traffic pollutant exposures. Training: This grant provide training for Dr. Beamer. She has been accepted to the AzCRTP program. I completed 5 courses last year. For this project I will serve as Ms. Sugeng's primary sponsor. The main objectives of this project is to quantify pesticides in farmworker homes, understand how they are getting into the home and what are important characteristics of the pesticides and the homes to assess in future studies. RESEARCH: Ms. Sugeng has collected samples from 21 farmworker homes. They have been analyzed by Battelle Laboratories and we are currently in the process of assessing which factors were most important to their detection in the homes. SERVICE: We collaborated with Campesinos sin Fronteras to recruit participants. Each household will also receive the results of the analyses in their homes. TRAINING: This grant is primarily a training grant for Ms. Sugeng as it is her MS and dissertation work.

Research: For this contract, I am conducting a process and outcome evaluation of Tucson Indian Center's Native Pride Project funded through the Indian Health Service. Native Pride is an 8 week program designed to increase protective factors, and decrease risk factors, for suicide and substance abuse among Native youth in the greater Tucson area. As lead evaluator, I coordinate all evaluation, data collection, and reporting activities.  Service: I attend biannual advisory committee meetings to disseminate results of the project to TIC staff, community members, and other key stakeholders. I have also developed presentations to disseminate results at regional and national Indian Health Serivice conferences. I also assist TIC with grant proposal development and submission to secure funding to continue Native Pride and other mental health related projects. Nancy Stroupe was a contributor on this project but has since left the University of Arizona.

I have been the PI since 2005. Grant is renewed annually. I typically employ an MPH graduate student as a Research Associate to work on the grant. In 2012, I employed an individual completing a Master's degree in another UA department/college. RESEARCH:  The grant does not involve data collection.  However, we provide research assistance (i.e., conduct literature reviews, find statistics and resources) for ADHS and funded Contractors to improve the use of empirically-validated prevention strategies. Also, we maintained a program website with current research and statistics. SERVICE:  See above. Provide research assistance to ADHS and funded Contractors in Arizona. 

Description:  This randomized, controlled dietary intervention trial is being conducted among lactating women in order to test the hypothesis that adoption of a Mediterranean diet rich in walnuts and citrus during lactation will be associated with a significant decrease in estradiol-17-beta and SHBG as compared to usual diet and a secondary hypothesis that adherence to a Mediterranean diet rich in walnuts and citrus will decrease the oxidative stress biomarkers 8-OHdG and 8-iso-PGF2alpha.  Impact:  The results of this trial may have implications for dietary recommendations/practices during lactation to promote improved health in both mother and child. The recruitment manuscript was published in Contemporary Clinical Trials  Stendell-Hollis NR, Laudermilk MJ, West JL,Thompson PA, Thomson CA. Recruitment of lactating women into a randomized dietary intervention: successful strategies and factors promoting enrollment and retention. Contemp Clin Trials. 32(4):505-511, 2011. [PMID: 21382511].

The study started in 1993 to evaluate health outcomes in aging postmenopausal women and to identify factors associated with healthy aging. Between 1993 and 1998, more than 161,000 women between 50 and 79 years of age joined the WHI. Beginning in October 2004, participants were consented for sequential 5-year WHI Extension Studies (ES). The research team continues to collect self-reported as well as medical record adjudicated health and mortality data. A team of junior investigators are engaged with data analysis in an effort to advance the dissemination of WHI research findings. Arizona research team members have published over 45 manuscripts in the past 8 years using this well-characterized and robust phenotypic information.

Funded through the Health Resources and Services Administration's (HRSA) Rural Health Network Development Grant Program, Mariposa CHC and partnering agencies will formalize and advance the Santa Cruz County Adolescent Wellness Network (SCC AWN). As Network partner I will provide technical assistance and evaluation services.

I facilitated a process of participatory evaluation with Mariposa Community Health Center on a program entitled Salud Si, a health promotion project targeting Latinas of child bearing age that was originally funded in 2000 and developed with our collaboration. Salud Si utilized CHWs to provides weekly nutrition classes, physical activity opportunities, and emotional support as strategies to improve nutrition and physical activity behavior. Coping with stress is also addressed. The contract included a study of the maintenance of behavioral and health outcomes that had been established through prior evaluation.Analysis of 5 years of pre/post questionnaires was being complemented with qualitative data collected by the program director and myself with a sample of women who graduated at least one year prior to the time of interview. A final report was submitted to Mariposa and the results of this evaluaiton guided decisions to sustain the program within Mariposa. A collaborative manuscript was prepared and submitted on evaluation findings.

This project is a contract with the Arizona Governor's Office to work with communities on the Border to develop task forces designed to address the needs of battered immigrant women. The specific role of MEZCOPH is to use a participatory framework to provide technical assistance to project partners in seven Southern Arizona counties. Activities have included implementation of a needs assessment with community providers, technical assistance to community coordinators in the development of task forces, and interviews with battered immigrant women who have self petitioned through the Violence Against Women Act. In the past year, we completed an online interactive tool on developing a community protocol to help immigrant women apply for VAWA and we have submitted the product to peer review on CCPH CES-4 Health.

Since summer of 2000 the state of Arizona has begun addressing the needs of battered immigrant women in terms of safety and access to crucial legal, health and human services, to ensure that they will be met as mandated under the Violence Against Women Act (VAWA). Since 2002 the "Southern Arizona Battered Immigrant Women Project" has been funded through the US Department of Justice Violence Against Women Office to lay the groundwork for:1) education, outreach, information and awareness, 2) training, 3) improved services, and 4)resource development. The first phase began when Pima, Cochise and Santa Cruz Counties each formed a Battered Immigrant Women Task Force charged with developing a multidisciplinary training curriculum for law enforcement, legal services, victim services and other health and human service agencies and organizations. In 2004 the project expanded to include Pinal, Yuma, Graham and Greenlee Counties.  During the life of this project I have continued to act as a Co-PI,  contracted project consultant, for the Governor's Division for Prevention of Family Violence (GDPFV) through funding from the U.S. Department of Justice Rural Domestic Violence and Child Victimization Grant. I have provided technical assistance to county Battered Immigrant Women Task Forces, implemented service provider training needs assessments, in addition to developing and implementing in-depth interviews for women who have attempted to obtain their VAWA approval letters with the intent of providing feedback to key service providers for quality improvement and training recommendations, and the subsequent development of a model protocol toolkit for coordinated community response to immigrant victims of violence.  In 2011 the toolkit went live on the Center for Rural Health website.   

Through the Society for Adolescent Health and Medicine's Spirituality Interest Group, we are collaborating with physicians and mental health providers internationally to conduct an on-line cross-sectional survey of providers' personal spiritual beliefs and practices and how these influence adolescent health care.

Community-based participatory methods support building both professional and organizational capacity were used to develop a web-based database to enhance the capacity of Mariposa Community Health Center to address disparities in perinatal health in Santa Cruz County.  Fundamental to this evaluation contract is building a team-based culture of work in a multi-cultural, bilingual environment that contributes to consensus building and empowerment among internal and external partners.

This project created 11 reports for the State, a statewide report, and 10 additional regional reports on factors related to the demand for child care in Arizona.

The goal of this study is to examine modifiable mechanisms for this health disparity by refining the previously examined role of parent health literacy in asthma outcomes. We will also extend this knowledge by exploring associations with asthma control, asthma symptoms, and understanding of treatment recommendations, as well as sociocultural variables that may affect these relationships. Funded by HRSA/MCH

A cross-sectional survey of early adolescent girls attending rural and semi-rural schools. Research is part of my dissertation.

This program is a continuation of the ongoing surveillance of autism ​​spectrum​ disorders and intellectual disability among children age​​s​ 4 and​​​​ 8​ in Maricopa​ County.​

Preventing youths' high-risk sexual behaviors represent some of the most difficult and important challenges for social and behavioral scientists. Adolescent sexual risk-taking behaviors are major causes of premature death and disability in the US as well as lead to unplanned pregnancies. Despite evidence suggesting differing patterns of sexual behaviors between and within ethnic groups, the role of socio-cultural factors within comprehensive theory-guided models of the determinants of high-risk sexual behaviors have been relatively untested. This study will identify factors contributing to youths' high-risk sexual behaviors and their disparities. The objectives involve testing a causal model of sexual behaviors guided by the theory of triadic influence, a model well-tested in predicting other adolescent risk behaviors that specifies the operation of key proximal factors as well as more distal factors. Proximal factors will include self-efficacy, attitudes, and social norms. Distal factors include global positive expectancies, depressive symptoms, parental relatedness, and academic orientation. Finally, potentially vital socio-cultural influences will be tested as ultimate (most distal) factors in the model. Global expectancies and cultural orientation in Latinos are two important factors of emphasis in the model that are understudied within comprehensive models of adolescents' sexual behaviors. The objectives will be accomplished through secondary analyses of Add Health data (National Longitudinal Study of Adolescent Health) collected from 1994-2002. Behavioral outcomes of focus at follow-ups include reported early intercourse, unprotected sexual intercourse, and number of sexual partners. Additionally, reported unintended pregnancies, reported STDs, and positive tests on STD assays at Wave III will be included to validate the behavioral reports and to provide further testing of the model's predictive efficacy. By clarifying the causal paths leading to these behaviors and identifying which specific protective or risk factors are most critical for adolescent groups where disparities are apparent, the proposed project may aid in the development of more effective sexual-risk reduction programs designed for diverse adolescent populations. By clarifying such factors like cultural orientation within such a theoretical model, this study will assist preventive programs in their efforts to address the most critical sexual risk-taking deterrence factors for diverse adolescent groups. The project was completed January 31, 2011. The project report was provided to the funder, National Institutes of Health, on April 1, 2011.

Technical assistance and evaluation contract with the Arizona Department of Education in partnership with the Arizona Department of Health Services, funded by the CDC's Division of Adolescent and School Health (DASH). Funding to the ADE began in 2008 and continues through 2013; this is the first time Arizona has received this DASH funding, which has been available since the 1990's. I provide technical assistance, in addition to evaluation leadership. Assist with development of five year Strategic Plan, annual Work Plans, conference planning, and technical assistance planning for communities. I provide linkages to the AzPHA School Health Section, the Arizona School Based Health Care Council, and partners in the southern Arizona.

Evaluation contract with the Yuma County Public Health Services District (YCPHSD). YCPHSD was awarded a grant for community based trainings by the First Things First Yuma Regional Partnership Council. YCPHSD will provide parent education in the community setting and through home visits. I work with YCPHSD to meet reporting requirements to the state and develop local program evaluation. Will develop database to be transfered to local site. Contract will most likely continue for a total of 3 years.

This project was an evaluation subcontract for part of a $16 million CDC-funded cooperative agreement awarded to Pima County Health Dept. to focus on policy and environmental strategies to prevent obesity. Evaluation teams included the following roles: Co-PI, Sr. Research Specialist, Sr. Program Coordinator, Research Specialist, 2 GRAs, and data input specialist. Maia Ingram served as the Co-PI for this subcontract, and co-lead team in primary and secondary data collection activities. She also served as Youth Risk Behavior Survey Coordinator for the project. This project successfully obtained weighted YRBS data for Pima County by surveying over 1300 students in 21 high schools. 

The over arching goal for the training program is to increase the number and quality of culturally competent MCH professionals who will provide the next generation of MCH public health leadership for the development of evidence-based policies, programs, and program evaluation to address the health and wellness women, children and families throughout the Southwest and Rocky Mountain region, and nationally. This ambitious goal will be attained by building on five years of experience and achievements as a HRSA funded MCH Training Program, and by enlarging the scope and impact of existing program through a new set of goals and objectives. This training grant supports the development MPH, DrPH, and Junior Faculty trainees in the areas of maternal and child health for a consortium of public health training programs in the Rocky Mountain region. Funded by HRSA/MCH

Populations in isolated Indian Health Service regions and Appalachian counties have disproportionately worse maternal and child health (MCH) outcomes than national averages. Public health professionals serving these populations have identified the need for training in MCH epidemiology. To increase the capacity in MCH epidemiology of health workers serving in rural, isolated, and underserved Indian Health Service regions and Appalachian counties, this project will develop and implement a 15-credit online Graduate Certificate in MCH Epidemiology, using innovative internet technologies and delivery approaches that surpass the face-to-face classroom experience.

Purpose: The purpose of this pilot study was (1) to evaluate feasibility of attendance and parent satisfaction with an intensive outpatient physical and occupational therapy program for young children with spastic cerebral palsy (CP) and (2) to examine changes in motor function. Methods: Sixteen children with CP, age range 18–36 months (mean 24.3 ± 6.3 months), received physical and occupational therapy sessions (30 minutes each) 5 days per week for 12 weeks. Attendance rates and parent satisfaction were assessed. Change in motor function using a one-group pre-post design was evaluated using the Gross Motor Function Measure-66 (GMFM-66), Quality of Upper Extremity Skills Test, and Pediatric Evaluation of Disability Inventory. GMFM-66 outcomes were also compared with expected outcomes using previously published normative developmental trajectories of children receiving standard therapies. Results: An average of 82% of scheduled outpatient physical and occupational therapies for 16 children were completed and the 11 parents who completed the Hills and Kitchen’s Physiotherapy Outpatient Satisfaction Questionnaire were satisfied with the therapies and with their child’s progress. Participants showed notable, statistically significant improvement across all activity-related measures. Conclusion: An intensive protocol of outpatient therapies utilizing Perception-Action Approach was feasible for most families of young children with spastic CP to attend at the outpatient clinic location. As this was not an experimental study, no reliable conclusions related to efficacy can be made, but the promising results suggest that further research into the effectiveness of intensive protocols is worthwhile.

Using GIS modeling to compute traffic exposure for a cohort of children followed by the Arizona Respiratory Center. Traffic exposures are assessed in relation to incidence of lower respiratory tract infections and wheezy phenotypes.

Abstract not available. 

This is a field sampling based project to take water and breast-milk samples from women in Nogales, AZ and analyze them for TCE. A questionnaire is being developed to help identify risk factors. Ultimately, these results will be combined with a PBPK model for TCE in the infant and used to compute cancer risk from various routes of exposure.

Abstract not available.