Spring 2021 MPH Internship Virtual Presentations Abstract Booklet - Mel and Enid Zuckerman College of Public Health
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Spring 2021 MPH Internship Virtual Presentations Abstract Booklet 1
Contents Page Acknowledgements 3 Virtual Presentations 4 Presenters 5 Abstracts Environmental & Occupation Health / Industrial Hygiene 7 Epidemiology 9 Family & Child Health - Global Health & Maternal & Child Health Tracks 23 Health Behavior Health Promotion 34 Health Services Administration 47 MD/MPH Clinical Leadership 52 MD/MPH Public Health Policy and Management 63 One Health 65 Public Health Policy and Management 67 Public Health Practice 76 The MPH Internship Experience 82 2
Acknowledgements All of our wonderful internship sites throughout the state, nation, and world with whom we work to improve the state of public health The students and faculty of MEZCOPH, who are central to the success of the MPH Program The Office of Student Services and Alumni Affairs for their outstanding efforts, support, and encouragement Office of Student Services and Alumni Affairs Kim Barnes Tanya Nemec Gisela Ochoa Chris Tisch, Assistant Dean 3
Virtual Presentations We invite MEZCOPH faculty, staff, students, and alumni, as well as our wonderful internship preceptors and community members to view as many presentations as possible. These presentations terrifically highlight the depth and breadth of work that our students do with local, national, and global communities. This page will be available for asynchronous viewing of student presentations until Friday, May 7th. Presentation website: https://publichealth.arizona.edu/spring-2021-mph-internship- presentations For each presentation viewed, please complete a brief survey to provide valuable feedback to the presenters. This feedback is anonymous. Presentation Feedback form: https://uarizona.co1.qualtrics.com/jfe/form/SV_0NBAg6M3LFFaK7r We appreciate your participation in the Spring 2021 Virtual MPH Internship Conference! 4
Presenters Abstract Page Name Concentration* UA Email Address Number Esteban Cardona EOH ecardona@email.arizona.edu 8 Jumanah Abuasbeh EPI jumanahabuasbeh@email.arizona.edu 10 Janice Baldwin-Rowe EPI jbaldwinrowe@email.arizona.edu 11 John Ciconte EPI johnciconte@email.arizona.edu 12 Paulina Colombo EPI paulinacolombo@email.arizona.edu 13 Sidney Donzella EPI sidneydonzella@email.arizona.edu 14 Brenna Hall EPI brennahall@email.arizona.edu 15 Monica Hernandez-Cubias EPI hernandezmd@email.arizona.edu 16 Josh Hunsaker EPI joshuahunsaker@email.arizona.edu 17 Providence Ishimwe EPI ishimwep@email.arizona.edu 18 Maegan Matter EPI mmatter@email.arizona.edu 19 Cody Rocha EPI codyrocha@email.arizona.edu 20 Nmesomachi Sampson EPI nsampson@email.arizona.edu 21 Mark Wager EPI mwager@email.arizona.edu 22 Arwa Abdel-Raheem FCH GLOBAL arwaabdelraheem@email.arizona.edu 24 Cheryl Richard FCH GLOBAL clrichard@email.arizona.edu 25 Gloria Villa Barbosa FCH GLOBAL gvillabarbosa@email.arizona.edu 26 Alexis Wait FCH GLOBAL ahwait@email.arizona.edu 27 Rachel Cummings FCH MCH rachelcummings@email.arizona.edu 29 Carly Deal FCH MCH carlyjdeal@email.arizona.edu 30 Paula Garcia FCH MCH paulagarcia@email.arizona.edu 31 Hannah Launius FCH MCH hannahlaunius@email.arizona.edu 32 Alyssa Rankin FCH MCH ajrankin@email.arizona.edu 33 Davina Dobbins HBHP davinadobbins@email.arizona.edu 35 Carlos Garrido HBHP carlosgarrido@email.arizona.edu 36 Elena Greenberg HBHP elenagreenberg@arizona.edu 37 Lauren Jaeger HBHP ljaeger@email.arizona.edu 38 Brittany Jochum HBHP bjochum@email.arizona.edu 39 Miguel Lopez HBHP mlopez83@email.arizona.edu 40 Ricardo Montejano HBHP rmontejano@email.arizona.edu 41 Anette Real Arrayga HBHP arealarrayga@email.arizona.edu 42 Alexa Roy HBHP alexaroy@arizona.edu 43 Carrie Standage-Beier HBHP cstandagebeier@email.arizona.edu 44 Heena Timsina HBHP heenat@email.arizona.edu 45 Rodrigo Antonio Valenzuela-Cordova HBHP ravalenzuela@email.arizona.edu 46 Anthony Barrera HSA albarrer@email.arizona.edu 48 Princess Onyemeh-Sea HSA ponyemehsea@email.arizona.edu 49 Rena Verdugo HSA raverdugo@email.arizona.edu 50 Kaili Wagoner HSA kailiwagoner@email.arizona.edu 51 5
Saro Avedikian MD/MPH CL savedikian@email.arizona.edu 53 Samuel Beger MD/MPH CL sbeger@email.arizona.edu 54 Merry Berhe MD/MPH CL mberhe@email.arizona.edu 55 Pareena Kaur MD/MPH CL pareenak@email.arizona.edu 56 Akshara Malla MD/MPH CL aksharam@email.arizona.edu 57 Hallie Meador MD/MPH CL hmeador@email.arizona.edu 58 Kaitlyn Oelkers MD/MPH CL kaitlynoelkers@email.arizona.edu 59 Jasper Puracan MD/MPH CL jpuracan8298@email.arizona.edu 60 Kaitlyn Simmons MD/MPH CL ksimmon1@email.arizona.edu 61 Celina Virgen MD/MPH CL celinav@email.arizona.edu 62 Martin Dufwenberg MD/MPH PHPM dufwenberg@email.arizona.edu 64 Amy Lind ONE HEALTH lind1@email.arizona.edu 66 Gabriela Coronel PHPM coronelg@email.arizona.edu 68 Dexter Gulick PHPM dlgulick@email.arizona.edu 69 Christina Harris-Smith PHPM christinah1@email.arizona.edu 70 Benjamin Perlman PHPM bperlman@email.arizona.edu 71 Thu Pham PHPM thupham278@email.arizona.edu 72 Priyanshi Shah PHPM priyanshishah@email.arizona.edu 73 Caitlin Tillis PHPM ctillis@email.arizona.edu 74 A’Lantra Wright PHPM awright7@email.arizona.edu 75 Haley Coles PHP hcoles@email.arizona.edu 77 Mikaela Garcia PHP mikaelagarcia@email.arizona.edu 78 Ryan Ng PHP ryan3924@email.arizona.edu 79 Viet Tran PHP vtran@email.arizona.edu 80 Crystal Williams PHP cew33@email.arizona.edu 81 *Concentrations and Dual Degree Designations BIOS – Biostatistics EOH – Environmental and Occupational Health EOH IH – Environmental and Occupational Health Industrial Hygiene Track EPI – Epidemiology FCH GLOBAL – Family and Child Health, Global Health Track FCH MCH – Family and Child Health, Maternal and Child Health Track HBHP – Health Behavior Health Promotion HSA – Health Services Administration MD/MPH CL – Medical Doctor/Master of Public Health, Clinical Leadership Track MD/MPH PHPM – Medical Doctor/Master of Public Health, Public Health Policy & Management Concentration ONE HEALTH – One Health PHPM – Public Health Policy & Management PHP – Public Health Practice 6
MPH Environmental & Occupational Health Abstracts 7
COMPREHENSIVE ASSESSMENT OF ENVIRONMENTAL AND OCCUPATIONAL HAZARDS PRESENTED TO RESEARCHERS OUTSIDE A UNIVERSITY LABORATORY. Esteban Cardona. Tucson. MPH Internship Committee Chair: Paloma Beamer PhD. Site and Preceptor: Research Laboratory & Safety Services - Stephanie Griffin PhD, CIH. My internship with the Research Laboratory & Safety Services (RLSS) department focused on researcher safety whenever they conduct fieldwork at off-campus locations. During the internship, I examined the environmental and occupational hazards presented to researchers in the field. To ensure researcher safety, a safety manual was deemed the best way to support them. Before a safety manual was created, a qualitative gap analysis was performed to determine RLSS’s current state and how to attain a safety manual. The gap analysis was completed by looking at a survey given to researchers in early 2020. Since RLSS does not have a field safety manual, there is a large gap between their current state and their desired state. First, RLSS needs to reach out to all researchers to ensure that the research they conduct will be included in the program and identify all the resources available at the University of Arizona. After conducting the gap analysis, it was determined that a safety manual would take time beyond the internship’s scope. To support researchers as soon as possible, a condensed web version of the safety manual was made. The web version of the safety manual was created by obtaining information from other university field safety manuals and learning about the various safety services provided from different departments across the University of Arizona. The safety manual was divided into four different websites to provide general safety tips and resources to researchers before entering the field. The four websites will incorporate the field safety program, how to plan, proper training, and incident reporting. Included in the websites will be a field research safety plan by which researchers can systematically anticipate and recognize hazards to evaluate and control them to prevent injuries and incidents. 8
MPH Epidemiology Abstracts 9
THE ASSOCIATION OF VIRAL HEPATITIS B AND C AND HEPATOCELLULAR CARCINOMA IN THE U.S.: A META-ANALYSIS. Jumanah N Abuasbeh. Tucson. MPH Internship Committee Chair: Heidi Brown PhD, MPH. Site and Preceptor: The University of Arizona - Leslie Dennis PhD, MS. Background Liver cancer is the sixth most common cancer globally, where hepatocellular cancer (HCC) is the most common type. The number of viral hepatitis-related HCC cases are increasing in the United States, and there is no meta-analysis carried out exclusively in the United States. Methods PubMed database was searched for articles in the United States looking at the association between viral hepatitis B and C and HCC. Two reviewers reviewed the articles independently, and another investigator compared the review forms. Results A total of 14 articles were included in the meta-analysis for their data to be pooled; 10 articles had measures of association for hepatitis B, 12 for hepatitis C, and 4 for both hepatitis B and C. The pooled adjusted RR for hepatitis B and HCC was 9.40 (95% CI: 8.62, 10.24), 29.66 for hepatitis C (95% CI: 26.99, 32.60), and 35.65 for both hepatitis B and C (95% CI: 18.32, 69.37). Conclusion The risk of HCC is highest in patients infected with both hepatitis B and C, followed by hepatitis C alone and hepatitis B alone. Therefore, it is important to develop prevention programs for viral hepatitis to decrease the risk of HCC in the United States. 10
APPLYING ANIMAL SHELTER INTAKE & OUTTAKE RATES TO PREPARING FOR NATURAL DISASTER. Janice Baldwin-Rowe. Tucson. MPH Internship Committee Chair: Heidi Brown PhD, MPH. Site and Preceptor: Pima Animal Care Center - Bennett Simonsen; Timothy Krone, DVM. Aims It is unclear if companion animal ownership impacts natural disaster (ND) response. We hypothesized animal shelter organizations (ASOs) see increased intakes during ND. Using Federal Emergency Management (FEMA) and Shelter Animals Count (SAC) data, we tested whether ND alters intake rates. Methods Monthly SAC data were merged to FEMA records based on county level ND. Data were cleaned and restricted to years 2013-2018 and facilities with canines or felines. The final dataset included 100,656 entries (83,910 canines and 70,538 felines). We performed Wilcoxon Signed Rank tests to analyze the association between percent change (PC) in animal intake and ND. In analyses stratified by disaster type (hurricane and fire), ASO (government contract (GC); no contract (NC); government animal services (GAS)), and animal type (canine /feline), PC was compared between (1) the month of ND and the subsequent month, and (2) the month of ND and the same month in the subsequent year. Results GASs show significantly higher PC of canines in the month (Z score=-2.2, p- value=0.028) and year (Z Score=-2.2, p-value=0.025) post-hurricane. There is a significant difference in feline PC for GS organizations in months post-fire (Z Score=2.39, p- value=0.017) and in canine PC within NC organizations for months post-fire (Z Score=1.93, p=0.054). Conclusion Preliminary results indicate GASs are impacted by natural disaster. With changing climate indicating more extreme events, this suggests adaptation plans should be developed for ASOs to include more animal intakes post-ND. Further research should be conducted to corroborate these findings. 11
DISEASE PREVALENCE WITHIN THE STRAY COMMUNITIES IN TUCSON. John Ciconte. Tucson. MPH Internship Committee Chair: Kristen Pogreba-Brown PhD, MPH. Site and Preceptor: Pima Animal Control Center - Bennett Simonsen. Pima Animal Control Center (PACC) collected all intake data from the past 4 years to evaluate the effectiveness of the free vaccination clinics performed in 2019. Literature on the effectiveness of vaccinations and Canine Parvovirus (Parvo) show the causes of the ineffectiveness of the vaccine to be due to either various strains of Parvo or the interference of maternal antibodies towards the vaccine. The data was cleaned in SAS University and Stat ver 16.1 before being entered into GIS to identify areas of interest concerning Parvo between 2017-2019. Frequency tables containing the frequency of confirmed cases among the different reasons for intake at PACC were generated to identify trends among intake types. Between 2017 to 2018, “Owner Surrenders” doubled while the frequency of Parvo within both “Owner Surrenders” and “Strays” didn’t change significantly between the three years. GIS mapping showed concentrations of “Owner Surrenders” and “Strays” within Emery Park, Amphitheatre and along the 10 freeway that did not change all three years. There were no hot spots of Parvo cases in 2017-2018 but 2019 did show hot spots of Parvo near Rolling Hills Country Club Estates, and Davis-Monthan Air Force Base which was not near the areas of the held vaccination clinics. The frequency tables give evidence of the vaccination clinics not being effective in lowering the overall prevalence of Parvo within the Tucson area. However, the presence of hot spots within 2019 in areas not within range of the vaccination clinics may prove the effectiveness of clinics indirectly. While the effectiveness of the clinics may be debatable, the use of the vaccinations clinics could be improved by analytically placing them in areas with high incidences of “Owner Surrenders”/ “Confiscations”. 12
AZCOVIDTXT: INCREASING ARIZONA'S ACCESS TO CRITICAL COVID-19 INFORMATION. Paulina Colombo. Tucson. MPH Internship Committee Chair: Elizabeth Jacobs PhD. Site and Preceptor: AZCOVIDTXT - Kacey C. Ernst, MPH PhD. The current COVID-19 pandemic has presented a critical need for timely and reliable communication with the public regarding COVID-19 information. Surveys and focus groups administered to Arizona community members further support this need for information concerning COVID-19. AZCOVIDTXT is a bilingual, two-way texting service that provides Arizona-based messaging specifically tailored to the community’s concerns and needs. AZCOVIDTXT provides additional resources, including web-based articles that cover pandemic-related topics, as well as social media posts and graphics that are made available for community use. To access and join AZCOVIDTXT, users complete a one-time, household demographic survey before receiving weekly, COVID-19 related SMS messages. Participants are then asked to answer brief, weekly surveys consisting of questions pertaining to their household’s health status, COVID-19 safety precautions, and challenges encountered in the past week. Data collection for AZCOVIDTXT is ongoing. Initial findings suggest that the highest number of households reporting per week was 2,016 in July 2020. Preliminary data show that survey respondents were mainly white (87%) females (73%), between 40 and 60 years old (61%). Fifteen percent of all participants were Hispanic or Latinx. Between 98 to 99% of respondents reported taking weekly precautions to reduce their likelihood of contracting COVID-19 (e.g., tele-working, wearing a mask, avoided social gatherings, etc.). Between April and August of 2020, 36 COVID-19 diagnoses were reported through the weekly surveys, and 696 households recorded members feeling ill. AZCOVIDTXT hopes to continue providing services throughout the duration of the pandemic. COVID-19 vaccine-related content and survey questions have been added to capture increasing vaccination rates in Arizona. 13
CONCORDANCE BETWEEN SELF-REPORTED AND OBJECTIVELY-MEASURED SLEEP AMONG LATE STAGE OVARIAN CANCER SURVIVORS OF THE LIFESTYLE FOR OVARIAN CANCER ENHANCED SURVIVAL STUDY. Sidney Donzella. Tucson. MPH Internship Committee Chair: Leslie Farland ScD, MSc. Site and Preceptor: University of Arizona Collaboratory for Metabolic Disease Prevention and Treatment - Tracy Crane, PhD, RDN. Study objectives: To determine the concordance of subjective and objective sleep measurements (time to sleep, time awake, sleep duration, and sleep efficiency) among late stage ovarian cancer survivors to better inform sleep research among cancer survivors and individuals with other chronic diseases that may alter sleep-wake patterns. Methods: This analysis included a subsample of participants in the Lifestyle for Ovarian Cancer Enhanced Survival (LIVES) study. Participants were included in the analyses if they had 22 or more hours of actigraphy device wear time per day and completed the self-reported journal and the Pittsburg Sleep Quality Index questionnaire. We investigated the concordance of sleep measurements collected from self-reported journals, self-reported questionnaires, and actigraphy using intra-class correlation coefficients. Results: A total of 516 LIVES Study participants were included in the analyses. When considering the number of days worn, agreement between the actigraph and journal was best after 4 days of wear for time to sleep (ICC coefficient = 0.96) and time awake (ICC coefficient = 0.63) and after 3 days for sleep duration (ICC coefficient = 0.15). When compared to 2 consecutive weekdays, 3 consecutive weekdays did not change agreement in time to sleep and time awake but agreement increased from 0.07 to 0.11 for sleep duration. Conclusion: Agreement of self-reported and objectively measured sleep is high for time to sleep, moderate for time awake, and poor for sleep duration. Agreement of subjective and objective collection methods, sleep measurement of interest, and measurement tool used should be considered when measuring sleep among late stage cancer survivors and individuals with other chronic diseases. 14
EVALUATION OF A NON-PROFIT SUPPORT PROGRAM FOR HEALTHCARE WORKERS- HCW HOSTED. Brenna Hall. Tucson. MPH Internship Committee Chair: Katherine Ellingson PhD. Site and Preceptor: HCW HOSTED - Sana Khan, MPH. HCW HOSTED is a Tucson-based non-profit with the goal of facilitating community support for healthcare workers (HCWs) and their families. When the organization was founded in April 2020, the primary mission was to connect Tucson HCWs with isolation housing after exposure to COVID-19. I analyzed participant registration information and daily monitoring data to determine what drove people to seek help from HCW HOSTED, evaluated how well the organization met their needs, and recommended steps the organization could take to better serve its community. Additionally, I evaluated trends between HCW HOSTED registrations, COVID-19 cases in Arizona, and media coverage of our organization. The majority of registrants (81%) were nurses, 41.2% worked in hospitals, 51.3% had children in their home, and 45.4% lived with someone with a chronic condition. 27.3% of participants used the daily monitoring service and 8.8% used peer counseling services. Spikes in registrations correlated with early spikes in COVID-19 cases in Arizona and increased media coverage. While there was a greater need for isolation housing services at the beginning of the COVID-19 pandemic, the demand since April amongst participants has shifted towards mental health services and overall registrations have declined. In response to this change in need, HCW Hosted is shifting its focus away from housing and is taking on a larger advocacy role to generate greater community support of healthcare workers and their families, although it still aims to provide mental health and support services to participants when needed. We are currently developing an automated system to distribute surveys, resources, and feedback forms so that the organization can better adapt to the needs of the community and continue to provide HCWs with support beyond the pandemic. 15
UNIVERSITY OF ARIZONA STUDENT AID FOR FIELD EPIDEMIOLOGY RESPONSE (SAFER) COVID-19 CONTACT TRACING PROGRAM EVALUATION. Monica Hernandez-Cubias. Tucson. MPH Internship Committee Chair: Kristen Pogreba-Brown PhD, MPH. Site and Preceptor: University of Arizona - Mona Arora, Ph.D., MSPH. Background. In early 2020, as COVID-19 spread rapidly throughout Arizona, four local public health departments looked for the best way to induct contact tracing and case investigation programs that would allow timely interviews to be made. As part of the growing public health response, the University of Arizona Student Aid for Field Epidemiology Response (SAFER) team worked to increase case investigations in an effort to assist a rapidly escalating outbreak in a virtual setting. A program evaluation was conducted with the aim to 1) investigate and analyze the effectiveness of SAFER’s response during the COVID-19 pandemic, 2) evaluate and outline areas of strengths, improvements, and recommended strategies for implementation. Methods. An online survey was disseminated to all participating past and present SAFER volunteers, supervisors and staff members. The survey reviewed the effectiveness of recruitment and training, communications and general processes and procedures. A literature review was conducted to review past contact tracing programs as a framework in order to identify strengths and best practices to implement in SAFER. Results. Respondent demographics indicated that 35% of total participants started volunteering in the Fall 2020 semester, compared to July 2020. Training and onboarding were received well; 81.82% of respondents indicated the training received aided participants to start working with ease. In communication and flexibility in the virtual workplace, 68.75% of participants indicated positive experience in effectiveness in communication, 47.57% in timeliness and 69.64% in ease of communication. Conclusion. Through this evaluation, key areas of improvement include recruitment type and timing, training methods and availability and flexibility of communication between staff members and volunteers. 16
THE ARIZONA COVHORT. Josh Hunsaker. Tucson. MPH Internship Committee Chair: Kristen Pogreba-Brown PhD, MPH. Site and Preceptor: University of Arizona - Kelly Heslin, BA, MPH. The Arizona CoVHORT Public health in the second half of 2020, has been tasked with developing an unprecedented public health response aimed at controlling disease spread and maximizing vaccination efforts. There continues to be a need to collect and analyze fundamental information about pathogen transmissibility and risk factors associated with more severe COVID-19. It has also been made apparent that COVID-19 may lead to long-term health outcomes beyond acute infection. The Arizona CoVHORT is a longitudinal cohort study that aims to assess transmission, risk factors, related morbidities, short-term and long-term sequelae, and vaccination information linked to COVID-19. Participants of the study receive initial consent, demographics, and baseline surveys. They are then evaluated for prior history of infection but are not required to have been previously or currently infected with SARS-CoV- 2 to participate (all participants must be Arizona residents). All study participants receive follow-up questionnaires at three-month intervals in an attempt to evaluate health progression, disease transmission, vaccination history/attitudes, mental health, and an array of additional lifestyle factors. The CoVHORT has currently enrolled 3,564 participants and aims to reach 10,000 participants by the two-year mark. Current demographic data shows that participants are largely white (89.1%) and female (67.1%). Of the current enrollees, 16.2% identified as Hispanic or Latino/a. The CoVHORT has begun publication of preliminary data and will continue to collect COVID-19 information into 2021/2022. Key Words: CoVHORT, Arizona, COVID-19, SARS-CoV-2, prospective, cohort 17
REPRODUCTIVE HEALTH AND COVID-19. Providence Ishimwe. Tucson. MPH Internship Committee Chair: Leslie Farland ScD, MSc. Site and Preceptor: Mel and Enid Zuckerman College of Public Health - Sydney Pettygrove, PhD. Abstract Background: The COVID-19 pandemic has affected the entire world, but vulnerable medical groups, such as pregnant women have even suffered to a greater extent. Previous research on infectious agents and pregnant women has found that pneumonia and influenza increased the risk of pregnancy complications. Therefore, the objective of this internship was to investigate COVID-19 on reproductive health through a literature review on Coronavirus and reproductive health, and the creation of a novel questionnaire for studying the COVID-19 pandemic and reproductive health. Methods: PubMed was used to conduct a literature review on influenza, coronaviruses, and pregnancy outcomes among articles that were available as of July 21st, 2020. A database was created on the main pregnancy outcomes of interest: miscarriage, Fetal Growth Restriction (FGR), perinatal and neonatal death, maternal mortality, Premature Rupture of Membranes (PROM), placenta previa, preeclampsia, cesarean section, vertical transmission, fetal distress, neonatal asphyxia, admission to Intensive Care Units (NICU), pre-term, and low birth weight. Additionally, to support research on COVID-19 reproductive health, the researcher designed a novel questionnaire for reproductive-aged women through Redcap. Results: The findings from the literature review included in the final report were used to guide the questionnaire development. The questionnaire will be used by the College of Public Health research team to collect data on COVID-19 and reproductive health outcomes among women who are pregnant and women of reproductive age. Conclusion: We saw an increased proportion of adverse health outcomes for all coronaviruses. However, more research is needed to investigate how COVID-19 pandemic affected women trying to conceive, not trying to conceive, and pregnant women. 18
MAPPING CONSUMER HEALTH AND FOOD SAFETY PERMITTED FACILITIES AND BALANCING THE DISTRICT WORKLOAD. Maegan Matter. Tucson. MPH Internship Committee Chair: Kristen Pogreba-Brown PhD, MPH. Site and Preceptor: Pima County Health Department - Amanda Anderson, RS, MPH. Foodborne illness imposes a large public health burden in the United States, which may be alleviated through the proper use of food safety precautions. Local health departments play a critical role in ensuring the health of community members by implementing environmental health inspections for facilities that serve food to the community. The goal of these inspections is to identify any food safety concerns that may pose a risk to the community. The Pima County Health Departments’ Consumer Health and Food Safety Department (CHFS) is in charge of investigating and inspecting various types of facilities throughout the county, such as restaurants, mobile food establishments, and schools. Currently, there are 8,500 permitted facilities requiring multiple inspections, resulting in more than 17,000 total inspections performed every year. To ensure the large CHFS workload is completed in an efficient manner, the workload needed to be redistributed both spatially and quantitatively. Using Esri’s ArcGIS Online, all permitted facilities were weighted based on their inspection requirements and mapped using point data. Additionally, district polygons were created and used to run aggregation analyses to find an equally distributed workload per district. As a result, 17 new CHFS districts were created varying in size and shape and averaging 255 permitted facilities per district. With the newly distributed workload, CHFS staff will be able to more efficiently complete all inspections in Pima County. 19
SOCIAL MEDIA OUTREACH AND THE OPIOID EPIDEMIC IN GILA COUNTY, ARIZONA. Cody Rocha. Tucson. MPH Internship Committee Chair: Kristen Pogreba-Brown PhD, MPH. Site and Preceptor: Walk for Hope - Jackie Talamantes, BSW. Background: There has been a dramatic increase in rates of prescription and non-prescription opioid use in the United States over the last several years. The drug-related mortality rate in Gila County, a rural county in eastern Arizona, is 73% higher than the national average. Over 70% of American adults use social media and, in the midst of the COVID-19 pandemic, social media was utilized as a tool for outreach. Results: A social media implementation guide was developed for use in this and future social media campaigns. Guidelines were developed for the content of social media posts, the frequency of posts, and how to engage with social media users. To better inform the social media outreach campaign, a literature review of opioid use disorder (OUD) and opioid use was conducted. Literature relating to the epidemiology of OUD, treatments for OUD, and policy related to opioid use were reviewed and synthesized. Discussion: Prior to the initiation of the social media outreach campaign, the social media implementation guide and the literature review was conducted to inform the content of outreach. Both the social media implementation guide and the literature review should be considered for similar outreach interventions, especially in rural communities where it is more difficult to reach community members. 20
POISON CENTER RESPONSE DURING THE COVID-19 PANDEMIC. Nmesomachi Sampson. Tucson. MPH Internship Committee Chair: Kristen Pogreba-Brown PhD, MPH. Site and Preceptor: Arizona Poison and Drug Information Center - Laura Morehouse, MPH. AzPDIC created the COVID-19 Hotline to help field all novel coronavirus-related calls at the beginning of the COVID-19 pandemic. The objectives for this internship were to understand the role of the AzPDIC as a public health service and learn the data software specific to poison centers. Also, I was tasked to perform data analysis on COVID-19 response calls, generate a GIS mapping report and generate a study design based on data analysis. Internship data was collected by the AzPDIC through the COVID-19 Hotline, including exposure and information calls. AzPDIC provided six questions that would help with the data analysis. For instance, how has the COVID-19 outbreak affected exposure to household cleaners? With these questions, I was able to clean the data, remove any missing data, and run a logistic regression on it as well as create frequency tables and GIS maps. Although there were six questions I answered, the question about household cleaners would be the most important to AzPDIC. The number of calls regarding household cleaners increased from 2019 (623) to 2020 (756) with the majority of those calls came from Pima County. The most common route of household cleaners for 2019 and 2020 was through ingestion, and the common age reported for exposure to household cleaners was 2-year-olds. While the information about the COVID calls was useful to the AzPDIC, they found that results related to the household cleaners may be more useful data. Knowing what I have found, the AzPDIC can stratify their data to determine which cleaners have had an increase between 2019 and 2020. This information is specifically unique to the poison control center because it could be used to do a retrospective study of household cleaner exposure cases. 21
COVID-19 IN COCHISE COUNTY: TRANSMISSION AND HIGH-RISK POPULATIONS. Mark Wager. Tucson. MPH Internship Committee Chair: Zhao Chen PhD, MPH. Site and Preceptor: Cochise County Health and Social Services - Martha Montano, MPH, RS. Background Given that the coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, determining the severity of viral transmission through calculating the basic reproductive number (R0) can help determine whether current intervention efforts are effective. Furthermore, understanding demographic risk factors for COVID-19 infection can help public health officials know where intervention efforts are most needed. Methods COVID- 19 case data was collected by Cochise County Health and de-identified. Statistical analyses were conducted using SAS University Edition software. A populations-level model was used to estimate the basic reproductive number, and summary statistics examined rates of infection between demographic groups. A Pearson Chi-squared test was used to analyze any significant association between individuals who experience a chronic illness and the onset of COVID-19 symptoms. Results Between March – November 2020, 4,109 COVID-19-positive cases in Cochise County were diagnosed using PCR testing (mean age = 42.3 years). Of these, 2,759 cases were interviewed. The mean R0 of Cochise County for this timeframe was estimated at 1.04 with the highest estimated daily rate occurring just before the Arizona economic shutdown in April 2020 (R0=1.15) and lowest just before schools reopened in August of the same year (R0=1.00). The highest percentage of cases were in the age range of 21-30 years (17.29%), but the proportion of cases who experienced symptoms increased with age and the presence of certain comorbidities (p-value
MPH Family & Child Health – Global Health Track Abstracts 23
STRESS STRATEGIES FOR ADOLESCENTS PROJECT. Arwa Abdel-Raheem. Tucson. MPH Internship Committee Chair: Burris Duncan MD. Site and Preceptor: El Rio Health and Wellness Center - Klya James, MA, MPH. Adolescence is the peak of vulnerability to mental health problems, a period of critical development and change. In 2019, 23% of children in the US have or have had a diagnosed psychiatric condition. In 2020, suicide was the second leading cause of death in the U.S. for individuals between the ages of 7-24. During the COVID-19 pandemic, all age groups have experienced increased stress levels. In Pima County, the Arizona Department of Health found a 67% increase in suicide rates in adolescents. There is emerging research on the benefits and effectiveness of mindfulness practice to reduce stress and anxiety in adolescents. There is no clinical evidence-based mindfulness program for youth to mitigate stress. Existing school based mindfulness curriculum may bridge this gap. Dot b (.b), is the UK’s premier evidence- based mindfulness curriculum for adolescents. .b stands for to ‘stop and be’, a simple practice at the heart of this ten lesson course delivered in school classrooms. .b teaches adolescents to incorporate mindfulness practices in their everyday lives to develop healthy and protective coping mechanisms. The curriculum has been shown to reliably reduce adolescent stress and anxiety, as well as to improve attentional control and awareness, further supporting learning and healthy decision making. This paper is an overview of the Stress Strategies for Adolescents Project at El Rio Health, a federally-qualified health center in Tucson, AZ currently serving 36,000 pediatric patients. Included is the literature review of mindfulness practices mediating anxiety and depression for adolescents, an overview of the .b mindfulness curriculum and a discussion of how the scholastic .b curriculum can be successfully implemented in the clinical setting of El Rio Health, and the proposed necessary infrastructure support. 24
ASSESSING SOCIAL ISOLATION & LONELINESS AMONG PIMACARE AT HOME CAREGIVERS AND CLIENTS. Cheryl L. Richard. Tucson. MPH Internship Committee Chair: Martha Moore-Monroy MA. Site and Preceptor: PimaCare at Home - Rebekah McGee, BA. The purpose of the PimaCare at Home (PCAH) internship was to improve non-medical health care service delivery for socially isolated older adults in Pima County. Social isolation and loneliness have an equally negative association with health as obesity, in-activity, and smoking. The COVID-19 pandemic heightened the social isolation and loneliness clients and caregivers were already experiencing. The relationship between home health care agencies and clients offers a unique opportunity to address unmet social needs. PCAH stakeholder’s insight concerning social isolation and loneliness determined that processes to assess, monitor, and address social isolation and loneliness are needed for both clients and caregivers. Current PCAH processes include non-validated interpersonal questions gathered during initial intake interviews. A literature review provided health evidence supporting the necessity to assess, monitor, and address social isolation/loneliness. This evidence-based research supports the need to use validated measurement tools enabling the agency to compare data for future program monitoring. The UCLA Loneliness Scale and Lubben Social Network Scale were chosen due to validity and ease of implementation. A PCAH evaluation plan was created using the input collected from stakeholders and the literature review evidence-based research. The PCAH evaluation plan creates a recommended policy allowing the implementation of validated measurement tools. The data gained from validated measurement tools will assist in determining the scope of need among caregivers and clients. Over time, this will provide PCAH the opportunity to monitor how services influence social isolation and loneliness among clients thus improving agency services and the health of clients and caregivers. 25
COVID-19 CULTURALLY AND LINGUISTICALLY APPROPRIATE MESSAGES FOR IMMIGRANTS AND FARMWORKERS IN YUMA, COUNTY. Gloria Carolina Villa Barbosa. Tucson. MPH Internship Committee Chair: Martha Moore-Monroy MA. Site and Preceptor: Campesinos Sin Fronteras - Emma Torres, MSW. Introduction: A year after the COVID-19 pandemic was declared, farmworker communities in Yuma County, AZ., face challenges for survival every day. Lack of effective education and health literacy are among the barriers faced by vulnerable groups. To successfully increase awareness, messages must be customized for the rural, border location and population structure. Messages must be linguistically and culturally appropriate and address issues relevant to immigrants accounting for differences in generational attitudes. Methods: A literature review was conducted to develop an understanding of the community and to identify successful and appropriate message methods. Media tools such as radio, TV, and social media were used to deliver information about COVID-19 including testing sites, prevention methods, farmworkers rights and employers’ obligations. Multiple events were held by community partners to distribute PPE and resources needed. Lastly, a survey was conducted in collaboration with interns at Campesinos Sin Fronteras to identify farmworkers’ attitudes about COVID-19 vaccine. Results: There is very limited research conducted about farmworkers. This is a barrier to identify cultural and linguistic appropriate interventions. Testing and PPE were limited among farmworkers communities during the beginning of the pandemic, and now limited vaccine availability is an ongoing issue. The survey conducted among 200 farmworkers showed that less than 2% were vaccinated at the time, and up to 90% were willing to receive the vaccine if available. Conclusion: Farmworkers are considered essential workers. However, they still experience significant disparities such as health care access, and more advocacy is needed. Stakeholders and representatives must take actions and provide the support and care they need and deserve. 26
CROWDSOURCING RETAIL SECTOR'S RESPONSE TO COVID-19. Alexis H. Wait. Tucson. MPH Internship Committee Chair: John Ehiri PhD, MPH, MSc. Site and Preceptor: The University of Arizona - Mona Arora, PhD, MsPH. Introduction: On March 13, 2021, there were 119 million cases of COVID-19 globally and 29 million cases in the U.S. The purpose of this project is to understand the retail sector’s response to COVID-19 by crowdsourcing information from retailer websites and emails. Methods: Using social media campaign, emails from retailers were recruited from March to December 2020. A data dictionary was developed to characterize the communication message by various factors such as intended audience and adopted guidelines. A content analysis was executed on the recruited emails and evaluated to determine retailer communication strategies. These strategies were compared to those of federal guidelines from the CDC, OSHA, WHO, and FDA. Using web scraping techniques on Web Archives the project team collected additional qualitative data from national retailers about their COVID-19 response. Results: 93 emails from 77 distinct service-oriented businesses were collected through crowdsourcing. 4 emails were excluded from the analysis. 69% of the emails were sent to consumers in March 2020. Many of the retail emails referenced disinfection (48%) and hygiene (35%) strategies, while 14% of the emails did not specify which COVID-19 mitigation strategies were adopted. About 46% of the emails referenced the CDC as the source of COVID-19 guidelines, however 43% of the emails did not reference any source of COVID-19 guidelines. Finally, of the emails collected face coverings were not mentioned until April 2020. Conclusions: Although robust analysis of retailer’s response could not be conducted due to the limited number of emails obtained, the analysis of the diverse service sector emails highlighted great diversity in COVID-19 prevention practices as illustrated by emails sent to customers and loyalty members. 27
MPH Family & Child Health – Maternal and Child Health Track Abstracts 28
COLLEGE SEXUAL VIOLENCE: MAGNITUDE, RESPONSE, AND ADVOCACY. Rachel Camille Cummings. Tucson. MPH Internship Committee Chair: Maia Ingram MPH. Site and Preceptor: Survivor Advocacy - Karyn Roberts, MPH. Background. The prevalence of sexual violence is extremely high on the University of Arizona campus with at least one quarter of undergraduates identifying as survivors. This internship included research into the magnitude of sexual violence, as well as different university responses to violence. It explored the feasibility of integrating peer-led components into the UA Survivor Advocacy program. Methods. I conducted a literature review into the prevalence of violence on college campuses, risk factors for victimization, and the effectiveness of peer advocacy. After identifying university advocacy programs with peer-led components, zoom interviews were conducted with stakeholders at each university. Lastly, an IRB application, interview guide, and recruitment materials were completed for a future study with survivors on the perceptions of the university’s response to sexual violence. Results. While university programs vary, there are also common themes. Each university utilizes their student workers for both violence prevention and advocacy work. Support groups are run by students as well, providing a space for survivors to heal together. Several universities also host hotlines for student triage. A unique component found was the addition of specialized support for marginalized groups, including LGBTQ+ and students of color. Conclusions. Ultimately, the University of Arizona would benefit from a peer-led advocacy program for survivors of sexual violence. Peer advocacy poses a challenge to organize and sustain, but can be an immense benefit to university students. The program should include both prevention and support services in the form of support groups and/or a hotline. There is a need for increased funding and capacity for the response, and peer advocacy could be a practical and meaningful route to take. 29
ADVOCATING FOR COMPREHENSIVE SEX EDUCATION. Carly Deal. Tucson. MPH Internship Committee Chair: Martha Moore-Monroy MA. Site and Preceptor: Planned Parenthood of Arizona - Maria Rodriguez. My internship was at Planned Parenthood of Arizona as the Education Intern. The goal of the internship was the creation of a toolkit that focused on advocating for sex education which was the primary deliverable. The other deliverables included a data analysis, two literature reviews and a marketing strategy for the toolkit. The data analysis and the first literature review were completed prior to the toolkit and helped guide the process of creating the toolkit. The second literature review guided the marketing strategy. The data analysis consisted of researching and gathering existing information from similar toolkits and comparing and contrasting language and information in these toolkits. The first literature review discussed best methods for toolkits as well as comparing and contrasting existing toolkits that cover comprehensive sex education. The second literature review looked at existing materials on advocacy, community engagement and research information dissemination during a pandemic. This literature review helped guide the creation of the marketing strategy for the toolkit. The purpose of this toolkit is to serve as a guide to increase the capacity of individuals and organizations to advocate for sex education in Arizona. The toolkit is aimed at a wide audience, including anyone interested in learning more about comprehensive sex education, sex education policy, steps to take to advocate in one’s community and techniques for discussing sexual health with their children. While creating the toolkit I learned how to select information for different audiences and sectors as well as understand different needs for different audiences. In addition to this, I gained research skills as a big part of creating the toolkit was researching information regarding comprehensive sex education. 30
KEEP WORKING ON YOUR RECOVERY AND LOVE YOUR BABY. A QUALITATIVE ANALYSIS OF MATERNAL AND INFANT ATTACHMENT AMONG MOTHERS WITH A HISTORY OF SUBSTANCE USE. Paula Garcia. Tucson. MPH Internship Committee Chair: Velia Leybas Nuño PhD, MSW. Site and Preceptor: Arizona State University School of Social Work in collaboration with Banner University Medical Center - Lela Williams, PhD. Background: Findings show 30% of mothers with a history of substance use relapse during the first 3 months postpartum, while almost half relapse 6 months postpartum, thereby making this period of time crucial for intervention. The purpose of this research was to identify social and psychological factors that contribute to a mother’s potential to use substances as it relates to bonding and attachment. Methods: A secondary data analysis was conducted from 42 semi-structured interviews with women with a history of substance use. Interviews averaged 60-90 minutes and included 183 questions. Mothers were asked about their pregnancies, birth and bonding experiences, physical health, depression, anxiety and stress levels, parenting confidence, home environment, relationship with their biological mother, newborn father involvement, relationship quality, Department of Child Safety (DCS) involvement, and their desires to use substances. Transcripts were coded using NVivo 12 qualitative data analysis software. Results: Three categories emerged: mothers with urges to use substances, mothers with no initial urges that later developed urges, and mothers with no urges. Mothers who did not breastfeed were more often among those with urges. Mothers who had difficulties breastfeeding, or breastfed only for a short amount of time, were more often among those with no initial urges who later developed urges. Mothers who had a positive breastfeeding experience often reported more positive attachment and bonding experiences with their newborns. Conclusion: These observations hold implications for the importance of breastfeeding in helping mothers develop strong bonds and attachments to their newborns, thus potentially decreasing their desires to use substances. 31
EXPANDING LOCAL HEALTH RESOURCE INFORMATION FOR AMPHITHEATER PUBLIC SCHOOLS THROUGH A COMPREHENSIVE SCHOOL HEALTH RESOURCE GUIDE AND WEB PAGE. Hannah Launius. Tucson. MPH Internship Committee Chair: Lynn B Gerald PhD, MSPH. Site and Preceptor: The Asthma & Airway Disease Research Center - Ashley Lowe, MSPH. Background: US schools operate in diverse settings with varying degrees of health resources available. In Tucson, Arizona, many students remain disconnected from the health care system and families often look to their school for assistance with bridging the gap between the school’s resources and accessing community health resources. Purpose of Research: The purpose of this project was to create a comprehensive list of local, health services and low- cost programs located within the Tucson community benefitting families with children enrolled in Amphitheater Public Schools (APS). Methods: An extensive internet and social media search for existing health resources among local organizations was conducted. Additional resources were identified by consulting with MEZCOPH faculty, public health practitioners and the district nurse at APS. Resources were organized by health category and compiled by subject matter. Program materials were further obtained by requesting information from local organizations via email and phone. When tangible materials were not available, materials were created using the organization’s website. Lastly, meetings with APS’s communications team and Director of Health Services were held to design a web-based format of the list of resources that would be accessible to APS families. Results: Approximately 200 community health programs and organizations were identified and compiled into 18 unique categories. Common resources included materials for nutrition, family support, and early childhood programs. Conclusion/ Recommendations: Numerous health resources exist for students in Tucson; however, information regarding these resources is constantly changing. Partnering with local school districts to update this comprehensive list including creating Spanish-language materials remains necessary. 32
ADAPTATION FOR ONLINE DELIVERY OF THE GROWING GIRLS YEAR-LONG AFTER-SCHOOL PSYCHOSOCIAL PROGRAM. Alyssa Julianna Rankin. Tucson. MPH Internship Committee Chair: Velia Leybas Nuño PhD, MSW. Site and Preceptor: Marana Unified School District’s Estes and Quail Run Elementary Schools - Lindsay M. Bingham, MPH, CHES. Background: Marana Unified School District’s Estes and Quail Run Elementary Schools and The University of Arizona partner to offer an after-school program. Growing Girls is designed for 5th and 6th grade students to develop knowledge and skills in the areas of psychological and social health. The purpose of the internship is to practice group facilitation and leadership, adapt curriculum, and pioneer online delivery of the program. Activities: The curriculum was developed for in-person delivery, but adapted into an online format due to the COVID-19 pandemic. Lessons were shortened from 1.5 hours to 1 hour. A combination of icebreakers, activities with images and videos, and discussions were delivered during lessons to promote learning and engagement. Three group leaders delivered one-hour lessons most weeks after- school via Zoom throughout the school-year. Five to eight girls participated in one of three groups. A sample of topics are problem solving, puberty, and safety online. At the end of the academic year, parents and girls receive a survey to assess satisfaction and recommend changes. Results: Throughout the program 88% of lessons had greater than 10 girls attend. There were 25 lessons, adapted from the previous year’s 19 lessons, each one hour long, during the academic year. The lessons about development/puberty had the highest attendance, 17+ girls. Conclusion: Converting an in-person program to an online delivery method was feasible. A number of challenges were encountered, but resolved. Ultimately, girls were able to participate in a program that might not have otherwise been offered due to school campus closures. 33
MPH Health Behavior Health Promotion Abstracts 34
REPORTING ON STOCK INHALER USE OVER TIME. Davina N. Dobbins. Tucson. MPH Internship Committee Chair: Lynn B Gerald PhD, MSPH. Site and Preceptor: Asthma & Airway Disease Research Center - Ashley Lowe, MSPH. Background: In Pima County, an estimated 15.9% of children have asthma and only about 15% of those children have access to life saving rescue medication at school. The Stock Inhaler for Schools Program provided rescue medication (albuterol sulfate) to children experiencing respiratory distress at school. The objective of this report was to describe details of an internship completed by the first author to report program findings back to schools that participated in the program. Methods: Descriptive statistics were obtained and used to create district-specific reports for three-years of program data. The reports contained the following information: 1) number of schools that reported a stock inhaler event, 2) student asthma diagnosis and disposition status for each event (sent home, returned to class, called 9-1-1- and transported or called 9-1-1 and no transport), 3) number of medication errors (measured by proportion of events with medication dose 4 puffs or 8 puffs vs. other dose), 4) program- related costs per school and 5) recommendations. Results: Overall, 165 schools reported 2,738 stock inhaler events during the 3-year period. Of these events, known asthma diagnosis was associated with 79% of events over time. Twelve-percent of events resulted in a student being sent home, 74% returned to class, 0.4% had 9-1-1 called with transport and 0.3% had 9- 1-1 called with no transport. Fifty-nine percent of events had a medication error and program related costs were $70.79 per school. Six recommendations were made for each district. Discussion: The completed aspects of the internship benefit the Asthma & Airway Disease Research Center as project outcomes could increase the strength of relationships with schools, support from the county and state to continue funding the stock inhaler program and improve reporting outcomes. 35
TOWARD ACHIEVING HEALTH EQUITY: AN EVIDENCE-BASED TRAINING TO REDUCE IMPLICIT BIAS IN HEALTH CARE. Carlos O. Garrido, PhD. Tucson. MPH Internship Committee Chair: Scott Carvajal PhD, MPH. Site and Preceptor: El Rio Health - Moira Alexander, MPH. Background. Implicit stereotyping and prejudice ("implicit bias") are unconscious associations/attitudes that humans hold about members of social groups. Despite its automaticity, implicit bias affects impressions by influencing poor quality interactions. Physicians exhibit significant levels of implicit bias that patients detect through negative verbal/nonverbal behaviors. For example, physicians with anti-Black bias exhibit dominant and anxiety-related language with Black patients. In turn, patients are less likely to comply with treatment recommendations. This internship consisted of creating a health equity workshop for El Rio Health employees to mitigate implicit bias. Method. The workshop is based on the premise that implicit bias is a habit that can be broken through practice. A review of the scientific literature was conducted to determine 1) steps to break the habit of biased responses, 2) effectiveness of strategies proposed by the literature, and 3) presentation method appropriate for use among medical staff. Two versions of the workshop—2-hour in- person and 1-hour on-line—were created. Pre- and post-workshop surveys were created and provided to El Rio to facilitate assessment of the effectiveness of the workshop from participants in meeting learning objectives. El Rio satisfaction with the workshop was assessed through qualitative feedback from El Rio staff. Results. The final workshop consisted of narrated and interactive slideshows for in-person and on-line versions. Ongoing meetings with El Rio staff were conducted and their feedback was regularly incorporated. Conclusion. Final product resulted in the successful completion of the two workshop versions delivered to El Rio Health. Feedback gave rise to high confidence that the workshop leads to long-term reductions in implicitly biased responses. 36
PUBLIC HEALTH EVALUATION WITH THE UNIVERSITY OF ARIZONA’S COOPERATIVE EXTENSION. Elena Greenberg. Tucson. MPH Internship Committee Chair: Cynthia Thomson PhD, RD. Site and Preceptor: University of Arizona Community Research, Evaluation & Development (CRED) Team - Michele Walsh, Ph.D. ABSTRACT Public Health Evaluation with the University of Arizona’s Cooperative Extension Background Members of the Community Research, Evaluation & Development (CRED) team support program evaluation for the University of Arizona's Cooperative Extension. Cooperative Extension aims to connect the University to the public by serving as a statewide network of educational programming and outreach. In order to communicate the success of their programming, the objective of this project was to assess the evidence of effectiveness of Family, Consumer, & Health Science (FCHS) programming. We used recently developed “common measures” meant to assess the expected short term program outcomes and conducted literature searches that provide evidence of likely longer term FCHS programming effectiveness. Methods After reviewing the depth and breadth of programming that the FCHS conducts throughout the state, we conducted literature reviews on 6 public health programming topics: gardening; physical activity; nutrition education; food safety; school readiness and early literacy; and parenting and caregiving. For each topic, we conducted an umbrella review on literature published between years 2010-2021on PubMed, Embase, and Google Scholar to inform the evidence of effectiveness of these types of programming. We then developed topic-specific infographic templates that can be used to display region- specific post-program survey data results. Results Based on the literature searches, we created 6 one-page literature summaries and 6 corresponding infographic templates about the evidence of effectiveness for FCHS programming. Conclusion These literature summaries and infographic templates inform Cooperative Extension stakeholders of FCHS programming and provide evidence for continued investment. 37
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