Recent Publications by Tulane Public Health Researchers


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The Department of Community Health Sciences
Selected Recent Publications

Researchers	Title	Publication	Abstract
Farley T, Meriwether R, Baker E, Watkins L, Johnson C, Webber L.	Safe play to promote physical activity in inner-city children: results from a pilot study of an environmental intervention.	Am J Public Health 2007; 97(9):1625-1631.	Objectives We evaluated the effect of providing a safe play space on the physical activity level of inner-city schoolchildren. Methods In 1 of 2 matched neighborhoods, we opened a schoolyard and provided attendants to ensure children's safety. Over the next 2 years we directly observed the number of children and their physical activity levels in the school-yard, as well as in the surrounding intervention and comparison neighborhoods. We also surveyed children in the schools in the intervention and comparison neighborhoods regarding sedentary activities. Results After the schoolyard was opened, a mean of 71.4 children used it on weekdays and 25.8 used it on weekends during the school year. When observed, 66% of these children were physically active. The number of children who were outdoors and physically active was 84% higher in the intervention neighborhood than the comparison neighborhood. Survey results showed that children in the intervention school reported declines relative to the children in the comparison school in watching television, watching movies and DVDs, and playing video games on weekdays. Conclusion When children were provided with a safe play space, we observed a relative increase in their physical activity. Provision of safe play spaces holds promise as a simple replicable intervention.
Johnson C, Murray D, Elder J, Jobe J, Dunn A, Kubik M, Voorhees C, Schachter K.	Depressive symptoms and physical activity in adolescent girls.	Med Sci Sports Exerc.	Purpose To evaluate the relationship between depressive symptoms and physical activity in a geographically and ethnically diverse sample of sixth-grade adolescent girls. Methods The Trial of Activity for Adolescent Girls (TAAG) baseline measurement included a random sample (N = 1721) of sixth-grade girls in 36 schools at six field sites. Measurements were accelerometry and the 3-d Physical Activity Recall (3DPAR) for physical activity, and the Center for Epidemiological Studies-Depression scale (CES-D) for depressive symptoms. Results Girls with complete data (N = 1397), mean age 12 yr, had an average CES-D score of 14.7 (SD = 9.25) and engaged in an average of about 460 min of sedentary activity, < 24 min of moderate to vigorous physical activity (MVPA), and < 6 min of vigorous physical activity (VPA) in an 18-h day. Thirty-minute segments of MVPA ranged in number from 3.9 to 1.2, and METS for these segments ranged from > 3.0 to > 6.5. Mixed-model regression indicated no relationship between depressive symptoms and physical activity; however, a significant but modest inverse relationship between sedentary activity and depressive symptoms was observed. Conclusion A sufficient sample size, standardized procedures, and validated instruments characterized this study; however, a relationship between depressive symptoms and physical activity was not observed for sixth-grade girls from diverse geographic locations. The average CES-D score was lower than is considered clinically meaningful for either adolescents or adults, and MET-minutes of sedentary activity were high. This combination of data may be different from other studies and could have contributed to the unexpected finding. This unexpected finding is informative, however, because it shows the need for additional research that includes a wider range of possible combinations of data, especially with young adolescent girls.
Jaycox LH, Tanielian TL, Sharma P, Morse L, Clum G, Stein B.	Schools' mental health responses after hurricanes Katrina and Rita.	Psychiatr Serv 2007 Oct; 58(10):1339-1343.	Objective After the displacement of students following hurricanes Katrina and Rita, schools in several states enrolled many students with potential mental health needs. This study sought to understand how schools perceived the mental health needs of these students and what mental health programs they implemented. Method Mental health personnel at 19 public schools or school systems and 11 private or parochial schools in Louisiana, Alabama, Texas, and Mississippi were interviewed at two time points(spring and fall-winter of 2006). Results Schools undertook diverse approaches to interventions, depending on the preexisting mental health infrastructure and personnel, the perceived needs of students, and the barriers or facilitators in each system. Interviewees described a rapid and comprehensive approach to the crisis in the immediate aftermath. Shortly afterward, some schools perceived little need for mental health services and refocused on their academic missions. Other school systems perceived student need but were unable to implement trauma-focused programs because staff were not prepared to deliver such services and funding was lacking. However, some systems and schools were able to implement new programs or extend programs to displaced students. Implementation challenges included difficulty communicating with parents, burnout among staff and program implementers, and efforts to balance the needs of the displaced students with those of the preexisting student population. Conclusions Despite significant efforts to support students affected by the hurricanes, schools were limited in their ability to implement disaster-focused programs. Extension of crisis plans to include precrisis training in mental health programming for students and staff who have ongoing difficulties after a disaster or crisis may be beneficial.
Taylor CA, Sorenson SB.	Intervention on behalf of children exposed to intimate partner violence: assessment of support in a diverse community-based sample.	Child Abuse and Neglect 2007; 31:1155-1168.	Objective The aim of this study is to assess community-based support for intervening on behalf of children exposed to intimate partner violence (IPV) and to determine what contextual and respondent characteristics are associated with that support. Method An experimental vignette design was used in a random-digit-dial survey of six ethnic groups in California. For each respondent (n = 3679), seven vignettes about IPV were generated using randomized categories of victim and assailant characteristics (i.e., gender and sexual orientation, age, ethnicity, nativity, occupational status, and relationship status) and situational characteristics (i.e., motivation, weapon use, type of abuse, alcohol use, frequency of the incident, and child present). All vignettes analyzed for this manuscript (n = 6556) mentioned that “there was a child in the other room” during the incident. Results In 70% of the IPV scenarios, respondents supported intervention on behalf of the child. Support was lowest when the IPV was purely psychological in nature (62–63%), higher when it involved threats, coercion, or limited physical abuse (68–71%), and highest when it involved severe physical abuse (76–81%). The odds of supporting intervention also were elevated when a weapon was involved, when the IPV occurred multiple times, and when the IPV involved gay men. Men and Vietnamese Americans had the lowest odds of favoring intervention. Conclusions Public opinion assessed in this survey is aligned with that of professionals who believe that the potential impact of IPV on children should not be ignored and who have suggested that criteria should be developed to guide a graded intervention response for such cases.
Rose D.	Food Stamps, the Thrifty Food Plan, and meal preparation: the importance of the time dimension for US nutrition policy.	J Nutr Educ Behav 2007 Jul-Aug; 39(4):226-32.	The Thrifty Food Plan (TFP) has a unique role in US Nutrition Policy, integrating both dietary guidance and antihunger policies. Not only are food items in the TFP market basket chosen based on the latest dietary recommendations, but the Plan serves as the basis for inflation adjustments to Food Stamp allotments. To be economical, the TFP logically assumes that most dishes are prepared from raw ingredients. This assumption likely contradicts welfare policy, which promotes increased labor force participation of low-income women. This article presents empirical evidence on meal preparation times in US households and compares this evidence to the TFP implicit assumptions about food preparation. The trade-offs between time and money inputs used in the preparation of meals are discussed using the economist's household production approach. Implications of policy contradictions are explored, as well as related needs for research and practice.
Scott A, Ellen J, Clum G, Leonard L.	HIV and housing assistance in four U.S. cities: variations in local experience.	AIDS Behav 2007 May 18; [Epub ahead of print]	This paper provides an account of how young, HIV-positive women manage their lives on limited budgets in four United States cities: New York City, New Orleans, Miami, and Chicago. The study findings elucidate city-to-city variability in housing assistance, and how this manifests in locality specific differences in the experience of HIV. Our research suggests that the receipt of housing assistance has ramifications for women's engagement in care, and for their health. Women not receiving aid often move frequently in and out of homelessness, or "double up" with others in complex household arrangements to share costs. Women with long-term housing assistance, while still struggling financially, possess a stable base from which to approach daily life and HIV care. This account suggests a need for empirical research assessing the impact of local variations in housing assistance on specific health outcomes for those with HIV. It also highlights the importance of understanding local contexts when designing housing interventions at both the individual and structural levels.
Trent M, Clum G, Roche Km.	Sexual victimization and reproductive health outcomes in urban youth.	Ambul Pediatr 2007 Jul-Aug;7(4):313-6.	Objective Adolescents and adults with a history of sexual victimization (SV) are at increased risk of engaging in sexual risk behaviors. This study seeks to examine race- and gender-based differences in SV as well as the association between SV and reproductive health outcomes (pregnancy and sexually transmitted infections [STIs]) among young adults from an urban community with high rates of both outcomes. Methods This study used cross-sectional data from the Young Adult Survey of the Baltimore Prevention Program's intervention trials. Participants initially enrolled as first graders were interviewed for the Young Adult Survey as they entered adulthood. A total of 1698 participants were asked about SV, pregnancy, and STIs. Data were analyzed by logistic regression analysis. Results History of SV did not vary by racial background, but female participants were more likely to report SV than their male peers. Results for models predicting STIs revealed a significant interaction between gender and SV. Adolescent girls who reported a SV were significantly more likely to have an STI than adolescent girls who did not report victimization. Both adolescent boys and girls who reported SV were more likely to report involvement in a pregnancy. Conclusions Youth in urban communities with a history of SV are far more likely than those without victimization histories to have a pregnancy or STI before young adulthood. Further research is needed to explore the mediators of these outcomes and the value of sexual safety and child protection programs for pregnancy and STI prevention in urban environments.
Beaudoin CE, Fernandez C, Wall JL, Farley TA	Promoting healthy eating and physical activity: short-term effects of a mass media campaign	Am J of Preventive Medicine. Mar 2007. 32(3):217-23	Background Soaring obesity levels present a severe health risk in the United States, especially in low-income minority populations. Intervention: high-frequency paid television and radio advertising, as well as bus and streetcar signage. Setting/Participants: a mass media campaign in New Orleans to promote walking and fruit and vegetable consumption in a low-income, predominantly African-American urban population. Messages were tailored with consideration of the African-American majority. Design Random-digit-dial telephone surveys using cross-sectional representative samples at baseline in 2004 and following the onset of the campaign in 2005. Measures Survey items on campaign message recall; attitudes toward walking, snack food avoidance, and fruit and vegetable consumption; and behaviors related to fruit and vegetable consumption, snack food consumption, and utilitarian and leisure walking. Results From baseline, there were significant increases in message recall measures, positive attitudes toward fruit and vegetable consumption, and positive attitudes toward walking. Behaviors did not change significantly. In 2005, message recall measures were associated with positive levels of each of the outcome variables. Conclusions Over 5 months, the media campaign appeared to have stimulated improvements in attitudes toward healthy diet and walking behaviors addressed by the campaign. These findings encourage the continuation of the media campaign, with future evaluation to consider whether the behavioral measures change.
Xiong X, Wightkin J, Magnus JH, Pridjian G, Acuna JM, Buekens P	Birth weight and infant growth: optimal infant weight gain versus optimal infant weight	Maternal & Child Health J. Jan 2007. 11(1):57-63	Objective Infant growth assessment often focuses on "optimal" infant weights and lengths at specific ages, while de-emphasizing infant weight gain. The objective of this study was to examine infant growth patterns by measuring infant weight gain relative to birth weight. Methods We conducted this study based on data collected in a prospective cohort study including 3,302 births with follow up examinations of infants between the ages of 8 and 18 months. All infants were participants in the Louisiana State Women, Infants, and Children Supplemental Food Program between 1999 and 2001. Growth was assessed by infant weight gain percentage (IWG%, defined as infant weight gain divided by birth weight) as well as by mean z-scores and percentiles for weight-for-age, length-for-age, and weight-for-length calculated based on growth charts published by the US Centers for Disease Control (CDC). Results An inverse relationship was noted between birth weight category and IWG% (from 613.9% for infants with birth weights <1500 g to 151.3% for infants with birth weights of 4000 g or more). In contrast, low birth weight infants had lower weight-for-age, weight-for-length z-scores and percentiles compared to normal birth weight infants according to CDC growth charts. Conclusions Although low birth weight infants had lower anthropometric measures compared to a national reference population, they had significant catch-up growth. We suggest that growth assessments should compare infants' anthropometric data to their own previous growth measures as well as to a reference population. Further studies are needed to identify optimal ranges of infant weight gain.
Farley TA	Sexually transmitted diseases in the Southeastern United States: location, race, and social context	Sexually transmitted diseases. Jul 2006. 33(7 Suppl):S58-64	Abstract Heterosexual transmission of HIV in the United States appears to be following the epidemiologic pattern of bacterial sexually transmitted diseases (STDs) such as syphilis and gonorrhea, disproportionately affecting blacks in the Southeastern region. Nationwide, rates of syphilis and gonorrhea are nearly 30 times higher in blacks than in whites, and this racial disparity underlies most of the regional and county-level differences in rates. The racial disparity cannot be explained by traditional measures of socioeconomic differences, and it cannot be explained by individual-level determinants of sexual behavior, but rather reflects deeper group-level social and environmental factors for which race is a marker. A theoretical model based on previous ecologic studies is proposed to explain the relationship between racial discrimination and elevated rates of STDs in blacks. Key factors in the model include: 1) chronic joblessness, 2) drug and alcohol marketing, 3) social disorganization (or social capital), and 4) male incarceration.
Kissinger P, Schmidt N, Mohammed H, Leichliter JS, Gift TL, Meadors B, Sanders C, Farley TA	Patient-delivered partner treatment for Trichomonas vaginalis infection: a randomized controlled trial	Sexually Transmitted Diseases. Jul 2006. 33(7):445-50	Objectives Infections with Trichomonas vaginalis (TV) are common and recurrence rates are high. Better methods of treating partners of women with trichomoniasis are needed. GOAL: To determine if patient-delivered partner treatment (PDPT) is better and more cost-effective than partner referral. Study Design Women attending a family planning clinic who were culture-positive and treated for TV (N = 463) were randomized to either standard partner referral (PR), booklet-enhanced partner referral (BEPR), or PDPT. At baseline and 1 month, women were interviewed and cultured for TV. Detailed cost information was also collected. Results Most women had 1 partner, were less than 24 years old, and were black. The percentage of women reporting that their partners were treated was similar for PDPT but significantly lower for BEPR compared to PR. TV follow-up rates were similar. PDPT cost less and was cost saving compared to PR and BEPR. Conclusion Among women with TV, PDPT did not result in more partners taking the medicine or lower follow-up rates than PR but was less costly.
Farley TA, Mason K, Rice J, Habel JD, Scribner R, Cohen DA	The relationship between the neighbourhood environment and adverse birth outcomes	Paediatric and Perinatal Epidemiology. May 2006. 20(3):188-100	Background Intrauterine growth retardation and preterm birth are more frequent in African-American women and women of lower socio-economic status, but the reasons for these disparities are not fully understood. The physical and social environments in which these women live may contribute to these disparities. Methods We conducted a multilevel study to explore whether conditions of mothers' neighbourhood of residence contribute to adverse birth outcomes independent of individual-level determinants. We analysed data from 105 111 births in 1015 census tracts in Louisiana during 1997-98, merging it with data from other existing sources on neighbourhood socio-economic status, neighbourhood physical deterioration, and neighbourhood density of retail outlets selling tobacco, alcohol and foods. After controlling for individual-level sociodemographic factors, tract-level median household income was positively associated with both birth weight-for-gestational-age and gestational age at birth. Neighbourhood physical deterioration was associated with these birth outcomes in ecological analyses but only inconsistently associated with them after controlling for individual-level factors. Neither gestational age nor birth weight-for-gestational-age was associated with neighbourhood density of alcohol outlets, tobacco outlets, fast-food restaurants or grocery supermarkets. Conclusions We conclude that measures of neighbourhood economic conditions are associated with both fetal growth and the length of gestation independent of individual-level factors, but that readily available measures of neighbourhood retail outlets are not. Additional studies are needed to better understand the nature of environmental influence on birth outcomes.
Thurman TR, Snider L, Boris N, Kalisa E, Nkunda Mugarira E, Ntaganira J, Brown L	Psychosocial support and marginalization of youth-headed households in Rwanda	AIDS Care. Apr 2006. 18(3):220-9	Background This research aims to characterize the psychosocial aspects of well-being among youth-headed households in Gikongoro, Rwanda, through examination of social support and marginalization. Data is presented on perceived availability of support from relatives, an unidentified adult, peers, and other community members and an index of social marginalization. Methods A total of 692 interviews were completed with youth-headed households age 13-24 who are beneficiaries of a basic needs program. Sixteen percent of youth reported there was no one they felt they could go to with a problem. In times of need, only 24% felt relatives would help them, while 57% felt neighbors would offer assistance. Most youth reported significant caring relationships: 73% reported access to a trusted adult who offers them advice and guidance, and most indicated close peer relationships. However, many youth also perceived a lack of community support, with 86% feeling rejected by the community and 57% feeling the community would rather hurt them than help them. Conclusions Social support is a low-cost critical resource for the care of vulnerable youth and an understanding of existing social support networks would enhance the design and implementation of psychosocial and community-based care initiatives.
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