ASPHN Annual Meeting

Background: The HIV/AIDS epidemic consistently impacts disease and socioeconomic burdens, especially on racial minorities and impoverished communities. Problem Statement: In urban poverty tracts, HIV prevalence rates inversely associate with annual household income, implying the lower the household income, the higher the HIV prevalence rate. Besides the yearly household income, all other metrics of socioeconomic status (e.g., education, poverty level, homeless status, and employment status) have an inverse relationship with HIV prevalence. Non-Hispanic Blacks (1.7%) in the United States have an HIV prevalence rate that is over eight times the HIV prevalence rate for non-Hispanic Whites, while Hispanics (0.6%) have three times the HIV prevalence rate of non-Hispanic Whites (0.2%). Poverty is responsible for some racial-ethnic disparities associated with HIV prevalence rates, as 46% of non-Hispanic Blacks and 40% of Hispanics reside in poverty tracts compared to 10% of their non-Hispanic white counterparts. Recommendation: Prevention programs that involve a vaccine serve to control the viral load in most cases or eradicate the infectious disease burden in certain circumstances. There is no one-size-fits-all strategy for preventing HIV/AIDS that is likely to induce a dramatic impact. All-inclusive approaches for preventing, screening, and managing HIV/AIDS beyond high-risk populations yield better outcomes. Policy Implication: Reversing the trend of the HIV epidemic will involve mixed techniques such as surgical, behavioral, and biomedical strategies for HIV prevention. Conclusion: A safe and efficient vaccine against HIV would significantly promote successful preventive interventions to control the HIV/AIDS epidemic and minimize the impact of poverty.

Anthony Uchenna Emeribe <aneme1@morgan.edu>

Morgan State University, School of Community Health and Policy

HIV/AIDS, vaccine, racial minorities, poverty

ASPHN Policy Brief Abstract Hailey Lewis, BS Introduction The Farm Bill is significant legislation that authorizes and funds programs related to the agriculture industry. The Bill was first enacted in 1933 in response to the Great Depression and was created to provide financial assistance to farmers and establish policies to stabilize commodity prices and protect natural resources. Research The Bill is typically renewed every five years. The 2018 Farm Bill included several provision changes to Commodity Programs, Nutrition Programs, Conservation, Rural Development, Credit, Horticulture, Miscellaneous, and the Forestry title. My research for this policy brief included looking up the history of the Farm Bill, analyzing different position statements and top priorities for various organizations to identify common themes and guidance, and researching different reports and briefs surrounding recommendations for the 2023 Farm Bill. Policy Implications The Farm Bill provides funding for programs that address social and economic issues, promote sustainable practices, and ensure food security. The reauthorization of the 2023 Farm Bill - Title IV Nutrition Programs carries significant implications for food and nutrition security, health outcomes, and the economy in the United States. Recommendations The 2023 Farm Bill - Title IV Nutrition Program - Policy Recommendations aim to address some of the shortcomings of the current policy. The recommendations suggest improving SNAP access, integrity, and operations for participants and retailers, modernizing food distribution programs, and improving food and nutrition security for priority populations through other food and nutrition assistance programs. Conclusion The Farm Bill is a vital piece of legislation that plays an essential role in shaping the agriculture industry in the United States. The recommendations for the Farm Bill ensure that farmers, ranchers, processors, distributors, and consumers are all taken into account and provided funding for programs.

Hailey Astin Shelby Lewis <hlewis18@vols.utk.edu>

University of Tennessee, Knoxville, Department of Nutrition

Policy Brief, Farm Bill, Agriculture, Nutrition, Title

Introduction: The rate of pre-pregnancy obesity among mothers is about 20% and it is associated with an increased risk for adverse pregnancy and birth outcomes including pre-eclampsia and pre-term delivery. Mothers with pre-pregnancy obesity are also at higher risk for developing hypertension and type 2 diabetes than mothers with normal weight before pregnancy.

Problem Statement: In 2021, the maternal mortality rate in the United States increased to 32.9 deaths per 100,000 live births compared with a rate of 23.8 per 100,000 live births in 2020 and 20.1 per 100,000 live births in 2019. Non-Hispanic black women were disproportionately affected with a rate of 69.9 deaths per 100,000 live births which was 2.6 times the rate for non-Hispanic white women. In Illinois state, despite contributing less than 20% of total state births, African American women are six times as likely to die of a pregnancy-related condition as non-Hispanic White women. Obesity has been documented to be associated with about 44% of pregnancy-related death in Illinois State

Recommendations: Research and urgent intervention to address the rising prevalence of pre-pregnancy obesity among women of reproductive age group in communities with high infant and maternal mortality are needed. Maternal and child health stakeholders should consider prioritizing advocacy and funding to address obesity among women of reproductive age groups in Illinois.

Research: Scopus, Google Scholar, PubMed, and websites of Federal agencies, Illinois State, Cook County, and Chicago city public health agencies were searched for peer-reviewed publications and reports on maternal mortality and social determinants of health in Illinois and Chicago. An average of 75 Illinois women died while pregnant or within one year of pregnancy each year during 2008-2017. The highest number was recorded in 2017, which translated to a pregnancy-associated mortality rate (PAMR) of 49 deaths for every 100,000 live births in Illinois. Maternal obesity has been documented to be associated with about 44% of pregnancy-related death in Illinois.

Policy implications: Pursue advocacy and policy efforts to achieve accelerated pre-natal obesity prevalence reduction through mechanisms in which food policies affect diet. This includes providing an enabling environment for learning healthy food preferences, overcoming barriers to the expression of healthy food preferences, encouraging people to reassess existing unhealthy food preferences at the point of purchase, and stimulating a food-systems response. The integration of maternal nutritional counseling in adolescent health services, Women, Infants, and Children (WIC), Supplemental Nutrition Assistance Program (SNAP), and the Healthy Start program is also advocated.

Conclusion: Pre-pregnancy obesity is a major contributing factor to the wide, persistent racial disparities in maternal mortality in the state of Illinois. There is a need for policymakers to encourage the enactment and implementation of food policies focusing on diet which can promote the prevention of obesity among women of reproductive age group. Specific examples include the provision of vegetables, a low-carb diet, and fruits for beneficiaries of WIC and SNAP programs.

Tolu Arowolo <toaro1@morgan.edu>

Morgan State University School of Community Health and Policy

Maternal mortality, Obesity, Health Equity

Plan: Children from low socioeconomic and diverse backgrounds are at a higher risk of increased BMI’s. One key to improving a child’s weight status is to implement a healthier diet. The purpose of this project was to study the effectiveness of hands-on nutrition and cooking lessons to improve children’s knowledge of healthful food choices and ability to practice food preparation skills.

Do: This project was conducted as a series of cooking classes for elementary school-aged children in a Boys’ and Girls’ Club in a community setting. The program met weekly for six weeks and used a pre-designed curriculum. Lessons included nutrition facts, hands-on kitchen safety and cooking skills, tastings to introduce new recipes and foods, and active games to reinforce learning. Data were collected through pre- and post-evaluations at the first and last sessions, and were analyzed using SPSS v. 27.

Study: Twenty-one 4th and 5th grade students participated in the project. Elementary-aged students showed significant knowledge improvements from pre- to post-intervention on benefits of fruits and vegetables (p = 0.016) and meal planning skills (p = 0.001). There was evidence of an intervention dose-response effect, with a significant difference in fruit and vegetable benefits knowledge between students attending 1-3 sessions and those attending 4 – 6 sessions (p = 0.005).

Act: Elementary-age students with adverse social determinants of health were able to learn nutrition knowledge and skills through hands on learning and active participation in cooking activities. The greatest challenge for this program was promoting consistent participation. Partnering with a program like Boys and Girls Club can assist in recruitment and retention, but the challenges persist.

Abraya Johnson

Department of Nutrition and Health Care Management

Nutrition education, cooking skills classes, elementary-age children

Background: Maternal obesity has been indicated as a great contributor to the infant mortality rate (IMR) and preterm births (PTB) in Tennessee (TN). Noticeable racial disparity is also seen in IMR and PTBs with African Americans having a disproportionate burden. Objective: This review aimed to explore the contribution of maternal obesity to racial disparity in the infant mortality rate and preterm birth rates in Tennessee. Methods: In this scoping review, PubMed, National Library of Medicine, Google Scholar, Tennessee Maternal Mortality Review Committee (MMRC) Report, Tennessee Department of Health Report (TNDH), and other relevant sources were searched for ‘infant mortality rate’, ‘preterm births rate’, ‘racial disparity’, ‘maternal obesity’ and ‘prepregnancy obesity’ from 2011 to 2021. Result: In 2021, TN had an IMR of 6.2 deaths per 1,000 live births. The racial distribution shows an IMR of 12.6 and 4.2 deaths per 1,000 live births for African American or Black and People without color (PWC) respectively. African American or Black have a PTB of 14.8 deaths per 1,000 live births, which is greater than the rate among all other women by 45%. In 2020, 31.1% and 36.7% of women of childbearing age have obesity in the U.S. and TN respectively, with African American or Black making up 46.4%, People without color or White 33. 8% and Hispanic 27.8%. Maternal obesity contributed to 24% of maternal complications and pregnancy-related deaths in TN. Conclusion: Maternal obesity before pregnancy is associated with adverse outcomes for the infant and the mother, with racial and ethnic minority groups experiencing the worst outcomes. Public health interventions should target these vulnerable groups.

Catherine N. Ononogbo <caono1@morgan.edu>

School of Community Health and Policy, Morgan State University, Baltimore Maryland

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Introduction: Prior to the COVID-19 pandemic, 1-in-7 households with children experienced food and nutrition insecurity (FNIS). COVID-19 may have made households with children uniquely vulnerable to FNIS risk. This study aimed to determine factors that influenced the risk of FNIS in households with children compared to households without children. Methods: We conducted a secondary analysis of the University of Tennessee, Knoxville COVID-19 Food Survey data about the food and nutrition security of 5,627 US households from March 17 to May 31, 2020. Chi-square analysis was used to assess differences between groups, and binary logistic regressions were used to estimate associations between sociodemographic characteristics and financial availability for food at the beginning of the pandemic. Results: There were significant differences in age, education level, income, SNAP participation, and money for food at the beginning of the COVID-19 pandemic between households with and without children. Households who were at risk for FNIS prior to the pandemic or had a child were less likely to have enough money to buy food at the beginning of the pandemic. However, households with a bachelor’s degree or higher, income above $35,000, and access to transportation for food were more likely to have enough money for food at the beginning of COVID-19 Discussion: Identifying factors influencing FNIS risk, either positively or negatively, during COVID-19 in households with children can lead to research-informed actionable steps and inform FNIS-related interventions to reduce the prevalence of FNIS in future pandemics.

Emilie Holloway <ehollow5@vols.utk.edu>

UTK, Department of Nutrition

student, food and nutrition insecurity, COVID-19, survey

Background: It has been hypothesized that positive, asset-based interventions using strategies from within the community may be more effective at influencing behavior change than deficit-based interventions. Results from the Positive Deviance in Child Obesity Prevention (PD) Study emphasized that some Minnesota WIC children were able to have positive health outcomes due to engaging in deviant health behaviors.

Aim: The aim of this project is to use strategies identified by families in the PD Study to create asset-based messages for use in WIC counseling sessions.

Methods: Minnesota WIC staff are interested in creating short WIC videos with PD Study findings, using content provided by members of diverse cultures. WIC staff across local agencies assessed this project to ensure videos would be successful. Initial video scripts were drafted using parental quotes from the PD Study which illustrated positive deviant behaviors. The first 2 videos were filmed in Spanish in the Spring of 2023, and Pretesting of the video clips was conducted with WIC peer counselors.

Results: The formative evaluation of the initial video scripts showed that staff had a general interest in using asset-based videos with WIC participants and that they found the topics relatable. Pretesting the initial videos with WIC peer counselors provided additional helpful feedback such as how many respondents indicated prefer a shorter video.

Next Steps: The next steps of this project are to finish editing the initial videos and then pilot-test them with WIC participants and WIC peer counselors before being used across the state. A future process and outcome evaluation will be conducted to assess implementation and measure the effectiveness of videos in creating behavior change.

Krista Nagel <nagel129@umn.edu>

University of Minnesota School of Public Health

Student, WIC, Asset Based Messages, Positive Deviance, Counseling, Evaluation, Behavior Change

Background: Among the Organization for Economic Cooperation and Development ( countries, the United States ( ranks 39th for the lowest infant mortality rates If the US ranked among the OECD countries based only on its non Hispanic black IMR, it would rank 44th instead of its current ranking at 39th position. Maryland mirrors the national profile in these health indices The structures of racism strongly influence the effect of social determinants of health ( on the infant mortality rates of NHBs Eliminating persistent racial disparities in health outcomes will require policy interventions that address the life course of the African American experience.

Purpose: This narrative scoping review aims to highlight the counties in Maryland with significant racial disparities in infant mortality rates, highlight the contributory factors and make recommendations on how Historically Black Colleges and Universities (HBCUs) can be critical partners in providing solutions.

Methods: Google Scholar and PubMed electronic databases were used for literature extraction. Inclusion criteria: peer reviewed published literature assessing racial disparities in infant mortality and the influence of social determinants of health; data from the CDC and state health departments. Exclusion criteria: unverified data sources; studies without data on African American population . Keywords for the literature search: infant mortality, racial disparities, social determinants of health, United States, African Americans, Blacks, Hispanics, Latinos, racial minorities, and people of color.

Results: Infant death rates in the US are higher than in other high income countries, even though the US spends more on healthcare per person and as a share of GDP. The US infant mortality rate (IMR) in 2020 was 5.8 deaths per 1,000 live births, while the average rate for OECD countries was 3.8 deaths per 1,000 live births. The IMR for NHBs was 10.38 per 1,000 live births, while NHW infants had mortality rates of 4.40 per 1,000 live births. African American women in the US have higher rates of poor birth outcomes, including preterm delivery, low birth weight (LBW), and small for gestational age, than NHWs and Hispanic women. Historically, the IMR for all races combined in Maryland has been higher than national rates because of the higher proportion of black people and higher black infant mortality rates compared to whites. The IMR in Maryland in 2020 was 5.7 per 1,000 live births. Non Hispanic black infants had an IMR of 9.9 per 1,000 live births, while NHW infants had an IMR of 3.3 per 1000 live births. The three leading causes of IMR in Maryland are LBW, congenital abnormalities, and maternal complications of pregnancy. The counties with the highest IMRs in 2020 are Dorchester (13.3), Wicomico (11.2), and Baltimore City(10.3). Low birth weight is the leading cause of IMR in Maryland, and NHB infants have a four time more likelihood of mortality from LBW than NHW infants. The influence of social determinants of health on infant mortality differs by race. Social inequalities, geographic disparities, and lifelong wear and tear effects of racism on African American mothers contribute to higher black infant mortality rates in the US compared to other races

Discussion: There is ample evidence that African Americans have the highest infant mortality rates across all racial and ethnic groups in the United States Newborn physician racial concordance is associated with significant improvements in the survival of black newborns The racial diversity of nurses is also associated with improved maternal and child outcomes. Building a diverse maternal and child (workforce that equitably includes underrepresented minorities that look like the communities they serve can be a game changer to improve health outcomes and reduce or eliminate racial disparities Historically Black Colleges and Universities are uniquely positioned to provide community based participatory research and a culturally matching workforce to address racial disparities in health indices. Research & Program Implications: Setting up MCH academic programs in HBCUs would increase the diversity of the MCH workforce in training and improve community based participatory research in their communities to improve maternal and child health outcomes.

Research & Program Implications: Setting up MCH academic programs in HBCUs would increase the diversity of the MCH workforce in training and improve community based participatory research in their communities to improve maternal and child health outcomes.

References: Bediako, P. T., BeLue, R., & Hillemeier, M. M. (2015). A Comparison of Birth Outcomes Among Black, Hispanic, and Black Hispanic Women. Journal of Racial and Ethnic Health Disparities, 2(4), 573 582. https://doi.org/10.1007/s40615 015 0110 2 Hill, L., Artiga, S., & Ranji, U. (2022). Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them. Kaiser Family Foundation. https://www.kff.org/racial equity and health policy/issue brief/racial disparities in maternal and infant health current status and efforts to address them/ Schneider, E.C., Shah, A., Doty, M.M., Tikkanen, R., Fields, K., Williams, R.D. (2021). Mirror, Mirror 2021 Reflecting Poorly: Health Care in the U.S. Compared to Other High Income Countries. https://www.commonwealthfund.org/publications/fund reports/2021/aug/mirror mirror 2021 reflecting poorly

Tamaraemumoemi Emmanuella Okoro <taoko1@morgan.edu>

Historically Black Colleges and Universities/Predominantly Black Institutions Alliance Team for Maternal, Child, And Family Health Equity Initiative (HAT), Maryland USA

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