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WIN Conference 2011

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Cynthia R. Albarrán, RN, MS, CNS, Doctoral Student

Purpose: To apply the Theory of Gender and Power (Connell, 1987) as a lens to examine the sexual risk factors of Mexican female migrant farmworkers. 
Description of Theory: The Theory of Gender and Power was adapted for understanding women's HIV risk by Wingwood and DiClemente (2001).  Originally developed by Connell (1987), this theory is social and structural in nature.  It posits that the gendered relationships between men and women are characterized by: the sexual division of labor, the sexual division of power, and the structure of social norms and affective attachments.  These three structures exist interdependently at both the societal and the institutional level.  The society is the highest level at which schema of power are imbedded (via historical and sociopolitical forces), and ascribed (via gender roles and norms).  At the institutional level, places of work, schools, families, religious institutions, healthcare and the media continue to reproduce gender inequities and foster unequal power dynamics between men and women.
Logic Linking Theory to Problem:  Agricultural labor is one of the most dangerous jobs in the United States.  Female workers are placed in a particularly vulnerable situation as they negotiate a high demand work environment complicated by the threat of sexual harassment from both supervisors and peers.  At home, intimate partner violence can heighten the risk of HIV and sexually transmitted infections (STIs).  Often, migrant women report that they lack a social support system to assist in coping with these risks.  Migrant farmworkers are commonly uninsured, undocumented, and impoverished.  They often live in crowded and unstable housing and have low HIV knowledge.  In addition, the partners of migrant women are at high risk for contracting HIV/STIs through sexual risk, problem drinking, and the use of illicit drugs. Mexican cultural norms of "machismo" and "marianismo" influence migrant women's relationship power and ability to negotiate for protective sex in the face of infidelity.  Undocumented migrant farmworkers are often weary to access healthcare for fear of deportation, making the identification and treatment of HIV/STIs extremely complex.  Finally, depression and psychological stress further add to the cumulative risk factors experienced by female farmworkers.
Internal Consistency of Theory:  Prior research has demonstrated findings that are guided by the theoretical constructs in the Theory of Gender and Power.  This theory must be examined with further qualitative and quantitative analysis to confirm its utility with this population and analyze relationships between concepts.
Conclusion: The Theory of Gender and Power assists in organizing what is known about female migrant farmworkers and highlights potential sexual health risks.  Although HIV does not yet appear to be endemic in migrant farmworker populations, further research is necessary to understand the interplay between cultural beliefs, relationship power, intimate partner violence, and gender roles in Latino migrant couples.  Research should also examine how migrant women utilize self-protective strategies and strength factors as coping mechanisms.  This is necessary so that nursing and policy interventions can offer timely prevention and care to this vulnerable population.



Leah FitzGerald, RN, PhD, FNP, Assistant Professor, UCLA School of Nursing

Purposes/Aims:   The aim of this study was to compare allelic and genotypic frequencies of the Interleukin-6 (IL6) -174 G>C and -572 G>C polymorphism and baseline plasma IL6 values between endurance athletes and healthy controls.  We hypothesized that IL6 would be influenced by allelic and genotypic frequencies and physical activity. 
Background: IL6 plays a role in metabolism regulation during exercise and in mediating inflammation.  In certain environments various genes may influence physical aptitude. Genetic polymorphisms in IL6 gene promoter -174/-572 positions affect IL6 expression, human exercise performance, and health-related phenotype.
Several studies report exercise intervention programs reduce systemic low-level inflammation in patients with coronary vascular disease. Evidence for a diminished acute phase reaction due to regular exercise suggests a suppression of the inflammatory response.  Alternatively, enhanced plasma levels of IL6 represent a strong risk marker in chronic disorders associated with systemic low-level inflammation and an independent predictor of CVD. 
Methods: 61 serious endurance athletes and 90 healthy controls (aged 18 - 65 years old), were recruited by flyer, targeting cycling and triathlon clubs. Cross-sectional assessments data included anthropometric measurements and blood sample for DNA isolation and IL6 measurement.
Results:  The allele distribution was in Hardy-Weinberg's equilibrium.   There were significant overall group differences in plasma IL6 levels (p <0.01) and endurance athletes with -572 G>C allele had significantly lower logIL6 values (p=0.0) compared to controls.  In the -174G > C, 24 (40%) were G/G homozygote's, 31 (51%) were G/C heterozygote's, and 6 (10%) were C/C homozygote's in the athletes.  In the -174G > C, 55 (61.1%) were G/G homozygote's, 31 (34.5%) were G/C heterozygote's, and 4 (4.4%) were C/C homozygote's in the controls.  In the -572C > G, 3 (5%) with the C/C genotype, 12 (20%) with the C/G genotype and 45 (75%) with the G/G genotype in endurance athletes.  In the -572C > G, 11(12%) with the C/C genotype, 22(25%) with the C/G genotype and 56 (63%) with the G/G genotype in controls.  Linear regression with logIL6 as the dependent variable and age, BMI, gender, and SNP's -174 and -572 as covariates and group (endurance athlete vs. control) as a fixed factor supports  age, (p = 0.04) BMI (p = 0.02), SNP -572 (p = 0.02), group (p < 0.01),  (-)572*gr interaction (p= 0.03) significant in predicting logIL6.
Conclusions:  Higher levels of physical activity are associated with reduced levels of peripheral inflammatory mediators compared with a more sedentary lifestyle.  Our findings suggest that the -572C allele may have an effect on baseline plasma IL6 levels in healthy controls as well as age, BMI and activity level, suggesting there may be a genetically determined difference in the degree of the IL6 response to exercise stimuli between individuals.  An exercise-induced reduction in the proinflammatory burden may explain a part of the relation among regular physical activity and prevention in chronic disorders associated with systemic low-level inflammation.  



Leah FitzGerald, RN, PhD, FNP, Assistant Professor, UCLA School of Nursing

Purposes/Aims:   The aim is to examine whether exercise knowledge, self-efficacy and social support predict time spent in moderate and vigorous physical activity (measured by accelerometer technology Personal Activity Monitor -PAM) in persons with ID.
Background: Prevention of disease, promotion of health, and maintenance of functional independence require such behaviors as regular physical activity, sports participation, and active recreation.  ID is a state of functioning beginning in childhood, characterized by limitation in both intelligence and adaptive skills.  Although ID is usually not associated with a known biological causes it is associated with insufficient physical activity (PA) resulting in high rates of chronic disease, contributing to increased premature and preventable morbidity. 
Methods: 22 (10 female/12 male) participants with ID/DD aged 18 - 65 (mean 33.1 + 11.8 yrs) who were part of a larger study using PAM, to describe PA patterns 24 hours of the day for a 28 day period and determine if the use of a PAM increases physical activity in adults with ID.  Baseline assessment included completion of the Exercise Health Education Self-Assessment Packet for Adults with Developmental Disabilities, and anthropometric measurements.  Physical activity levels were determined using the PAM which detects acceleration, vibration, rotation, changes in posture for a maximum 14 day baseline period.
Results:  Low knowledge was negatively correlated with higher amounts of low activity minutes per day (R=-.55, p=.05).  Social support strongly correlated with high physical activity (R=0.84, p<.01). Results of ANOVA model indicate that exercise knowledge (p = 0.04) and social support (p=0.05) were both significant predictors of high activity levels.  Gender and age did not predict activity. Self efficacy did not correlate with low or high activity levels.
Conclusions:  Our findings indicate that low activity is correlated with low exercise knowledge in persons with ID/DD wearing PAM. Alternatively, exercise knowledge and social support predicted high activity levels in persons with ID/DD wearing PAM.   Secondary conditions resulting from ID may require certain revisions to various health promotion interventions to assure successful adaptation and outcomes. 


Eileen Fry-Bowers, JD, MS, RN, CPNP, Doctoral Student

Background: Patient satisfaction is defined as the extent to which a patient's general health care and condition-specific expectations and needs are met.  Dissatisfied patients are often reluctant to seek health promotion / disease prevention services or to follow up with diagnostic or treatment plans which negatively impacts health outcomes.  As a result, patient satisfaction is an important indicator of the quality of health care experiences. Although satisfaction frequently depends on the patient's perception of the quality of care received, prior research indicates that it may also be influenced by patient background, including race and ethnicity. 
Methods:  This cross-sectional descriptive sub-study examined the relationships between patient satisfaction with care and specific sociodemographic variables among a low-income population receiving ambulatory care services at a large, urban county hospital serving ethnic and minority populations in Southern California.
Results: The mean age of participants was 55±9 years, 64% (n=21) were females and 42% (n=14) were Latino. The majority of respondents (n=26, 80%) reported an annual income <  $30,000 and 66% (n=22) had less than a high school education.  Most participants (n=24, 72%) reported having public insurance.  Mean acculturation score was 2.94 (SD 1.75) and most respondents had lived in the U.S. for at least 20 years (n=24, 73%).  As level of acculturation rose, patients became less satisfied with care as measured by four of seven patient satisfaction subscales: general satisfaction (r = - .372, p =.047), technical quality (r = - .383, p =.044), communication (r = - .514, p =.004), and accessibility and convenience (r = - .396, p = .037).  Non-Latino and Latino participants differed regarding the subscales of technical quality (t = - 2.33, p = .027) and communication (t = - 2.22, p = .034).  No significant difference in mean subscale scores was found between men and women or between groups for birthplace, type of insurance, whether the patient had recently seen a provider, by usual place for health advice or by usual place of receipt of care.  Those without insurance reported significantly lower levels of satisfaction for general satisfaction (t = - 5.821, p < .001), technical quality (t = - 3.795, p < .001), interpersonal manner (t = - 2.698, p = .011), communication (t = - 3.163, p = .003), time spent with doctor (t = - 2.806, p = .009) and accessibility and convenience (t = - 3.384, p = .002).  Ethnicity/race, acculturation and insurance status were predictive of "general satisfaction" and "interpersonal manner."  Insurance status and acculturation, but not race, were predictive of "communication" and "accessibility and convenience."  Health insurance and race predicted "technical quality," while "health insurance alone" predicted time spent with doctor. 
Conclusion: Health insurance status, race and level of acculturation were found to be predictive in six of the seven subscales for patient satisfaction among low-income patients.  Further inquiry is required to determine how each of these characteristics influences patient satisfaction in this population in order to guide appropriate interventions and improve patient outcomes.



Rana Halabi Najjar, RN, CPNP, Doctoral Student
Lorraine S. Evangelista, PhD, RN  UC Irvine
Karabi Sinah Tandy, PhD UCLA School of Nursing
Peggy Compton, PhD, RN UCLA School of Nursing

Objective: Data indicate significant parallels between obesity and addiction to alcohol and drugs. However, the relationship between obesity and patterns of drug use in patients with substance abuse disorders is poorly understood. A secondary analysis of data collected from a larger clinical trial with Methadone maintenance patients was conducted to 1) describe the prevalence of obesity; and 2) compare patterns of drug use between normal weight, overweight, and obese patients. 
Method: Fifty-four patients (29 males and 25 females), were categorized into three groups of body mass index (BMI) indices using the CDC's nomenclature (BMI 18.5 - 24.9 kg/m2= normal weight; 25 - 29.9 kg/m2 = overweight; and ? 30 kg/m2 = obese).  Patients were all on Methadone and in a substance abuse treatment program for opioid addiction.  Urine toxicology was done weekly for 6 weeks to establish patterns of drug use.
Results: Overall, 31.5% and 42.6% of the sample were overweight and obese, respectively.  The most commonly used drug across weight groups was benzodiazepine.  There were no significant correlations between the amount or type of drug use and BMI.   Interestingly, data showed that participants with higher BMI had fewer addiction indicators, as evidenced by toxicology, than those with lower BMIs.
Discussion: Our findings reveal a higher than expected rate of overweight and obesity in a cohort of patients with substance abuse disorders. Future research is warranted to better understand the relationship between problematic substance use and eating behaviors. 



Deborah Koniak-Griffin, RNC, EdD, FAAN, UCLA School of Nursing
Professor & Audrienne H. Moseley Endowed Chair in Women's Health Research

PURPOSE:  This paper examines the evolving role of promotoras through presentation of a randomized controlled trial (RCT) designed to evaluate the effects of a healthy lifestyle behavior intervention (LSBI) on decreasing risk for cardiovascular disease (CVD) in overweight Latino women. Separate teams of promotoras served as recruiters, intervenors and data collectors in this longitudinal study.  
BACKGROUND: Latinos, the fastest growing minority population in the U.S., are disproportionately affected by CVD and other chronic illnesses because of several factors, including high rates of obesity, diabetes and lack of preventive health care. Health disparities such as CVD may be combated by involving members of the community in health care delivery and research. Traditionally, promotores de salud (community health workers) have helped link health care institutions to at-risk Latinos, serving as "cultural brokers" who provide education and outreach services.  This RCT builds upon earlier community-based participatory research (CBPR) conducted by our team that supported the feasibility of applying a promotora model in an intervention to reduce CVD risk among Latinas. The transtheoretical model of behavior change provides a theoretical framework for the RCT.
METHODS:  Applying CBPR principles, a Community Advisory Board guided the planning and implementation of this RCT. Participants were recruited in 4 cohorts into this study and randomly assigned to a 6-month LSBI or to a comparable length control condition (disaster preparedness and home safety). Separate promotoras served as facilitators for both conditions. The LSBI included 8 classes based upon an adapted form of the curriculum Su Corazón, Su Vida (Your Heart, Your Life), followed by individual teaching and coaching delivered by telephone and home visits. Participants were evaluated at baseline and post-intervention with physiologic and behavioral measures. The sample included 237 overweight (BMI: Mean=32.7) Latinas, ranging in age from 35-64, who were predominantly poor and had little education.
RESULTS:  Comparison of baseline to 6-month findings on the first cohort of women recruited into the study (n=53), show that those in the LSBI lost weight (Mean=2.1 lbs) compared to those in the control group who gained weight (Mean=2.3 lbs). This difference of 4.4 lbs between groups approached significance (F=3.81, p=.058). A similar positive trend was observed for change in waist circumference (F=3.82, p=.058), with a reduction in size (Mean=.54cm) for those receiving the LSBI and an incrfease (Mean=3.50cm) for control participants. Changes in the LDL levels were clinically but not statistically significant; i.e., a 16.3-point decrease in the LSBI group and a 1.7-point increase in the control group. At baseline 19% of the LSBI group attained the recommended 10,000 steps per day; the percentage improved to 44% at follow-up.
Implications:  Findings across studies support integration of the promotora model for promoting healthy lifestyle behaviors among immigrant Latinos. Promotoras are able to effectively recruit hard-to-reach immigrant Latinos into research. Women in the promotora facilitated LSBI demonstrated improvements in physiologic measures and physical activity. To ensure program success, researchers working with promotoras need to provide extensive training and supervision and be prepared to address potential challenges (e.g., staff turnover).

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