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TRANSCRIPT
TOWARDS A NEW CONCEPTUALIZATION OF
WOMEN’S HEALTH
Francisco García, MD, MPH Distinguished Outreach Professor
Public Health, Obstetrics & Gynecology, Nursing, Clinical Pharmacy
Director, Center of Excellence in Women’s Health
Female/Male Sex and Gender Differences Impact Health • biology and physiology
• sex differences in these categories relate to size, hormones, and the reproductive system
• there are other such differences that influence overall health
Brittle C and Bird CE. Literature Review on Effective, Sex- and Gender-Based, Systems/Models of Care, 2007.
Medical Model of Women’s Health
“sick women” seeking medical care
community
social network
family
all women
“sick women”
Differences Cont.
• Same diseases but disproportionate rates or different symptoms.
• Females and males are socialized with a set of expectations and way of life that varies by gender.
• Gender is related to diverse kinds of stress and resources that interact with health.
Individual Experience of Disease
DISEASE INDIVIDUAL
gender
culture
history
family
education
work
partner
class
faith
Women’s COE Program: Old Model
• Established during the Clinton administration
• Goal of developing new models for comprehensive women’s health care delivery
• Modeled after Magee Women’s Hospital
• Programming in the area of clinical care, research, education, community outreach & leadership
National CoEs in Women’s Health 1996: • Magee-Women’s Hospital • University of California at San
Francisco • University of Pennsylvania/Drexel 1997: • Boston University Medical Campus • Indiana University Medical Center • University of California at Los Angeles 1998: • Harvard University • Tulane/Xavier University • University of Illinois at Chicago • University of Puerto Rico • University of Wisconsin
2003: • University of Arizona • Oregon Health Sciences University • University of Missouri • Brown University • Virginia Commonwealth University • University of Mississippi 2004: • West Virginia University • University of Texas at San Antonio • University of Missouri
Women’s Center of Excellence: “Old Model”
• Core programs
– Clinical care
– Research
– Education
– Outreach
– Leadership
– Evaluation
MISSION STATEMENT
Improve the health and promote wellness of women throughout the life cycle.
Vision
WCOE will be the leader in women’s health and wellness in Arizona by providing health education and promotion programs that are
–woman centered
–evidence-based
–culturally competent
–community responsive
–tailored to women with the greatest need
Pre-Conception
Pregnancy
Infancy
Childhood
Adolescence Young Adult
Adult
Midlife
Elderly
Educational Programs
Community Extension
Clinical Care
Research/
Evaluation
Our New Model
Clinical Research
Sampling of Current Research
National Children’s Study
Children’s Health Act 2000
Nat’l Institute of
Environ-mental Health
Services
U.S. Environ-mental
Protection Agency
Centers for Disease
Control and Prevention
National Institutes of Health
Eunice Kennedy Shriver National Institute of Child
Health and Development
National Children’s Study
• Prospective cohort of 100,000 children followed prior to birth to 21 years of age
• $44 million Pre-
conception Pregnancy Birth
Up to 21
years
Primary Aims
• Investigate the separate and combined effects of environmental exposure (chemical, biological, physical, and psychosocial) .
• Investigate the gene-environment interactions on pregnancy outcomes, child health and development, and precursors of adult disease.
Outcomes Being Studied
• Pregnancy complications like premature birth and birth defects
• Developmental disorders like autism and learning disabilities
• Child health and development
• Injuries such as head trauma
• Asthma
• Obesity and growth
• Reproductive development
The Study Defines “Environment” Broadly
A number of issues are taken into account, including:
• natural and person-made environmental factors
• biological and chemical factors
• physical surroundings
• social factors
• behavioral influences and outcomes
• genetics
• cultural and family influences and differences
• geographic locations
NCS – Arizona Study • The University of Arizona is the Study Center
• Fernando Martinez, MD – Study Center PI
• There are 3 study locations
– Pinal County – Mari Wilhelm, PhD
– Apache County – Francisco Garcia, MD, MPH
– Maricopa County – Sydney Pettygrove, PhD
• Specific communities from each county will be selected
• About 1,000 pregnant and non-pregnant women will be recruited randomly from each study location.
• Community engagement activities & recruitment underway.
Other WCOE Led or Facilitated Programs & Research
MCH Training Grant
• Health Resources and Services Administration
• Maternal and Child Health (MCH) Bureau
• Second 5-year round – first round led by Dr. Doug Taren
• Current 5-year round co-led by Drs. Francisco Garcia and Lynn Gerald
• One of six Diversity in MCH Collaborative Teams selected
MCH Training Grant Goals
2010-2011 Trainees
– 12 Scholars ( 1 doctoral, 11 master level)
– All women
– Age range 20-29 years
Expand the number and quality of graduate MCH trainees
2011 Scholars & Faculty Mentors
Shruti Bala Dr. Duncan
Radhika Barbaria Dr. Taren
Deidre Demers Dr. Yuan
Karen Dreisbach Dr. Giacobbi
Lynette Knopp Dr. Ehiri
Crystal Kynard-Amerson Dr. Garcia
Michelle Larson Dr. Cutshaw
Natasha Miramontes Ms. Hughes
Teri Moore Dr. L. Gerald
Grace Rice Dr. Duncan
Nicole Thurlow Dr. Giacobbi
Gerilene Tsosie Dr. Teufel-Shone
MCH Training Grant Goals
Advance the careers of junior faculty
• Faculty development program
– Partial salary covered for protected time (2 faculty)
– Mentorship
MCH Training Grant Goals
Increase the MCH capacity that target the priorities of the Rocky Mountain Region
• Partnership with the Rocky Mountain Region Public Health Education Consortium & AZ Public Health Training Center
• Trainings for MCH professionals in the field
• Technical Assistance
Community-Based Cervical Cancer Prevention
• Women continue to fall through significant gaps in the screening, dx, and treatment safety net
• Disproportionately affects poor women from communities of color
• Many partners already addressing different aspects of the cvx ca prevention
• Meaningful improvement in cvx ca incidence/ mortality requires systemic coordinated effort
• One death from cervical cancer is one too many!
Specific Challenges • Science/practice of cervical ca prevention has advanced
tremendously in recent years
• Non-industry related patient education materials/health education reflect outdated paradigm
• Populations most in need of information has the least access to it
• Prophylactic HPV vaccination makes school districts major players
• Health care sector may be under prepared for new screening technologies and for the vaccine based cervical cancer prevention
Pima County Cervical Cancer Prevention Partnership
1. lay community health worker train-the-trainer program
2. bilingual, school-based parent-to-parent peer-education regarding HPV vaccination
3. point-of-service navigator program to facilitate the diagnosis/follow up of abnormal screenings
4. technical assistance to school districts, community health centers, and county health departments
Partners • Pima County Health Department
• Community-Based Organizations
• School Districts
• FQHCs & CHCs
• Elected Officials
• University of Arizona – University Physicians
– Arizona Health Sciences Library
– Arizona Cancer Center
VISION
Improve the quality of life for Latino families through girl/woman focused education,
leadership and wellness.
CoE trains
Promotoras &
provides
resources
Center of Excellence
in Women’s Health
CoE provides
resources to
Latina
Institute
Mothers of LI girls
take workshops
while girls advance
in LI
SHARED
VISION Latina Institute
provides after-
school & summer
camp for rural
girls to promote
health, education,
& culture
Neighborhood
Coordinators/
Promotoras del
Barrio
Promotoras teach
health & wellness
to community
Health & Wellness • 500+ moms from low
performing schools surveyed about health priorities
• 3 community forums to narrow priorities
• Developed/implemented training programs in diabetes, breast cancer and cancer prevention
“We want information for people who have little resources.” -Forum participant
Outcomes
• Trained 91 (promotoras) community health workers • Promotora trainings
– diabetes knowledge improved by 19% – breast cancer knowledge improved by 30% – cervical cancer under evaluation
• Promotoras conducted 703 home visits and community presentations
• The average visit was 37 minutes
• Held 4 after-school girls’ clubs & summer camps focused on health, education, and culture (n=56)
• Pilot-tested mother class on psychosocial topics and navigating educational systems to support daughters’ academic success (n=5)
Middle School Girls Program
Outcomes • 80% US born
• 60% parent born in US
• Self-esteem was normal to high for 95% of girls
• Depressive symptoms higher than expected
• Favorable attitudes toward school
• Family is highly influential in the lives of girls
Supporting the Families with Cancer
• Dr. Catherine Marshall
• Partnership with El Rio Health Center
• Pilot-test Un Abrazo para la Familia Platform
• Funded by Komen
• Grant submitted to NIH Jan 2011
Abrazos Program Description •3 classes (English or Spanish)
•Designed especially for each family
•Classes held at a place, day, and time convenient to each family (weekends, evening, homes, libraries, churches)
•Content of 3 hour classes
•Skills in coping and caregiving
•Held in understanding depression
•Skills for solving problems
•Information about risks of breast cancer
•Emotional support
Evaluation Research and Development (ERAD)
Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR UP) – US Department of Education – Factors predicting post-secondary education – Sunnyside School District
Vail CARES – SAMHSA – Strengthening healthy child development, mental
health, violence and drug use prevention – Vail School District
Hispanic Women’s Health Literacy Initiative (pending) • NIH R01 application ($1.9m) • Partnership with SIROW, AHSL, TUSD, AZCC-Disparities
program • Specific Aims
– Evaluate a novel sustainable community informed peer educator training program to improve disease screening behavior, and promote long-term maintenance.
– Conduct randomized controlled trial of small group, peer-to-peer, culturally and linguistically tailored, promotora intervention to improve chronic disease screening behaviors at 12 and 24 months.
Community Partners School Districts
– Tucson
– Sunnyside
– Vail
– Mammoth-San Manuel
– Sahuarita
Pima County Health Dept
– Well Women’s Health Check
– Epidemiology
– Public Health Nursing Prog
– Family Planning
– STI Clinic
Community Based Organizations
– Tucson Hispanic Coalition
– SACASA
– Tucson Center for Women & Children
– Pima County Women’s Commission
Health Entities
– St. Elizabeth of Hungary
– El Rio CHC
– United CHC
– Mariposa CHC
– Planned Parenthood of Arizona
– Navajo and Tucson Area IHS
Institutional Partners • Center for Physical
Activity & Nutrition
• Cooperative Extension/CALS
• Mexican-American Studies & Research Center
• Southwest Institute for Research on Women
• Lifeworks
• MEZCOPH
• UPH – Kino
– UFC
– PBCs
• AHEC
• Arthritis Center
• AZ Respiratory Center
• AZ Cancer Disparities Insitute
• AHSL
Graduate Students MASTER’S Candidates • Ada Dieke
Pregnancy Wellness* • Anita Hanna Domestic Violence in Indonesia* • Christine Krikliwy Patriarchy & Women’s Health* • Melissa Page Pregnancy/Postpartum Wellness • Olga Pena* Health Education approaches to
Hispanic women’s health • Kristie Wilkensen HPV/cervical ca awareness among
legislators • Kristina Valenzuela Educational needs of Latino parents
considering HPV vaccination *previous trainees
DOCTORAL Candidates • Thomas Nuño
Cervical Cancer Interventions Cancer Prevention
• Andrew Abalos HPV infection among heterosexual
partners - Cancer Prevention • Mary Roary Diabetes in Minority Pops Epidemiology* • Velia Leybas Nuño
Girls/adolescent health • Marcela Sotomayor
Pregnancy/Postpartum Wellness*
POST-DOC SCHOLARS • C Marshall, PhD: WCOE Sr. Fellow & NIH Ruth Kirschstein Fellow
– Studies the unique interplay between poverty, literacy and ethnicity among families of women with cancer
– Mentors: F Garcia, T Badger, L Larkey, K Weihs • A Wilkinson-Lee, PhD: WCOE WARMER Foundation Scholar
– Health Care Access among Hispanic women and children – Mentors: F Garcia, M Wilhelm, S Carvajal
• S Kasle, PhD: ACR New Investigator Award – The Couples and Arthritis Study, disease modulating effects of relational
support – Mentors: M Wilhelm, A Vautra
• Jesse Nodora, DrPH: AZCC – Systemic and contextual factors impacting Hispanic participation in
clinical trials – Mentors: F Garcia, D Alberts
• Melissa Curran, PhD: ERAD – Family and social support needs for first time parents – Mentors: M. Wilhelm
A Dynamic Conceptualization of Women’s Health
disease
environment work
relationship
safety
spirituality
peer group
family
economic security
WCOE Recurring Themes
• Woman focused
• Community engaged
• Life-span oriented
• Collaborative
• Interdisciplinary
• Capacity promoting
Promoting Wellness & Preventing Disease
• Informed women/girls
• Educated providers
• Access to services
• Empowered communities
Healthy Women=Healthy Communities
