Spring 2021 MPH Internship Virtual Presentations Abstract Booklet - Mel and Enid Zuckerman College of Public Health

Page created by Gail Wallace
Spring 2021
MPH Internship Virtual Presentations
         Abstract Booklet


Acknowledgements                                                           3
Virtual Presentations                                                      4

Presenters                                                                 5


 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

        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

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:

   For each presentation viewed, please complete a brief survey to
    provide valuable feedback to the presenters. This feedback is

                    Presentation Feedback form:

              We appreciate your participation in the
          Spring 2021 Virtual MPH Internship Conference!

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
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

MPH Environmental & Occupational Health


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.

MPH Epidemiology


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.

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.

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”.

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.

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.

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.

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.

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

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.

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.

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.

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.

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


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.

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.

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.

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.

MPH Family & Child Health –
Maternal and Child Health Track


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

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

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.

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.

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.

MPH Health Behavior Health Promotion


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.

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.

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.

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