2010-2011 Capstone Project Abstracts

Amigas Latinas Motivando el Alma (ALMA)

Capstone Team: David Andrews, Esther Majani, Rachel Page

Community Partners: Melissa Green, MPH; Gigi Perez, MSW, P-LCSW

Faculty Advisor: Geni Eng, DrPH

Title: Amigas Latinas Motivando el Alma “Latina Friends Motivating the Soul”

Abstract: The members of the Capstone team worked with Project ALMA (Amigas Latinas

advisor model, or promotora, and is designed to improve the mental health of participants and

their immediate community through peer education. The Capstone team joined project ALMA

during the end of phase one, and conducted process evaluations of the program. The team

conducted preliminary analysis of the pilot data. Findings from phase one suggest that the

ALMA promotora program has been successful in reducing mental health issues such as anxiety

and depressive symptoms. The second phase of project ALMA is currently being implemented

and addresses salient community concerns through a Community Based Participatory Research

(CBPR) method known as Photovoice. The Capstone team adapted Photovoice guides to meet

the needs of Project ALMA, implemented the first cohort of Photovoice, and conducted

preliminary qualitative analysis of the transcribed sessions. The Photovoice phase concludes

Major Deliverables: Compilation of Secondary data and media outlets; ALMA Promotora

Curriculum; Analysis of preliminary data (phase one and two); and ALMA Photovoice guide

curriculum

Cervical Cancer-Free NC

Capstone Team: Kim Hayes, Ashley Leighton, Brittany O’Malley

Community Partner: Pamela Entzel, JD MPH

Faculty Adviser: Noel Brewer, PhD

pap smear screening with follow-up care. While national guidelines recommend the HPV

vaccine for those ages 11-26, uptake is still low among American adolescents. In designing a

program to increase HPV vaccine uptake among North Carolina adolescent girls, schools offer a

natural point of intervention. In order to inform subsequent interventions, we conducted

formative research to assess barriers to HPV vaccine provision in North Carolina school health

centers. We also identified and described extramural school-located vaccination programs.

Methods. We created interview guides and conducted structured and semi-structured

interviews in Fall 2010 with staff from North Carolina school health centers that stocked HPV

vaccine and program staff from extramural programs. Of 55 school health centers in the state,

33 stocked HPV vaccine, and all of these participated in the study. We identified and described

many had limited staff to support such efforts. Respondents believed that incentives for

getting adolescent vaccines and parent reminders that children are due for adolescent vaccines

were the most likely to increase HPV vaccine uptake. Extramural Programs Project. Most

programs offered the HPV vaccine as part of a broader effort to increase uptake of adolescent

vaccines. All programs offered HPV vaccine at no cost to students. Most did not have a

mechanism to bill private insurance, and some found Medicaid reimbursements to be a

challenge. Clinic configuration, including location of and flow of students to the clinics, varied

substantially among programs. Programs achieved modest rates of initiation of the three-dose

HPV vaccine series (median 10%); however, among those who initiated the series, completion

rates were high (median 78%). HPV vaccine uptake was lowest for a program that offered HPV

Codebook; Manuscript; Executive summary; Intervention and selection report. Extramural

Programs Project: Manuscript; Executive summary

of addiction. The social norms model posits that overestimation of peer drinking behaviors

among underage youth may increase social pressure to drink alcohol and may be associated

with increased initiation of underage drinking. Social norms marketing strategies have been

shown to reduce misperceptions of risk behaviors and reduce risk behavior in high school and

college settings. This report summarizes our experience working with the Northern Orange

Partnership for Alcohol and Drug Free Youth (the Partnership) to implement and evaluate a

pilot social norms marketing campaign to correct misperceptions of underage drinking among

students in a rural northern Orange County, NC, high school. Project activities: Project activities

included formative conversations with key stakeholders, a survey to assess norms, behaviors,

and attitudes of underage drinking, and development of a multi-faceted social norms marketing

several challenges, including time constraints associated with planning and implementing a

multi-faceted social norms marketing campaign in the span of only nine months; and logistical

challenges of administering a large-scale survey and obtaining consent from parents. Impact

and benefits: We expect that this intervention will decrease misperceptions of peer drinking

behaviors, leading to reduced social pressure to drink alcohol and a subsequent reduction in

drinking initiation. Additional benefits of the project include enhanced visibility of the

Partnership’s drug and alcohol prevention efforts and an opportunity for the student team to

gain hands-on experience in formative research and program planning and implementation.

Major Deliverables: Survey summary report; Staff conversations summary report; Health class

NC Coalition Against Domestic Violence

Capstone Team: Maggie Carlin, Jillian Casey, Katie Reilly, Nicole Wilkes

Community Partner: Leah Perkinson, MPH

Faculty Adviser: Beth Moracco, PhD

emotional, mental, and sexual health outcomes.

,

North Carolina’s intimate partner violence

(IPV) primary prevention efforts are currently funded through the DELTA Project (Domestic

Violence Prevention Enhancement and Leadership Through Alliances), a Centers for Disease

Control and Prevention (CDC) initiative dedicated to building capacity to prevent violence

before it happens. In collaboration with members from Chatham County’s Family Violence and

Rape Crisis Services (FVRC); the county’s coordinated community response (CCR), the Coalition

for Family Peace (CFP); and the North Carolina Coalition Against Domestic Violence (NCCADV),

the 2010-2011 Capstone Team supported local level evaluation initiatives in Chatham County,

NC. This included developing and administrating a community social norms assessment;

analyzing and summarizing assessment results; creating a community assessment toolkit which

results and makes recommendations for translation into prevention practice. To ensure

sustainability, the toolkit was built to explain how the assessment was conducted so that it can

be replicated elsewhere. Finally, the outcome evaluation tools will be used to measure the

impact of current primary prevention activities on knowledge, attitudes and beliefs concerning

IPV and the policy review will assist FVRC in the creation of its own DV policy to serve as a

model for the rest of the county.

Major Deliverables: Community Social Norms Assessment; Community Assessment Descriptive

Analysis; Community Assessment Toolkit; Outcome Evaluation Tools; and Review of Domestic

Violence Organization and General Workplace Policies on Domestic Violence (IPV Policy

Community Partner: Florence Siman, MPH

Title: Líderes de Salud: Curriculum Design and Evaluation of a Latino Lay Health Advisor Program

Abstract: Over half of Latinos living in North Carolina are uninsured, and 43% of Latino children

in NC were living below the poverty line in 2009 (Miranda, Boteach, & Wright, 2010; NC State

Center for Health Statistics, 2009). However, many Latinos are ineligible for public safety nets,

and state infrastructure has not yet adapted sufficiently to provide services to the Spanish-

speaking population (Simán, 2007). The promotores (Latino lay health advisors) model has

shown to be an appropriate and effective strategy to produce positive changes in a variety of

health behavior and outcomes among Latino populations in the US (Ayala, Vaz, Earp, Elder, &

Cherrington, 2010). Líderes de Salud focuses on reaching out to Latino families and individuals

program evaluation, and developing a binder of resources to facilitate future fundraising. The

team found that most published lay health advisor programs centered on specific health topics,

rather than addressing a variety of issues and skills like the Líderes de Salud curriculum. While

challenging, working with this unique program provided many benefits to the Capstone

students. Deliverables will positively impact El Pueblo’s sustainability and success through the

improvement of the training curriculum, increased funding ability, and evaluation.

Major Deliverables: Revised and update training curriculum; Literature review on lay health

advisor programs with Latinos in the US; Program evaluation framework; Binder of resources to

facilitate future fundraising

Community Partner: Joann O’Neal

Faculty Adviser: Carol Golin, MD

family for some period of time (Nord, Andrews, Coleman-Jensen & Carlson, 2010). Lack of

nutritious food, a problem faced by many food insecure families, is linked to a variety of

negative health issues. In order to address the issue of food insecurity in North Carolina, this

Capstone project partnered with the Inter-Faith Food Shuttle (IFFS), a Raleigh-based food bank

with a focus on distributing healthy foods to area food pantries. We conducted a literature

review and qualitative interviews with pantry staff and clients, and used the findings to inform a

series of reports and an assessment survey for IFFS to administer their member food pantries.

These deliverables aim to increase IFFS’s knowledge of the practices and needs of their member

food pantries in order to facilitate more strategic use of their limited resources and support

their pantries as effectively as possible. The ultimate impact of this Capstone project is an

Major Deliverables: Literature Review; Staff Summary Report; Client Summary Report;

Formative Research Synthesis Presentation; Pantry Self-Assessment Survey; Pantry Application

Form; Pantry Self-Assessment Survey Database

NC BEAUTY

Capstone Team: Claudia De Oliveira; Jessica Hopkins; Morgan Jones; Kimberly Liao

Community Partners: Morris Boswell; Cherise Harrington, PhD

Faculty Adviser: Laura Linnan, ScD

that efforts should also address cosmetologists’ personal health. As members of the NC

BEAUTY Capstone team, we aimed to improve the health of cosmetologists by creating online

health promotion courses that fulfill state continuing education (CE) requirements. To

accomplish this goal, we conducted a literature review of previous BEAUTY work, online and

adult learning theories and trends, and current national cosmetology CE policies. We also

engaged the community by conducting field visits, observational research, and data collection.

Findings from these activities shaped the structure and content of two 2-hour online courses

addressing physical activity and chemical safety. Concurrently, we produced a manuscript for

publication that describes the development of the online CE courses and advocates for health

promotion in cosmetologists. We expect that cosmetologists who enroll in our courses may

Capstone Team: Rachel Dooley, Rachel Kramer, Sarah Rhyne

Community Partner: Mariana Garrettson, MPH

Faculty Adviser: Carol Runyan, PhD

economic costs for our nation as a whole. In the United States, injury and violence account for

thirty percent of all years of life lost annually—more than cancer and heart disease combined

(Centers for Disease Control and Prevention, 2011c). Considered by many as an inevitable part

of life, most events resulting in injury, disability or death are, in fact, predictable and therefore

preventable. However, prevention efforts have gone unrealized due in part to the wide gaps in

the capacity of the current workforce to apply the necessary knowledge and skills to these

problems. In order to inform the development of future training programs that increase the

knowledge, skills, and abilities of individuals involved in injury and violence prevention (IVP),

our Capstone team conducted needs assessments for: North Carolina Trauma Centers, the

North Carolina Injury and Violence Prevention State Advisory Council (NC-IVP SAC), and the

substantial need for training in general. We presented our findings for each needs assessment

in a report to the sponsoring organization with the hope that they will use the evidence to

inform future IVP training opportunities.

Major Deliverables: Needs assessments; Summary reports

Toxic Free, NC

Capstone Team: Lindsay Herendeen, Abby Lowe, & Jordan Perry

Community Partners: Ana Duncan Pardo, BS; Fawn Pattison, MA

Faculty Advisor: Carolyn Crump, PhD

disease, infertility, cancer, and birth defects (NIEHS 2010). Toxic Free NC is a statewide, non-

profit agency with a goal to “fight pesticide pollution in North Carolina by advocating for

common-sense alternatives that protect health and the environment” (TFNC 2010). Toxic Free

NC has experienced success in engaging individuals that are health-affected, well educated,

and/or of higher socioeconomic status. However, Toxic Free NC continues to face challenges in

effectively meeting the needs of vulnerable communities most affected by exposure to toxics,

namely rural, low-income communities of color. The purpose of the Capstone project was to

identify toxics issues of concern to communities in order to make recommendations for

strengthening engagement and outreach strategies, perceptions of Toxic Free NC, evaluation

methods, and mission expansion to inform the Toxic Free NC 2011-2016 Strategic Plan. The

engagement efforts: prioritize community concerns; acknowledge the impact of race and health

equity when working with marginalized communities or organizations; invest time to develop

relationships with gatekeepers, organizations, and communities; and focus on developing

relationships with organizations rather than individuals. In addition, the Team recommends

that Toxic Free NC develop technical assistance capacity to complement community organizing

efforts already in effect, provide clear and consistent messages about Toxic Free NC from both

staff and Board, and implement a plan for evaluation. By adopting these recommendations,

Toxic Free NC may experience greater success engaging and working with all North Carolina

communities.