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New research from IU School of Public Health-Bloomington

October 31, 2012

Researchers from IU Bloomington’s newly organized School of Public Health recently participated in the American Public Health Association’s annual meeting in San Francisco. Here are summaries of some of the studies discussed:

Move local, fresh foods beyond ‘privileged’ consumers

Farmer’s markets and community-supported agriculture programs largely attract a “privileged” class of shoppers, according to said James Farmer, assistant professor in the Department of Recreation, Park and Tourism Studies in the IU School of Public Health-Bloomington.”Our findings present a need for broadening local food opportunities beyond the privileged, higher-income consumer, through alternative payment plans and strategic efforts that make fresh foods accessible to a diversity of people,” he says.

The study focused on farmer’s markets and CSAs in Indiana, which has more than 130 farmer’s markets and more than 50 CSAs. In a CSA, individuals pay an upfront fee, typically $250 to $700, in exchange for a routine allotment of a farm’s bounty. This can include fruits and vegetables, along with eggs, meat, dairy products, and other goods.

Nationally, the popularity of both has grown exponentially, Farmer says, with farmer’s markets seeing a 450 percent increase since 1994. More than 12,500 CSAs operate across the United States. Generally speaking, local foods are more often produced using sustainable farming practices that eliminate or decrease the use of chemical applications that can be found in conventionally produced farm products.

“When you consider freshness as an important value for consumers, hands down local foods that are distributed directly from the farmer to the consumer get from the field to the table in a much shorter period of time,” Farmer says. “Also, when you shop at a chain grocery store, the money you spend quickly leaves the local economy, as opposed to being spent several times over within one’s own town or city.”

Farmer says alternative payment models do exist for CSAs and farmer’s markets, but they need to become more widespread. Many farmer’s markets accept WIC Program vouchers and other government assistance for food. Many CSAs have incorporated payment installment plans and work-exchange programs, with a smaller number offering a sliding payment scale.

“Additionally, the need for farmer’s markets and CSAs to be positioned in locations proximate to people who are food insecure would also increase access,” he says.


Women undergoing IVF report problems with sexual relationship

Women undergoing in-vitro fertilization report that the process of infertility treatment has many negative impacts on their sexual relationships with their partners. Little attention has been given to the sexual dynamics of couples as they navigate infertility and treatments such as IVF, despite the important role that sex plays in a couple’s attempt to conceive a child.

“Sex is for pleasure and for reproduction, but attention to pleasure often goes by the wayside for people struggling to conceive,” says Nicole Smith, a doctoral student with the Center for Sexual Health Promotion at the IU School of Public Health-Bloomington. Smith is conducting the study in collaboration with Jody Lyneé Madeira, associate professor in the IU Maurer School of Law. “With assisted reproductive technologies (ART), couples often report that they feel like a science experiment, as hormones are administered and sex has to be planned and timed. It can become stressful and is often very unromantic and regimented; relationships are known to suffer during the process.”

This study, which is one of the first in the United States to examine women’s sexual experiences while undergoing assisted reproductive technologies, used the Sexual Functioning Questionnaire to assess the impact of IVF treatment on couples’ sexual experiences. Compared to a sample of healthy women, women undergoing IVF reported significantly less sexual desire, interest in sexual activity, and satisfaction with their sexual relationship. They had more difficulty with orgasm and were more likely to report sexual problems such as vaginal pain and dryness. Similar to emotional and relationship challenges associated with assisted reproductive technologies, the sexual problems intensified as a couple’s use of ART proceeded.

When couples meet with their physicians, their sex life might not top the list of issues they want to discuss, either because of unease talking about the subject or simply because they have so many other important issues to discuss. Still, Smith and Madeira say, the doctor-patient relationship is key, and couples can be told up front about the potential sexual side effects and resources that can help.

“There’s just a dearth of knowledge on how infertility affects sexual behavior,” Madeira says. “The focus is more likely to be on the social and support dimensions of the relationship, but sex is a big part of that. Just letting patients know they aren’t alone in this would be helpful.

If more information about sexual challenges becomes available, couples might find it on their own.

“Women interested in ART are generally well-educated and tend to spend time researching these issues,” Madeira says. “They would be very responsive to this information, and proactive.”

The study involved 270 women who completed an online questionnaire; interviews with 127 men and women using IVF to try to conceive; and interviews with 70 professionals, including physicians, nurses, mental health experts, and other providers who work directly with patients.

IVF is a procedure in which mature eggs are retrieved from a woman’s ovaries and fertilized by sperm in a lab, forming embryos. The embryo(s) are then implanted in the woman’s uterus. It is considered an effective procedure but one that is used after couples try several other less invasive procedures. By the time couples begin IVF, they might have been trying to conceive for many years. Nine percent of the women in their study had been through five IVF cycles, which could take at least a year.

The research was supported in part by the Kinsey Institute for Research in Sex, Gender and Reproduction, the IU School of Public Health-Bloomington, and the Faculty Research Support Program in IU’s Office of the Vice Provost for Research.


Soda consumption, screen time, team sports at school influence students’ weight

Soda consumption, TV and video/computer games, and the frequency of meals heavily influenced students’ weight in an Indiana University study that examined the impact of a school-based obesity intervention program over an 18-month period.

More soda consumption and screen time meant students were more likely to be overweight or to gain weight. The more frequently students ate meals each day, the less likely they were to stay overweight or gain weight during the study, which examined the Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools (HEROES) program.

Dong-Chul Seo, associate professor in the IU School of Public Health-Bloomington, says participation in team sports also contributed to students’ ability to achieve a healthy weight.

“Schools and families may be able to successfully focus on these modifiable risk factors, decreasing the burden of childhood obesity,” he says.

HEROES, implemented by schools in southern Indiana, northwestern Kentucky, and southeastern Illinois, is sponsored by the Welborn Baptist Foundation and based on the Centers for Disease Control and Prevention’s Coordinated School Health Model. HEROES is intended to enhance schoolwide wellness culture through changes in physical education, nutrition, the physical environment, health promotion efforts for school staff and family, and community involvement. Researchers from IU’s School of Public Health-Bloomington and the Indiana Institute on Disability and Community have been evaluating the HEROES initiative for the past four years.

“Predictors for Persistent Overweight, Deteriorated Weight and Improved Weight Status During 18 Months in a School-Based Longitudinal Cohort” involved 5,309 students at 11 schools.

Seo says the findings confirm the connection between higher levels of soda consumption and persistent overweight and deteriorating weight status, and they support the recent controversial New York City ban on sales of supersized soda and other sweetened beverages.

The finding about the relationship between the number of meals students eat daily and their weight contributes to a scant amount of evidence in this area.

“Thus, encouraging students to maintain a regular meal pattern with at least three meals a day appears to be a good strategy to help students achieve healthy weight,” Seo said.

The research found that the overall socio-economic status of a school had an impact on students. Those attending schools with lower socio-economic status were more likely to be overweight or to gain weight during the study period. This could reflect the greater opportunities students have for nutritious food offerings and physical activity at schools with high socio-economic status, Seo said, or it could reflect peer influence.


New HealthyState mobile app can inform relocation, retirement decisions

Indiana University students created a free mobile app, available for Android devices, that crunches health data from various sources to provide a comprehensive picture of health challenges specific to each state. Choosing where to live is an important health decision, the students contend, and their app can provide useful insights.

“Our app, which we named HealthyState, is designed to help people make informed decisions based on how health conditions vary across the 50 states,” says Mukta Gundi, a graduate student in the Department of Applied Health Science in the IU School of Public Health-Bloomington.

Gundi is part of a team of graduate and undergraduate students from the School of Informatics and Computing at IU Bloomington, who are members of the Pervasive Health Information Technology lab, devoted to empowering both the ill and the healthy to manage and improve their own health and make healthy choices. Members include Michele Degges, Anthony Monaco, Pranav Gupta, and Matthew Holfelner, now graduated and working at Netsmart Technologies. Advisors for the project were Kelly Caine, assistant professor of human-centered computing at Clemson University and former principal research scientist at IU’s Center for Law, Ethics and Applied Research Health Information, and IU adjunct research scientist Sameer Patil.

HealthyState transforms statistical data from the Department of Health and Human Services’ Health Indicators Warehouse, the Centers for Disease Control and Prevention, the Kaiser Family Foundation’s State Health Facts and the United Health Foundation’s America’s Health Rankings into an easy-to-read visual display that provides images and information about the overall health of the population of each state.

“The students designed and built a really useful tool that can help people make health decisions that affect all parts of their lives,” Caine said.

Earlier this year, the team placed third, winning $3,000, in the national Go Viral to Improve Health: IOM-NAE Health Data Collegiate Challenge, organized by the Institute of Medicine and National Academy of Engineering. Watch a demonstration.

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