Breastfeeding study aims to break barriers
The California Adolescent Health Collaborative's Breastfeeding Among Young Mothers research project was featured this February by Alec Rosenberg of the UC Newsroom. Read the article here or on the University of California website.
Breastfeeding isn’t only good for babies. It’s also good for the health of mothers. It helps moms bond with their newborns, recover from childbirth and can reduce their risks of Type 2 diabetes, heart disease and breast cancer.
But breastfeeding rates are low for young moms, particularly low-income women of color.
An innovative study — funded by the California Breast Cancer Research Program with the help of donations from state tax filers — aims to address that issue and boost breastfeeding rates among young moms.
“It could really make a difference on the public health level,” said co-investigator Alison Chopel. “If we find ways to increase breastfeeding, we’ll see future savings to taxpayers.”
Chopel’s interests in the breastfeeding study are both personal and professional. She has firsthand experience as a young mother.
“I was aimless and barely making it through high school,” she said. “Having a child changed my perspective. It put me on a completely different path.”
Chopel now directs the California Adolescent Health Collaborative for the Public Health Institute and is teaming on the breastfeeding study with Danielle Soto of Brighter Beginnings, a nonprofit working to support children and families.
When Brighter Beginnings surveyed young moms, it found that only 3 percent still breastfed after six months, compared with more than half of mothers nationally.
Young moms know about the importance of breastfeeding, but they face social and structural barriers, Soto said.
The 18-month study, supported by $150,000 in funding, aims to identify those barriers and develop interventions.
A key barrier seems to be the stigma of being a young mom.
“They experience a lot of stigma and unwanted advice as young mothers,” Chopel said. “A lot of people feel they shouldn’t be mothers. They are judged. It makes it more challenging to breastfeed in public.”
The researchers have been studying mothers 16-24 years old, most of whom are African American or Latina. They have been mapping where the mothers do and don’t feel comfortable breastfeeding.
“Some say they would never breastfeed on BART. Another said she might,” said Elva Castellanos with the Public Health Institute. “One said she would never breastfeed at church. One said she would feel comfortable there. One 17-year-old mom said, ‘I wouldn’t breastfeed anywhere.’ There were no places she felt comfortable.”
Finding a safe space to breastfeed can be a barrier. Many young moms go to school, work or do both. For example, one mom worked nights and didn’t feel safe sitting in a parking lot at night pumping milk, Chopel said.
Caregiver attitudes also can be a barrier.
“Young mothers rely heavily on others to help with child care,” Chopel said. “They can be susceptible to the opinions of those around them.”
Involving the community
The study’s community-based approach has helped increase its relevance, rigor and reach, researchers said. They formed an advisory committee that helped select key community stakeholders to interview about young moms. Then, building on Brighter Beginnings’ relationships with its clients, they found young moms and their decision-making partners to participate in the study. One of the young moms, Bre’Jaynae Joiner, also became a co-investigator on the project.
“It’s incredibly valuable,” Soto said. “We are doing research not just on young mothers but with young mothers. We are doing taxpayer-funded research with taxpayers.”
Once they analyze the mapping data, the researchers will design potential interventions, which they hope to pilot at multiple sites in a follow-up study. They also plan to share their research results not only with the scientific community but with the public as well, such as tabling at health fairs.
“It’s a perfect marriage between research, partnership and public health,” Soto said.
The California Breast Cancer Research Program is one of two University of California-administered cancer research programs that taxpayers can support with voluntary contributions when they file state income taxes. These programs aim to prevent breast, lung and other cancers, and increase survival rates by funding cutting-edge research and health education such as the breastfeeding study.
“This study exemplifies how tax check-off contributions help us identify tangible solutions for elevated breast cancer risk in underserved communities,” said Mhel Kavanaugh-Lynch, director of the California Breast Cancer Research Program. “Through their generous contributions, Californians are leading the way in advancing breast cancer research and increasing our arsenal of strategies to prevent the disease.”
Happy Holidays from CAHC!
Wishing you happy holidays and a memorable new year.
This holiday season, I have been reflecting on what holidays mean. There are so many different traditions and a multitude of ways to celebrate, but all traditions and celebrations, at their core, are similar. Essentially, the holidays are about community, about taking the time to be with loved ones and to express values we hold like generosity, gratitude, and service, among others.
With these values in mind, I wanted to reach out to the California Adolescent Health Collaborative community, our many wonderful partners, supporters, colleagues, and participants, and say, "Thank you" - thank you for being a part of our community. While we don't always have the opportunity to convene in person, we value our ties with each of you and hope you will continue to stay connected with us online through Facebook, Twitter, and our website.
We have accomplished so much together this year, so I wanted to share with you a special sampling:
- We've provided (and continue to provide) healthy relationships education, comprehensive sex ed, and technological vocational education to nearly 200 young people in the Central Valley.
- We've trained five youth co-researchers with whom we have collaboratively conducted and analyzed 15 interviews exploring social and structural factors that influence breastfeeding among young mothers, and created over 90 photo-narratives on the marketing of E-Cigarettes to young people in Oakland.
- We've launched a new project with Asian Health Services in Oakland and Livingston Community Health in the Central Valley. This project will aim to build and connect inter-generational research boards in these two diverse communities.
This year, we've also spent time as a team working with the fabulous Nicole Sirivansanti in order to articulate the values that are foundational to all of the work that we do, values that we proudly share with you this season.
Our values inform our current work, partnerships, internal team functioning, and future directions:
Youth are valued partners in all our work, they hold meaningful decision-making roles in our programs and our teams. We reject adultism and the systemic stigmatization of adolescents.
We engage with people, organizations and movements as allies. We strategically lead, partner, or follow in our collaborative initiatives. We are students of collective impact.
We ascribe to the WHO definition of health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
4. Social Justice:
We recognize that patterns of health and illness are shaped by social structures and systems; to improve and protect our health, youth health, and community health we must change systems.
In order to make change, we need to change the way we do business. We use research methods to answer new questions and innovate new solutions.
6. Equity Focused:
With limited resources we strategically focus on identifying populations and communities with the greatest opportunity to add value.
We believe in our work, are passionate about quality and outcomes, and are responsible stewards of resources that have been entrusted to us.
Humor is essential to wellness, communication, and team chemistry.
9. Cultural Humility:
We choose to be humble, curious, and always learning.
With gratitude for our community, we at CAHC wish you all the happiest of holidays, and we look forward to a wonderfully productive and joyful 2017.
Alison, Bre'Jaynae, Chelsey, Elizabeth, Elva, Gayle, Julia, Katie, Robert
The California Adolescent Health Collaborative Team
CAHC Statement on Structural Racism as a Public Health Issue
Posted October 11, 2016
The California Adolescent Health Collaborative (CAHC) stands with Black Lives Matter, the Movement for Black Lives, NAACP, Race Forward, Showing Up for Racial Justice, other national leaders, and the California Department of Public Health’s Office of Health Equity in condemning racialized violence, police brutality, and the structural racism underpinning the long-standing epidemic of violence targeted towards people of color in the United States. With the advent of smartphones and social media, the incessant profiling and exclusion of people of color is once again part of the public consciousness. Systemic racism and targeted violence are critical public health issues that affect the wellness, health, and vitality of all communities, not just the communities and individuals literally impacted. Addressing police violence is addressing public health and dis-ease.
CAHC is demonstrating solidarity in the following ways:
1) We join Nancy Krieger and other Harvard scientists in calling for public health institutions to include deaths from police violence in their reporting efforts. The Centers for Disease Control and Prevention counts and reports deaths from multiple causes in their Morbidity and Mortality Weekly Reports, and the increased attention to law-enforcement-related deaths (both of people at the hands of the police, and of police killed in the line of duty) makes clear that one of the many threats to health faced by Americans of all races and ethnicities, but most especially those with darker skin, is law-enforcement-related death. There is no question we need to address this issue. The question, then, is where to begin. Our duty, as public health leaders and practitioners, is to help identify the scope of the problem.
2) We applaud the Black Lives Matter movement for developing a robust policy platform; it is the perfect starting point for a visionary discussion of policies that will help us strive towards equity rather than inequity. While we cannot adopt the platform in its entirety, we are committed to advancing public policies that improve economic equity and broaden political power in recognition that these are these are undeniable determinants of public health.
3) The CAHC is backed financially by both federal and private funds. As responsible stewards of these resources, we are committed to joining the injustice boycott. CAHC is joining Shaun King and tens of thousands of others in “making a pledge that we will boycott cities, states, businesses, and institutions which are either willfully indifferent to police brutality and racial injustice or are deliberately destructive partners with it,” with one caveat: we will not abandon geographic regions that may be named in the boycott. We are committed to serving certain communities and in that we will not waiver.
Systemic racism is a threat to public health, and it is incumbent upon public health professionals to take the lead on revealing the roots of the threat just as John Snow did with the Broad Street water pump in 1855. Furthermore, we must starve the source of the threat, and history tells us that when violence with impunity is protected by economic power, we must vote with our dollars.
California sprints to the head of the class on sex education, as all students this year will be taught about consent
Posted on August 8, 2016 10:19 am by Kate Stringer
He sexually assaulted an unconscious woman behind a dumpster. But Stanford student Brock Turner received a mere six-month prison sentence for his “20 minutes of action,” because anything longer would have had “a severe impact on him,” the judge in the case decided.
The story, which generated enormous outrage after the young woman’s powerful victim impact statement was widely publicized, happened in California, but it’s certainly not isolated. Dismissals of sexual assault are not uncommon, as universities and courts across the United States make news for failing to take rape seriously.
But California is pioneering a solution, and it’s starting with sex education and the issue that many of these assault cases turn on — consent.
This school year, the state will be the first in the U.S. to require that high schools teach sexual consent — what it is and how it’s established. While some high schools already taught consent, Gov. Jerry Brown signed a law in October 2015 requiring all schools that mandate health courses to do so beginning in the 2016 school year.
“Our dedication to a more comprehensive approach to sex ed — principles that are evidenced based, culturally appropriate, nonjudgemental, the whole thing about establishing parameters about not having sex — is really revolutionary, positively revolutionary, because none of the other states are dealing with those issues,” said Claire Brindis, a pediatrics professor and adolescent health policy researcher at University of California, San Francisco.
California will also join 23 other states in requiring that sex education be taught to 7th- through 12th-grade students. It’s remains a distinction in a nation where many states don’t require that sex education be taught or that it be medically accurate.
California may be late to the mandatory sex ed game, but it required the courses that were taught be medically accurate starting in 2003. The state made national headlines in 2014 for requiring that sexual consent be based on a “yes-means-yes” standard rather than “no-means-no,” meaning sexual partners must verbally agree to sex — a way to address rapes that occur with unconscious victims.
Many urban school systems, like the Los Angeles Unified School District, already had comprehensive sex education as a requirement, but are still spending the summer training teachers to have these sensitive conversations with students, said Tim Kordic, project advisor for health education. Lessons include preventing shaming, LGBT inclusiveness, human trafficking, contraception, HIV/AIDS intervention, and yes-means-yes consent.
“The mantra we use is medically accurate, current, and nonbiased,” Kordic said.
At a time when Congress bumped funding for abstinence-emphasized education to $25 million, California’s efforts are progressive.
And it’s thanks in part to state Sen. Hannah-Beth Jackson, D-Santa Barbara. She wanted to address what she observed was a “culture of rape” thriving on college campuses. And while she pushed to make consent clearly affirmative, she also recognized that it wasn’t enough.
“If we start this discussion at the college level, we’re starting too late,” Jackson said, adding that “the goal is to prevent sexual assault and to create a culture that is consent- and support-driven.”
After seeing through the consent-based sex education bill last year, Jackson wants to start even earlier. This session, she’s introduced a new piece of legislation that proposes first- through eighth-grade students learn about healthy relationships, interpersonal communication skills, and how to respond to harassment or bullying.
She said she “absolutely” thinks that these progressive sex education bills could change a culture that leads to sexual assault cases like that of Brock Turner, whose arrest and conviction came after after two bicyclists riding by saw him sexually assaulting his unconscious victim behind the fraternity house dumpster and chased him down.
While California has made some great strides in sex education, the courses weren’t mandatory until last year and not all California sex ed was equal. A 2011 University of California San Francisco study surveyed districts statewide and found medical inaccuracies and biases in their instruction. One in five districts reported most of the class was spent teaching abstinence with only a few mentions of birth control. Some taught that condoms did not prevent pregnancies, STDs or HIV, which is inaccurate. One-third of school districts didn’t require that their sex ed teachers be trained.
These misrepresentations led to parents, physicians, and the Gay-Straight Alliance Network filing suit against the Clovis Unified School District in 2012. The district taught abstinence as the only effective method of avoiding pregnancy, depicted women who had premarital sex as dirty, and didn’t teach comprehensive solutions to preventing disease. The court ruled in their favor in 2015, forcing the district to make significant changes so its curriculum would be medically accurate and bias-free.
Schools are important gateways for information about sex, said Brindis, the UCSF professor who was the author of the 2011 study.
Some parents worry that providing comprehensive sex education will only encourage students to have sex, which is not the case, Brindis said. When parents and schools are squeamish to have honest conversations about sex, students receive all their information from peers, media, porn, and the internet.
“I feel like young people are drowning in very irresponsible messages about protecting oneself,” Brindis said.
The United States has a significantly higher teen pregnancy rate than other industrialized nations, 57 per 1,000 compared to 14 per 1,000 in countries such as the Netherlands, according to the Centers for Disease Control. And that costs taxpayers $9.4 billion per year to provide health and foster care.
Yet states with medically accurate sex education have lower teen birth rates. Mississippi doesn’t require accuracy, and its rate is 42.6 per 1,000 girls: double the national average. New Jersey, which does require medical accuracy, has a birth rate of 14.8 per 1,000 girls.
Brindis is hopeful the new legislation can change the culture of misinformation surrounding sex. But, she said, it will require teachers who can make the education applicable, by role-playing affirmative consent and how to say no, teaching how to access contraception and the consequences of pregnancy.
CAHC Launches 4-Year Healthy Relationships and Economic Pathways Project in the Central Valley
The California Adolescent Health Collaborative (CAHC), is excited to announce the launching of the Healthy Relationships and Economic Pathways (H-REP) project on July 15, 2016.
Coinciding with the passing of the California Healthy Youth Act in October 2015, mandating age-appropriate comprehensive sex education in all California public schools, CAHC is partnering with Central Valley-based organizations to leverage this Act by implementing H-REP at Stanislaus and Merced County public schools.
H-REP, a four-year federally-funded study, prepares high school and opportunity youth (disconnected from school) between the age of 14 to 24, with the knowledge, skills and abilities to build healthy relationships and achieve economic stability.
After a year of planning, CAHC’s youth-serving Central Valley partners are ready to deliver comprehensive sex education curriculum, technology and soft skills training, career coaching, and case management at their respective site.
The H-REP project seeks to stimulate and encourage sex-positive health education; increase youth access to medically accurate and gender-inclusive information; empower adolescents to build healthy relationship skills and develop economic opportunities that enable adolescents to thrive into adulthood.
H-REP partners include the Alliance for Community Research and Development, Center for Human Services, Ceres Unified School District (Project YES), Empower, Hack the Hood, Haven Women’s Center of Stanislaus County, Merced County Office of Education, Riverbank Unified School District, Valley Crisis Center and Waterford Unified School District.
The EMPOWER Program, a Merced-county educational assistance and job training program helping out-of-school youth complete school and transition to college and/or a career, launches H-REP at their site on July 15, 2016.
Project YES (Youth Employment Services), a Ceres County workforce and academic program designed to help economically disadvantaged youth overcome barriers to personal success, will launch August 1, 2016.
To learn more about the Healthy Relationships and Economic Pathways Program, visit: http://www.californiateenhealth.org/
CAHC Open House
The California Adolescent Health Collaborative (CAHC) hosted an Open House February 2016 to celebrate their new location and staff. CAHC is located in Preservation Park, a Bay Area landmark with 16 turn-of-the-century buildings that have been renovated to house a variety of public and non-profit organizations and programs. Attendees included other Public Health Institute (PHI) programs and staff as well as PHI affiliates, partners and friends. The CAHC also announced expansion of their work in the Central Valley, made possible by a multi-million dollar DHHS award leveraging the educational, health and economic services delivered by stakeholders of adolescent health and wellness.
Youth Addressing Adolescent Relationship Abuse in the Central Valley
Teens in Modesto and Riverbank are learning the danger of abusive relationships and just how pervasive they are – especially among young people. This year, they will be spreading awareness to other high school students as part of a pilot project being watched statewide. Read more here: http://www.modbee.com/news/local/education/article18813735.html
North American Forum on Family Planning 2016 Annual Meeting
Association of Reproductive Health Professionals (ARHP) will hold their 2016 Annual Meeting in conjunction with the North American Forum on Family Planning in Denver, Colorado November 4-8, 2016. They will be working with their colleagues at Planned Parenthood Federation of America and the Society of Family Planning. For more information on how to register visit: https://www.arhp.org/professional-education/annual-meetings/2016-annual-meeting
Healthy Teen Network 2016 Conference
Join Healthy Teen Network, colleagues and experts from across the nation to engage in critical conversations about Roles, Relationships, and Relevance in the Changing Landscape of Adolescent Health November 14-16, 2016 at the JW Marriott Resort and Spa in Las Vegas, Nevada. To learn more about the conference visit: http://www.healthyteennetwork.org/confere