Urban Health Chronicles 2017

chronicles

In this edition Summer 2017 Student Research Presentations Brooklyn Health Disparities Internship Program Social Determinants of Health, Environmental Issues & Public Health Trinidad & Tobago Internship Program

2017

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Year Eight: BHDC Summer Internship 2017 The Arthur Ashe Institute for Urban Health (AAIUH), for eight consecutive years, has conducted a summer internship program in Brooklyn for high school students, as part of the Brooklyn Health Disparities Center (BHDC). In 2014, the AAIUH in partnership with the SUNY Downstate Medical Center, and the Office of the Brooklyn Borough President created the Brooklyn Health Disparities Center (BHDC).

Funded by a grant from the National Institutes of Health – National Institute on Minority Health and Health Disparities (NIMHD), the Center’s mission is to reduce health disparities among minorities and new immigrants in Brooklyn, New York through clinical and community based research, education, outreach and training.

The Brooklyn-based internship is a community engaged health disparities summer program for students recruited primarily from the Institute’s Health Science Academy, a three-year after-school science enrichment program. In addition to didactic training on health disparities, students conduct research projects in collaboration with members of participating community-based organizations (CBOs).

In 2017, 20 high school students participated in the 4-week internship program designed to engage minority youth while building the capacity of CBOs to conduct Community–Based Participatory Research (CBPR) on health equity issues. Student research projects were conducted on a variety of health disparities topics, including HIV/AIDS, cancer and maternal and child health. Students provided policy recommendations related to their projects at a closing ceremony held at SUNY Downstate Medical Center, which was attended by parents, community members, BHDC faculty and legislators. Brooklyn’s Deputy Borough President, Ms. Diana Reyna, was a special guest speaker for the event.

The New York based program was replicated in the Republic of Trinidad & Tobago with support from two William J. Fulbright awards received in 2012 and 2013 respectively. In 2017, the fifth iteration of the program was conducted in collaboration with the University of the West Indies, and with support from the US Embassy. Non-governmental organizations (NGOs) in Trinidad served as host sites for students to conduct their community based research projects. As in the Brooklyn program, students presented their research findings at a closing ceremony. Parents, faculty members, community based partners and staff of the US Embassy’s Public Affairs Office attended the ceremony.

This publication highlights the great work completed by students in both the New York and Trinidad & Tobago based programs.

Marilyn Fraser, MD CEO, AAIUH

Urban Health Chronicles Funded by: The National Institutes of Health National Institute for Minority Health and Health Disparities (Grant: 1P20MD006875) Editors: Marilyn Fraser, MD and Cicely Johnson, PhD Designer: Catherine Herrera

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c hr o n i c l e s

What’s Inside:

Trinidad & Tobago:

Access to Care:

Social Determinants of Health:

Temporary Protected Status Interns: Tolulope Atolagbe, Tommy Vasquez CBO: Diaspora Community Services (DCS) Supervisor: Vanessa Mejia Research Mentor: Rafait Kassim (pgs 4-5)

Assessing Wheelchair Accessibility in Brooklyn City Council Members’ Offices Interns: Alex Alexakos & Jennasia Otway CBO: Brooklyn Center for Independence of the Disabled Inc. (BCID) Supervisor: Valerie Josephs, Yessenia Torres, Joe Rappaport Research Mentors: Ariel Crawford, Ivan Cervantes

Health Awareness, Risks, Perceptions & Behavior: The Knowledge, Attitude and Perception of PrEP Among Youth Interns: Leila Begy, Zoe Nangle CBO: Health and Education Alternatives for Teens (H.E.A.T.) Supervisors: Tiffany Patterson, Amelia Williams Research Mentor: Line Nana Practicing Safe Sex in the Community Interns: Luz Maria Flores, Zoe Montgomery, Tianna White CBO: Protecting the East Supervisors: Diedra Miller & L. WIlliams Research Mentor: Cecille Nelson Prevalence of Prescription Drugs in Arab Communities Interns: Aysha Choudhry, Shahida Islam, Christelle Sagesse CBO: Arab American Family Support Center Supervisor: Maha Attieh Research Mentor: Moneba Zaman (pgs 6-9)

How One’s Daily Lifestyle Affects The Likelihood of Developing Diabetes Interns: Richard Brezault, Juleanna Francois, Cyrena Washington CBO: Community Counseling and Mediation (CCM) Supervisor: Myriam Lamothe Research Mentor: Deniya Thompson (pgs 10-12) Violence as a Public Health Issue: Violence as a Public Health Issue Interns: Nelson Asemota, Alpha Kouanda, Sherron Yorke CBO: Arthur Ashe Institute for Urban Health (AAIUH) Supervisor: Vinessa Gordon Assessing the Knowledge and Experiences of Brooklyn Residents toward Domestic Violence Interns: Kira Jennings & Amyah Wright CBO: Caribbean Women’s Health Association (CWHA) Supervisors: Harriette Jordan, Emanuela Joseph, Debra Lessane Research Mentor: William Chambers (pgs 13-15)

Depression Teenage Depression Interns: Sherise Elliott, Kennille Phillips, Shenica Balgobin NGO: United Nations Educational, Scientific and Cultural Organization (UNESCO) Supervisor: Phillip Sookhai (pgs 18-19) Environmental Impact on Health: Connecting People to Nature Interns: Enen-SA-Tefa Ab Khafra, Merkisa Pierre NGO: Fondes Amandes Community Reforestation Project Supervisor: Kemba Jaramogi Impact of Flooding on Different Types of Communities in Trinidad Interns: Reanna Ramkeesoon and Shamaii Gaspard NGO: The Pointe-a-Pierre Wildfowl Trust Supervisors: Tamara Goberdhan, Silene Noel, Jaleen West, Dr. Maurice Frank The Impact of Work Environment on Personal and Professional Life Intern: Kayle Diljohn NGO: Oilfields Workers’ Trade Union (OWTU) Supervisors: Kandis Sebro, & Oswald Warwick (pgs 10-23) Health Inequalities Inequalities in Health Interns: Jewel Mulrain and Andrea Robley NGO: The Esimaje Foundation Supervisor: Teria Reid The Impact of Decline in Medicine on People Interns: Jamaal Matthews & Tarique Richards NGO: Heartbeat International of Trinidad and Tobago Supervisor: Farouk Khan-Hosein (pgs 24-25)

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Access to Care

The United States prides itself on being a nation that provides better opportunities for its residents. Our students assessed the benefits of Temporary Protected Status, as well as the negative impact, if any, that it may have on immigrants.

Research: Temporary Protected Status Interns: Tolulope Atolagbe, Tommy Vasquez CBO: Diaspora Community Services (DCS) Supervisor: Vanessa Mejia Research Mentor: Rafait Kassim

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Temporary Protected Status Tolulope Atolagbe & Tommy Vasquez

Brooklyn Health Disparities Center and Diaspora Community Services

Introduction

Diaspora Community Services (DCS) founded in 1981 is a Brooklyn-based multi-service and multicultural organization that provides support for low income residents, immigrants and the chronically ill. DCS has many programs that address the causes of problems the community faces everyday. A big part of DCS is the youth programs that help encourage and educate the youth.

Some of the services they provide are access to quality health care, supportive housing, youth education and the social support services (Diaspora Community Services, 2016).

Since 1990, the United States has granted a form of humanitarian relief called Temporary Protected Status (TPS) to nationals of certain countries that have become embroiled in violent conflict or suffered a natural disaster. An estimated 340,000 people currently hold TPS status (Messick, M., & Bergeron, C., 2017). As its name implies, TPS is not a grant of permanent legal status in the United States. Recipients do not receive lawful permanent residence (a “green card”), nor are they eligible, based on their TPS status, to apply for permanent residence in the U.S or for U.S. citizenship. The United States can end a country’s TPS designation once it has decided that it has recovered from the triggering event. TPS is only granted to nationals of 13 countries which are El Salvador, Guinea, Haití, Honduras, Liberia, Nepal, Nicaragua, Sierra Leone, Somalia, Sudan, South Sudan, Syria and Yemen (U.S Citizenship and Immigration Services, 2017).

Although TPS might sound great, there are consequences to it. One of the most recent issues arising is Haiti being cut off of TPS. This forces thousands of immigrants to move back to their country that may not be completely recovered. And in addition to that, they might be unable to support themselves.

Questions such as, “How can one transition from living a better life in the US to going back to instability?” inspire the need to research the positive and negative effects of TPS.

Hypothesis

Limitations

TPS has more of a negative impact on immigrants than a positive impact, because it is only a temporary benefit that eventually still sends TPS holders back to their struggling country.

Our limitations were that we weren't able to find enough people on TPS to gather more information about how TPS directly affects them. Most people we approached did not know about TPS but based on the blurb on our survey and the information we provided, they were able to formulate their own opinions on TPS despite not directly being on TPS or knowing someone on TPS.

Methodology

The methodology included handing out surveys, in order to conduct quality research. The survey was created to evaluate the negative and positive effects of TPS on immigrants. Our target audience was the general public in order to educate them about TPS and bring awareness to the topic. We distributed surveys in our local area in East Flatbush/Crown Heights area, at the SUNY Downstate Medical Center, and at Kings County Hospital. Additionally, online links were also shared through social media for people to virtually take surveys.

Conclusion Figure #4: This graph illustrates that not many people have help after their TPS is cut and may have to return to their country or their formal status. This research concludes that they are better off staying in the United States with TPS.

Acknowledgements

Figure # 2: This chart represents the current country on TPS, when their TPS was granted and what the expiration date is and the reason the country has was granted TPS.

Results

Despite having a limited number of TPS holders, we were able to find more people who know someone on TPS. Data analysis showed an incline of TPS having a larger positive impact on TPS holders and friends and families of TPS holders.

When we asked people about their opinion of TPS, whether they were TPS holders or not they generally had positive outlook on TPS.

Figure #5: This graph illustrates that out of the 102 people we surveyed 34.2% believed that TPS did not affect the money gain or loss to support their family while 50.0% said it improved their lives slightly.

Policy Recommendation §

§

Figure #1: This chart represents the countries with TPS designations and the estimated number of beneficiaries

In conclusion, our hypothesis is not supported by our data, our data shows a clear path that TPS in fact has a overall positive effect on immigrants rather than a negative one like we initially predicted. In alignment with our findings, a report by the University of Kansas Center for Migration Research found that U.S. immigrants from El Salvador, Nicaragua and Honduras on Temporary Protected Status, despite its in-between and temporary nature, generally do better than undocumented immigrants in educational attainment and civic engagement in their communities. The report only included TPS holders, thus proving that TPS immigrants have an edge over undocumented immigrants (University of Kansas, 2017).

Figure #3: This graph shows that out of the 102 people that we surveyed 8.0% of those were TPS holders.

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U.S. Citizenship and Immigration Service(USCIS) take into consideration whether the country will be able to take the immigrants back.

USCIS should keep relations with the immigrants that are sent back, incase they can not support themselves when they go back to their country and renew their TPS.

We would like to acknowledge our CBO director, Vanessa Mejia; our programs director, Ms. Gordon; the directors and founders of the Brooklyn Health Disparities Center for giving us the opportunity to be in this program.We would also like to thank our parents; fellow interns; our research mentor, Rafiat Kassim; and most importantly the people who took time out of their busy lives to complete our surveys.

Bibliography 1. (2017, May 24). Retrieved July 11, 2017, from https://www.uscis.gov/humanitarian/temporary-protected-status 2. University of Kansas . (2017, June 30). (2017, May 24).

Retrieved July 10, 2017, from https://phys.org/news/2017-06-immigrants-temporary-statuscivically-engaged.html 3. Alvarez, L. (2017, May 22). 59,000 Haitians Displaced by Earthquake Get Extra 6 Months in U.S. Retrieved from https://www.nytimes.com/2017/05/22/us/haitians-displacedextra-6-months-us.html 4. Menjívar, C. (2017). THE EXPERIENCES OF HONDURAN AND SALVADORAN IMMIGRANTS. 1-36. Retrieved from http://ipsr.ku.edu/migration/pdf/TPS_Report.pdf

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Health Awareness, Risks, Perceptions & Behaviors Health behaviors, risks, and perceptions are often a reflection of awareness and knowledge. In order to understand the perceptions of PrEP and assess the prevalence of prescription drug use in the Arab community and behaviors towards safe sex within the Brooklyn community, our students conducted research focused on these particular topics of health.

Research: The Knowledge, Attitude and Perception of PrEP Among Youth Interns: Leila Begy, Zoe Nangle CBO: Health and Education Alternatives for Teens (H.E.A.T.) Supervisors: Tiffany Patterson, Amelia Williams Research Mentor: Line Nana Practicing Safe Sex in the Community Interns: Luz Maria Flores, Zoe Montgomery, Tianna White CBO: Protecting the East Supervisors: Diedra Miller & L. WIlliams Research Mentor: Cecille Nelson Prevalence of Prescription Drugs in Arab Communities Interns: Aysha Choudhry, Shahida Islam, Christelle Sagesse CBO: Arab American Family Support Center Supervisor: Maha Attieh Research Mentor: Moneba Zaman

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The Knowledge, Attitude and Perception of PrEP Among Youth Student Researchers: Leila Begy and Zoe Nangle Contributors: Line Nana and Tiffany Patterson

Brooklyn Health Disparities Center (BHDC) and Health and Education Alternatives for Teens (H.E.A.T.)

Introduction

Methods

There are many Sexually Transmitted Diseases (STDs) and STIs that affect people in the United States. Youth ages 15 to 25 are the most affected with about 88% of the cases in 2000. HIV, which stands for Human Immunodeficiency Virus, can be transmitted through semen, blood, and other bodily fluids that are exchanged between someone and a person that is HIV positive. It can also be contracted by sharing needles with a person that has HIV. Sadly, many children and young adults are unaware of how high the risk of getting HIV is, and unfortunately there is no known cure; However, there is a new medication called PrEP that is used to help prevent new infections in people who do not have HIV but are at a higher risk of contracting HIV. PrEP or Pre Exposure Prophylaxis is used as an antiviral medication. Before taking PrEP, one must first be tested to find out his/her HIV status. Before approving PrEP, the Food and Drugs Administration (FDA) looked at the results from several research studies that found PrEP was safe to use. This has been around for over a year but is not very common (whatisPrEP.org). PrEP, also known as Truvada, is a medication, taken once a day. Truvada has been approved for those who are 18 and older, as well as those who are HIV negative. PrEP users are required to visit their doctor/ provider every three months for follow ups. A single pill taken once a day can have a very big impact against HIV. This pill helps keep someone who does not have HIV from getting infected with HIV, but the person can not skip a day of the pill or else it will become less effective.

In the United States, about 50,000 people are infected by HIV every year. Additionally, 1.2 million people in the United States are living with HIV and do not know that they have it. Using a condom has been one way to stay safe from HIV and another way is to use PrEP. Youth, who identify as heterosexual, lesbian, gay, bisexual, and transgender, that decide to take PrEP every day reduce their risks of getting HIV by 99%. People who do not take PrEP every day are at a higher risk of not being protected properly. It takes about a week to build the maximum protection when using PrEP. Taking extra pills within a day will not provide individuals with extra protection, but instead, will make them sick. One pill a day is the only way to find success in PrEP. PrEP is not a cure for HIV, however, it makes living with an infected sexually partner a lot easier. For example, some people live with a person who has HIV and would need to take PrEP in order to protect themselves.

An organization that advocates for HIV awareness and promotes PrEP is known as H.E.A.T., which stands for Health and Education Alternatives for Teens. This is the only health care program of its kind in Brooklyn that provides age and developmentally appropriate, culturally competent care for those who are living with or have very high-risks of contracting HIV/AIDS. H.E.A.T. is a huge promoter of PrEP through many events and activities. HEAT holds youth specific events that connect and bring about awareness. Such as skate parties, special events just for girls and Balls. H.E.A.T promotes PrEP through brochures and pamphlets. Interns in the Brooklyn Health Disparities Summer Internship Program at the Arthur Ashe Institute for Urban Health are helping to bring awareness to the youth about HIV & PrEP through survey data and distribution of information.

We introduced ourselves to the participants by mentioning that this survey data was being collected to conduct a research project, which would later be presented at Borough Hall. Later on, we attracted the attention or community members by asking them if they were willing to fill out the surveys. We collected data at Prospect Park in order to reach more people. We also handed surveys at SUNY Downstate Medical Center’s cafeteria and finally to our fellow classmates. In total, we gathered 132 surveys. People were willing to fill out the surveys mainly because we told them it was not confidential and we also gave them a brief definition of PrEP, along with it’s purpose and how it works. After collecting and analyzing all of the surveys, we used the data to create graphs and charts to display our findings.

Results Cont’d

Conclusion

After gathering data from our teenage participants, ranging between the ages of 14 to 24, we concluded that our hypothesis was correct. The majority of teens that we had surveyed lacked knowledge about the PrEP medication. We also can conclude that the percentage of the people we surveyed that were transgender knew more about PrEP than the participants that identified as male or female.

The survey can be improved by adding the options of “other” for certain questions. There should also be extra options such as “all of the above,” “N/A.” In the Gender section, there should be a box which includes the option of “other” because some people may not identify themselves as a male or female.

Hypothesis

Percentages: Age 14-17: 21% have heard of it Age 18-21: 40% have heard of it Age 22-24: 32% have heard of it

PrEP is a very recent medication and there is a lack of education on the topic for the youth. Due to this fact, we hypothesized that the knowledge, attitudes, and perception of PrEP among youth were very uncommon.

Male: 34% have heard of it Female: 32% have heard of it Transgender: 50% have heard of it

Results

Limitations

Throughout the internship program, we faced many limitations. One of the biggest limitations was the stigma that is associated with HIV. Many people did not want to take the survey because they thought that they would be judged or people would think that they had HIV if they completed the survey. Another limitation was the location utilized for survey distribution. Since we were only in the area of SUNY Downstate Medical Center, we were not able to access a wider range of participants.

This figure shows the correlation between the ages of participants and their knowledge of PrEP.

Policy Recommendations

As we were conducting this research we came across some recommendations for the H.E.A.T. program. For the upcoming years we think that there should be more advertisements for the PrEP medication, including commercials and billboards, to advertise PrEP, what it is, and how it works.

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Acknowledgements

We would like to thank our supervisor of the Brooklyn Health Disparities Summer Internship Program, Ms. Vinessa Gordon for the guidance she gave us throughout the program. We would also like to acknowledge our supervisor at the H.E.A.T program, Ms. Amelia Williams, for showing us the way that the H.E.A.T program functions, as well as helping us conduct research on the program itself. We would like to thank our research mentor Line Nana for being such a great support to our team in helping us to gather information to present in front of such an amazing group of people.

We would also like to thank the participants who completed the surveys.

Bibliography

1. K Rivet Amico, University of Michigan, and Sybil Hosek, Stroger Hospital of Cook County Chicago, in collaboration with Chris Balthazar, Stroger Hospital. Animation by Tom Coggia. http:// www.whatisprep.org/ 2. http://www.heatprogram.org/history.html 3. https://us.triumeq.com/what-is-hiv-aids (2017) The ViiV Healthcare group of companies.

4. Knight, R., Small, W., Carson, A., & Shoveller, J. (2016).

Complex and conflicting social norms: implications for implementation of future HIV pre-exposure prophylaxis (PrEP) interventions in Vancouver, Canada. PloS one, 11(1), e0146513.

5. Farthing, Heather. "Discomfort Discussing HIV/AIDS Limits the Potential for Partner-to-partner PrEP Education." IDWeek 2016.

Idsa, 2016.

Practicing Safe Sex In The Community

Researchers: Luz Maria Flores, Zoe Montgomery, and Tianna White Other Contributors: Vinessa Gordon, Deidra Miller and Cecille Nelson Protecting the East and The Arthur Ashe Institute for Urban Health

Introduction In New York City, 55% of unwanted pregnancies were among individuals ages 15-44 years old (Guttmacher Institute, 2016). According to the CDC (2015), New York State ranked 4th among the 50 states of newly diagnosed Human Immunodeficiency Virus (HIV) cases in 2015. Human Immunodeficiency Virus (HIV) is a chronic potentially-life threatening condition, which damages the immune system, and leaves the body without the ability to fight diseases. In 2015, New York State also ranked 12th in Chlamydial infections and 16th in Gonorrheal infections among the 50 states (CDC, 2015). In East New York, a central location in Brooklyn, New York, HIV is the seventh most common cause of death with a rate of 18.7% per 100,00 (Community Health Profile, 2015). Unfortunately, many individuals have contracted HIV or other STDs and do not know. In East New York, 26% of adults do not have access to health care compared to the city rate of 20% (Community Health Profiles, 2015). Lack of access to health care may result in individuals being unaware of their HIV/ STD status.

There are many services & workshops being provided to youth ages 13-25 about protecting themselves from Human Immunodeficiency Virus (HIV), Sexual Transmitted Diseases (STDs), Sexual Transmitted Infections (STIs) and pregnancy prevention. However, many people do not listen to the information given to them or are not fully aware of the opportunities provided for practicing safe sex. This makes them more likely to contract certain diseases through sex, or end up having an unwanted pregnancy. Protecting The East, in partnership with East New York Farms, is one of the organizations that try to make youth in their community more aware of the dangers of not practicing safe sex. Protecting the East is an organization located in East New York focused on educating the community members on sexual health. Some of their ways of doing this is by the distribution of condoms, outreach within the community, and workshops that focus on the importance of safe sex.

Hypothesis

We hypothesize that some residents of East New York and the surrounding neighborhoods are unaware of the potential risks of having unprotected sex and not getting tested for STDs/STIs. This lack of awareness results in residents living a sexually unhealthy lifestyle.

Methods

Results (continued)

.

The study was conducted in East New York, Brooklyn. The area in which the study has taken place was determined

by Protecting the East. The study was conducted by three high school students/interns. The three students went around East New York and interviewed random individuals on the street, asking them questions from a survey that they developed. The students surveyed people on Mondays, Wednesdays and Fridays from around 2pm to 5pm.

How important is it to practice safe sex?

Policy Recommendation ● HIV Testing be required for people in a a certain age group ● More advertisements for the free facilities that help treat people with STDs/STIs and get them tested.

Conclusion

The survey questions that were being used to interview the randomly selected participants were questions that focused on the topic of safe sex. The questionnaire consisted of 14 questions involving demographic information and sexual health knowledge. Individuals were not given the surveys to complete on their own. The students asked individuals the questions and checked off the answer that was given to them by the participant. The students also collected information at train and bus stations in the community.

How o%en do you or your partner wear condoms during sex?

Once the data was collected, the information was then entered into a shared spreadsheet. The data was then analyzed by the students to figure out the answer to the research question.

Results

We came to the conclusion that local community members actually are practicing safe sex because they are aware of the risks they would be increasing if they did not practice safe sex. Most of the people we surveyed felt that practicing safe sex was very important for preventing STDs/STIs, HIV and pregnancy. A lot of local community members were aware of the free facilities that do treat people with STDs, and were also aware of the consequences of not practicing safe sex. They were also aware that the easiest way to prevent these things was to use condoms. We came to the conclusion that local community members, for the most part, knew the dangers of not practicing safe sex and would rather keep themselves safe from HIV, STDs/STIs.

Bibliography

In our research, we found that many people in the community have knowledge about using protection, and few did use protection because they were married or committed to someone, yet they all were aware of the dangers of not practicing safe sex. More than half of the people that were surveyed expressed practicing safe sex was very important and reported using condoms during sex.

As we can see in the graphs more then 75 people in the community said that it was very important for them to practice safe sex. In the other chart the result states that 34.8% of the members in this community said that they always used condoms when they had sex.

Limitations

In the surveys we asked the participants from the community of their daily activities, and if there was a low risk, high risk, or no risk at all for contracting HIV through certain daily activities. Only a few answered all the statements correctly, The statements that were mostly answered wrong were those related to “using public restrooms” and “Being born by a mother with HIV.” They stated that there was a high risk instead of low risk in both these statements.

A lot of people didn’t want to share information because most of the questions that were being asked were about their sex lives. We surveyed a wide variety of people who varied in ages instead of focusing on one age group. We also surveyed people who live in different neighborhoods in Brooklyn.

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1) Guttmacher institute: Percent of unwanted pregnancy in New York City retrieved from: https:// www.guttmacher.org/fact-sheet/state-facts-aboutunintended-pregnancy-new-york 2) Protecting the East website retrieved from https://ucceny.org/programs/protecting-the-east/ 3) Community health profiles https://www1.nyc.gov/assets/doh/downloads/pdf/data/ 2015chp-bk5.pdf 4) Contexual factors and sexual risk behaviors among young black men- Jamal Jones, MPH, Laura F, Salzar PHD, and Richard Crosby

Prevalence of Prescription Drugs in Arab Communities Aysha Choudhry, Shahida Islam and Christelle Sagesse

With The Brooklyn Health Disparities Center and Arab American Family Support Center (AAFSC)

Introduction The use of prescription drugs among the youth and adults today is a big issue. Prescription drugs are pharmaceutical drugs that legally require a medical prescription from a physician such as doctor, dentist, psychiatrist, pharmacist, or any specialized doctor. Prescription abuse is more common in the second generation. These are individuals born in the United States with at least one foreign parent, adapting to social norms (Jamil HJ, 2016). These individuals are more vulnerable to falling onto wrong paths in order to feel accepted. The misuse of prescribed drugs can lead to millions of people dying or lead to higher risks of diseases. Some people believe that the consumption of street drugs are more of the reason for the deaths of millions of people in poor communities, however, prescription drugs have a higher incidence of death due to the way the drugs are used. For example, people may overdose because they utilize the drugs as painkillers for mental illnesses, pain or even recreationally.

In the U.S. alone, more than 15 million people have abused prescription drugs. However, most people don’t discuss the effect that the misuse of prescription drugs may have on the Arab community in particular. Both immigrants and later generations of Arab Americans are currently enduring intense negative media images and overt hostile political rhetoric, due to stereotypes and bias political views as well as discrimination; all of which constitute ongoing stress. Most Arab countries, such as Iraq, Yemen, Kuwait, Saudi Arabia, etc., are located in the Middle East and Northern Africa. The Arab population in the United States is a population of people who speak Arabic as their first language, there are about 3.7 million in the United States (Arab American Institute, 2009).

The Arab-American Family Center (AAFSC) is an organization that provides social services to Arab American immigrant families throughout New York City, assisting them with their unique needs. For instance, the AAFSC arranges E.S.L (English as a Second Language) classes for adults who don’t speak English, assists couples experiencing domestic violence, assists individuals in obtaining health insurance, offers citizenship courses, summer and weekend programs for kids of ages 7-12, legal assistance and much more. The AAFSC promotes a stronger and more united Arab community while positioning a stronger voice for this often ignored minority. It is important to know the prevalence of prescription drugs in the Arab community. The research conducted at the Arab American Family Support Center will not only help determine the prevalence of prescription drug abuse in the Arab community, but educate people as well.

Methodology

Results Cont’d

In order to collect information on the Arab community, the AAFSC at their main office surveyed adults, as well as a high amount of Arab teenagers, as they are more vulnerable to prescription drugs. A myriad of questions were created to address if people of the Arab society were comfortable discussing the issue of prescription drugs and seeking help if needed. For example, the last question on the survey focused on how often a person uses prescription drugs and if they were misusing it. Information on resources that would treat drug abuse were given to all participants. Moreover, the surveys also allowed researchers to investigate whether or not culture and religion play into the prevention of misuse of prescription drugs.

After collecting our survey data, we had an interesting outcome of responses from each question. For example, when participants were asked if their culture/religion prevents them from misusing drugs, 42.1% of participants said no and 57.9% of participants said yes. Of the 42.1% (age range of 36-55), individuals believed that their religious morals were more important than committing what they consider a sin. Another question that individuals were surveyed on, was if they felt peer pressured to use prescription drugs. Of the 76 surveyed, 66 participants did not feel peer pressured into utilizing prescription drugs, 7 felt somewhat peer pressured, the remaining 3, felt peer pressured. We also asked participants their reason for using prescription drugs. Some chose not to disclose- out of the 76 surveyed, 54 chose to answer. The main reason for prescription drug use was for chronic pain while the least common reason for using prescription drugs was for anxiety. Finally, the last question was how often people used prescription drugs - 32 participants said they used prescription drugs occasionally when they have pain, 9 said everyday for an illness, 9 said once a day, and 3 said monthly. Interestingly, individuals were comfortable reporting that they can’t stop taking the prescription drugs because it’s hard for them to stop.

Those individuals said they mostly used the prescription drugs for pain killers. Some participants may not have wanted to answer why they take the prescription drugs because they felt uncomfortable and felt as if their privacy was invaded. In conclusion, the survey given out to the participants did help us learn more about the Arab community and gave us insight into the way that prescription drugs are being used.

Results

The Need to Use Prescription Drugs

Limitations Some of the problems experienced while distributing the surveys were that a few individuals declined to take it or skipped vital questions. Also, because it was the summertime many of the Arab community had left the country for vacation after Ramadan, which was during the months of May and June. This made it difficult to get more people to take the survey and get their input on our project.

Conduction of this research would have been best before or during the month of Ramadan because we might have been able to get more participants.

Does culture prevent you

from misusing?

Policy Recommendations

● People with low economic statuses should be given therapy sessions, financial aid, and should be educated on the effects of misusing prescription drugs within the Arab community. ● Education must be provided to health care prescribers and the general public through school programs at every institution to ensure there is a fair chance for everyone in minority communities. ● Have health advocacy brochures in multiple languages to reach immigrants that are likely to abuse prescription drugs.

Hypothesis

It is hypothesized that the prevalence of prescription drugs in the Arab community will not be very common. This is because their religion (Islam) has strict regulations and morals that prevent misuse of these pharmaceutical drugs.

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Conclusion After conducting research on the Arab community with the help of the Arab American Family Support Center, we have come to the conclusion that the prevalence of the misuse of prescription drugs is not very common. When trying to find the reason behind the results, we learned why the Islamic religion is a preventative factor in abusing prescription drugs.

According to the Journal of Immigrant and Minority Health, Arab countries have both religious prohibition on and social discouragement of drinking, especially on women, as it can bring shame to the entire family (M. J., & Jamil, H., 2011).

Furthermore, the influence of assimilation may lead to social pressure to misuse drugs. Barriers such as language or denial of problems can also impede prescription drug misuse treatment. However, we found out that compared to the white demographic, they are more likely to misuse prescription drugs. In fact, according to the article, “Health Issues in the Arab American Community,” Arabs are 51% less likely to abuse drugs than their white counterparts. Arabs are also less likely to receive treatment than other ethnic demographics (Arfken, 2007). Moreover, treatment participation of the Arab Community is relatively low in comparison to other ethnicities, which could correspond to socioeconomic status or cultural stigma. As stated in the article, “Unemployed immigrants or those with a lower socioeconomic status were more susceptible to abuse prescription drugs” (Alison L. Koch, 2007). Overall, the misuse of prescription drugs is not very common in the Arab society.

Acknowledgements We would like to thank our CBO advisor, Maha Attieh; our program supervisor, Vinessa Gordon; and our research mentor, Moneba Zaman.

Bibliography - Arab American Family Support Center. (n.d.). Retrieved July 13, 2017, from http://www.aafscny.org/ - Watch Truth About Drugs Documentary Video & Learn About Substance Addiction. Get The Facts About Painkillers, Marijuana, Cocaine, Meth & Other Illegal Drugs. (2006). Retrieved July 13, 2017, from http://www.drugfreeworld.org/drugfacts/prescription/ abuse-international-statistics.html - Arfken, C. L., Arnetz, B. B., Fakhouri, M., Ventimiglia, M. J., & Jamil, H. (2011). Alcohol Use Among Arab Americans: What is the Prevalence? Journal of Immigrant and Minority Health /Center for Minority Public Health, 13(4), 713–718. http://doi.org/10.1007/ s10903-011- 9447-8 - Arfken, Cynthia L., Sheryl Pimlott Kubiak, and Alison L. Koch. "Health Issues in the Arab American Community. Arab Americans in Publicly Financed Substance Abuse Treatment." Ethnicity and Disease 17 (2007): 70-77. Ethnicity & Disease.

July 2007. Web. 23 June 2017.

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Social Determinants of Health There are many social determinants of health which impact daily life and access to opportunity. For those living in Brooklyn, including those with disabilities, ethnic background and disability status play pivotal roles in how individuals are able to live their lives. Students conducted research to assess the impact of these social determinants, and their impact on healthcare.

Research: Assessing Wheelchair Accessibility in Brooklyn City Council Members’ Offices Interns: Alex Alexakos & Jennasia Otway CBO: Brooklyn Center for Independence of the Disabled Inc (BCID) Supervisor: Valerie Josephs, Yessenia Torres, Joe Rappaport Research Mentors: Ariel Crawford, Ivan Cervantes How One’s Daily Lifestyle Affects The Likelihood of Developing Diabetes Interns: Richard Brezault, Juleanna Francois, Cyrena Washington CBO: Community Counseling and Mediation (CCM) Supervisor: Myriam Lamothe Research Mentor: Deniya Thompson

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Assessing Wheelchair Accessibility in Brooklyn City Council Members’ Offices Student Researchers: Alex Alexakos and Jennasia Otway Other Contributors: Ariel Crawford and Ivan Cervantes Brooklyn Center for Independence of the Disabled Inc. and Brooklyn Health Disparities Center

Introduction

Methods (Cont’d)

Since its founding in 1956, Brooklyn Center for Independence of the Disabled (BCID) has been advocating for the civil rights of people with disabilities. They have recently expanded their efforts in their new partnership with the Open Doors program. The Open Doors program mainly helps with implementing various training programs for people working in transportation, stores and other aspects of the city to ensure accessibility and to meet the guidelines of the ADA. Accessibility for a disabled person can be summed up in two words: independence and freedom. Those with physical disabilities do not want to rely on the assistance of others in their everyday lives. Everyone is an individual and should not be labeled because he/she is unable to complete certain tasks. This shows why making different places in Brooklyn more accessible for the disabled is extremely important to BCID. Their main goal with the Open Doors program is to increase accessibility in retail stores, institutions, Brooklyn public spaces and offices for people with disabilities. From a legal standpoint, there are various laws and regulations that apply to disability rights. For instance, the Americans with Disabilities Act (ADA), amended in 1990, helps the disabled on five different aspects. This act gave them the chance to become employed, become more involved in state and local activities, having more independence using public transportation, public accommodations and telecommunications relay services. Moreover, the Fair Housing Act, which was amended in 1988, prohibits discrimination based on disability status and race. This offers people with disabilities a fair opportunity to buy or sell housing. With these legislations in place, we hoped to determine which City Council member's district offices were wheelchair accessible.

● Other accommodations included the placing of buzzers to those in need. Furthermore, the type of door handle and the proper use of alternate entrances for wheelchair accessibility were also observed in our surveys.

Hypothesis

Results (Cont’d)

If we found that the offices we visited were wheelchair accessible, we would give them a stamp that would inform others that they were indeed wheelchair accessible. Otherwise, if we found that they were not, we gave them a questionnaire for them to reflect on how they could improve the accessibility of their office.

Figure 3: The pie chart above shows the percentage of offices with entrances that allow a wheelchaired person to get into independently.

Results

A lot of the offices that have a separate entrance for wheelchair accessibility did not have directions to the accessible entrance and had steep ramps. Our recommendation is that the accessible entrance be in the same area of the main entrance. If the accessible entrance is not in the same area of the main entrance, there should be directions to the accessible entrance. We also recommend that the slope of the ramp be 1:12 minimum, so it would not be too steep for a wheelchair to get up the ramp independently. Due to the lack of directions and the steepness of the ramps, we marked District 45 and District 36 not accessible.

Conclusion

Based on our observations, we were able to indicate that only 1 out of 6 city council members’ offices were fully accessible. When we visited the offices, we noticed common characteristics. All the offices that were not accessible were local offices. These local offices were in more urban neighborhoods and were much smaller. Many of these offices had an issue of not having enough money or could not find a way to make their entrance more accessible. Whereas, District 35, the state office that was accessible, was much bigger and seemed like they had more money than the local offices. Therefore, our hypothesis was correct because the majority of the city council members’ offices were local offices and were not accessible at all.

District 35 1=Yes 2=No 3=N/A

Acknowledgments

Figure 1 : The bar graph above shows the answers to the various characteristics we observed in the City Council members’ offices.

We would like to thank our research mentors, Ariel Crawford and Ivan Cervantes for helping us with this research project and with gathering our data at BCID. We would also like to thank our CBO supervisors: Valerie Josephs, Yessenia Torres, Joe Rappaport and the rest of the staff at BCID for educating us on the importance of places to be fully accessible for the disabled. Most importantly, we would like to thank our program coordinator Ms. Gordon for giving us this amazing opportunity to learn and work more in depth with health disparities.

We predict that the majority of the City Council Members’ offices will not be wheelchair accessible.

Methods Our research methods involved field observation of Brooklyn City Council district members’ offices. We first looked up the addresses of all the council members’ offices through the New York City Council website (https://council.nyc.gov/districts/). Then, we put all the addresses on google maps to plan out our trips. In order to collect our data, we were provided surveys and questionnaires by BCID, and observed various characteristics of the offices’ main entrances.

District 41 Figures 4 and 5: The images above demonstrate the difference between accessible and non-accessible entrances that we observed. The entrance depicted in figure 4 is accessible while the entrance depicted in figure 5 is not.

Limitations

The characteristics we observed are listed below: ● The leveling and height of the entrances on both sides ● The size of the threshold in the doorway ● The measurements of the entrance, including the door length and the slope of ramp leading to the door

Policy Recommendations

1. Because of the limited time there was to collect data and some City Council offices being in the far reaches of Brooklyn, we were unable to visit all of the offices.

2. Most offices could not sign off on our survey because they were government offices.

Figure 2: The pie chart above indicates the percentage of offices which had doorways that had openings larger than 32 inches in order for a wheelchaired person to fit in the doorway.

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Bibliography US Department of Justice, (2017) A Guide to Disability Rights Laws Retrieved from: https://www.ada.gov/cguide.htm Open Doors Program, (2017) Retrieved from: http://opendoorsnfp.org/ (2017) Brooklyn Center for Independence Retrieved from: http://bcid.org/about/ New York City Council, (2017)“Council Members & Districts." Retrieved from: https://council.nyc.gov/districts/

How One’s Daily Lifestyle Affects The Likelihood of Developing Diabetes Student Researchers: Richard Brezault, Juleanna Francois, Cyrena Washington Other Contributors: Myriam Lamothe and Deniya Thompson

Community Counseling and Meditation (CCM) and Brooklyn Health Disparities Center (BHDC)

Introduction

Methods

Community Counseling & Mediation (CCM), founded in 1982, is an innovative community-based organization that provides social support, counseling, education, and housing services to over 7500 at risk families in poor, minority populated areas in Brooklyn. CCM works to help families of African-American, Caribbean and Latino children achieve their goals and face their challenges. One challenge faced by minorities is the prevalence of diabetes within the African American and Afro-Caribbean populations. Diabetes mellitus, commonly known as diabetes, is a disease that affects the body’s ability to digest and metabolize carbohydrates. Insulin, a hormone produced by the pancreas, helps break down these carbohydrates to sugar, or glucose, that’s stored for later use.

There are two main types of diabetes: Type 1 Diabetes and Type 2 Diabetes.

There is an epidemic within the African-American and Hispanic population surrounding diabetes. Studies show that 77% of African-Americans are more likely to develop diabetes than Non-Hispanic Whites and that Mexican Americans are two times more likely to develop diabetes than their white counterparts (Webmd, 2017). African Americans, in particular, suffer the most from common diabetic complications: amputation and kidney failure. About 30% of Type 1 diabetics and 10% - 40% of type 2 diabetics will develop kidney failure, resulting in being placed on dialysis.

When one experiences kidney failure, dialysis helps maintain homeostasis in the body by removing waste and other impurities, controlling blood pressure, and keeping a safe level of chemicals in the blood (Kidney.org, 2017). Some other factors that may lead to the development of kidney disease, and diabetes, are: smoking, poor diet, high blood pressure, obesity, the prevalence of diabetes and kidney failure in your family, not knowing about diabetes, and not going to the doctor regularly.

The research interns traveled around the area of Crown Heights/Eastern Parkway to hand out surveys. The interns visited surrounding parks, libraries, and museums in the neighborhood, as well as programs within the organization, Summer Youth. Data was also collected to see how well people eat on a daily basis, and if they, or anyone they knew, had the condition. The survey consisted of 10 questions in which the research interns questioned people of all races and ages to see if they were aware of diabetes and dialysis.

Results Cont’d

• Raise awareness about the severity of diabetes in the community.

• Make healthier foods more accessible to more communities in Brooklyn.

Conclusion Results indicated that the hypothesis the research interns came up with was correct. When asked about someone they know having the disease, 56% of them said yes. Those that said yes live in neighborhoods where there is not access to organic food markets, so they end up eating unhealthy and fast food at various times during the week.

The survey consisted of questions such as: 1. How often do you incorporate fruits and vegetables in your diet?

2. How often do you have three healthy meals in a day?

3. How often do you exercise?

Figure #2: This graph shows that the majority of the people that were surveyed drink water daily or weekly.

Acknowledgements The research interns would like to acknowledge and thank the CBO advisor, Ms. Myriam Lamothe of Community Counseling & Mediation (CCM); our program supervisor, Ms. Vinessa Gordon; our research mentor, Deniya Thompson; along with the rest of the staff at the SUNY Downstate Medical Center and the Arthur Ashe Institute for Urban Health.

Results

Bibliography

Figure #3: This graph shows that majority of the people surveyed either consumed fast food (Chinese, McDonalds or any other brands) for dinner sometimes or weekly, in comparison to those who consumed fast food either daily or never.

Hypothesis A person’s diet and their daily habits would play a big role in their likelihood of developing diabetes. Minorities would be the most affected by diabetes because of the way they were brought up, their lack access to healthy foods, and their knowledge of diabetes and dialysis. Their water intake, and the foods they consume play a big role in developing diseases.

Policy Recommendations

Limitations 1. While distributing surveys, the research interns realized they weren’t able to collect data from a more diverse group of people, such as Hispanics, Latinos(a) and Asian Americans.

2. Some participants did not fill out the survey completely making their survey invalid, which was crucial for the data.

3. Also, some participants did not want to take the survey because the research questions discouraged them.

Figure #1: Statistics show that 44% of the people surveyed did not have diabetes and neither did any family members. It also shows that 56% of the people surveyed, or their family members, had diabetes.

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1. Afkarian M, Zelnick LR, et.al. Clinical manifestations of kidney disease among US adults with diabetes. Journal of the American Medical Association 2016; 316(6); 602-610 2. Mokdad AH, Ford ES, Bowman BA, et al. Diabetes trends in the U.S.: 1990-1998. Diabetes Care 2000;23(9):1278-83.

3. Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med 1996;125(3):221-32. (AHRQ Grant HS 07397).

4. Musey VC, Lee JK, Crawford R, Klatka MA, McAdams D, Phillips LS. Diabetes in urban African-Americans. I. Cessation of insulin therapy is the major precipitating cause of diabetic ketoacidosis. Diabetes Care. 1995 Apr;18(4):483– 489.

5. McFarlane SI, Chaiken RL, Hirsch S, Harrington P, Lebovitz HE, Banerji MA. Near-normoglycemic remission in AfricanAmericans with Type 2 diabetes mellitus is associated with recovery of beta cell function. Diabet Med. 2001 Jan;18(1): 10–16.

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Violence as a Public Health Issue

Violence, which greatly impacts many aspects of life, is a recurring theme in communities of color. Violence is the #1 cause of death for African-American and Latino males aged 15-24, and is also directly linked to chronic disease (heart disease, asthma, stroke, cancer, etc.), mental health problems (PTSD, stress, anxiety, depression etc.), lower quality of life, and increased risk of perpetrating violence. Students conducted research to assess the role and impact of violence in Central Brooklyn.

Research: Assessing the Knowledge and Experiences of Brooklyn Residents toward Domestic Violence Interns: Kira Jennings & Amyah Wright CBO: Caribbean Women’s Health Association (CWHA) Supervisors: Harriette Jordan, Emanuela Joseph, Debra Lessane Research Mentor: William Chambers

Violence as a Public Health Issue Interns: Nelson Asemota, Alpha Kouanda, Sherron Yorke CBO: Arthur Ashe Institute for Urban Health (AAIUH) Supervisor: Vinessa Gordon

summer2017 13

Violence as a Public Health Issue Nelson Asemota, Alpha Kouanda, Sherron Yorke Other Contributors: Ms. Vinessa Gordon

Arthur Ashe Institute for Urban Health and Brooklyn Health Disparities Center

Introduction The Arthur Ashe Institute for Urban Health (AAUIH) was founded by Arthur Ashe, a famous HIV positive, African American tennis player and humanitarian. His main goal was to make the public aware of certain health issues affecting multi-ethnic communities within Brooklyn. Arthur Ashe’s vision of health promotion, was collective with other institutions to promote better health care for those in need; part of this goal is discovering the various causes of health disparities.

The institute works to raise awareness for the health disparities prevalent in the lives of people of color. Some of these diseases include cardiovascular disease (CVD), diabetes, and arthritis. In order to explore their causes, we must first address the social determinants of health, or the socio-economic conditions that are responsible for the country’s most unethical health differences.

Violence, although often overlooked as a social determinant of health, is the root of many of the health disparities we see today.

Violence is the behavior involving any force intended to hurt, damage, or kill someone or something. Research has provided many factors which contribute to the overall tendency of violence, as well as its impact on public health. These studies have found that, not only over 75% of urban youths have been exposed to community violence, but 14.5% of these children have seriously considered suicide at least once as a result of it. In addition to this, homicide assumes the number 2 spot on the list of causes of death amongst youth ages 10-24. Despite the notion that one instance of violence only affects the few individuals involved, when taken in conjunction with others, it can have a major impact on the entire community as well. Some of the long-lasting effects on the community are a higher average mortality rate due to homicide, and an increased risk of stress on the residents of that community. This may result in a higher general consumption of alcohol and drugs, and a hindrance in the ability of the residents to find employment or educational opportunities.

Methodology

Results Cont’d

In order to formulate a valid conclusion regarding the effect of violence on public health, interns administered paper surveys to their control group; individuals in the community from different racial, gender, and age groups. Using convenience sampling, various locations in Brooklyn and Queens were surveyed due to their prevalence in a wide diversity of races and incomes. Questions on the survey were focused mainly on the frequency at which community members witnessed or experienced violence, as well as its current effect on them. These questions helped the interns to make inferences about the severity of violence in the various neighborhoods, which,

- 28% of survey-takers admitted that they were more easily stressed after witnessing or experiencing violence.

- 56% said that they were more fearful after their violent experiences.

when paired with the findings from other sources, allowed for a correlation between the overall statistics in each neighborhood and its tendency toward violence. This further illustrated which neighborhoods were more or less likely to be in good health due to

Policy Recommendations

their severity of violence.

Results

Violence is a big part of our everyday lives, whether it be through personal experience or through witnessing violent acts and behaviors. To potentially terminate this issue, certain policies to satisfy the need for education on how to handle anger without violence should be implemented. Many of our youth lack the knowledge on what to do when they experience abuse or even when they witness a violent attack. This then leads to them resulting to violence, not because they wanted to, but rather because they lacked the knowledge to do otherwise. Schools are a big part in the upbringing of children, especially those ages 5 to 18.

More counselors should be hired in schools to teach and discuss topics such as leadership, self-control, respect, and hard work.

However, the responsibility also lies in ourselves. We are to learn not to just be bystanders, but to defend one another. This means not to attack the assailant, but to immediately inform the police and help tend to the victim of the attack.

While 55 people (41.4% of survey takers) experienced NO form of violence, 88 people have experienced at least one form of violence. People

Hypothesis

Limitations

Our literature review found that those who experienced Adverse Childhood Experiences (ACE) become less likely to go to college and maintain healthy lifestyles, but rather have an increased risk of substance abuse, stress, depression, social problems, and early death. We believe that our survey data will show that those who have experienced or witnessed violence will become more prone to health-risk behaviors or exhibit violent behavior themselves.

We would like to acknowledge the factors which limited our data, such as location, lack of incentive, and survey length. Our locations did not allow us to reach many demographics, the lack of incentive took away from the likeliness of individuals to participate in our survey, and concerns about the length of the survey (question capacity) discouraged our ability to add more health related questions.

- Out of those who experienced at least one form of violence, only 11 people (the lowest percentage of people) actually reported the violence to the police.

- 36 people (45.6% of survey -takers) handled the stress of keeping the abuse to themselves.

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Conclusion Based on our survey data and analysis, we have concluded that violence, in its many forms, affects the health of both youths and adults negatively and can result in a life of immense stress and serious disease for those directly and indirectly impacted by violence. Coinciding with this statement is the tendency of those who have witnessed or experienced violence to become more easily stressed and depressed by it, keep it to themselves, or to inflict this violence upon someone else. While stress places an individual at high risk for many diseases and conditions such as stroke, high blood pressure, and heart disease, violence places an individual at increased risk for having these diseases. This correlation indicates that violence’s effect on public health is negative.

Acknowledgements The research interns would like to acknowledge Ms. Vinessa Gordon for being both our mentor and CBO supervisor, and for persistently guiding us through this experience. We also thank the Arthur Ashe Institute for Urban Health for giving us the opportunity to push ourselves, work with new people, and ultimately expand our knowledge of urban health. Lastly, we would like to thank SUNY Downstate Medical Center for hosting us throughout this wonderful program. Without your help, this project would not have been possible.

Bibliography C. (n.d.). How to End Violence in Your Community. Retrieved July 20, 2017, from http://cvfriendsofthefamily.org/?page_id=60 A Public Health Approach to Preventing Violence: FAQ. (2009, October). Retrieved June & july, 2017,from https:// www.preventioninstitute.org/publications/a-public-healthapproach-to-preventing-violence -faq Children's Exposure to Violence. (2016, April & may).

Retrieved July 20, 2017, from https://www.childtrends.org/ indicators/childrens-exposure-to-violence/ Community Health Empowerment. (n.d.). Retrieved July 20, 2017, from http://www.arthurasheinstitute.org/arthurashe/home/ mission/ Violence Prevention. (2016, June 14). Retrieved July 20, 2017, from https://www.cdc.gov/violenceprevention/acestudy/ about.html

Assessing the Knowledge and Experiences of Brooklyn Residents toward Domestic Violence Student Researchers:Kira Jennings & Amyah Wright Other Contributors: William Chambers, Emanuela Joseph, Harriette Jordan & Debra Lesane Caribbean Women’s Health Associaltion (CWHA) & Brooklyn Health Disparitiies Center (BHDC)

Introduction

Methods

The Caribbean Women’s Health Association, Inc. (CWHA) is a Brooklyn based women’s advocacy organization, founded in 1982.

The organization’s mission is to provide high quality, comprehensive, culturally appropriate health, immigration and social support services to its diverse constituency. They have a vision to transform lives, strengthen families and build bridges across culturally diverse communities.

The research team administered 102 paper surveys in the Flatbush area of Brooklyn. The survey population was sourced through CHWA-related services and convenience sampling. Select surveys were verbally translated for Spanish speaking participants.

Survey questions aimed to assess participants knowledge and experiences towards the diverse forms of domestic violence.

Survey responses were recorded in a database and analyzed to make reasonable conclusions. Prior to administering the survey participants were informed that participation is voluntary and completely anonymous. There were no financial compensations provided for participation. However, condoms, water bottles, pens, and informational brochures were given as incentives.

The organization serves to address the health and social needs of the community specifically pertaining to women’s physical and mental wellness. The CWHA has provided the community with various outreach programs such as parenting skills classes, dance fitness classes, support groups, Medicaid/health insurance, and free HIV/AIDs testing. Most importantly, the CWHA has served as an advocacy group to speak out against domestic violence towards women. Domestic violence is defined as any aggressive behavior within the home. It specifically involves intimate or domestic violence against a partner or a spouse. Such violence presents itself in physical, verbal, emotional, economic and sexual forms.

Domestic violence is a nationally recognized problem. Research shows that every minute an average of 20 people are physically abused by their intimate partners. This equates to more than 10 million abuse victims annually (National Coalition Against Domestic Violence, 2015). There are about 280,000 police reports on domestic violence nationwide, as it accounts for 15% of all crimes. The National Coalition Against Domestic Violence states that, “19% of domestic violence involves a weapon”, and that domestic victimization is correlated with a higher rate of depression and suicidal behavior” (2015). Only 34% of people who are injured by intimate partners receive medical care for their injuries. It’s also been noted that 21-60% of victims of domestic violence lose their jobs due to reasons stemming from the abuse. Most of the respondents were of a Caribbean decent. It is said that Caribbean women respond to domestic violence differently than women of other backgrounds.

Caribbean women tend to binge-eat while African-American women turn to behaviors such as drugs and alcohol after being abused by their partners. “We found differences in physical and mental health outcomes between abused African American and Caribbean Black women,” Dr. Krim K. Lacey, one of the researchers, told medical news website, (www.medicalresearch.com).

Hypothesis

Results Cont’d

The data collected on this research project fairly supported our hypothesis that Brooklyn residents are unable to properly seek adequate help and counseling. However, they are not knowledgeable about the diverse forms of abuse they may be experiencing. The analysis revealed that participants believed domestic violence is a significant problem in their community. The analysis also portrayed that they know how to seek help in their community if they are experiencing domestic violence.

Figure 3:

Figure 3 shows that domestic violence is a serious problem in the community. 17.6% of participants view it as a major problem, 17.6% view it as a problem, 26.5 % view it as somewhat of a problem, and 38.2% view domestic violence as not a problem at all.

Results Demographics: ● Gender: Female (66.7%), Male (33.3%) ● Marital Status: Married (26.7%), Single (69.3%), Divorced (3%), Separated (1%) ● Age: 0-12 (2%), 13-24 (24%), 25-36 (24%), 37-48 (23%), 49-60 (16%), 61+ (14%)

Conclusion

Figure 4:

Figure 1:

Policy Recommendations • School systems should discuss the topic of domestic violence in classrooms.

• Counseling centers should be opened up for people to express their experiences with domestic violence and provide adequate advice and help.

• Advocacy groups should be formed to speak out against unfair treatment in relationships and abuse overall.

• Hospitals should develop outreach programs to bring greater awareness around the topic of domestic violence known.

Acknowledgements The research interns would like to acknowledge and thank the CBO supervisor of the Arthur Ashe Institute for Urban Health (AAUIH), Ms. Vinessa Gordon, our research mentor William Chambers and the staff of SUNY Downstate Medical Center.

Figure 4: Portrays that most people know how to seek help in their community if they experience domestic violence (68.6%). However 31.4 % of respondents are unable to seek adequate help in their community if the experience domestic violence.

Figure 1: Displays that most participants consider domestic violence to be physical abuse, (86.3%), sexual abuse (81.1%), and relationship abuse (81.1%).

Limitations

Figure 2:

Due to a small sample size that included only Flatbush residents, the results cannot be generalized, as our focus population was only in the Flatbush area of Brooklyn. Out of 102 surveyed participants, they were all of either AfricanAmerican or Hispanic decent.

Victims of domestic violence are unaware that they are experiencing abuse and are unable to properly seek adequate help and counseling. A lack of knowledge of the diverse forms of abuse, also contributes to this unawareness.

Figure 2: Displays that 42.6% of participants know someone who has been a victim of domestic violence, while the remaining 57.4 % do not know someone who has suffered from domestic violence.

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Bibliography (1) Stockman, J. K., Hayashi, H., & Campbell, J. C. (2015). Intimate Partner Violence and Its Health Impact on Disproportionately Affected Populations, Including Minorities and Impoverished Groups. Journal Of Women's Health (15409996), 24(1), 62-79. doi:10.1089/jwh.2014.4879 (2) (2016). New York State Department of Health Announces $2.2 million in Federal Grants to improve efforts to prevent sexual violence in New York State. States News Service.

(3) Gwynne, J. (2002). Providing services to combat domestic violence in New York City's minority communities. Closing The Gap (15467678), 12-13.

(4) Bent-Goodley, T. (2004). Perceptions of domestic violence: a dialogue with African American women. Health & Social Work, 29(4), 307-316.

(5) (2002). Campaign seeks to combat domestic violence in New York.

EFE World News Service.

(6) Fry, D. A., Messinger, A. M., Rickert, V. I., O'Connor, M. K., Palmetto, N., Lessel, H., & Davidson, L. L. (2014). Adolescent Relationship Violence: Help-Seeking and Help-Giving Behaviors among Peers. Journal Of Urban Health, 91(2), 320-334. doi:10.1007/ s11524-013-9826-7 (7) Humphreys, C., & Joseph, S. (2004). Domestic violence and the politics of trauma. Women's Studies International Forum, 27559-570. doi: 10.1016/j.wsif.2004.09.010

bhdc brooklyn

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chronicles

Social Determinants of Health, Environmental Issues & Public Health Trinidad & Tobago Internship Program

2017

17

chronicles

Depression

Depression among adolescents results in poorer outcomes in terms of quality of life and social and physical functioning, and it is associated with increased morbidity and mortality. Students conducted research on the level of depression among teenagers, between the ages of 13-19, living in Tobago.

Research: Teenage Depression Interns: Sherise Elliott, Kennille Phillips, Shenica Balgobin NGO: United Nations Educational, Scientific and Cultural Organization (UNESCO) Supervisor: Phillip Sookhai

summer2017 18

Teenage Depression

Student Researchers: Sherise Elliott, Kennille Phillips & Shenica Balgobin Supervisor: Mr. Philip Sookhai United Nations Educational, Scientific and Cultural Organization(UNESCO), Arthur Ashe Institute for Urban Health and University of the West Indies

Introduction Tobago is part of the twin island Republic of Trinidad and Tobago; it is situated in the southernmost part of the Caribbean. The area of Tobago is approximately 300 square kilometers. The total population of Tobago is 60,874. There are 6,348 persons between the ages of 13-19; with 3,246 males and 3,102 females falling within that age group (2011 census, Central Statistical Office). The average teenagers within that age group come from low income families usually making less than $4,000TT ($600US) per month. These families are normally single parent households or contain a step-parent; some teenagers come from extended families structure, while a limited amount of teenagers come from nuclear families (2011 census, Central Statistical Office).. Teenagers from Tobago are strongly influenced by North American and Jamaican cultures such as music, dress and mannerism.

For the purpose of this research a quantitative method was employed using a standardized Patient Health Questionnaire (PHQ-A) modified for adolescents. Fifty (50) questionnaires were distributed to teenagers between the ages of 13-19 years using stratified random sampling. Twenty-five (25) males and twenty- five (25) females were randomly selected from different geographical areas in Tobago. Questions were focused on determining whether or not teenagers were depressed and if so, the severity of their depression. Items were ranked and given a weighting from 0 to 3. Data was analyzed using various statistical methods and presented graphically.

Mental Health as defined by the World Health Organization (WHO) is “a state of well- being in which every individual realizes his/her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his/ her community”. Depression is a mental health illness affecting teenagers in Tobago. The American Psychiatric Association (APA) states that depression “is a common and serious medical illness that negatively affects how you feel, the way you think and how you act.”

Results

Researchers have found that depression has increased tremendously among teenagers in recent years from 8.7% in 2005 to 11.5% in 2014 (Schrosdorff, 2016). The American Psychiatric Association identified some of the symptoms of depression as feeling sad, changes in appetite, trouble sleeping, and loss of energy or thoughts of suicide.

Some factors which may lead to depression in teenagers would include the desire to receive good grades in school, peer pressure, unrealistic expectations set by guardians and society, poor family life such as abuse, incest and the absenteeism of parents. Depression can also be caused by feelings of existential angst and the inability to form idealistic human bonds (Denkmire and Kittleson, 2005). At this tender stage of human development, these issues, coupled with all the other changes occurring in the body can make teenage depression arguably a greater issue than that which occurs in adults (Denkmire and Kittleson, 2005). Some consequences of depression include increases in suicide rates, less productivity and ability to focus on simple tasks, and lower quality of life (Denkmine and Kittleson, 2005). The objective of this research is to assess the level of depression in teenagers between the ages of 13-19 years living in Tobago. The paper aims to answer the following research questions Research question 1: What is the level of depression among teenagers between the ages of 13-19 years living in Tobago?

Research question 2: Compare the levels of depression between males and females between the ages of 13-19 years living in Tobago?

Thesis Statement

A substantial number teenagers between the ages of 13-19 years are suffering from some form of depression and for those who suffer from depression; the majorities are females.

Results cont’d

Methodology

This bar chart compares the score between males and females. More females tend to score higher at the 10-14 and 15-19 ranges, while males scored highest with the score range of 0-4 and 5-9.

Figure 4: Showing the comparison between males and females scoring ranges on the Patient Health Questionnaire.

Interpretation of Findings

This pie chart shows that over 64% of teenagers of the sample is suffering with depression, while 36% of teenagers do not have this disease.

The results obtained showed that sixty-four percent of all teenagers suffer from some form of depression. It is seen that more females (72%) are in the range (monitoring, moderate, moderately severe, severe) to be classified as depressed whereas males are only fifty-six per cent (56%). However when comparing the ranges, more males tend to fall in the monitoring stage with their scores than the females. This may suggest that males are better able to mask their feelings than females or this may also suggest that they are less inclined to share sensitive information even when told it would be confidential. Data further indicates that 20% of the males and 52 % of the females had a score of at least ten (10) or greater. According to the screening guidance for the PHQ-9 test modified for adolescence, a score of 10 and above suggest the presence of a Major Depressive Disorder (MDD).However clinical validation is required to determine this.

Figure 1: Showing the general data of the severity of depression in teenagers in Tobago.

Fig. 2 tells of male depression in Tobago. It is seen that 44 % of the males do not suffer with depression. Of the 56 % that is suffering from depression, 36% of the males need to be monitored.

Figure 2: Showing the Percentage of Males depressed in Tobago.

This chart above shows that 28 % of females are not depressed. It is also seen that 4% of the sample is severely depressed; 48 % of the females are suffering with some form of depression while 20 % need to be monitored.

Limitations 1) Finding a convenient time when teenagers were available to administer questionnaires.

2) Transport difficulties to get to the different geographical areas.

3) Some respondents were reluctant to answer the items on the questionnaire as they found them quite personal.

Figure 3: Showing the Percentage of Females Depressed in Tobago.

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Recommendations 1) There need to be more programs to raise awareness.

2) There should be formal assessments on depression or other mental health issues in the school and community.

3) Teachers, parents and other professionals should be trained to recognize symptoms of depression.

4) More health workers are needed to treat teenagers diagnosed with mental health issues.

5) Need programs specifically for females.

Conclusions Conclusively, it can be inferred that many of the teenagers living in Tobago suffer with some form of depression. Generally there are more females depressed than males, thus the thesis statement was proven correct.

Acknowledgement Many thanks to those who assisted in the research of this project. Special thanks to the Almighty Father who kept us alive to the completion of this project, and to our Supervisor Mr. Philip Sookhai, Mr. Brandon Rajkumar, Dr. Fraser, to those who took the time to participate in our questionnaires, and to the Arthur Ashe Institute for Urban Health in choosing us to be a part of this Internship.

Bibliography 1) Brundtland, D. G. (2001). What is Mental Health? Retrieved August 02, 2017, from World Heath Organization: https://books.google.tt/ books?hl=en&lr=&id=GQEdA-VSIgC&oi=fnd&pg=PR9&dp=world +health&ots=d1PA_ldfsC&sig=jUL0bD69G17Y0qh26vy502JP5eU&r edir_esc=y#vonepage&q=world%20health%20organization %20definition%20on%20mental%20health&f=false 2) Development, M. o. (2011). Census Database. Retrieved August 03, 2017, from Central Statistical Office : cso.gov.tt 3) Kittleson, M. J., Denkmire, H., Kane, W., & Rennegarbe, R. (2005). The truth about fear and depression. New York: Facts on File.

4) Ranna Parekh, M. M. (2017, January). What is Depression? Retrieved August 03, 2017, from American Psychiatric Association : www.psychiatry.org/patients-families/dpression/what-is-depression 5) Schrosdorff, S. (2016, November 15). There's a Startling increase in Major Depression Among Teens in the the U.S. Retrieved July 31, 2017, from TIME Health: www.time.com?4572593/increasedepression-teens-teenage-mental-health/ 6) Services, U. S. (2010). Developmental, Behavioral, and Psychosocial Screening Assessment .

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Environmental Impact on Health The environment affects many aspects of our lives and has a direct correlation with health. Different aspects of the environment can have positive or negative effects on health. Students conducted research on the impact of nature, flooding, and work environment on personal and professional life.

Research: Connecting People to Nature Interns: Enen-SA-Tefa Ab Khafra, Merkisa Pierre NGO: Fondes Amandes Community Reforestation Project Supervisor: Kemba Jaramogi Impact of flooding on Different Types of Communities in Trinidad Interns: Reanna Ramkeesoon and Shamaii Gaspard NGO: The Pointe-a-Pierre Wildfowl Trust Supervisors: Tamara Goberdhan, Silene Noel, Jaleen West, Dr. Maurice Frank The Impact of Work Environment on Personal and Professional Life Intern: Kayle Diljohn NGO: Oilfields Workers’ Trade Union (OWTU) Supervisors: Kandis Sebro, Oswald Warwick

summer2017 20

Connecting People to Nature

Enen-SA-Tefa Ab Khafra and Merkisa Pierre UNIVERSITY OF THE WEST INDIES/ FONDES AMANDES COMMUNITY REFORESTATION PROJECT

Introduction Connecting people to nature is extremely important as humans are constantly interacting with the environment.

This interaction needs to happen to ensure the preservation of the environment, which affects the life of humans and all life. The theme for this year’s world environment day is connecting people to nature and it is celebrated every year on June the 5th.

Fondes Amandes Community Reforestation Project (F.A.C.R.P) is an environmental NGO with a main theme of connecting people to nature, derived by the global theme implemented by the U.N. for Environmental Day. According to Newsday (2012), the FACRP began in 1982 when the late Tacuma Jaramogi and wife Akilah Jaramogi, the current managing director, devised a plan to fight the dry season fires that had been ravaging the Fondes Amandes watershed every year. Seemingly they have been successful in achieving this goal, as according to Newsday (2012), for the past ten years, there have been no bush fires in the hills of Fondes Amandes due to the work of F.A.C.R.P. The Fondes Amandes Community Reforestation Project attempts to connect people to nature through the variety of programs that they offer for the public to participate in such as volunteer programs, tours, hikes and sessions on a regular basis and many educational activities pertaining to the environment from the primary to tertiary levels. The main interest for this particular research project is to focus on the herbal programs, and also educate the average person about their natural environment. F.A.C.R.P engages in sessions where persons of all ages are given the opportunity to come and experience the natural environment. Some of the sessions available are planting of trees, making herbal tea, herbal kits and lots more. As researchers, we also had the opportunity to take home a miniature pot and herb from the herbal kit session.

THESIS QUESTION To determine if the average person is aware of herbs and the use of herbs in their environment, and if they would be interested in learning about herbal programs implemented

by Fondes Amandes,

Methodology

Results (Con’t)

An online questionnaire of 13 questions was used to gather the relevant data needed for this research. The questionnaires were filled out by persons over the age of 16. This questionnaire was used to determine if the average person had any knowledge about herbs and its use in the environment. A questionnaire was used as it was a quick and efficient way to gather the necessary data.

Thirty randomly selected individuals responded to the questionnaire.

Persons were given a list of herbs and were required to select the herbs they were aware of.

Barchart:1 Depicts the number of persons that knew each of the listed herbs

Pie Chart 2: Depicts the number of persons that answered “YES” they would volunteer with an organization such as Fondes Amandes or “NO” they would not.

Discussion/ Analysis (Con’t) The 50% of respondents that answered “yes” about having knowledge of herbs were asked where they gained the knowledge about herbs, and they responded that they got it from parents, grandparents or elders. One person stated that they gained knowledge from books, while one person stated that they got knowledge from doing research. When persons were asked if they would like to volunteer with an NGO such as Fondes Amandes (they were given a brief description of Fondes Amandes), 86% stated they would volunteer while a mere 14% stated that they would not. Additionally, 78.6% of people said they would go to a herb kit or herb bread session at Fondes Amandes if given the opportunity, whilst 22.4% stated that they would not. This concluded that most of the respondents are interested in sessions, similar to those implemented by Fondes Amandes.

Limitations 1. Small sample population

2. Time constraints

Conclusion Discussion/ Analysis

Results

Upon examining what was stated by the respondents, a large amount of the respondents knew about herbs and had used herbs before.

When respondents were asked questions such as if they would trust a pharmaceutical drug more than the herb if they are known for treating the same ailment, 63% trusted the herb more while 37% didn’t. When asked to explain, the general reason was that the herb was more natural and hence safer to use than the drug. Some went on to state that the drug can contain dangerous chemicals. One of the respondents stated that it could depend on the person’s body. When asked to select which of the herbs they knew out of a list of 14 herbs, at least 50% of the persons knew 8 or more of the herbs listed. When asked if they had any knowledge about herbs, 50% had knowledge of herbs, and 50% did not.

• 53.6% of the respondents were female;46.4% were male.

• 100% of the persons achieved a higher level of education than the primary level, and 32.1% achieved tertiary level of education.

Pie Chart 1:Depicts the percentages of persons that would trust either a pharmaceutical drug or herb if they are known for treating the same ailment.

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It was concluded that the average person has basic knowledge about the herbs found in the environment. Individuals who have gathered knowledge over the years from their family or by word of mouth are willing to learn more about their environment and its benefits. After conducting this research, it was concluded that the average person would be interested in learning about programs and/ or attending programs implemented by Fondes Amandes.

Bibliography hPromoting Sustainable Community Forestry Practices. Retrieved from http://facrp1.webs.com/

Impact of Flooding on Different Types of Communities in Trinidad Student Researchers: Reanna Ramkeesoon and Shamaii Gaspard Other contributors: Tamara Goberdhan, Silene Noel, Jaleen West, Dr. Maurice Frank The Pointe-a-Pierre Wildfowl Trust and the Arthur Ashe Institute for Urban Health (AAIUH)

Introduction The Pointe-a-Pierre Wildfowl Trust has been at the forefront of Environmental Education and Conservation efforts in Trinidad and Tobago since its inception in 1966. The area encompasses two lakes and approximately 75 acres of land within the major petrochemical and oil refining complex, Petrotrin. The Pointe-APierre Wildfowl Trust, a wetland habitat, is a peaceful haven where members and numerous visitors may enjoy a guided educational nature walk, relax in the environs, birdwatch, enjoy photography and interpretive trails. The Wildfowl Trust, through its environmental & public awareness programmes, creates environmentally-minded people, promoting environmental management, socio-economic well-being,physical and mental health. The Trust has implemented programmes, policies & plans to combat climate change and its effects- namely natural disasters (e.g. flooding) and environmental degradation.

Flooding has been of significant concern to humanity for centuries. Floods are the most common natural disaster worldwide.

Their aftermaths leave nations with significant morbidity and mortality. In the Caribbean region, islands are susceptible to hurricanes and similar weather phenomena during the rainy season from June to December. With climate change on the rise, the island has seen an alteration in weather patterns. There has been an increase in the frequency and intensity of rainfall during the rainy season. Trinidad has aslo been experiencing a surge in the number of floods in the rainy season.

Flooding has impacted numerous parts of the nation, imposing a burden on both the individual, communities and the government. In August 2012, after severe flooding, the estimated cost of damage and infrastructural loss in the Diego Martin region and surrounding communities was over $100 million TT. This natural disaster has also brought about many secondary health concerns. There are notable spikes in arboviruses, water borne diseases, and physical injuries in affected populations.

However, it is observed that individuals who reside in areas of different developments in Trinidad are affected to various extents by flooding. This refers to urban, suburban and rural areas.

According to Oxford Dictionary an urban area is defined as, “relating to, or characteristic of a town or city.” A rural area is defined as, “in relation to, or characteristic of the countryside rather than the town.” On the other hand, a suburban area refers to “an outlying district of a city, especially a residential one.”

In today’s society, urbanization is becoming more prevalent as many people prefer an urban lifestyle due to the various health, educational, employment and recreational benefits. Since the majority of citizens reside in urban or suburban areas, the government of Trinidad and Tobago is more likely to invest money on proper drainage systems, disaster preparedness plans and maintaining the general standard of these areas. Due to this, many rural areas are often neglected, thus they are more susceptible to the adverse after effects of flooding. Therefore this project aims to reduce the negative after effects of flooding in our country by determining if the level of development of a particular area plays a role in how individuals in Trinidad are impacted by flooding.

Hypothesis

The level of development of an area affects the extent to which flooding impacts individuals in Trinidad. The individuals who reside in more urbanized areas are less impacted by flooding.

Methodology A twelve item survey, consisting of both open ended and close ended questions, was developed by the student interns from the Arthur Ashe Institute for Urban Health in collaboration with the Pointe-a-Pierre Wildfowl Trust. Fifty surveys were distributed randomly to visitors at the Trust. Several persons of various ages (16 and above), races, and financial backgrounds were surveyed to gather information such as: • What area/district in Trinidad and Tobago do you belong to?

• How does the family/community/government prepare for a flood?

• What properties have you lost due to flooding in your area?

• In what way do you/your family/community deal with the adverse effects of floods?

• Have any of your family members become ill/ injured as a result of flooding?

Other questions asked related to level of education, income, age and gender to further aid with the analytic process. When all the data was collected, the information was analysed and placed into chart formats. Conclusions were then drawn to either prove or disprove the validity of the hypothesis.

Limitations • Lack of interest in completing the survey by some participants.

• Numerous participants were uncomfortable discussing their monthly incomes.

• The small sample size (N=50) and time limitations do not offer a true representation of the situation in Trinidad.

• Although the majority of the questions were answered, some participants did not clarify their responses for the open-ended questions. A few questions were left unanswered.

Recommendations When the research interns reviewed the surveys, it was found that many people did not know how to prepare for floods nor efficiently combat its after effects. To address these issues: • There should be adequate funding for natural disaster planning to enhance the country’s disaster preparedness.

• Communities and schools, particularly in flood prone areas, must have access to disaster preparedness best practices and to environmental conservation.

• It is also recommended that advertisements on television, radio, mass media sites, be used to inform & educate the public on disaster preparedness so as to minimize injury, loss of income and the spread of diseases.

• This study should be done on a larger scale in collaboration with ODPM in order to truly represent the population of Trinidad and Tobago.

Fig.1- Map of Trinidad Showing Distribution Of Survey Participants

Fig.2 –Bar Graph Showing the Different Types of Communities and Whether They Flood or Not

Fig.3 – Bar Graph showing the Impacts of Flooding in the Different Types of Communities

Conclusion The aim of this project was to investigate and conclude whether the social determinant of the level of development of a particular area contributes significantly to flood preparation and the methods to deal with the secondary effects of a flood. A significant percentage of individuals, (66%), experienced flooding in their area. From the results displayed in Fig. 2, there is a higher frequency of flooding in the rural areas. In fact, rural areas accounted for 60.6% of the flooding which occurred.

In the respondents who experienced flooding, 72.7% were affected in some way. Of the respondents experiencing significant losses, 70.83%, came from rural areas. It was noted that monetary losses were most common after flooding. Of these individuals, 73.3% were rural dwellers. On average, those who endured monetary burdens suffered losses of $11,800 TT. 75% of the individuals, who only experienced health related issues as a result of flooding, belonged to rural areas. The one respondent who experienced monetary losses and a disease, secondary to the flood, was a member of a rural community.

It is glaring that many respondents were unaware of flood damage mitigation measures and general flood preparedness. This was especially observed in the rural areas. Of the urban dwellers surveyed, most took measures to ensure that they were prepared for flooding in their area. Several also claimed on their surveys that the government also assisted in their preparation for natural disasters such as flooding. On the other hand, many rural inhabitants complained of the lack of government assistance in terms of proper drainage, excellent communication networks and maintaining the standard of cleanliness in their communities. One may postulate that the level of preparedness of an individual for natural disasters is generally proportional to the level of development of their area.

22

Acknowledgements The research interns, would like to express gratitude to the Pointe-a-Pierre Wildfowl Trust, in particular Tamara Goberdhan, Silene Noel and Jaleen West, for their continuous guidance and support throughout our research project. We are also appreciative of our programme coordinator, Brandon Rajkumar, who dedicated time and effort to regularly monitor our progress.

We would like also to thank the participants of the survey. We are extremely thankful to the Arthur Ashe Institute for Urban Health for the opportunity to participate in this educational and beneficial internship.

Bibliography World Health organization. “Weekly Morbidity and Mortality Report,” Volume 1: epidemiological week 46 (12-18 November, 2005 Retrieved from: http://www.who.int/hac/ crises/international/pakistan_earthquake/sitrep/ FINAL_WMMR_Pakistan_1_December_06122005.pdf

THE IMPACT OF WORK ENVIRONMENT ON PERSONAL AND PROFESSIONAL LIFE Student: Kayle Diljohn, Supervisors: Kandis Sebro & Oswald Warwick Oilfields Workers’ Trade Union The Arthur Ashe Institute for Urban Health The University of the West Indies, Faculty of Science and Technology

Introduction The work environment involves the physical geographical location as well as the immediate surroundings of the workplace. It can be separated into two categories: internal and external work environment. A comfortable work environment is just as much a need to workers as is a salary.

In 2010, the preliminary estimate employment rate in Latin America and the Caribbean, in terms of percent of the population was 60.7% (the guardian, 2011), which is more than half of the population.

Considering this statistic, studies have linked work environment to productivity and even the probability of quitting. They found that a good work environment had a positive effect while the same is true for the opposite. These studies also concluded that the work environment can affect your health, family relationships, mood and even your mental health.

The aim of this study is to inform others about the effect of the work environment on both personal and professional lives. This research employs health and safety standards to determine the characteristics of a good working place. According to health and safety rules, a workplace should have proper lighting, optimum temperature and adequate ventilation, among other factors.

The Oilfields Workers’ Trade Union (OWTU) began many years ago in 1937 out of the general strike in the oilfields of South Trinidad. Contrary to the name, their services are available to more than just oilfield workers. Some of these services include fighting for fair treatment, and handling any disputes that may arise between an employee and an employer.

Non-compliance to health and safety rules is denying workers of their rights to a proper and comfortable work environment, which is a problem OWTU can address since OWTU deals with fair treatment of workers.

HYPOTHESIS

COMPLIANCE TO HEALTH AND SAFETY STANDARDS HAVE A POSITIVE EFFECT ON BOTH PERSONAL AND PROESSIONAL LIFE.

Results

METHODOLOGY

For this study, both primary and secondary sources were used to gather data for analysis.

To obtain primary data, printed questionnaires were used to collect responses from participants of two different companies. The questionnaires were self-administered. Twentyfive (25) questions had close ended questions with options to choose from. Five (5) were left blank for the respondent to write his/her own thoughts, also known as open ended questions.

There was a total of thirty questions (30). Only three (3) questionnaires were completed. After collection of data, it was organised and analysed into charts and graphs.

Before questionnaires were constructed or administered, secondary research was done. This included books, internet sources and newspapers. Secondary data helped the researcher to become more familiar with the area of study.

Pie chart showing some effects of work environment on employees

30%

30%

late arrival feel to quit sickness feel irritable

20%

Figure #1

Figure #2

20%

Figure #3

Limitations

Recommendations

1. Finding available data on health and safety codes for Trinidad and Tobago was difficult and only international standards were available.

2. Some companies were reluctant to let researcher speak to employees, resulting in a small sample size (n=3).

1. Regular inspection of companies to ensure they are following health and safety guidelines.

2. Additional taxes for any violation of health and safety guidelines for companies.

Discussion

This research centred on the effect employees experienced in their private and professional life due to their work environment. From Figure 1, it was observed that everyone sampled was aware that their work environment influences their life. Figure 2 shows that more than half of the work population believed their work environment was not up to health and safety recommendation guidelines, meaning, the lighting, noise level, ventilation and waste removal were not optimum. In this case, since the work environment was not up to standard, there were negative impacts as shown in figure 3. The most popular impacts were late arrival and feeling irritable which is in agreement with a similar study done by Woo and Postolache (2008), in which they characterized irritable feelings as mood disorders. However, there may be other factors that could influence this, such as distance from work place or traffic congestion (for late arrivals) and lack of sleep (for feeling irritable.)

23

Conclusion

The research showed that a negative working environment, defined as not meeting health and safety minimum guidelines, can have a negative effect on workers. The main impacts were late arrival and feeling irritable on the job. It was also concluded that all workers knew that their work environment influenced their life.

Bibliography 1. BusinessDictionary.com. “Work Environment” WebFinance, Inc. http:// www.businessdictionary.com/definition/work-environment.html (accessed: August 01, 2017).

2. O.G.Edholm. n.d. The biology of work. Verona: Officine Grafiche Arnoldo Mondadori.

3. The health and safety executive. (December 2007). Workplace health, safety and welfare: a short guide for managers. December.

4. Theguardian. 2011. “Global employment: What is the world employment rate.” theguardian, 25 January.

5. Woo, J.-M., & Postolache, T. T. (2008). The impact of work environment on mood disorders and suicide: Evidence and implications. International Journal on Disability and Human Development : IJDHD, 7(2), 185–200.

chronicles

Health Inequalities

Individuals from varied socioeconomic backgrounds, countries, and social groups have different health experiences. Differences in health outcomes can exist across various regions of the world, but also across regions within a country. Our students assessed inequalities in health across groups, and the consequent impact on health outcomes.

Research: Inequalities in Health Interns: Jewel Mulrain and Andrea Robley NGO: The Esimaje Foundation Supervisor: Teria Reid The Impact of Decline in Medicine on People Interns: Jamaal Matthews & Tarique Richards NGO: Heartbeat International of Trinidad and Tobago Supervisor: Farouk Khan-Hosein

summer2017 24

Inequalities in Health

Jewel Mulrain and Andrea Robley

The Esimaje Foundation, Arthur Ashe Institute for Urban Health (AAIUH) & The University of the West Indies, Faculty of Science and Technology Supervisor: Teria Reid

.

Introduction

Literature Review (Con’t)

There are indications that regional health policies and programs do not make the reduction of social inequalities a priority.

However, a few studies have suggested that such disparities and indicators illustrate important socioeconomic distinctions between and within countries, as differences in social class are still a major determining factor in the quality of healthcare received. Living in the city of Port of Spain and belonging to a low socioeconomic class has proven to have potentially deadly consequences for several reason - its association with other determinants of health status and the constraints on care at sites serving people who have low incomes. Therefore, this research sought to examine the relationship between the socioeconomic status and the quality of health care received by the population living in Port-of-Spain.

This study disclosed quite a bit about large inequalities which were found in the use of health care for the self-reported health problems within countries included in the study. Similarly, the survey revealed that low-income respondents expressed much greater dissatisfaction with health care than did middle-income respondents and this result demonstrates that one’s socioeconomic status is an important determinant of access to and quality of healthcare.

Study Area

Discussion

Results 6.50%

13%

q q q

Yes Yes No No Not Sure Not Sure

80.50%

Hypothesis Figure 1.0 – Figure showing the inequalities within the health sector of Trinidad and Tobago

The quality of public healthcare received is determined by one’s socioeconomic status.

Trinidad and Tobago is an archipelagic state which is found in the southern Caribbean between the Caribbean Sea and the North Atlantic Ocean, northeast of Venezuela. The capital city of Trinidad and Tobago is Port of Spain. It has a population of 49,031 and lies on Trinidad’s northeast coast. Port of Spain is rich in history and is home to icons in the field of sports, culture and business. The area is comprised of several communities which are distinct in size, character and appearance, and display many differences in their physical and socio-economic characteristics.

Some parts of the capital city, like East Port of Spain has developed a reputation for crime, violence and poverty which contributes to social and economic stigmatization, while other areas like uptown Port of Spain are lined with luxurious waterfront apartments and serves primarily as the retail and administrative center of the island.

J. Norberto and W. Dachs (2002 explained that inequalities in health in Latin America and the Caribbean are large and, in some countries, they are increasing, although most average health indicators are improving. They then went on to state that the inequalities in self-reported health problems among the different economic strata were small, and such problems were usually more common among women than men. In addition to this, Dachs claimed that the presence of small inequalities may be due to cultural and social differences in the perception of health.

Norberto and W. Dachs’ survey also revealed that low-income respondents expressed much greater dissatisfaction with healthcare than did middle-income respondents. This perspective was conveyed in Figure 1.1, where more than half of the respondents (55.8%) believed people of high social status receive better healthcare at public health facilities. This result illustrates that one’s socioeconomic status is an important determinant of access to and quality of healthcare.

Becker and Newsome’s study (2003) proposed that race is an antecedent and determining factor of SES and that racial and social class differences in SES reflect the successful implementation of discriminatory practices within the healthcare systems. This was affirmed by the results in Figure 1.2 which showed that 47.8% of the sample population that were healthcare professionals stated that wealth and class are the greatest determining factors of the quality of public healthcare received, which was followed by race (26 .1%).

Conclusion

Literature Review

Gary Becker and Edwina Newsome (2003) suggested that addressing differences in social class is critical to an examination of disparities in health care. Their study also proposed that race is an antecedent and determining factor of SES and that racial differences in SES reflect the successful implementation of discriminatory practices within the healthcare systems. Further to this, Becker (2003), stated that SES is intimately associated with racism, which has restricted socioeconomic attainment for members of minority groups. Likewise, Newsome lamented on the fact that although there has recently been a growing tendency to disentangle ethnicity and socioeconomic status (SES) in studies of the health, the results from their research provided evidence that SES is not just a confounder of racial differences in health but part of the causal pathway by which race affects health.

Figure 1.0 illustrates that although the vast majority of the respondents had access to health care facilities, 80.5% of the sample population believed that there are inequalities within the health sector of Trinidad and Tobago. This was upheld by Dachs (2002) in his study which disclosed a great deal about large inequalities found in the use of health care for the self-reported health problems within countries of Latin America and the Caribbean region.

Figure

1.1 – Figure showing the determinant factors of the quality of healthcare received

Methodology Conceptualization

Literature Review

Acessibility

• Involved understanding of the research and formulating objectives.

Patient level of education

8.60%

Acknowledgements

4.30%

Class

• Understanding what others have done on the research topic with the use of secondary sources such as articles and journals.

Survey Development

Self Administration of Questionnaire

Analysis & Conclusion

Bibliography

26.10%

Wealth

• A total of 79 questionnaires were administered digitally across the country including the study area with the use of convenience sampling technique. This was the primary source.

0.00%

25

Becker, Gary and Edwina Newsome. 2003. “Socioeconomic Status (SES) and Dissatisfaction with Health Care Among Chronically Ill African Americans.” American Journal of Public Health 93, no. 5 (May): 742-48.

47.80%

10.00%

20.00%

30.00%

40.00%

50.00%

Figure 1.2 – Figure showing the relationship between social status and the quality of care received at public health facilities

• The data was collected and analyzed for trends and anomalies, cross referenced with secondary sources and conclusions were made.

We would like to give special thanks to Terisa Reid, Dr. Oti Esimaje and all the staff of the Esimaje Foundation. We would also like to extend our gratitude to the Arthur Ashe Institute for Urban Health for giving us this amazing opportunity.

47.80%

Race

• Based on the literature review, an 8 question pilot survey followed by a 25 question survey was developed which aimed to obtain answers to the objectives formulated.

In conclusion, socioeconomic status does play a major role in the quality of healthcare received at public health facilities. Although social class deems to have the greatest impact, wealth and race were also found to be major contributors as well. Three areas that are directly affected by inequalities within the health sector were addressed throughout the study - access to healthcare, rates of disease and health outcomes. The analysis of these factors showed the growing tendency of considering race and socioeconomic status when administrating healthcare which often leads to discriminatory health practices. Our research accepted the hypothesis. Although the research was deemed successful, limitations such as misunderstanding of questions and unwillingness to participate, (among others) may have hindered the accuracy of the results.

60.00%

Dachs, J. Norberto W,Ferrer, Marcela,Florez, Carmen Elisa,Barros, Aluisio J. D,Narvaez, Rory,Valdivia, Martin (2002) Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries. PanAmerican Journal of Public Health.

Jamaica Observer. "Neonatal mortality rates in the Caribbean concern health officials." Jamaica Observer, 2013: 1 ,from. http:// www.jamaicaobserver.com/news/Neonatal-mortality-rates-in-theCaribbean-concern-health-officials_13894490

The Impact of Decline in Medicine on People Tarique Richards & Jamaal Matthews, Supervisor: Mr. Farouk Khan-Hosein Heartbeat International of Trinidad and Tobago, Arthur Ashe Institute for Urban Health University of West Indies, Faculty of Science and Technology

Introduction HEARTBEAT INTERNATIONAL OF TRINIDAD AND TOBAGO Over the last 32 years Heartbeat International of Trinidad and Tobago (HBITT) has been donating and implanting pacemakers and defibrillators to the indigent citizens of Trinidad and Tobago, thus saving the lives of over 1500 citizens in Trinidad and Tobago from 1985 to 2017. In 32 years of existence, HBITT has been contributing significantly to the provision of first rate health care and saving the lives of the nationals of Trinidad and Tobago. These citizens would not have survived if they did not get this life saving surgery and treatment.

Every month HBITT has a new patient intake of patients, and every month HBITT’s patient waiting list increases. Included in this backlog are patients who are awaiting a change of a device due to battery depletion. Each patient has a mandatory appointment two months post surgery/implant and every 3-6 months thereafter. The lifespan of a pace-making device is dependent on the age, diagnosis and lifestyle and of the patient and also varies by patient. HBITT has acquired considerable firsthand experience about the impact of these factors on device lifespan in its 32 years of implanting devices. It needs to be emphasized that if the patients do not receive this type of treatment they will die. HBITT has not only saved citizens’ lives but they have saved the lives of the heads of households, mothers, fathers, and children.

Apart from the urgent and immediate need for replacement devices, the program also requires support in the form of consumables such as leads, introducer sheaths, micro puncture kits, balloon catheters and testing cables which are essential equipment used in the surgical procedures undertaken for indigent patients. The intervention decreases patient mortality by providing indigent patients with a new, state of the art pace-making device which can be one of six types - namely Single Chamber Pacemaker, Dual Chamber Pacemaker, Single Chamber ICD, Dual Chamber ICD, Biventricular Pacemaker or Biventricular ICD, with each device being tailored to the patient’s specific needs.

Hypothesis The decline in the provision of medication to indigent patients at HBITT has a negative socio-economic impact on patients and their health.

Methodology

A survey containing (17) close ended questions was conducted at the HBITT office in order to collect data on patients and non-patients. The questions were asked orally to participants as they entered the clinic and the answers were filled out by the conductors. Secondary data sources included articles from the official HBITT website and pamphlets from HBITT.

Results Graph 2:Comparison of medication obtained through purchases and prescriptions

45

30 25

21

20 15

11.3

10

0

6.5 6.5 0

0 <20

9.7

6.5

0 21-30 31-45 46-60 Ages of patients and non-patients

Figure #1

61+

Frequency of medication required by patients

Percentages(%)

35

5

Graph 3:Employment status of patients and non-patients

35

38.7

40

32.3

30 25

24.4

twice a month

Percentages(%)

Graph 1:Age demographic of patients and non-patients

purchase prescription

75.6

monthly

15

20

30

40 50 Percentage(%)

60

70

80

11.3

10

0 10

19.4

8.1

5

78

0

19.3

20

14.5

90

3.2 employed

3.2

unemployed self-employed employment status

3.2 retired

Figure #3

Figure #2 Discussion and Analysis

The study conducted was centered around patients and non-patients at HBITT. Based on our research, it was found that most of the patients were above the age of 60, with the large majority stating that they were retired.

Secondly, based on the data collected on the methods by which patients obtain their medication, it was shown that most patients purchased medication within a two month period as opposed to having prescriptions. Patients stated that they purchased medication when the hospital was unable to provide them with the medication they required, and also stated that the medication was expensive.

Lastly, as shown by graph 3, a large portion of the patients were unemployed or retired, this suggests that they would have greater difficulty in purchasing medication thereby highlighting financial ability and socioeconomic status one of the impacted areas in the decline in the provision of medication.

Conclusion The high cost of medication, the rise in the cost of living, and the public sector not meeting the demand of drugs for patients has implications on the economic situation of he patient.

Bibliography Ramphall, Farouk Khan Hosein and Dr.Sateesh. "Heartbeat International of Trinidad and Tobago."

Heartbeat International of Trinidad and Tobago, 2017: 4.

Hosein, Farouk Khan. "Who Is HBITT?" 2017: 3.

Ramphall, Farouk Khan Hosein and Dr.Sateesh. "Heartbeat International of Trinidad and Tobago."

Heartbeat International of Trinidad and Tobago, 2017: 4.

Recommendations Have monthly inspections in hospitals and health facilities to ensure the proper distribution of medicine.

26

trinidad & tobago Special Thanks To: The UWI: Principal Brian Copeland; Deputy Principal Indar Ramnarine; Past Deputy Principal Rhoda Reddock; Dean Brian Cockburn; Head of Department, Adesh Ramsubhag; Mrs. Paulette Belfonte; Mrs. Casandra James-De Freitas; Mrs. Abigail Joefield and staff of the various departments, especially the Department of Life Sciences.

Presenters: Ms. Ayaana Alleyne-Cumberbatch; Dr. Bennie Berkeley; Dr. Monica Davis; Mrs. Dennise Demming; Dr. Bernice Dyer Regis; Dr. Oti Esimaje; Ms. Lynette JosephBrowne; Dr. Rohan Maharaj; Mr. Salorne McDonald; Ms. Nandi Mitchell; Mr. Gregory Sloane-Seale; Mr. Rubadiri Victor; Mr. Kheston Walkins; Dr. Allan Williams; Ms. Ginelle Yearwood-McDonald US Embassy: Mr. Michael Barrera; Ms. Gail C. Seeberan; Mr. Stephen Weeks Special Acknowledgements: This internship would not have been successful without the commitment and dedication of the Arthur Ashe Institute Staff and many others, including the following: Program Coordinator: Mr. Brandon Rajkumar Sponsors: The Arthur Ashe Institute for Urban Health; The University of the West Indies; U.S. Embassy

summer2017

ch r on icles

BHDC and Community Engagement Core Marilyn Fraser, MD Principal Investigator Director of Community Engagement Core Cicely Johnson, PhD Associate Executive Director Research & Training Vinessa Gordon, MPH, CHES Education Coordinator Mary Valmont, PhD Associate Director, Health Science Education

In Memoriam This year’s journal is dedicated to the memory of Mr. Farouk Khan-Hosein, who passed away on September 16th, 2017. Farouk was a great collaborator and friend of the Arthur Ashe Institute for Urban Health. Farouk was the Program Coordinator of Heartbeat International of Trinidad & Tobago and worked with the Institute’s summer interns in Trinidad each year. He devoted his time endlessly to Heart Beat International of Trinidad and Tobago and the Trinidad and Tobago Heart Foundation in his humanitarian efforts to help thousands of people to live a better, healthier life. Farouk had bypass surgery in 2010, and this later fueled his drive to help others afflicted with cardiovascular disease. He was also instrumental in being part of the initial start up committee for the Alliance for Non Communicable Diseases in Trinidad & Tobago. He will be missed by all of us who knew him.

Office of the Brooklyn Borough President

Moro Salifu, MD Principal Investigator Michael Joseph, PhD Co-Director, Community Engagement Core Humberto Brown, MA Seminar Director Pamela Straker, PhD Administrator

summer2017 Brooklyn Health Disparities Center: A partnership between the SUNY Downstate Medical Center, the Arthur Ashe Institute for Urban Health & the Brooklyn Borough President’s Office Health Disparities Summer 2017 Internship Program Funded by the NIH-NIMHD (IP20MD006875)