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Last modified: Tuesday, October 30, 2012

IU researchers discuss fresh food access, sex and IVF, smoke-free workplaces and more at APHA

Oct. 30, 2012

Indiana University researchers in public health, law, informatics/computing, sociology and other fields participated in the American Public Health Association's annual meeting Oct. 27 to 31 in San Francisco. Below are summaries of some of the studies discussed.

Moving local, fresh foods beyond 'privileged' consumers
In-vitro fertilization's impact on sexual relationships
Hoosiers support of indoor workplace smoking bans
Soda consumption, screen time, team sports at school influence students' weight
HealthyState: a mobile app to help with relocation decisions
Health impact assessment of Indy Parks usage
Sociologist Bernice Pescosolido honored with Carl Taube Award
Brian Dodge assumes chair of APHA section for HIV/AIDS

Greater effort needed to move local, fresh foods beyond 'privileged' consumers

An Indiana University study that looked at consumers who buy locally grown and produced foods through farmer's markets and community-supported agriculture programs found the venues largely attract a "privileged" class of shoppers.

Farmers' market

Farmer's market

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"Our findings present a need for broadening local food opportunities beyond the privileged, higher-income consumer, through alternative payment plans and strategic efforts that make fresh foods accessible to a diversity of people," said James Farmer, assistant professor in the Department of Recreation, Park and Tourism Studies in the IU School of Public Health-Bloomington.

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

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

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

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

"Additionally, the need for farmer's markets and CSAs to be positioned in locations proximate to people who are food insecure would also increase access," he said.

The research team is discussing the study during two presentations. Findings concerning CSAs were discussed Oct. 29; findings concerning farmer's markets will be discussed at 3:30 p.m. EDT Wednesday, Oct. 31. Co-authors for the presentations are Ya-Ling Chen and Charles Chancellor, IU School of Public Health-Bloomington.

Farmer can be reached at 812-856-0969 or For additional assistance, contact Tracy James at 812-855-0084 or Top

Study: Women undergoing IVF report problems with sexual relationship

Nicole Smith

Nicole Smith

An Indiana University study has found that women undergoing in-vitro fertilization report that the process of infertility treatment has many negative impacts on their sexual relationship with their partner. Little attention has been given to the sexual dynamics of couples as they navigate infertility and treatments such as IVF, despite the important role that sex plays in a couple's attempt to conceive a child.

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

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

Jody Madeira

Jody Lyne Madeira

When couples meet with their physicians, their sex life might not top the list of issues they want to discuss, either because of unease talking about the subject or simply because they have so many other important issues to discuss. Still, Smith and Madeira say, the doctor-patient relationship is key, and couples can be told up front about the potential sexual side effects and resources that can help. If they have issues with dryness, for example, they could be counseled on remedies such as purchasing lubricant or other sexual enhancement products. In addition to referring couples to mental health counselors, reproductive endocrinologists could also refer them to sex therapists.

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

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

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

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

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

Here are some of their other findings:

  • Women who reported being sexually active with a partner in the past month also were more likely to engage in masturbation and report fewer sexual problems.
  • The women reported similar problems with sexual function regardless of the type or source of infertility involved: male factor, female factor, or both male and female factor.
  • Hormonal treatments used in assisted reproductive technologies likely affect women's sexual experiences and pain, but these effects are not as well understood and receive less priority than other conditions, such as heart disease and cancer.

Smith will discuss "Utilizing Assisted Reproductive Technologies and the Impact on Sexual Function: Validating the SFQ Among a Sample of Infertile Women," at 7:30 p.m. EDT Tuesday, Oct. 30. The research was supported in part by the Kinsey Institute for Research in Sex, Gender and Reproduction, the IU School of Public Health-Bloomington, and the Faculty Research Support Program in IU's Office of the Vice Provost for Research.

For more information, contact Madeira at 812-856-1082 or For additional assistance, contact Tracy James at 812-855-0084 and Top

Indoor workplace smoking bans garner strong support from Hoosiers

Terrell Zollinger

Terrell Zollinger

Public health researchers examining data from an Indiana Adult Tobacco Survey found nearly 75 percent of Hoosiers support a statewide or community indoor workplace smoking ban.

The results of this study could be important in increasing focused public awareness strategies aimed at reducing exposure to secondhand smoke, said Terrell Zollinger, professor of epidemiology and associate director of the Center for Health Policy in the Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis, who led the study.

Indiana is 49th on the list of 50 states for protection of workers from smoking at worksites.

Numerous studies have linked adult exposure to secondhand smoke with numerous diseases, including multiple cancers and heart diseases.

It is important that policy makers understand the basis of their constituents' support for clean air policies, Zollinger said. Policy makers generally rely on opinions expressed at hearings or in emails and telephone calls from constituents; critical opinions of smoke-free policies are often overrepresented in those circumstances, Zollinger said.

"What this study does is give policy makers a much more complete picture of how their constituents support these kinds of laws in an objective way," he said.

Data the researchers analyzed came from a 2008 cross-sectional statewide study of 2,140 Indiana adults conducted by the Indiana Tobacco Prevention and Cessation Agency.

The study found that 72.3 percent of the respondents supported laws making indoor workplaces smoke-free. Strong support for banning smoking in indoor workplaces was found regardless of whether the respondent lived in an urban or a rural area, Zollinger said.

According to the study, three variables were significant predictors of support: People who never or formerly smoked were more supportive, as were females and those who were more aware of the health hazards of secondhand smoke.

About 32 percent of respondents who are current smokers support indoor workplace smoking bans; 68 percent of former smokers did so, while 85 percent of respondents who had never smoked said they support indoor workplace smoking bans.

The study concludes support was constant among most groups across the state, suggesting policy makers would have the backing of their constituents to pass such legislation.

According to Zollinger, the results of this study suggest that efforts to gain additional support for smoke-free-air laws should focus on men, people unaware of the health hazards from secondhand smoke, and smokers and former smokers.

Zollinger will present the study at 3:30 p.m. EDT Tuesday, Oct. 30. Co-authors are Robert M. Saywell, IU School of Medicine; Joshua Robinson, U.S. Department of Veterans Affairs; Stephen Jay, Fairbanks School of Public Health, IUPUI; and Miranda Spitznagle, Tobacco Prevention and Cessation Commission, Indiana State Department of Health.

For more information, Zollinger may be reached at 317-278-0307 or For additional assistance, contact Rich Schneider at 317-278-4564 or Top

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

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

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

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

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

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

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

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

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

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

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

Seo will discuss this study with Mindy King at 6:15 p.m. EDT Tuesday, Oct. 30. Co-authors are King and Danielle Neukam, with the Indiana Institute on Disability and Community at IU; Nayoung Kim, IU School of Public Health-Bloomington; and Rhonda Meade, Welborn Baptist Foundation.

For more information, contact Seo at or King at For additional assistance, contact Tracy James at 812-855-0084 or Top

New HealthyState mobile app can inform relocation, retirement decisions

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

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

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

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

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

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

Gundi discussed the app Oct. 29.

For more information, contact Caine at For additional assistance, contact Tracy James at 812-855-0084 or Top

Health impact assessment of Indy Parks usage

Frequenting city parks could promote a healthy lifestyle for urban residents, but not all Marion County, Ind., residents do so. Students in a health impact assessment course at the Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis surveyed residents to determine what kept them out of the parks.

Their findings resulted in "Incorporating a Health Impact Assessment Into the Indy Parks Comprehensive Plan" to be presented by Jessica Mullin, a recent Master of Public Health graduate, and Cynthia Stone, who teaches the health impact assessment course. The group surveyed 382 residents, 40 percent of whom admitted not using the Indianapolis Parks and Recreation Department facilities.

People who do not frequent parks in Indianapolis expressed a variety of reasons, including:

  • No reason to use parks -- no children, children grown, have gym membership.
  • Unaware of park locations.
  • Believe the parks are unsafe.
  • Time constraints.
  • Dislike the outdoors.
  • Age or health issues.

Recommendations made to Indy Parks include:

  • Increase access by improving ramps, sidewalks, bike ramps and benches.
  • Disseminate more information about the park programs, including locations, hours and facilities.
  • Create safe, continuous routes to connect parks to neighborhoods.
  • Increase the variety of activities at the parks.
  • Diversify activities by partnering with other groups to host farmer's markets, health fairs, community gardens and other healthy activities.

Stone said health impact assessment is a new tool in the United States, although it has been used for several years in the United Kingdom and other countries.

Stone said the health impact assessment class at IUPUI is one of only eight in the United States. Health impact assessment is a fast-growing field that looks at policies and procedures that make a difference in people's health, she said. By providing facts and statistics, combined with health expertise and public input, health impact assessments are designed to help policy makers craft legislation and regulations that can have a positive impact on the public's health and lifestyles.

The study was discussed Oct. 29.

For additional assistance, contact Mary Hardin at 317-274-5456 or Top

Sociologist Bernice Pescosolido receives Carl Taube Award

Bernice Pescosolido

Bernice Pescosolido

Print-Quality Photo

Indiana University Bloomington sociologist Bernice Pescosolido received the 2012 Carl Taube Award during the American Public Health Association's annual meeting. Given by the Mental Health Section of the APHA in memory of National Institutes of Mental Health staffer Carl A. Taube, the award honors "those who have made significant contributions in the field of mental health services research."

Pescosolido is Distinguished Professor of Sociology in the Department of Sociology in the College of Arts and Sciences, and director of the Indiana Consortium for Mental Health Services Research. Her research agenda addresses how social networks connect individuals to their communities and to institutional structures, providing the "wires" through which people's attitudes and actions are influenced. This agenda encompasses three basic areas: health care services, stigma and suicide research.

On Monday she presented "Stigma of Mental Illness: An Overview of Research Findings and the New Directions They Demand."

Read more about the award and presentation. Top

Brian Dodge assumes chair of APHA section for HIV/AIDS

Brian Dodge, associate professor in the IU School of Public Health-Bloomington, has become chair of the American Public Health Association's HIV/AIDS section, one of the largest sections in the APHA. The leadership role culminates more than a decade of active involvement in the group, which includes some of the top HIV researchers and AIDS service organizations.

Dodge said the APHA's HIV/AIDS section was created to address issues surrounding what was, at the time, a new and emerging public health crisis in the mid-1980s. First known as the AIDS Working Group, its task was to take rapidly emerging scientific literature and formulate it into public health materials that could be used to educate the general public and the professional sector with factual information regarding HIV infection.

"The section is unique in that is has been made up of not only of doctors and researchers but also grassroots activists, community-based public health professionals and HIV-positive individuals; membership has grown exponentially from several dozen to more than 1,000 active members, representing over 3 percent of the total membership of APHA," Dodge said.

Dodge is an associate professor in the Department of Applied Health Science and associate director of the Center for Sexual Health Promotion.

For additional assistance with these items, contact Tracy James at 812-855-0084 or Tweeting @Vitality_IU, with more news from IU at #IUNews and #IUMedNews; blogging Health & Vitality. Top