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    Education

    The Push for Healthy Communities

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    As COVID-19 took its toll on the U.S. in 2020, the numbers began to show that not everyone was equally affected by the virus. Data from the CDC and National Center for Health Statistics showed Black and Latinx populations were almost three times more likely to be hospitalized for COVID-19 than white populations, and it was two times more likely that their cases resulted in death.

    But COVID-19 only revealed the health disparities that were already rampant in the nation. And, these underlying disparities did not only affect people of color, but also occurred based on other factors such as socioeconomic status, gender, sexual orientation, geography and age.

    As the most economically and ethnically diverse university in the nation, the CSU is committed to ensuring all community members are served equally, including access to health care. Here are a few ways campuses are pushing for that access.​

    A Little Motivation

    The Stanislaus Recovery Center (SRC), which provides addiction recovery treatment for patients on Medicaid or Medi-Cal who are often unemployed or unhoused, is the site of a pilot study led by Shrinidhi Subramaniam, Ph.D., assistant professor of psychology at California State University, Stanislaus.

    Working together since 2018, Dr. Subramaniam and the SRC team noticed when patients were transferring from residential to outpatient care, their participation in treatment dropped off. To address the issue, Subramaniam, her students and the SRC launched the project—funded by a Research, Scholarships and Creative Activities grant—to study whether monetary incentives, paid on reloadable credit cards, increased patient participation in outpatient services as well as improved abstinence and treatment outcomes.

    “I expect the participants in our study to all be in the category of socioeconomic disadvantage, and hopefully the little bit of money that we can give them with the incentives will also encourage them to access other recovery resources through continuing care,” Subramaniam says.

    This pilot study is based off research she conducted during her post-doc at the Johns Hopkins School of Medicine on motivational incentives in health care, including encouraging HIV patients to take their medication and chronically unemployed individuals recovering from substance use disorder to abstain from drug use. Another study also looked at the efficacy of incentivizing patients to do other important tasks like sign up for health insurance, complete job training or acquire identification like a Social Security card or ID.

    Subramaniam hopes her work can expand to incentivize patients to use other services at SRC, includin​g its existing resources that link clients to training or local job opportunities—with the ultimate goal of setting up her own “therapeutic workplace” where individuals can receive treatment as well as help securing education, employment and housing.

    “We have to deal with a lot of stigmas working with this population; both the stigma of addiction and the stigma that comes along with poverty,” Subramaniam says. “So, one of the major goals of my research program is to figure out what it takes to help people with that combination of addiction, unemployment and poverty to get out of their situation to the best of our ability. Of course, there are structural changes that need to be made to help people in that position, but there are also things psychology can do on an individual basis to help people access resources that are available. And incentives are a great way to help motivate people to do those difficult tasks.”​

    The Next Generation

    Named in honor of the unsung medical personnel dubbed heroes during the COVID-19 pandemic, the proposed Regional Healthcare Initiative Health Education, Research, and Clinical Outcomes (HEROs) Institute at San Diego State University would seek to improve health care services and reduce disparities in its community by addressing issues in health education.

    “We can’t address access to health care if we don’t address access to health care education,” says Harsimran Baweja, Ph.D., associate professor in exercise and nutritional sciences. “Our idea is to make a grassroots-up change to health care delivery, so that these students who go out now, our alumni, will be the changemakers.”

    Specifically, the goal is to implement interprofessional education, in which classrooms would bring together students from different health care programs, reflecting the interdisciplinary teams they will experience in the workforce. By introducing this type of learning, their training times would be significantly shortened, and they could independently serve patients more quickly. In addition, the institute will form clinical partnerships with community health care providers, who will likewise provide instruction and training in the classroom and likely employ the students post-graduation.

    Specifically, the goal is to implement interprofessional education, in which classrooms would bring together students from different health care programs, reflecting the interdisciplinary teams they will experience in the workforce. By introducing this type of learning, their training times would be significantly shortened, and they could independently serve patients more quickly. In addition, the institute will form clinical partnerships with community health care providers, who will likewise provide instruction and training in the classroom and likely employ the students post-graduation.

    “We will be accelerating the delivery [of health care] from bench to bedside or to the community, because the problem in health care access and delivery is the pace at which it’s given,” Dr. Baweja explains. “We need to reduce the burden on the health care system and reduce the burden on the money that is spent. Our trainees who will go out will know how to run the system more efficiently. We really have to create a better and more efficient work system and workflow.”

    Spearheaded by Baweja, María Luisa Zúñiga, Ph.D., campus director of the Joint Doctoral Program in Interdisciplinary Research in Substance Abuse, and other faculty in research and innovation, public health and physical therapy, the HEROs Institute will also consolidate efforts currently occurring separately in the colleges. For example, the NIH-funded Addiction Scientists Strengthened Through Education and Training (ASSET) Program aims to increase the number of Black and Latinx scientists in substance abuse addiction and education, while the California Outreach Challenge, which SDSU participates in, has physical therapy programs compete for the most community service hours. Under the institute, similar programs could be implemented that extend across SDSU’s health care disciplines.

    Lastly, professors in the participating programs would imbue students with the values, cultural competence and community understanding that would prepare them to drive health care policy changes in the future.

    “If we not just prep students to be ready for whatever is coming in the future, but we guide them with the value system that you have to serve your community before they graduate, then the health care system is going to be better prepared for itself than it was in the past 12 months,” Baweja says. “These are going to be the people who are going to be not only informing the workforce, but will be informing the policies in the future.”

    The team is currently seeking public, private and industry partnerships to jumpstart the HEROs Institute, which is part of the​ SDSU Big Ideas Initiative​.

    A Health Care Transformation

    Building on the campus’s Mi Gente, Nuestra Salud (My People, Our Health) effort, California Polytechnic State University, San Luis Obispo is piloting a new institute that facilitates community-led initiatives to address health equity around the cities of Santa Maria and Guadalupe on California’s Central Coast.

    “Our solution is a people’s movement for health ownership,” says Suzanne Phelan, Ph.D., professor of kinesiology and public health and co-principal investigator of Mi Gente, Nuestra Salud. “The Mi Gente, Nuestra Salud initiative flips our current system upside down, empowering people—and especially those who are currently minoritized in America—to identify and address their most pressing health concerns. We aim to transform health care into health ownership.”

    To meet this goal, the Cal Poly Institute for Community Health Training and Research will largely provide resources that enable existing groups to better serve all members of the community with the help of collaborators from all six of the school’s colleges. These resources will include training in health equity principles, data on the community, funding opportunities and strategies for community partnerships, health advocacy and program evaluation.

    “We see this effort as collaborative and, ultimately, community-driven,” says Marilyn Tseng, Ph.D., assistant professor of kinesiology and public health and co-principal investigator of Mi Gente, Nuestra Salud. “We see the institute as providing resources that will help the process along; we are only one piece in the complex health ecosystem in Santa Maria. If we can help generate ripples that will produce larger beneficial impacts on community mobilization, health ownership and health equity, we will consider the effort to be completely worthwhile.”

    To secure support for the project, the team has already forged partnerships with the city of Santa Maria, nonprofits and University of California, Santa Barbara. It also recently received funding from the California Breast Cancer Research Program to study breast cancer risk disparities in the Latinx and immigrant communities of Santa Maria.

    These efforts will also be bolstered by Cal Poly San Luis Obispo’s Women and Infants Mobile Health Unit, which, in addition to supporting local health workers and providing free medical care to uninsured women and infants, will serve as a connection point between the institute and the community.

    Finally, the team hopes to introduce health advocacy and ambassadorship training into the classroom, preparing Cal Poly San Luis Obispo students to effectively care and advocate for these communities.

    Inspiration for these efforts grew out of a program in Jamkhed, India, called the Jamkhed Comprehensive Rural Health Project (CRHP), aimed at empowering people to address health disparities in their communities by first addressing the social, cultural and economic challenges that exacerbate those inequities.

    “All of us conduct research and teach courses in which we confront issues of health inequities rooted in systemwide, structural inequities in access to healthy environments, opportunities and resources,” Dr. Tseng says. “The Jamkhed CRHP has been successful and cost-effective in India, but more importantly, its principles resonated with all of us. We felt that health ownership was something we would like to see here given the stark disparities in health, even in our region.”

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    Justice

    The Future of Criminal Prosecution for Self-Induced Abortion & Pregnancy Endangerment

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    The intensifying avalanche of restrictive U.S. abortion laws since 2012 has made it more difficult for many people to terminate their pregnancies. These restrictions have also had the effect of increasing what are considered illegal abortions. But the face of illegal abortion has shifted since the 1973 Roe v. Wade decision by the Supreme Court. Today’s procedures rarely resemble the back-alley abortions of the past, given the availability of medications that can effectively induce abortions and the rise of the internet as a tool women can use to procure such medications and to learn how to use them. Some things, however, have not changed. Just as pregnant women were sometimes prosecuted after aborting or attempting to abort pregnancies in the pre-Roe era, pregnant women today are still sometimes prosecuted for similar acts, even if the exact methods are different.

    In the United States, pregnancy occupies a contradictory socio-legal space. For many, pregnancy and resultant parenthood are much desired (and encouraged) conditions. But being pregnant can also result in the loss of important constitutional rights, including rights to privacy, liberty, and free religious expression, along with rights to due process, freedom from cruel and unusual punishment, and equal protection. Because of the potential for such lost rights, my research argues that pregnancy legally creates a lower class of person – a situation I call “pregnancy exceptionalism.” Pregnant women hold a tenuous position under the law if they go outside legally recognized methods of abortion, either by choice or because are otherwise unable to access those methods. An examination of recent instances in which pregnant women have been prosecuted offers possible clues as to future directions of the law, insofar as reductions in pregnancy prevention services continue along with erosion of legal options for ending pregnancies.

    Prosecuting Pregnant Women

    Three states – Alabama, South Carolina, and Tennessee – have expanded criminal law through legislatures or courts to include what they define as “unborn children.” My research on these three states has identified nearly 900 cases of arrest of pregnant or formerly pregnant people for terminating, attempting to terminate, or otherwise causing harm to their pregnancies between 1973 and 2016. In all three states, arrests of pregnant women for these offenses occurred before formal definitions were entered into the code of law.

    Other states have taken similar steps. To date, every state but Vermont and Delaware has participated in the arrest and prosecution of pregnant women, allegedly in defense of their embryos and fetuses. Most of these arrests have involved pregnant women or newborns who tested positive for drugs, but cases involving attempted suicide have also been documented. One woman who attempted to evade the police was additionally charged with reckless endangerment of a minor because she was running while pregnant. Mysteriously, two women were charged with crimes against their “unborn children” but were later released when they were found not to have been pregnant in the first place. Other arrests occurred when pregnant women attempted to abort their pregnancies illegally, or were accused of doing so.

    Prosecutions of pregnant women have gotten little public attention, with some exceptions in cases where medical providers reported women who were later prosecuted:

    • In Indiana in 2013, a woman named Purvi Patel was hiding a pregnancy from her conservative Hindu parents. She expressed some ambivalence about the pregnancy and texted a friend about procuring abortion pills online. After having a miscarriage at her family’s restaurant, Patel placed the fetus in the dumpster. She eventually went to the hospital, where policy interrogated her. Later, she was arrested for causing the fetus’s death, convicted and sentenced to two concurrent 20-year sentences. An appeals court later vacated the feticide charge and reduced her sentence to 18 months.

    • In Tennessee in 2015, Anna Yocca allegedly attempted to perform a self-induced abortion using a wire clothes hanger. At 24 weeks pregnant, Yocca would have needed to travel to Washington, New York, Maryland, or Colorado to obtain a legal abortion. When she began to bleed heavily, her boyfriend drove her to the emergency room. She received medical care and her baby survived, although the baby was born prematurely and likely to have lifelong disabilities. After Yocca’s healthcare providers notified police that Yocca made “disturbing” statements about wanting to end the pregnancy, she was charged and arrested for attempted murder.

    Key Questions for Continued Research

    As nascent research proceeds on prosecutions of pregnant women dealing with new legal restrictions, many important questions remain to be investigated:

    • How and why are people pursuing illegal abortion in the United States?

    • How has illegal abortion changed since Roe v. Wade, both legally and practically?

    • How are state legislatures and courts addressing illegal abortion?

    • What are the characteristics of criminal cases brought against women who have sought or procured illegal abortion?

    • What are the legal arguments used in making these criminal prosecutions?

    No matter the answers to these questions, it is already clear that as legal abortion becomes harder to access, women will likely seek extra-legal means of terminating undesired pregnancies, even if such efforts may result in their prosecution and imprisonment. As researchers examine the safety of newer medications and technologies for self-induced abortions, they must also explore the legal risks and treatment facing people who make use of those methods. The possibility that a new Supreme Court majority may overturn Roe v. Wade or further eviscerate legal abortion rights warrants a thorough examination of the precedents that will go into adjudicating cases like those of Puri Patel and Anna Yocca that, while rare in the past, may appear more frequently in the future. More research now can help all concerned be better prepared for the new legal as well as medical world that may arrive as legal abortions become more circumscribed in the United States.

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    Education

    Social Emotional Learning Skills by Grade Level: Part III

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    As discussed in parts one and two, social emotional learning (SEL) skills have become an even greater focus now that students are limited in their opportunities to socialize, collaborate, and communicate with peers in person at school. By the time students reach middle school, the basic foundational skills for social-emotional intelligence are in place. Preteens and teenagers are now ready to face greater obstacles and challenges, especially with regard to peer relationships, stress, and self-motivation. To meet new benchmarks, students in middle and high school must learn to deal with more significant academic struggles, greater peer influences, ever-changing teenage social dynamics, and their own personal growth and development at the same time. Below is our continued list of specific grade-level SEL standards for middle schoolers and high schoolers.

    Middle School

    Students should begin to recognize circumstances and situations that cause extra or unnecessary stress; they should begin to adopt strategies to help with motivation, stress management, and task completion. Middle schoolers should begin to recognize the benefits of strong self-advocacy skills and how to best utilize the resources and supports that are at their disposal. For instance, if schools offer after–school homework help, students who know that they struggle to complete assignments on their own should take initiative by signing up for the club/program and making a point to attend.

    Since learning to set goals in elementary school, middle schoolers should now be equipped to assess the validity of their goals so that they may make more informed, realistic, and specific goals moving forward. They should also be able to determine why they were able to reach success or not, i.e., What helped them to reach their goal? If they didn’t reach it, then why not? What prohibited them from finding success? By middle school, students should not only be able to recognize other people’s emotions, feelings, or perspectives, but they should be able to surmise why they feel or think that way. In this sense, they’re activating the ability to take another’s perspective that they learned in elementary school, then further expanding on that by making inferences.

    Preteens not only recognize cultural differences, but they should begin to acknowledge how certain cultural differences can result in some peers being ostracized or bullied. They should then be able to begin to find ways to combat or address the bullying and/or to make others feel included and recognized. Middle schoolers should be well-aware of group dynamics and what it takes to ensure the success of the group. This includes assigning roles, taking responsibility, sharing the workload, cooperating with others, etc.

    Students in the middle school grades should be aware of negative peer pressure, what it looks like, sounds like, and feels like. They should also be able to come up with ways to combat negative peer pressure in non– confrontational ways and under various circumstances. Preteens should be considering their decision-making in terms of others. Before making an important decision, they should consider not only how they will benefit from their choice, but how it could impact others as well.

    High School

    High schoolers should begin to understand how expressing one’s own emotions/feelings can have both positive and negative impacts on others. For example, as young adults, they need to know that positivity begets positivity, especially when emotions are running high. High schoolers will also have developed the ability to multitask by this point. However, more than multitasking, HS students should be able to shift back and forth between various tasks and under wavering conditions or circumstances. For instance, if completing a chapter review for English, a high schooler may need to answer a phone call or walk the dog to then return to the chapter questions later. Perhaps they need to maintain focus on several different homework assignments while working from a bustling coffee shop.

    Students in high school should be able to capitalize on their strengths and think creatively when facing a challenge. This ability connects with problem-solving skills and ingenuity. We can’t all be great at everything, but in what way can we use our personal/individual strengths to make challenging tasks easier? This is key for college and career readiness. High schoolers should also be thinking about setting goals for the future after graduation. College is not the “end all be all.” But if college isn’t their plan, then what is? Young adults need to recognize how important it is to find a path, take steps to follow that path, and evaluate their progress, preferences, and goals as they go. If they want to take a gap year, what do they hope to accomplish during that year? If they are going to study abroad, how will they decide on a program and pay for it? What skill set do they plan to use for supplementary income while in or out of college?

    High schoolers should be capable of showing respect for those with opposing or differing viewpoints, even if the opposing side is argumentative, dismissive, rude, etc. It is important to maintain a level of self-control even when others are not. Just because someone has a different opinion doesn’t mean they are wrong or right in their convictions. As young adults soon to be out on their own in the adult world, it is critical that high schoolers recognize how we must all be concerned about the well-being of all people; we may all be different races, but we’re all part of the human race. Therefore, we can positively contribute to our communities by advocating for human rights.

    High schoolers should be able to assess their ability to actively listen and explain how active listening helps with conflict resolution. They should also be able to demonstrate leadership abilities within group contexts without dominating or overtaking the goal of the group. Young adults should also be prepared to demonstrate knowledge of social norms and appropriate behaviors between and among various cultural groups. They should recognize certain expectations and norms when interacting with authority figures, children, elders, etc.

    Thus, we have completed our three-part series on SEL skills by grade level. The following series will serve best as a helpful resource rather than a scare-tactic of sorts. We all develop in our own ways, but it’s important we be mindful of these skills by grade level. If your child or student seems behind on any of these, consider the ways in which you can empower them.

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