In the November issue, Dr. Betty Leslie shared with us the results of her 2005 Walden dissertation on the Attitudes and Behaviors Toward Selected Cultural Factors and Barriers Contributing to Overweight and Obesity Among African-American Women. This health issue is another example of an underserved population.

• In response, Will Fassinger has these thoughts to share with us:

“Your piece is very interesting. I would recommend that you not limit yourself to obesity and overweight issues among African-American women. This issue is far-reaching and crosses gender and race. Numerous white women face the same issue.

 
I would suggest that you also explore women in rural settings in America. Having worked in two school settings in northern New York, the same issues may be present in a different population/race group. Obesity and weight issues are not limited to a specific race or gender. Numerous articles have been presented in news magazines and daily newspapers. Additionally, a good number of school districts are addressing the issue with enrolled students.

 
I would be interested to know if the project also addressed issues such as a lack of physical activity, a lack of family involvement in the same area, and the use of televisions and computers as child care providers rather than the child/adult being outside and getting some type of physical activity.

 
I base my comments on my developmental years when we were very active and not entertained by television or computers. I can also tell you that I spent 20 years in the U.S. Army. Issues of weight control were present in that arena also. However, we did have a very strict policy regarding weight and physical fitness. It very well could have been the physical training that kept the weight issue in check. However, that is an entirely different environment than average America. Physical training was a tool that assisted in keeping soldiers alive on the battlefield; one had to be fit in order to survive.

 
I believe that a good portion of weight control issues can also be addressed in line with self-control, self-esteem, and motivation. Individuals need to be motivated to take control of their situations.”

William J. Fassinger, M.S.Ed., C.A.S., is a doctoral student in the School of Health and Human Services, specializing in Criminal Justice. He is currently an assistant professor of criminal investigation and the chair of the Department of Public Safety at the School of Business and Public Service, SUNY Canton. He is a Retired U.S. Army First Sergeant and served in Somalia, Panama, and Haiti.

• In response to Fassinger’s commentary, Leslie writes:

“Thank you for responding to my article, which was based on my dissertation research. While I certainly recognize that overweight and obesity are not limited to African-American women, my research study was limited to this target group for the following reasons:

1. Recent research revealed that African-American women have the highest percentage of overweight and obesity in this country and that they have the highest risks for stroke, heart disease, diabetes, and other related health conditions.

2. Also, while it appears that many urban cities, as well as many rural areas in this country, have alarmingly high rates of overweight and obese individuals, various racial groups in certain cities in the southern region of the United States have been identified as having extremely high rates of overweight and obesity. The prevalence of obesity in the South was the main focus of my research.

3. Lastly, there was already a considerable amount of literature reporting the various aspects of obesity that focused on the experiences of non-African-American individuals. Therefore, the need was for more targeted and in-depth research investigating certain cultural factors associated with the attitudes and behaviors of African-American women, as they struggle with issues of overweight and obesity.

My research in the areas of overweight and obesity addressed a variety of related issues, including various food types and cooking patterns, body image, traditional family and parenting issues, dietary habits, tolerance toward obesity, lack of physical fitness, and a lack of nutritional education. This study also addressed weight-loss barriers, including time constraints, stress, lack of social and economic support, lack of motivation, and participation in social activities where large amounts of food are generally served.

My research also revealed implications of serious overweight problems among non-African-American individuals in this country. Therefore, based on my findings, I recommended that further research be conducted among younger African Americans, regardless of gender, as well as less educated and economically stable individuals, regardless of race. In addition, another area of study may include comparative research using African Americans, Caucasians, and other racial ethnic groups. Based on those findings, future researchers need to examine other factors, such as excessive drinking of alcohol, availability of fast food restaurants, the need for better communication concerning obesity-related issues, the influence of personal relationships, negative communications from others, and the lack of community awareness and support.

On a broader scale, my research study revealed implications for greater social change in the area of obesity research by promoting Healthy People 2010, which is a national health promotion and disease prevention initiative endorsed by the federal government. Therefore, in keeping with the general principles of Healthy People 2010, a health promotion action plan is being recommended for all Americans in general, and African-American women in particular, in maintaining healthier controls over their weight.

Based on the findings of my research study, I proposed a Lifestyle Skills Intervention Program, consisting of 10 class sessions, held once a week, followed by a graduation ceremony. The program requires the participants to keep a food and physical fitness diary over the 10 weeks of class sessions.

The first session involves conducting an initial health assessment survey, used to evaluate the general health of the participants and provide basic demographic information. The overall purpose of this intervention program is to facilitate self-help groups in promoting the reduction of overweight and obesity for all family members.

This Lifestyle Skills Intervention Program consists of the following scheduled sessions:

Session 1 – Administration and Evaluation of General Health Assessment Survey
Session 2 – Attitudes and Behaviors Associated with Overweight and Obesity
Session 3 – Cultural Factors and Barriers Influencing Overweight and Obesity
Session 4 – The Consequences of Not Being Healthy: Obesity Health-Related Conditions
Session 5 – Proper Eating and Nutrition, New Dietary Pyramid, and Portion Sizes
Session 6 – Alternative Food Preparation, Cooking Methods, and Consumption
Session 7 – Personal Values: Self-Esteem, Self-Confidence, Body Image and Size
Session 8 – The Importance of Physical Fitness Knowledge and Exercise Skills
Session 9 – Diary Assessment and Lifestyle Exercise/Aerobic Class Demonstration
Session 10 – Wrap-Up and Review of Necessary Lifestyle Changes to Implement
Final Activity – Graduation Ceremony/Reception for Participants Completing Program 

This proposed program model may be used more effectively by forming partnerships among various levels of state and local governments, local communities, and religious related organizations through a series of focus groups to address problems associated with overweight and obesity.”

Dr. Betty M. Leslie has a Ph.D. in Human Services with a specialization in Professional Counseling from Walden University, an M.Ed. with a major in counselor education, and a B.S. in secondary education with a major in English. She is currently an administrator in higher education and has served as the assistant academic dean at Bishop State Community College in Mobile, AL for 15 years.

 

In the November issue, Andrew Forshée, a doctoral candidate in Human Services, presented his dissertation research in “Having the Conversation: Meeting the Service Needs of Transgender Men.”

• In response, student Phyllis Wallace raises this question: How can health and human services programs better meet the needs of the transgender (trans) community?

“Health care matters to all of us some of the time;
public health matters to all of us all of the time.”
C. Everett Koop

“Hats off to Andrew Forshée for writing a rich commentary on the health service needs of FTM, transgender persons! This is an important, contributory piece of work!

Schools of public health can prepare public health students to lead, teach, serve, and advocate for the ethical practice of public health locally and globally.

Background
The diversity of Gay, Lesbian, Bisexual, and Transgender (GLBT) communities mirror that of the general U.S. population (Dean, et al., 2000). The U. S. Census (2004) estimate that approximately 5% to 10% is GLBT (Boehmer, 2002; Kaiser Permanente, 2000).

The National Coalition for GLBT Health (2004) lists 13 key health priorities for U.S. transgender persons. The 13 health priorities are (a) violence prevention, (b) HIV/AIDS disease and STD prevention and treatment, (c) substance abuse prevention and treatment, (d) depression, suicidal ideation, and suicide prevention, (e) lack of health insurance and underinsurance, (f) lack of health insurance coverage for trans health services, (g) gender identity disorder, (h) lack of FDA approval for transgender hormonal therapy, (i) widespread injection silicone use especially among MTF minorities, (j) continuing misclassification of sex reassignment surgery as “experimental,” (k) lack of training in U.S. medical schools, (l) health professional insensitivity and hostility, and (m) tobacco use.

 
Call to Action
As public health students, we are grounded in the 10 essential public health services, imbued with the spirit of the Public Health Professional’s Oath (American Public Health Association, 2003), and affirmed with accreditation to protect and promote the health of the public.

Role of Health Educators in Transgender Health

1. Educate yourself on the health priorities of transgender persons, gaps in social and medical services, barriers to perceived susceptibility, and risk behaviors of trans persons (e.g., needle-sharing, unprotected anal sex).
   
   
   
2. Partner with transgender health educators, physicians, and trans advocates to
   
   
   

   a. Identify social and environmental determinants (e.g., stigma, homelessness, poverty) that impact the health of trans persons.
   b. Appreciate the diversity of the trans community.
   c. Recognize the health-seeking behaviors of trans persons.
   d. Learn the unique trans jargon to develop meaningful, trans-friendly health promotion and prevention programs.
   e. Share funding, expertise, and knowledge of trans culture.

    

3. Design, implement, and evaluate trans-specific health prevention models to incorporate the needs of trans people (e.g., estrogen therapy, testosterone therapy, confidentiality).
   
   
   

4. Provide gender-sensitive health interventions that engage and empower persons who self-identify as transgender (e.g., Male to Female (MTF), Female to Male (FTM), Drag Queens, Drag Kings).
   
   
   

5. Offer Transgender Health 101workshops/trainings in schools, communities, and workplaces. Health educators can also offer prevention workshops to trans persons on weight management, nutrition and healthy eating, physical activity, breast and prostate cancer, smoking cessation, HIV/AIDS and STDs, and domestic partner violence.
   
   
   

6. Conduct evidence-based research studies. The health practitioner must team with transgender populations (e.g., trans youth, FTM) in order to inform the research methodology, sampling, and participant selection to be able to generalize findings to a wider audience.
   
   
   

7. Advocate for the inclusion of transgender health course selections (e.g., trans care, confidentiality, intake and assessment) in the U.S. medical school curriculum. Include a clinical rotation in transgender health at clinical institutions where service delivery for trans persons is pro forma.
   
   
   
8. Achieve certification status as a Certified Health Education Specialist (CHES). CHES are experts in health promotion practice with diverse populations, research design, ethics in practice, and connecting individuals to needed community health services.

    

9. Collaborate with health education organizations, such as the Society for Public Health Education (SOPHE), to write policy statements in support of vital social and medical services for transgender persons that promote physical, mental, and spiritual wellness.
   
   
   

10. Publish student monographs and academic papers and present at local and national conferences, particularly trans symposia such as the Harry Benjamin International Gender Dysphoria Association conferences, to educate public health practitioners on risk behaviors that contribute to illness, disease, and death, impacting all trans persons.

Walden faculty help define our practice, lead by example, and provide public health students with dogged-eared recipes that sooth the soul, seal the hurt, and stitch the broken seams.

References

American Public Health Association (2003). The public health professional’s oath. Retrieved September 2, 2005, from http://www.apha.org/codeofethics/oath.pdf

Association of Schools of Public Health. (n.d.). What is public health? Retrieved December 31, 2005, from http://www.asph.org/document.cfm?page=300

Boehmer, U. (2002). Twenty years of public health research: Inclusion of lesbian, gay, bisexual, and transgender populations. American Journal of Public Health, 92, 1125–1131.

Dean, L., Meyer, I., Robinson, K., Sell, R., Sember, R., Silenzio, V., et al. (2000, October). Lesbian, gay, bisexual, and transgender health: Findings and concerns [Electronic version]. Journal of the Gay and Lesbian Medical Association, 4, 105–151.

Kaiser Permanente National Diversity Council. (2000). A provider’s handbook on culturally competent care:Lesbian, gay, bisexual, and transgendered population.  Oakland, CA: Kaiser Permanente.

National Coalition for LGBT Health. (2004, April). An overview of U.S. trans health priorities: A report by the eliminating disparities working group. Retrieved December 16, 2004, from http://www.lgbthealth.net/

U.S. Census. (2004). 2004 American community survey: Data profile highlights. Retrieved December 28, 2005, from http://factfinder.census.org/

Phyllis M. Wallace, M.S.Ed., C.H.E.S., holds a master’s degree in community health from Southern Illinois University–Carbondale and is a Certified Health Education Specialist. Most recently, she was a Public Health Administrator III with the Chicago Department of Children and Youth Services and a supervisor with Children’s Health Services at Chicago Head Start. Wallace is a doctoral public health student at Walden University and an Emergency Medical Technician (EMT-B). She is a member of the Illinois Head Start Association Health Manager Committee. For the past 10 years, she has worked as a community health advisor for community and faith-based institutions developing, implementing, and evaluating health education programs.

• Barbara Patterson, R.N., M.S., Ed.D., a member of the nursing faculty at Walden University, offers another response:

“I couldn't find a place to make a comment at The Scholar-Practitioner site, but I found The Student Corner article about trangendered men in the November issue of The Scholar-Practitioner an interesting one. One of the points the author made was to be aware there are genders other than just male and female.

After reading the publication, I completed the survey. I noted in the demographic section of the survey, there were only choices of male, female, or "prefer not to say." The student author of the article in The Scholar-Practitioner would probably say this is another example of not recognizing transgendered people, and I must agree with him. Just a thought.”

• Andrew Forshée responds to their comments:

“Probably the best way to tackle the issue of gender in any online survey is to have people self-identify as “Male/Female” or something else entirely. Perhaps a blank "fill in" space for gender might help ease the anxiety for some trans folks who often have to choose one or the other.

 
You could have a box for “Male,” “Female,” and “Prefer Not to Answer,” and then add a blank space for people to individually categorize themselves, if they choose. Or, you could leave the labels out all together and just leave a fill-in blank for people to self-identify.

 
Although, many analysts might find this strategy too "watery" and statistically difficult to organize, it is similar to those individuals who don't find the categorization of "race" appropriate to their life experience. What we begin to realize is that it doesn't hold up for many people. Additionally, many people might feel lost when asked to self-identify their gender, since it appears as "logical" to most . . . but a bad paradigm is sometimes good.