Public Health Commons^™

Structural Violence And Gender-Based Violence In The United States, Sarbinaz Z. Bekmuratova

Theses & Dissertations

Three components of the dissertation project examined the relationship between three different constructs of structural violence and women’s experience of different violence types in their lifetime in the United States. The violence types examined in the study included psychological aggression, coercive control and entrapment, physical violence, stalking, sexual violence, and rape. 2010 National Intimate Partner Violence and Sexual Violence Survey with the final sample size of 9,827 was used for all three portions of the study to analyze the association of structural violence with six types of violence. Additional datasets used were Institute for Women’s Policy Research’s Status of Women …

Racial And Socioeconomic Disparities Are More Pronounced In Inflammatory Breast Cancer Than Other Breast Cancers, Ryan A. Denu, John M. Hampton, Adam Currey, Roger T. Anderson, Rosemary D. Cress, Steven T. Fleming, Joseph Lipscomb, Xiao-Cheng Wu, J. Frank Wilson, Amy Trentham-Dietz

Epidemiology and Environmental Health Faculty Publications

Inflammatory breast cancer (IBC) is a rare yet aggressive form of breast cancer. We examined differences in patient demographics and outcomes in IBC compared to locally advanced breast cancer (LABC) and all other breast cancer patients from the Breast and Prostate Cancer Data Quality and Patterns of Care Study (POC-BP), containing information from cancer registries in seven states. Out of 7,624 cases of invasive carcinoma, IBC and LABC accounted for 2.2% (N = 170) and 4.9% (N = 375), respectively. IBC patients were more likely to have a higher number (P = 0.03) and severity (P …

Understanding The Blogging Practices Of Women Undergoing In Vitro Fertilization (Ivf): A Discourse Analysis Of Women’S Ivf Blogs, Elizabeth Orr, Susan M. Jack, Wendy Sword, Sandra Ireland, Lois Ostolosky

The Qualitative Report

Infertility and its associated treatments, including in vitro fertilization (IVF), can have a profound impact on the emotional health and well-being of women desiring to become mothers. Researchers have measured the impact of infertility and described the experience of infertility and its treatment, leaving the rich descriptions of the IVF experience as captured in women’s blogs to be explored. This discourse analysis describes the blogging practices of women undergoing IVF, exploring both the content and function of the IVF blog discourse. Data were collected from the text of seven women’s blogs (n=1,149 blog posts) and resulted in four main functions …

The Fight Against Breast Cancer: A Policy And Programmatic Approach, Nandi Robinson

Master's Projects and Capstones

Abstract

Breast cancer continues to remain a significant health issue for women. Previously thought to only occur among postmenopausal women, breast cancer has impacted women of different ages; and rates of breast cancer have various impacts among different ethnic groups. For women living in a toxic environment, many of them have become the new wave of breast cancer cases. Screening and detection have succeeded in decreasing mortality rates. However, more research is needed in finding an efficient method of treatment. In the effort to assist in the fight against breast cancer through a policy and programmatic angle, I am fulfilling …

Progress And Priorities For Reproductive, Maternal, Newborn, And Child Health In Kenya: A Countdown To 2015 Country Case Study, Emily C. Keats, Anthony Ngugi, William Macharia, Nadia Akseer, Emma Nelima Khaemba, Zaid Ahmad Bhatti, Arjumand Rizvi, John Tole, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015.
Methods: We did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 …

Pregnancy Medicaid Expansions And Fertility: Differentiating Between The Intensive And Extensive Margins, Lincoln H. Groves, Sarah Hamersma, Leonard M. Lopoo

Center for Policy Research

The theoretical and empirical links between public health insurance access and fertility in the United States remain unclear. Utilizing a demographic cell-based estimation approach with panel data (1987-1997), we revisit the large-scale Medicaid expansions to pregnant women during the 1980s to estimate the heterogeneous impacts of public health insurance access on childbirth. While the decision to become a parent (i.e., the extensive margin) appears to be unaffected by increased access to Medicaid, we find that increased access to public health insurance positively influenced the number of high parity births (i.e., the intensive margin) for select groups of women. In particular, …

How Canada Can Help Global Adolescent Health Mature, Ashley Vandermorris, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: There is an emerging focus on adolescent health within the global health community as we come to recognize that the adolescent years are formative in determining health and health-related behaviours across the life-course. Such attention is not only relevant on the global scale but is imperative in Canada as well.

Main body: This commentary provides a brief review of recent investments targeting global adolescent health and presents five potential avenues for action which emerged out of the recent Canadian Partnership for Women and Children’s Health (CanWaCH) Global Adolescent Health conference. These avenues are: (1) Demand data; (2) Embrace complexity; …

A Delphi Study: Guidelines For Researchers Working With Teenage Mothers, Alison M. Chamberlain

Nursing Theses and Dissertations

Problem: It is difficult to get teenage mothers to participate in studies, yet some researchers have been successful. Researchers who understand the barriers to conducting studies with a vulnerable population and are guided in ways to overcome these barriers, will experience greater success when doing studies with this group. Improved study methods can lead to larger numbers of teenage mothers who participate in studies. Researchers who follow developmentally appropriate guidelines are more likely to conduct and replicate studies with this population. Access is essential to advance the science related to care for teenage mothers who are at risk for many …

Impact Of Sexual Violence Prevention Programming At Rowan University, Emily Kofman

Theses and Dissertations

The primary purpose of this study was to explore the impact of sexual violence prevention programming on the main Rowan University campus. This study focused primarily on the Take Back the Night event on April 4, 2017. The study evaluated the impact of the event on those who attended as well as looking at Social Norm Theory. A total population of 167 Rowan students were surveyed at the event with the instrument Take Back the Night Survey. Results of the data revealed that students positively benefitted from attending the event and were able to increase their knowledge of the subject. …

Pilot And Feasibility Test Of An Implementation Intention Intervention To Improve Fruit And Vegetable Intake Among Women With Low Socioeconomic Status, Michele A. Debiasse Phd, Rdn, Deborah J. Bowen Phd, Sherry L. Pagoto Phd, Joseph M. Massaro Phd, Nawfal Istfan Md, Phd, Lisa M. Quintiliani Phd, Rd

Journal of Health Disparities Research and Practice

Fruit and vegetable intake (FVI), a modifiable risk factor for chronic diseases, is lower in low socioeconomic status (SES) populations. Implementation intentions (a specific type of planning that extends the Theory of Planned Behavior) has been studied to improve FVI, but not exclusively with low SES groups. Using mixed methods, we evaluated the feasibility, acceptability, and preliminary efficacy of an implementation intention intervention (versus a general plan) to increase FVI in women with low SES. For the pilot randomized controlled trial, demographics, body mass index, attitude, perceived behavioral control, goal intention strength, and FVI were measured at baseline and FVI …

Public Health Research Priorities To Address Us Human Trafficking, Emily F. Rothman, Hanni Stoklosa, Susie B. Baldwin, Makini Chisolm-Straker, Rumi Kato Price, Holly G. Atkinson

Publications and Research

In this Perspective, HEAL Trafficking, the nation's leading public health anti-trafficking organization maps out a national research agenda to tackle the problem of human trafficking. Given the paucity of research on trafficking, HEAL Trafficking engaged its membership in a consensus development process throughout 2016 to develop its national research agenda. HEAL Trafficking proposes five priorities that public health researchers should focus on in the decade ahead to make meaningful progress on preventing and responding to human trafficking in the Unites States.

Supporting Mothers With Mental Illness: Postpartum Mental Health Service Linkage As A Matter Of Public Health And Child Welfare Policy, Jesse Krohn, Msed, Jd, Meredith Matone, Drph, Mhs

Journal of Law and Health

Through our work in youth advocacy as, respectively, legal and public health professionals, we are all too aware of the high levels of health care fragmentation experienced during pregnancy and postpartum by poor, young mothers of color. Meredith Matone’s research highlights the heightened risk of fragmentation for girls with histories of child welfare involvement. For example, she found that 66.7% of young mothers who had resided in out-of-home placements and who had taken antipsychotic medication prior to becoming pregnant failed to fill prescriptions for antipsychotics in their first postpartum year. Put another way, two-thirds of these vulnerable young mothers—a far …

Breast Cancer Screening In Patients With Newly Diagnosed Lung And Colorectal Cancer: A Population-Based Study Of Utilization, Gelareh Sadigh, Ruth C. Carlos, Kevin C. Ward, Jeffrey M. Switchenko, Renjian Jiang, Kimberly E. Applegate, Richard Duszak Jr.

Radiology Faculty Publications

Purpose—To assess breast cancer screening utilization in Medicare beneficiaries with colorectal and lung cancer versus cancer-free controls.

Methods—Female fee-for-service Medicare beneficiaries who were ≥ 67 years old and diagnosed with lung or colorectal cancer between 2000 and 2011 and who reported to a Surveillance, Epidemiology, and End Results (SEER) registry (case group) were followed for 2 years after their diagnoses, unless death, a diagnosis of breast cancer, or the end of 2013 came first. A similar number of cancer-free controls were individually matched to cases by age, race, registry region, and follow-up time. Screening utilization was defined as …

Anthropometric Indices For Non-Pregnant Women Of Childbearing Age Differ Widely Among Four Low-Middle Income Populations, K Michael Hambidge, Nancy F. Krebs, Ana Garcés, Jamie E. Westcott, Lester Figueroa, Shivaprasad S. Goudar, Sangappa Dhaded, Omrana Pasha, Sumera Aziz Ali, Antoinette Tshefu

Community Health Sciences

Background: Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC).
Methods: Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m²) was calculated. Z-scores were determined using WHO reference data.
Results: A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North …

Age And Sex Normalization Of Intestinal Permeability Measures For The Improved Assessment Of Enteropathy In Infancy And Early Childhood: Results From The Mal-Ed Study, Margaret N. Kosek, Gwenyth O. Lee, Richard L. Guerrant, Rashidul Haque, Gagandeep Kang, Tahmeed Ahmed, Pascal Bessong, Syed Asad Ali, Shahida Qureshi, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Objectives: The aim of the study was to describe changes in intestinal permeability in early childhood in diverse epidemiologic settings.
Methods: In a birth cohort study, the lactulose:mannitol (L:M) test was administered to 1980 children at 4 time points in the first 24 months of life in 8 countries. Data from the Brazil site with an incidence of diarrhea similar to that seen in the United States and no growth faltering was used as an internal study reference to derive age- and sex-specific z scores for mannitol and lactulose recoveries and the L:M ratio.
Results: A total of 6602 tests …

My Crown And Glory: Community, Identity, Culture, And Black Women’S Concerns Of Hair Product-Related Breast Cancer Risk, Dede K. Teteh, Susanne B. Montgomery, Sabine Monice, Laura Stiel, Phyllis Y. Clark, Eudora Mitchell

Health Sciences and Kinesiology Faculty Articles

Breast cancer (BC) incidence rates for Black and non-Hispanic White women have recently converged; however, Black women continue to die at higher rates from the disease. Black women also use hair products containing hormonally active chemicals at higher rates than other races and ethnic groups. Studies now link chemical components in hair and personal care products to breast cancer risk. Using a community-based participatory research approach, this qualitative study explored community concerns about the role of hair products on breast cancer risk. Focus groups and key informant interviews using triangulation to assure relevant perspectives (women with and without breast cancer …

Exploring The Health Effects Of Precarious Employment By Sex/Gender Using Mixed Methods, Kathleen Flandrick

Dissertations and Theses

Employment in the United States has changed dramatically since the mid-1970s. Labor market forces like globalization and diversification of the American workforce have led to a heavily segmented labor market where new types of flexible employment such as temporary, contingent, and nonstandard work arrangements are increasingly common. These newer types of work are often on the lower end of the precarious employment continuum, categorizing jobs by their degree of: 1) temporariness, 2) disempowerment, 3) vulnerability, 4) compensation (wages), 5) rights, and 6) ability to exercise worker rights. The increase in precarious employment likely disproportionately affects women when compared to men, …

Research Brief: "Impact Of Military Trauma Exposures On Post-Traumatic Stress And Depression In Female Veterans", Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

This brief is about the relation between combat stressors, depression, and PTSD among female veterans. In policy and practice, health providers should refer female veterans to services if they have experienced military sexual trauma; the DoD and VA should conduct analysis on the experiences of service and veteran women, and how they can best support service women who experienced military sexual trauma. Suggestions for future research include using an expanded sample and more sampling strategies, as well as use clinical interviews to collect data.

Notable Women Of Portland, Tracy J. Prince, Zadie Schaffer

Curriculum and Instruction Faculty Publications and Presentations

The story of Portland, Oregon, like much of history, has usually been told with a focus on male leaders. This book offers a reframing of Portland’s history--starting from 10,000 years of Native American women, to pioneer women, to women of the Progressive Era, WWI, WWII, post-war women, and chapters on Women in the Arts and Women in Politics. Many women made their mark and radically changed the Oregon frontier, including Native Americans Polly Johnson and Josette Nouette; pioneers Minerva Carter and Charlotte Terwilliger; doctors Marie Equi, Mary Priscilla Avery Sawtelle, and Bethina Owens-Adair; artists Eliza Barchus and Lily E. White; …

Narrating School, Narrative Self: Identity, Agency And The Hidden Curriculum Of (Hetero)Normativity, Mikela Bjork

Dissertations, Theses, and Capstone Projects

This dissertation analyzes sober women’s narratives of their schooling experiences to reflect on how educators and policy makers can improve the schooling experiences for othered students.. Inspired by the self-reflective and agentic pedagogy found within the figured world of Alcoholics Anonymous, I focused on the narratives of women in Alcoholics Anonymous, ages 18-85, as they narrated their schooling stories from pre-Kindergarten up to the last grade they completed. What the data of this qualitative research project reveals is that, despite the detrimental culture of denial at home and school, the participants, through the radical act of self-reflexivity and personal narrative, …

Community Living Integration Club For Women In Recovery From Sex Trafficking, Toni Thompson

Occupational Therapy Program Student Theses, Dissertations and Capstones

Sex trafficking is one form of human trafficking, a heinous human rights violation that transcends international borders. People who have been trafficked often present with complex neurobehavioral, psychological, emotional, physiological, sensory, and developmental difficulties. The United Nations developed the international 3 p protocol to guide governmental agencies, non-governmental groups, and individuals in developing programs and legal actions of trafficking prevention, protection, and prosecution. Protection encompasses the recovery of trafficking survivors and community integration has been identified as an essential foundation for successful recovery. Measurable components of community integration include safe housing, stable employment, and vocation-focused education. This Capstone describes the …

Counterfeit Medicines In Socioeconomic Perspective, Desy Nuryunarsih Nuryunarsih

Kesmas

Obat-obatan palsu berpotensi mencapai 70% dari pasaran obat internasional dengan proporsi terbanyak ditemukan di negara berkembang. Meningkatkan kesadaran masyarakat akan adanya obat-obatan palsu akan secara langsung memengaruhi permintaan produk obat palsu yang akhirnya akan mengurangi kegiatan pemalsuan obat. Akan tetapi, meningkatkan pengetahuan masyarakat akan bahaya obat-obatan palsu tidaklah mudah sebab profesi kesehatan masyarakat harus juga mempertimbangkan keberagaman faktor-faktor sosial, ekonomi dan pendidikan. Laporan ini menelaah artikel jurnal yang ditelaah oleh kelompok seminat, laporan media, laporan resmi pemerintah dan non-pemerintah. Sebanyak 179 artikel (dari 1990 sampai 2014) ditelaah untuk mengetahui hubungan antara indeks pembangunan manusia (IPM) dari USA, Jepang, Brasil, Iran, …

The Use Of “Kakayu Dental Flipbook” In Oral Health Knowledge Improvement For Elementary School Students In Depok, Rikawarastuti Rikawarastuti, Eka Anggreni, Rahaju Budiarti, Nurlaila Ramadhan Suid

Kesmas

Perlu adanya edukasi untuk meningkatkan pengetahuan anak Indonesia tentang pentingnya memelihara kesehatan gigi dan mulut. Penelitian ini bertujuan untuk menjelaskan hubungan antara faktor siswa sekolah dasar seperti kelas, usia, jenis kelamin dengan jumlah anak dalam keluarga atau faktor ekonomi seorang ibu rumah tangga atau berpenghasilan tetap, yang dipengaruhi oleh peningkatan pengetahuan dari edukasi kesehatan gigi dan mulut. Disain penelitian quasi experiment pre-test dan post-test tanpa desain grup kontrol melibatkan 141 siswa yang dipilih melalui purposive sampling. Sampel tersebar pada siswa kelas IV, V, dan VI sekolah dasar swasta di Depok, Jawa Barat, Indonesia pada April-Oktober 2016. Data penelitian diperoleh dari …

Extrovert Personality Type And Prolonged Second Stage Of Labor, Yuni Kusmiyati, Chandra Tyas Nurfitria, Suherni Suherni, Heni Puji Wahyuningsih

Kesmas

Kepribadian dapat memengaruhi respons individu yang dapat berdampak pada proses persalinan lama. Penelitian sebelumnya menunjukkan adanya hubungan kepribadian dengan waktu persalinan. Tipe kepribadian ekstrover (tipe A) cenderung lebih rentan terhadap stres dibandingkan orang dengan tipe kepribadian introvert (tipe B). Penelitian ini bertujuan untuk mengetahui hubungan tipe kepribadian ekstrover dan variabel luar (pendidikan, ekonomi, usia ibu dan paritas) dengan persalinan kala II lama. Studi kasus kontrol dilakukan pada 156 ibu bersalin yang memenuhi kriteria inklusi pada tahun 2015 di Yogyakarta. Sampel kasus adalah 52 ibu dengan persalinan kala II lama dan kontrol adalah 104 ibu dengan persalinan kala II normal. Penelitian …

Impact Of Women’S Empowerment On Infant Mortality In Indonesia, Hanik Stiyaningsih, Febri Wicaksono

Kesmas

Secara umum, otonomi dan pemberdayaan perempuan menjadi salah satu faktor penting dalam pembangunan. Kurangnya otonomi dan pemberdayaan perempuan dapat menyebabkan hasil negatif pada kesehatan dan kematian anak. Belum terdapat penelitian terkini yang menganalisis hubungan antara pemberdayaan perempuan dan kematian bayi di Indonesia. Penelitian ini berusaha mengisi kekosongan tersebut dengan menelusuri pengaruh pemberdayaan perempuan terhadap kematian bayi di Indonesia. Sampel berjumlah 9.754 perempuan berusia 15-49 tahun yang terakhir melahirkan pada periode tahun 2007-2012 diambil dari Survei Demografi dan Kesehatan Indonesia 2012. Pemberdayaan perempuan diukur dengan menggunakan indeks komposit yang dibangun dari delapan indikator dari tiga dimensi pemberdayaan perempuan, yaitu partisipasi dalam …

Risk Factors Of Acute Respiratory Infections In Practice Area For Community Of Medical Students In Semarang, Siti Thomas Zulaikhah, Purwito Soegeng, Titiek Sumarawati

Kesmas

Infeki saluran pernapasan akut (ISPA) menempati urutan pertama dari 10 besar penyakit di Puskesmas Bangetayu dengan persentase terbanyak di Kelurahan Penggaron Lor. Keterampilan untuk mempelajari distribusi dan frekuensi penyakit serta faktor determinan yang memengaruhi manusia sangat diperlukan untuk menetapkan intervensi yang paling efektif untuk meningkatkan derajat kesehatan masyarakat. Perlu dilakukan penelitian untuk mengetahui faktor risiko yang paling dominan berhubungan dengan kejadian ISPA di lokasi praktik komunitas mahasiswa Fakultas Kedokteran Universitas Islam Sultan Agung Semarang. Penelitian ini menggunakan desain potong lintang dengan jumlah responden 100 orang dan sampel dikumpulkan dengan menggunakan stratified random sampling. Sepuluh variabel yang diteliti adalah faktor risiko …

Effects Of Multilevel Intervention In Workplace Health Promotion On Workers’ Metabolic Syndrome Components, Zahtamal Zahtamal, Wasilah Rochmah, Yayi Suryo Prabandari

Kesmas

Sekitar 10-30% orang Asia dewasa mengalami sindrom metabolik. Penelitian ini bertujuan untuk mengungkap efek Promosi Kesehatan di Tempat Kerja PKDTK dengan intervensi multilevel pada komponen/penanda pekerja yang menderita sindrom metabolik. Penelitian ini dilakukan pada tahun 2014-2015 dengan menggunakan desain quasi experimental dengan intervensi subjek secara multilevel di Indonesia. Program PKDTK untuk kelompok intervensi multilevel berupa kombinasi latihan fisik, diet, pendidikan kesehatan, dukungan sosial, dan advokasi salama 12 minggu. Program PKDTK untuk kelompok kontrol hanya pendidikan kesehatan. Instrumen penelitian seperti IPAQ, table food recall 24 jam, alat pengukuran fisik, dan laboratorium klinis. Analisis data menggunakan Marginal Homogeneity, paired sample t, Mc …

Controlling Factors That Potentially Against Transmission Of Dengue Hemorrhagic Fever At State Elementary Schools In Yogyakarta, Tri Baskoro Tunggul Satoto, Nur Alvira, Tri Wibawa, Ajib Diptyanusa

Kesmas

Sekolah dasar merupakan tempat yang dapat mengakibatkan peningkatan penyakit dengue pada anak karena faktor lingkungan, adanya potensi penularan, belum adanya system manajemen lingkungan yang baik dan beberapa upaya pengendalian yang tidak lagi efektif. Penelitian ini bertujuan untuk mengetahui faktor yang berpotensi terhadap penularan demam berdarah dengue bagi anak, sehingga sistem kewaspadaan dini dapat ditegakkan. Jenis penelitian ini adalah analitik dengan rancangan potong lintang. Penelitian dilaksanakan pada 91 sekolah dasar negeri di Kota Yogyakarta. Variabel yang diobservasi adalah serotype virus DEN, resistensi insektisida, kepadatan vektor,dan kondisi fisik sekolah. Analisis data menggunakan analisis deskriptif dan korelasi-regresi (a = 0.05). Hasil menunjukkan bahwa …

Rebon Shrimp Powder Addition Influence To Nutritional Values, Organoleptic Properties And Acceptance Of Supplementary Food By Children Aged 4-5 Years Old, Priyo Sulistiyono, Dewi Marhaeni Diah Herawati, Insi Farisa Desy Arya

Kesmas

Prevalensi gizi kurang dan stunting pada anak bawah lima tahun (balita) di Kota Cirebon masih cukup tinggi yaitu mencapai 13,9% dan 15,7%. Udang rebon (Acetes erythraeus) memiliki kandungan protein dan kalsium yang tinggi. Pengaruh penambahan udang rebon dalam makanan tambahan (bubur lemu dan bolu kukus) terhadap kualitas gizi diteliti. Penelitian ini bertujuan untuk mengetahui pengaruh bubuk udang rebon terhadap nilai gizi, sifat organoleptik dan daya terima. Uji laboratorium dan perangkat lunak Nutriservey digunakan untuk analisis nilai gizi bubuk udang rebon dan gizi makanan tambahan. Uji organoleptik menggunakan rancangan acak lengkap dengan empat perlakuan (bubuk udang rebon 0%, 5%, 10%, 15%) …

Paying It Forward: Training Doulas As A Form Of Reintegration And Support For Communities Of Color, Sandra E. Luna-Martinez

Master's Projects and Capstones

As part of the birth justice movement in Alameda County, Roots of Labor Birth Collective (RLBC) is committed to support, empower and care for birthing members of the community. RLBC works to empower people of color with education and tools to have healthy babies and positive birth experiences regardless of their: gender, size, sexuality, orientation, culture or family structure. Healthy families begin with healthy communities and with that in mind, RLBC decided to tackle two major public health issues at once: recidivism and poor birth outcomes in communities of color. Doula training is not just an intervention to improve birth …