Randy M. Page, Department of Health Sciences

1. Evaluation of how well the academic objectives of the proposal were met

Outcome 1: Students will develop research and presentation skills and gain confidence in their abilities. This project directed students to work on research conducted in Thailand focusing on adolescent body image and smoking. Students participated in research planning, collecting data and making sense of results, constructing data tables, translating research instruments, developing presentations, presenting findings at international conferences, and developing a manuscript for submission. A survey instrument was constructed to assess appearance-related social pressure, body weight satisfaction, and weight loss/maintenance behaviors in adolescents. Students worked with researchers in Thailand to translate the instrument from English to Thai, and through the collaboration of Chiang Mai University, the instrument was administered to 1500 students attending six high schools in Chiang Mai. Students also worked analyzing secondary data concerning body weight issues and cigarette smoking among Thai youth to develop presentations that were made at international conferences. Students read relevant research, conducted literature searches, and provided input in the development of research activities. Students also worked to prepare IRB proposals for this research. To date this work has resulted in seven presentations at international conferences and one submitted article to a refereed journal.

Outcome 2: Students will gain a deep understanding public health problems impacting Southeast Asia through academic study and first-hand experience. Four students participated in a series of seminars conducted in the 2012 Fall Semester that were held every other week. Each student investigated and researched three separate topics concerning specific public health and/or cultural issues of importance to Southeast Asia. Students presented their findings on these topics and a discussion of each topic was ensued. It was very helpful that one of the students (Wichittra Wongwiraphab) was Thai and she was able to provide great insight to our discussions. Topics of our discussions and seminars included: the HIV/AIDS and other infectious disease threats in Southeast Asia, migration and border issues in Southeast Asia, economic and political transformation, the nutrition and epidemiologic transition in South East Asia (including the rising epidemic of obesity in the region; political and geographical stability in the region; religion; child and adolescent health issues; childhood injury in South East Asia; and global youth risk behavior studies.

These seminars prepared students for a study trip to Thailand conducted in November 2012. This provided a profound experiential learning experience for each of the participating students. This study trip allowed students to see pressing public health problems in Thailand up close and gave numerous opportunities for interacting with Thai people who are impacted by these specific problems and also public health professionals who are working to prevent and ameliorate them. In addition to several cultural activities, the students participated in several activities that are briefly noted here.

• We visited the Research Institute for Health Sciences (RIHES) at Chiang Mai University. The visit was hosted by the Director of the RIHES, Dr. Suwat Chariyalertsak, who is an internationally noted HIV research specialist. He gave the students a formal presentation described the health care situation in Thailand and many priority public health problems that his institute is active in addressing through basic and applied research. His presentation provided: an overview of the health care system in Thailand; the emergence of the HIV epidemic in Northern Thailand; research activities that he and his institute are currently engaged; and discussion of current health issues in Thailand including HIV/AIDS prevention and control, malaria, dengue, substance abuse, pollution/environmental health, and nutritional problems/concerns.

• We visited a local community health center about an hour’s drive from Chiang Mai. The director and members of his staff gave prepared presentations outlining the services provided by the center and challenges faced in trying to meet public health demands. We received a tour of the facilities and had the opportunity to interact with these staff. The students were able to observe and note that the focus was largely on traditional medicine practices such as the use of herbs, acupuncture, and massage. These were used in combination with “Western” or “scientific” approaches more familiar to the students. We observed several patients receiving treatment during our visit (privacy is clearly not a concern in this hospital unlike in the U.S.). Each student also had the opportunity to experience traditional Thai massage at this hospital.

• We had many visits with Professor Jiraporn Suwanteerangkul who teaches health promotion at Chiang Mai University. Jiraporn discussed health promotion efforts in northern Thailand and how her department (Department of Community Medicine) trains physicians and other health professionals in the area of health promotion. Jiraporn arranged for several cultural activities for the students while they were in Chiang Mai including the Khantoke dinner and cultural show, experiencing Thai cuisine and treats, elephant rides, and visits to several wats (temples).

• In Bangkok, we visited the Thai Health Promotion Foundation. This organization is funded from revenue derived from a tax that is placed on the sale of alcoholic beverages. This visit was of high interest to the students because many of them are studying health promotion at BYU. They learned about specific efforts in Thailand addressing priority health problems using health promotion strategies such as health education, media campaigns, public policy, and social participation. The foundation’s staff explained how health promotion projects address five identified priority problems in Thailand: high blood pressure, alcohol consumption, smoking, riding motorcycles without helmets, and unsafe sex.

• We visited USAMC-AFRIMS (U.S. Army Medical Research and Materials Command- Armed Forces Research Institute of Medical Sciences) in Bangkok. This organization in Thailand conducts clinical, epidemiological and laboratory studies that stress infectious threats of military importance including HIV/AIDS, malaria, scrub typhus, diarrheal diseases, and sexual transmitted diseases. The AFRIMS staff is composed of over 400 scientific, technical, administrative, and support personnel. It brings together U.S. officers, enlisted personnel, Thai Foreign Service Nationals, numerous contractors, and visiting scientists. Our host, Dr. Robert Gibbons who is Chief of the Department of Virology, explained the many research activities currently underway at AFRIMS and infectious disease threats of importance in Thailand and Southeast Asia.

• We visited Chulalongkorn University to attend a Ph.D. class in health education. Our host was Dr. Aimutcha Wattanaburanon who is Professor of Health Education and we gave a presentation to the class describing the adolescent health research we were conducting among Thai adolescents. This class session provided an excellent forum for the BYU students and Thai students to interact about health issues. The Thai students hosted our group to lunch. This exchange will foster further collaboration between BYU and Chulalongkorn University in the future.

Students participating in the study trip were required to write a final report in which they detailed what they learned through this experience.

Outcome 3: This program will solidify professional relationships between BYU, Southeast Asian Universities, and other public health agencies in Thailand. The study trip and research described above strengthened the relationship between the faculty mentor and Chiang Mai University. Professor Jiraporn Suwanteerangkul arranged and organized data collection in high schools and assisted in survey translation. She is a co-author on all the presentations and submitted manuscript. She has invited me to conduct further research in Chiang Mai and offered her assistance in future studies. This project also facilitated the opportunity to interact with Dr. Suwat Chariyalertsak. He is Director of the Research Institute for Health Sciences and he expressed his interest in further opportunities for collaboration involving BYU and the institute. The Thai Health Promotion Foundation has enjoyed hosting BYU students that I have brought for visits in the past and again with this group of students in 2012. They invite me to bring additional students for visits in the future and stated that they would welcome BYU MPH students as interns. Dr. Aimutcha Wattanaburanon (Chulalongkorn University) would like to collaborate in research studies focusing on adolescent health issues. She has also invited me to visit her university again and we are looking at opportunities for Thai students to visit the U.S. for further educational opportunities.

Outcome 4: Integrations of spiritual and secular learning. The nature of the issues that were explored in this project provided for experiences that helped students to integrate spiritual and secular understanding. For example, students became acquainted with principles and characteristics of the Buddhist religion through the course of the project and had the opportunity to observe religious practices in Thailand. Students also had the opportunity to interact with members of the LDS church in Thailand and learn about the challenges facing members living in a Buddhist nation. They also had the opportunity to interact with LDS missionaries serving in Thailand and discuss the challenges and opportunities they face in spreading the gospel to this part of the world.

2. Evaluation of the mentoring environment

The mentoring environment for this project consisted of: seminars during the 2012 Fall Semester to examine and discuss public health and cultural issues of concern in Southeast Asia; work sessions to plan and carry out the research activities; a study trip to Thailand; and work sessions to analyze data and prepare presentations/manuscripts. The students also received considerable mentoring and learning experiences provided by public health professionals in Thailand and attending professional conferences in Thailand. The study trip was timed to allow students to participate in the International Council on Women’s Health Issues Conference held in Bangkok. Students attended a wide range of sessions exploring women’s health issues at the conference and made research presentations. An additional student was able to attend and present research at the World Conference on Health Promotion held in Pattaya, Thailand, August 2013.

The seminars allowed students to examine key public health issues in depth and research activities provided experiential learning in research and survey design, data analysis, data reporting, and presentation skills. The opportunity to partner with a faculty mentor on research and on the creation of scholarly products increases opportunities for these students in graduate school and/or their careers in public health. The faculty mentor spent many hours working with students in analyzing the data collected in this project and discussing findings. Another level of mentoring was provided by Wichittra Wongwiraphab. Wichittra is Thai and she taught the other students several valuable insights about Thai culture and Thai people. Her familiarity with Thailand was a valuable addition to the project and greatly facilitated our travel. We were also able to visit her family and LDS ward meetings and activities in Bangkok, providing a wonderful cross-cultural exchange for the BYU students. The students reported that these interactions were a highlight of the study trip and their participation in the project.

3. List of students who participated and what academic deliverable they have produced or it is anticipated they will produce

A total of 6 students participated in aspects of this project

• Wichittra Wongwiraphab: native Thai; student coordinator for study team who assisted faculty mentor in planning for seminars and work sessions; assisted with logistical and organization of travel to Thailand; translation of survey instrument from English to Thai; provided Thai cultural training to undergraduate study trip participants; worked as language interpreter during study trip; seminar and study trip participant. Deliverables – survey translation, co-author on submitted research manuscript, co-presenter at international conference; presenter at Ph.D. class at Chulalongkorn University; final written report; seminar presentations.

• Kendra Ashcraft: seminar and study trip participant, data analysis and presentation/manuscript development; gave oral presentation at International Council on Women’s Health Conference. Deliverables –final written report, presentations at international conferences, co-author on submitted research manuscript, seminar presentations.

• Catherine Christiansen and Michelle Steele: seminar and study trip participants; data analysis and presentation; preparing and delivering conference presentations. Deliverables–final written report, presentations at international conferences, seminar presentations.

• Chelsea Sorensen: survey instrument development, IRB proposal development and submission, data collection, data analysis, presentation development, presentation at international conference. Deliverables— collected data, presentation at international conference.

• Jumin Chae: data analysis and poster presentation development. Deliverables—posters.

4. Description of the results/findings of the project

The research generated from this project, to date, has resulted in seven presentations at international conferences and one submitted manuscript. Students prepared and delivered two presentations at the International Council on Women’s Health Issues Conference in Bangkok, Thailand (November 2012). These presentation were “Body image and weight concerns in Thai adolescent females: Cross-cultural and gender differences” and “Perceived social benefits of smoking among adolescent girls in Thailand, Argentina, United Arab Emirates, and Czech Republic.” Both of these were oral presentations; Kendra Ashcraft gave the oral delivery for the body image presentation and the faculty mentor gave the oral delivery for the smoking study. Students also prepared 5 additional poster presentations for presentation at the World Congress on Children and Youth Health Behaviors, World Conference on Health Promotion, Society of Research on Adolescence, and Society of Cross-Cultural Research. These are listed here:

• Appearance-related social pressure in Thai adolescents. Presented at International Union of Health Promotion and Education World Conference on Health Promotion. Pattaya, Thailand, August 2013.

• Cross-cultural analysis of Thai youth smoking, smoking susceptibility, and social norm perceptions. Presented at World Congress on Children and Youth Health Behaviors/National Congress on Health Education. Viseu, Portugal, May 2013.

• Body weight concern and pressure to maintain thin body shape among Thai adolescent females. Presented at World Congress on Children and Youth Health Behaviors/National Congress on Health Education. Viseu, Portugal, May 2013.

• Thai Adolescent Pressure to be Thin and Attractive: Teasing, Encouragement, Exclusion, Norms, and Modeling from Peers and Parents. To be presented at Society for Research on Adolescence Annual Meeting, Austin, Texas, March 2014.

• Social Pressures of Thai Adolescents to be Thin. To be presented at Society for Cross-Cultural Research Annual Meeting, Charleston, SC, February 2014.l

One manuscript from this project has been submitted to a journal. The article “Body image and weight concerns in Thai adolescents: Cross-cultural and gender differences” was submitted to Transcultural Psychiatry and is currently in review. Kendra Ashcraft and Wichittra Wongwiraphab are co-authors on the paper. Two additional manuscripts from this research are currently in preparation; one focuses on the appearance-related social pressure of Thai adolescents, and another paper on perceived social benefits of smoking among Thai youth.

5. Description of how the budget was spent