Dr. Randy Page, Department of Health Sciences

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

Outcome 1: Students will gain a deep understanding of international public health through the opportunity to study in-depth the public health experience of a specific country undergoing rapid social and economic transition (Thailand).

This outcome was partially achieved through a series of seminars conducted in the 2009 Fall Semester. Four students and I met every other week during the semester and discussed the following topics: the HIV/AIDS epidemic in Thailand, avian flu in South East Asia, street children in Thailand, migration issues in Northern Thailand, economic and political transformation in Thailand, Tsunami response and recovery in Thailand, the nutrition and epidemiologic transition in South East Asia, sex trafficking and sex tourism in Thailand, Thailand’s political and geographical neighbors and political stability in the region; religion in Thailand; child and adolescent health issues in Thailand; childhood injury in South East Asia; the global epidemic of obesity; heroin trafficking in Southeast Asia, and global youth risk behavior studies. Each student investigated and researched three separate topics concerning specific public health issues in Thailand and South East Asia and subsequently gave presentations and led discussions with our group on those topics.

This outcome was further advanced during a study trip to Thailand conducted from January 22 through February 8, 2010. 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 visit 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.
• Dr. Chariyalertsak also facilitated a visit to a local village to meet with a Buddhist monk who is a strong advocate of public health. The students learned how he works to reduce stigma for HIV positive community members and works along with RIHES to provide community-based interventions to prevent HIV transmission. It was interesting for the students to learn how public health campaigns and interventions can be enhanced in Thailand when respected Buddhist monks become involved. They learned how involvement by monks increases cultural acceptance of public health programs and greatens the opportunity for success.
• We visited a rural community hospital about an hour’s drive from Chiang Mai, where the director of the hospital was our host. The director gave us an overview of the mission of the hospital, explained the services provided, discussed how health care is delivered in community hospitals in Thailand, and provided us a tour of the hospital’s facilities. 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 spent an afternoon in Chiang Mai with the AIDS ministry of the Church of Christ in Thailand (CCT). This organization is known as CAM which is an acronym for CCT AIDS Ministry. The purpose of CAM is to work alongside local churches and communities as they work to respond to the needs of people living with HIV/AIDS. The students learned about the five areas of services that the AIDS ministry provides. CAM supports and encourages churches in reaching out to people within their community who are living with HIV/AIDS. They provide workshops and educational events for people interested in learning more about caring for people living with HIV/AIDS. They provide volunteers with training to support individuals who provide care for individuals living with HIV/AIDS. These volunteers provide support for their neighbors living with HIV/AIDS and those with other needs. The students visited with a man and a woman with HIV/AIDS and gained appreciation for what life is like for people in Thailand with this health condition.
• 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).
• We traveled to the Golden Triangle region where Thailand, Burma (Myanmar), and Laos come together at the northern border. This area historically has been known for extensive illicit opium-producing. We spent an afternoon visiting the opium museum which was established by the King of Thailand, and learned about the King’s efforts to transform work opportunities for people from producing opium to other crops and vocational efforts. This project has been successful and has led to decreasing opium production in the region.
• 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 she asked me to present to her class about public health concerns in the United States. 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.
• We visit to a Thai high school which was one of the schools involved in our research project. During the visit, our hosts explained the Thai educational system and provided a tour of facilities. The BYU students interacted with several of the high school students and teachers.
• We participated in several cultural experiences in Bangkok including visiting theAncient City and Emperor’s Palace, taking a boat ride through canals (klongs), visiting a floating market, and spending time at Lumpini Park. The students were surprised to see how Lumpini Park offers numerous health promotion/fitness activities for Bangkok’s residents such as jogging/walking trails, outdoor aerobics classes, and outdoor gyms with weight machines.
• Upon returning from Thailand, students gave an oral presentation on their study trip to 90 students in two sections of HLTH 330. They also wrote a reflection paper about their experience.

Outcome 2: Students will develop valuable research and presentation skills and gain confidence in their abilities.

This outcome was achieved through participation in a research project that was initiated and developed for this purpose. The research project focused on adolescent smoking. A survey instrument was constructed to assess social normative perceptions and cognitive attributions about smoking. The survey instrument was translated from English to Thai, and through the collaboration of Chiang Mai University, was administered to 2,619 students attending four high schools in Chiang Mai. Under my guidance as faculty mentor, students helped analyze the data and make sense of results, constructed data tables, developed presentations and manuscripts, presented the findings at international conferences, and assisted in writing manuscripts. To date this work has resulted in one accepted manuscript in a refeered journal, two submitted manuscripts to refeered journals, and three presentations at international conferences. Data has also been analyzed for an additional manuscript to be written in the spring or summer of 2011. This research will also be part of a presentation anticipated to be presented at the World Conference on Tobacco OR Health in Singapore in March, 2012 and the Asia Pacific Consortium of Public Health conference in Seoul, Korea in October 2011.

Outcome 3: This program will solidify professional relationships between BYU, Chiang Mai University, and other public health agencies in Thailand.

The study trip and research project 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 manuscripts and presentations and has invited me to conduct further research in Chiang Mai and offered her assistance in future studies. During the course of the project, Dr. Suwat Chariyalertsak visited Provo and discussed further opportunities for collaboration involving the Research Institute for Health Sciences. The Thai Health Promotion Foundation has invited 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.

Evaluation of the mentoring environment

The mentoring environment for this project consisted of: seminars during the 2009 Fall Semester to examine and discuss public health and cultural issues of concern in Thailand; work sessions to plan and carry out the survey research project; a study trip to Thailand; work sessions following the study trip to analyze data and prepare presentations/manuscripts; and travel to an international conference in Bath, England. The students also received considerable mentoring and learning experiences provided by public health professionals in Thailand.

This mentoring environment provided a tremendous opportunity for the involved students. The seminars allowed students to examine key public health issues in depth and the research project provided experiential learning in research and survey design, data analysis, data reporting, and presentation skills. The presentation that they gave to other BYU students also provided an additional experiential learning experience. The opportunity to partner with a faculty mentor on a research project and on the creation of scholarly products will increase the opportunities for these students in graduate school and/or their careers in public health.

Another level of mentoring was provided by two of the students involved in the project. Kami Knudson is a returned missionary who served in Thailand. She taught the other students about Thai culture and taught Thai phrases that were helpful during the study trip. Her familiarity with Thailand was an valuable addition to the project and greatly facilitated our travel. Another student, Arielle Sloan, has fairly advanced research skills for an undergraduate student. She provided mentoring to students concerning data analysis and the research process. In particular, she provided in-depth mentoring of basic research principles and concepts to Jennifer Kironde, who before this project, had no previous research experience.

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

A total of 8 students participated in this aspects of this project:

• Kami Knudson: returned missionary proficient in Thai language; 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. Deliverables – survey translation, final written report.
• Rebecca Ricks and Maria Kemeny: seminar and study trip participants, data analysis and presentation/manuscript development. Deliverables –final written report, presentation in undergraduate HLTH 330 courses, poster developed for international conference, manuscript submitted as co-authors.
• Morgan Stoker and Lisa Hammond: seminar and study trip participants. Deliverables–final written report, presentation in undergraduate HLTH 330 courses.
• Arielle Sloan and Jennifer Kironde: data analysis and presentation/manuscript development, presentation at international conference. Deliverables— accepted manuscript, presentation at international conference.
• Lynn Philips: data analysis and presentation/manuscript development. Deliverables— manuscript submitted as co-author, accepted presentation at international conference.

Description of the results/findings of the project

The research project resulted in one accepted manuscript in Social Development. The title of the article which will appear in the journal in 2011 is “Thai adolescents’ normative beliefs of the popularity of smoking among peers, adults, the successful and elite, and parents.” Arielle Sloan and Jennifer Kironde who were student participants in this project worked on this research and are co-authors. These two students also traveled with me to the Society of Nicotine and Tobacco Research Conference in Bath, England in September 2010 to present this research in a presentation entitled “Social normative beliefs regarding smoking among Thai adolescents.” At the same conference, I gave another presentation from the data collected in Thailand with two other students who participated in the project, Rebecca Ricks and Maria Kemeny. This presentation was entitled “Meanings of smoking and smoking media literacy in smoking initiation of Thai adolescents.” This paper has been developed into a manuscript and submitted to International Journal of Health Education.

Lynn Philipps and Maria Kemeny have also been instrumental in the development of a third paper “Cross-cultural analysis of cognitive attributions of smoking in Thai and Korean adolescents” that I will present February 17, 2011 at the Society for Cross-Cultural Research in Charleston, South Carolina. With the help of these students, this presentation has been developed into a manuscript and has been submitted to Journal of School Health. An additional manuscript with these students is in preparation examining the association of smoking media literacy and smoking in Thai adolescent. Thesestudents will be involved in data analysis and manuscript preparation. This manuscript will be completed in the spring or summer of 2011 and submitted to a professional journal.
I have included reflection papers written by two of the student participants with this report (Rebecca Ricks and Arielle Sloan). These papers reflect the manner in which the study trip and research project impacted students.

Description of how the budget was spent

International airfare to/from Thailand – 4 students plus faculty mentor	$5,356.36
Study trip and research expenses – lodging, in-country flights, taxis, cultural activities. Also includes research expenses for survey duplication, data collection and data entry conducted by Chiang Mai University: January 22-Feb 8, 2010	$5,683.39
International airfare to/from England to present research at Society of Nicotine and Tobacco Research Conference – 2 students plus faculty mentor	$3,389.10
Conference expenses , Society of Nicotine and Tobacco Research Conference – lodging, car rental, train, taxi, conference registrations: Sept 5-12, 2010	$3,308.72
Society for Cross-Cultural Research Conference in Charleston, S.C. – airfare, lodging, registration for faculty mentor: prepaid for travel Feb 16-20, 2011	$1,508.67
Total	$19,246.24