HSC 4700 Portfolio

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Occupational Career Prep Portfolio
Alissa Piazza
HSC 4700 Senior Seminar Sec 02
Professor Gem Le
Fall Quarter 2016

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Contents Page
Section/Item Page
Portfolio Page………………………………………………………………......1
Contents Page…………………………………………………………………..2
Introduction…………………………………………………………………….3
A. Technical Report
Case Scenario Descriptions……………………………………………………4
Three Case Scenarios……………………………………………………….....5
Journal Article Summary Description…………………………………………9
Three Summaries of Articles……………………………………………….....10
Names of Five Journals…………………………………………………….....14
Three Samples of Previous Work…………………………………………….15
B. Career Search
Job Ad…………………………………………………………………………43
Cover Letter……………………………………………………………………45
Resume………………………………………………………………………...46
Personal Essay…………………………………………………………………47
C. System Analysis
Description of Chart……………………………………………………………50
Organization Chart……………………………………………………………..51
D. Legacy Role Paper
Legacy Role Paper….......………………………………………………………53
E. Alumni Role Paper
Alumni Role Paper……………………………………………………………..55
Proof of Attendance……………………………………………………………56
F. Statement of My Philosophy
My Statement…………………………………………………………………..59
G. NIH Office of Extramural Research
Human Subjects Protection Training Certificate……………………………….61

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Introduction
This portfolio is a demonstration of the work I completed for my Senior Seminar class as well as
a few samples of work from other upper division classes. Health Science is a diverse major that
prepares students for many different positions. Students are taught to view situations objectively
and ethically. Contained in this portfolio are case studies, journal article summaries, review of a
system analysis chart, several papers and a certificate of training on Human Subjects Protection.
Throughout my undergraduate career I have been able to build on my learning experiences and
broaden the way I think and process information. My ability to think critically and manage
multiple projects simultaneously while staying organized is a direct result of the effort I’ve put
into my studies. I look forward to what is ahead and am eager to apply the skills I have obtained
to the work force. There is not a specific field I want to go into but I know that I want to work
with people. I work well with teams and collaborate well with others.

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Case Scenario Description:
The objective of this assignment was to work out each case study by generating responses
appropriate in each case by creaking key points. Some case studies end up with a question, in
which case I was to answer the question as best I could. Many of these cases required me to think
back and use some of the skills I gained in the many HSC classes I took previously, and come up
with the key ideas required.

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CS#1 You manage a facility which deals with expecting and post-partum mothers. You want to
ensure that all expectant mothers who come to the facility have access to prenatal care. How will
you ensure they have the knowledge, resources, information and access to prenatal care?
1) Client Advocate: It is important to meet with every client and establish a connection. If the
client feels like someone is willing to take the time to engage with them, the client will be
more likely to keep in touch and be assertive about their own care. Knowing they are not
alone is crucial to the client’s care. If they know someone is looking out for their best
interests, they will be more driven to do what is best for themselves.
2) Home Life: It is important to assess a client’s home life and know if they are living in a safe
environment. If they feel threatened or in danger at home any help, resources and care they
receive outside the home would not be able to be continued in a conductive manner.
Additionally, a woman involved in domestic violence or other household dispute is most
concerned with her issue at hand and most likely would not be taking steps to maintaining
her health because she would be most concerned about her safety.
3) Access to Information: Make sure that all information provided to clients is easily
accessible and to the point. Even if all the information provided is beneficial, a client may
choose not to read it if it looks too lengthy. Colorful brochures with pictures are often a good
way to organize and display information on prenatal care, pregnancy or any other valuable
resources. Conducting education sessions that involve the interaction of clients would also be
a good way to pass on valuable information.
4) Easily Available Resources: Resources should be readily available to clients based on their
need. The best of resources are of no use if they are not easily accessible by the client. Any
partnerships and connections with other facilities should treat clients kindly and respectfully.
Resources can include brochures from other facilities that can accommodate clients’ needs
and should be given to clients after their initial consultation with their client advocate.
5) Appropriate Language: All documents should be written as to be understood by the
common person. Multiple translations should be available for those who need it. Translators
should also be available for those whose primary language is not English. This is crucial
because if a client cannot communicate with those who are trying to help they will not come
back and their health could suffer. All clients must feel comfortable. Understanding and
respecting the customs of different cultures is crucial as well.
6) Follow Up: Follow up with clients is very important. It lets the clients know you are thinking
of them as well as encourages them to keep up with their prenatal or after care. This is the
role of the client advocate. After they build a connection with their client, they need to
continue that relationship to ensure their client is well informed and continuing their care.
Without follow up a client who is postpartum, and may be feeling alone, will likely cease to
reach out and be an advocate for their own health.
7) Access to Transportation: Clients must have access to the facility and any near-by places
that are involved with their care. Providing clients with great resources are of no use if they
do not have access to them. It is important for the client advocates to ask clients about
transportation needs. If possible, rides can be set up with family members or friends. If
family or friends are not available, the facility should provide a shuttle service to and from
our facility and other local clinics.

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CS#2 As the health educator on campus, you know that students procrastinate in accessing the
resources they need on campus like academic advising, career planning, attending instructor
office hours, buying requited text books, etc. What strategies would you develop to assist
students succeed in college?
1) Raise Student Awareness: Often times students neglect to partake in services that would be
helpful to them because they are not aware they exist. Tabling on campus is a great way to
connect with students and let them know what services are available to them. Posting vibrant
posters around campus can also be a constructive way to raise awareness. Posting
advertisements on social media would be another great way to reach out to students,
especially those who may be taking online classes.
2) Get Connected: Connecting with students through social media is crucial. Many young adults
spend massive amounts of time browsing through social media so let’s take that advantage.
Creating facebook and Instagram pages allows students to stay up to date on upcoming events
as well as connect with other students. Additionally, creating an application that allows
students to organize their academic calendar could be a great way to break past organizational
barriers.
3) Give Incentives: Even if students are aware of the services offered to them, they may not take
advantage of them if they aren’t given a reason to. Students need to understand why they
would be benefited by something and the consequences of not partaking in it in order to
proceed. For example, why should a student spend hundreds of dollars on textbooks he/she
won’t open? If a student will truly benefit from purchasing the text material, the instructor
needs to express the need, benefit and consequence of not doing so.
4) Remove Barriers: Recognizing the barriers students may have to accessing student services
is an important step to furthering students’ academic success. Once the barriers are identified,
how can they be removed? Different barriers could include, lack of time, organization or
motivation. If a student consistently fails to make it to their professor’s office hours because
they can’t get out of bed in the morning, perhaps hosting an educational on the importance of
sleep and time management will cure the student’s inability to get up and help them in
multiple areas of their academic career. Professors could also set up multiple office hours in
order to make it more available to their students.
5) Motivational Tools: Raising students’ motivation is just as important as raising their
awareness. When a student is motivated to succeed they will most likely do anything they can
to make it happen. Peers can also play a large role when it comes to motivation. Often times
we become similar to those we surround ourselves by. If we can motivate the majority of the
student body, the slackers will likely be influenced by their fellow classmates.
6) Positive Reward System: A great way to motivate students is to offer a reward. Provide food
at a career planning seminar. Ask professors to offer extra credit if their students attend office
hours. Give them a discount code to purchase textbooks when they attend an academic
advising session.
7) Listen to Students: Take surveys and find out directly from students what they want and
what they would find beneficial. Surveys can be in paper and electronic form. Once enough
data is collected, review the findings and make the appropriate changes. Students can earn a
gift card to the student store for participating in the survey.

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CS#3 To ensure residents in your neighborhood save water due to the existing California
drought, what strategies would you recommend?
1) Meatless Mondays: The majority of our water use goes to agriculture and livestock. It takes
660 gallons of water to produce a 1/3-pound beef hamburger patty. This is an insane amount
of water! If every Californian gave up meat just one day a week, the amount of water saved
from the processing of meat would be quite substantial.
2) Shorten Showers: If anyone is like me they probably enjoy taking a nice, long, warm shower.
However, with the prevalence of the drought, cutting back on shower time is crucial. Timing
the shower or at least turning the water off while “soaping up” or shaving, can reduce a good
amount of the water used during a shower.
3) Turn off Faucet: Do not leave the water running while you are brushing your teeth. Allow
enough water to rinse the tooth brush but don’t leave the water running while actually
brushing teeth. The same goes for when you wash your face and hands. Use just enough water
to moisten and clean your skin but do not leave the water running while you scrub.
4) Save Rinse Water: It is important to rinse fruits and vegetables before consuming them,
however, the water used to rinse them can be recycled. Place a basin under the fruits and
veggies while you rinse them then use the water to water other plants or flush the toilet. The
same can be done when draining foods such as pasta.
5) Save Shower Water: Shower water can also be recycled, similarly to excess rinse water.
Place a bucket or two in the shower. This will catch a significant amount of the water you use
during showering. Since this water will likely be soapy it shouldn’t be used to water plants but
it can be used to flush the toilet, which saves water from the toilet tank.
6) Lose the Lawn: Watering a lawn uses hundreds of gallons of water a day. If you can’t give
up a green lawn, replacing live grass with fake grass could be an option. Additional
landscaping alternatives could include rocks or tanbark, or succulent plants that thrive in a
drought. Letting the lawn go yellow could also serve as a sign of compliance to conservation
and empower your neighbors to do the same.
7) Use Car Wash: Don’t wash your car at home, instead, take it to a car wash. Many car washes
use substantially less water than the amount you would use at home. Some car wash facilities
even use recycled water.
8) Don’t Flush: The saying “if it’s yellow, let it mellow” exists for a reason. Cutting back on the
amount of times the toilet is flushed can save a substantial amount of water. The toilet is
actually one of the most water-intensive fixtures in the house.
9) Fix Leaks: Countless amounts of water can be wasted from leaky faucets. If you can’t do it
yourself recruit a friend or hire a plumber to fix it. This will make all the difference when it
comes to saving water. Fixing leaky faucets is probably one of the simplest forms of water
conservation as well.
10) Don’t Run Appliances: Don’t run the dishwasher or washing machine unless its full.
Running an incomplete load will use just as much water as a full one and clean less items. It’s
important to be efficient in this area. Also, if you are hand washing dishes, fill up the sink
with water instead of letting it run the whole time you are scrubbing.

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Journal Articles Summary Description:
For this assignment I was asked to choose a scholarly journal article and summarize the main
ideas. The purpose of these summaries was to read, understand and then paraphrase the facts,
statements and ideas in a way that demonstrated I comprehended/understood the purpose of the
article and points the author conveyed. I was not to contribute my own ideas in this assignment.

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Journal Article Summary #1
TITLE: Exploring young people’s beliefs and images about sun safety
Queensland is the Australian state with the highest rates of melanoma. Participants
between the ages of 12 and 20 from different geographic areas were separated into 22 focus
groups and asked various questions to better understand young peoples’ low levels of sun
protection behavior. The purpose of the study was to discover more effective methods for
promoting sun safety behavior among this age group. In order to accomplish this goal, the
authors focused on four main research questions, “What do young people think are the
advantages and disadvantages of different types of sun protection behaviors? Who do young
people think are the individuals or groups of people who would approve and disapprove of sun
protection behaviors? What are the barriers that young people think prevent sun protection
behaviors and the motivators that encourage sun protection behaviors? [And lastly] How do
young people describe the characteristics of people who do and do not have a tan?”
When it came to the advantages and disadvantages of sun protection, the majority of
participants focused on the disadvantages. Sunscreen has to be reapplied continually and is time
consuming, long sleeved clothing is hot and wearing hats can be unfashionable. Shade was
brought up as an alternative to but is not always available. The authors concluded that the
disadvantages of practicing sun safety among young people are that it’s not appropriate for some
environments, it’s uncomfortable and can be unfashionable.
Among the various individuals and groups of people who approve and disapprove of sun
protection behaviors, parents and other family members were said to provide the highest support
for sun safety behaviors. Fathers, on the other hand, along with friends, peers and siblings, were
said to most likely disapprove of sun protection behavior. The authors note that young people
also look up greatly to celebrities and they can be major representations of whether it’s
fashionable to be tan or to practice sun safety behavior.
The authors stated that the two key barriers to practicing sun safety among young people
was forgetfulness and being busy. Other barriers include, “sun protection being unavailable or
too expensive, laziness, and people thinking that they won’t be out in the sun”. Based on this, the
authors concluded that having less expensive sun care products, providing sunscreen stations at
the beach/school/work, as well as creating more fashionable sun hats and protective clothing
would be good factors to promote sun safety behaviors.
The last main point the authors focused on was young peoples’ opinion of tanned and
pale people. Participants seemed to favor a tan person to a pale person. Although a pale person
was thought of as more intelligent, they were deemed less cool, unhealthy and shy. The authors
believe that “it may be beneficial to focus more on the negative perceptions of people who
deliberately tan and the positive perceptions of people without a tan. Lastly, the authors also
think that focusing on the idea that family, friends/peers and celebrities promote sun safety
behavior would be a good strategy to increasing a positive opinion of sun safety among young
people.

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TITLE: The Role of Spirituality in Health and Mental Health
Spirituality and religion are an important factor to many cultures and individuals. The
authors write that, “According to the Gallup Poll, 58% of individuals in the United States
identify as Protestant, 26% as Catholic, and 2% as Jewish… only 6% of the general population
does not claim any religious preference”. Despite these statistics, many health care professionals
are not trained to take patient’s religious and spiritual preferences into consideration when
providing care. This article discusses the importance of spirituality and how it plays a role in
health outcomes including: cardiovascular health, heath promotion and well-being, cancer, and
coping methods. The authors define spirituality as “the beliefs and practices that develop based
on personal values and ideology of the meaning and purpose of life”. Western medicine focuses
on measuring and observing phenomena’s using empiricism and rationalism. Since spirituality is
an intangible concept healthcare professionals are taught to remain objective and distant.
However, the authors state that it is important to address issues of spirituality and religion
especially when treating mental health conditions. “Studies have shown that physicians regularly
underestimate the degree to which their patients would like their concerns regarding spiritual or
religious issues addressed”.
Prayer is one of the most frequently used forms of alternative and complementary
medicine. Studies were done on the outcome of patients admitted to coronary care units who
were part of an intercessory prayer group. “The authors of the first study found that those who
were subjects of an intercessory prayer group required less ventilator assistance, antibiotics, and
diuretics than the control group; researchers in the second study determined that those who had
been recipients of prayer had significantly lower CCU course scores”. The authors suggest that
the most beneficial forms of prayer, when practiced by an individual, are the Ave Maria Prayer
and mantras because they “slow respiration to almost exactly six respirations per minute”.
Religion also seems to have an effect on health related behaviors. “In one study
conducted with 211 African American college students, researchers found that students with pro-
religious, intrinsic, or extrinsic religious orientation were more likely to engage in health
promoting behaviors, including eating well, reporting symptoms to a physician, and using stress
management techniques”. The authors state that when compared with those who were less
religious, the more religiously involved were less vulnerable to death. “In a longitudinal study
following adults with cancer for over 30 years, cancer mortality was found to be lower for those
who attend church more frequently when age and gender were taken into account”. Patients with
other chronic illnesses such as HIV and AIDs seemed to benefit from religious practices as well,
especially when health care providers promoted hope and created a sense of empowerment to
address spiritual issues. According to the authors, women diagnosed with cancer who practiced
spirituality were able to find meaning in their situation as well as a will to live.
When people experience health problems it can be common for them to turn to religiosity
or spirituality as a means of coping. The authors define three different types of religious coping:
self-directed coping, collaborative religious coping and deferred religious coping. Collaborative
coping, “the utilization of strategies within oneself and God or higher power(s)”, yields the
greatest benefit. In conclusion, the authors suggest that practitioners need to consider the impact
that spirituality and religion have on health and mental health and must be educated and sensitive
to the subject.

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Circumcision – A Surgical Strategy for HIV Prevention in Africa
HIV is a prevalent problem among men in Africa and researchers are saying that male
circumcision could decrease the rate of HIV. “Recent studies have shown that circumcision
reduces infection rates by 50 to 60% among heterosexual African American men. Experts
estimate that more than 3 million lives could be saved in the sub-Saharan Africa alone if the
procedure becomes widely used”. Scientists believe that the removal of the foreskin is beneficial
to preventing HIV because it removes the potential breeding ground for bacteria. “The foreskin
acts as a reservoir for HIV-containing secretions, increasing the contact time between the virus
and target cells lining the foreskin’s inner mucosa”. Multiple clinical studies were stopped early
due to overwhelming positive results between the prevalence of circumcision and decreased
HIV.
Among the positive results, only a few experienced complications with circumcision.
Doctors say that with proper training, complications should be close to extinct. “Adequate
training is essential since complication rates ranged from 1.7 to 3.6% among HIV-negative men
in the trials (as compared with rates of 0.2 to 2.0% associated with infant circumcision in the
United States) … Circumcision can be performed safely, with relatively few complications,
anywhere in the world, if clinicians are trained properly”. Of those how did experience
complications, many were minor but some bigger complications were reported outside trial
settings. It’s said that larger complications were most likely due to inadequate sterilization of
surgical instruments and procedure; however, this is completely avoidable.
Some critics are concerned that money spent on circumcision interventions will take
away funding from other vital programs. In South Africa specifically, there are many competing
health issues including tuberculosis as well as child and maternal health. Considering this,
“circumcision efforts must be funded as add-on services to guarantee that they will not detract
from other programs”. $26 million has already been granted to 13 different countries in Africa.
Despite funding for a widespread intervention, cultural beliefs may act as another barrier. “Many
South Africans frown on the practice, and after several young Xhosa boys died from
circumcision-related complications, then-President Thabo Mbeki signed a bill banning (with
some religious and medical exceptions) circumcision in boys under 16 years of age”. Public
health researchers are continuing to look into other cultural factors affecting circumcision
intervention. Overall, circumcision is going to continue to be a sought after intervention in
African American males for their health as well as the benefit experienced by women.

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Teenagers’ Sexual Identity May Not Reflect Behavior; Both Are Linked to Risk
Contrary to what some may believe, female adolescent’s sexual identity is not correlated
with their sexual behavior. Risk outcomes among young women are actually independently
related to their sexual identity and behavior. This article discusses the data received from a
Youth Risk Behavior Study done in Massachusetts. According to the data received from this
study, adolescent females who identify as heterosexual experience less health risks overall than
those who identify as lesbian, bisexual or unsure. Risk factors include: cohesion, pregnancy,
multiple/frequent partners and drug use. The study was conducted through a cross-sectional
survey of public high school students, who were sexually active, across the state of
Massachusetts.
Racial demographics made a surprising difference. “Women who were unsure were the
least likely to be white and the most likely to be Hispanic; heterosexuals were the least likely to
have immigrated in the last six years… same-sex experience were the least likely to be recent
immigrants. Those who identified themselves as being in a sexual minority also faced more
disadvantages, which put them at higher risk. “Women who identified as sexual minorities were
the most likely to report injection-drug use, very early intercourse, multiple lifetime partners,
pregnancy or STD history, and sexual coercion; they were the least likely to report having
received AIDS education in school”. However, those at the highest risk of dating violence and
lowest level of condom use, amongst those who had male partners, were those who were unsure
about their identity. “Heterosexuals had the lowest risk profile”. Those experiencing the highest
risks overall were those who had partners of both sexes. “Lesbians and bisexual women who had
ever had a male partner were more likely than heterosexuals to have been pregnant, and women
who were unsure of their sexual identity had reduced odds of reporting condom use at last sex if
they had only male partners”. Lastly, those who have partners of both sexes are at a higher risk
for injection-drug use and tend to have more partners and in a shorter period of time.
Due to the results that yielded from this study, it is important that interventions arise to
help young people make healthy choices. It’s also important that these interventions are
“sensitive to the complexity of sexual orientation development during adolescence”. It is evident
that those whose sexual orientations and behaviors drift from the heterosexual norm have an
increased risk for unhealthy results. Therefore, action needs to be taken to prevent adolescents
from encountering these risks.

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Names of Five Journals:
1. American Journal of Public Health
2. American Journal of Preventative Medicine
3. Journal of Policy Analysis and Management
4. Journal of Clinical and Diagnostic Research
5. Journal of Medical Library Association

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Sample Work #1
A Review of the Effectiveness of the Women, Infants, and Children (WIC) Program
Alissa M. Piazza
California State University: East Bay

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Abstract
The effectiveness of the WIC program is defined by the intake of nutritious foods,
pregnancy and birthing outcomes, breastfeeding outcomes and incentives, and overall wellbeing
of the program’s participants. WIC has been successful at increasing pregnant and postpartum
women’s intake of fruit and vegetables. Participation in WIC is linked to positive gestational age
and birth weight. The program provides great incentives and support services for breastfeeding.
Overall, the program contributes positively to participant’s health and equips them with the
necessary tools to live a healthy life. WIC was established in 1972 to provide nutrition education,
supplemental nutrition, breastfeeding support and referral to additional services for pregnant and
postpartum women. The primary goal of WIC is to enhance the health of young children and
women by providing these services. Based on these outcomes, WIC can be considered an
effective program because it enhances the lives of low-income and disadvantaged families by
providing nutritional food, promoting healthy gestational age and birth weight, and helping
mothers overcome barriers to breastfeeding.
Keywords: WIC, program, effectiveness, outcomes, health benefits

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Introduction
This paper will explore the effectiveness and various benefits of the Women, Infants, and
Children (WIC) program. WIC was established in 1972 to provide nutrition education,
supplemental foods, breastfeeding support, and referral to additional services for low-income
pregnant and postpartum women, infants, and children under five years. The program focuses on
improving the health and development of young children, increasing access to needed services,
as well as improving fetal growth and development (Colman et al., 2012). In 2012,
“approximately half of the infants born in the United States, 25% of children under five years of
age, 29% of pregnant women and 26% of postpartum women” were aided by the WIC program.
(Andreyeva, 2012). Considering that WIC has reached so many people in this country, it is
important to evaluate the effectiveness of their services and overall benefit to the families they
work with. Does WIC actually improve the nutritional health of pregnant and postpartum women
and their children? Are some races affected differently and do some benefit more than others?
Answers to these questions will be discussed based on the research results of various studies. I
am currently interning at the WIC in Hayward and have spoken with some of the dieticians on
the functioning of the program as well as observed brief educational lessons taught by the staff
members. I have also been working on an educational presentation about the importance of food
safety, which includes a power point and brochure. Based on my observations and experience, I
believe that WIC does have an overall positive effect that helps many low-income families by
providing more nutritious meals to their young children and support in various areas. I think
mothers are also able to receive valuable nutrition education that enables them to carry on the
practice of healthy eating even after they are no longer clients at WIC. Intake of nutritious food,
pregnancy and birth outcomes, breast feeding outcome and incentives, as well as the benefit to

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minority groups are all standards by which the effectiveness of the WIC program will be
assessed and discussed.
Methods
Peer reviewed, scholarly articles were used as the research basis of this paper. Sources
were obtained from google scholar and the CSUEB online library. Limits were set on the type,
length and publication date of the articles. Only, full length articles that were peer reviewed and
published between 2000 and 2016 were used. Key words used included, “WIC”, “effectiveness”
and “outcomes”. The common search phrase was “the effectiveness of the women, infants and
children program”. Several sources were obtained from the American Journal of Public Health.
Additional sources came from other scientific journals and governmental materials such as the
United States Department of Agriculture (USDA) on food and nutrition service, as well as a
publication from the Agriculture & Applied Economics Association. Experience and
observations at WIC in Hayward were used as resources as well, along with informational
materials, such as brochures. The supervisor of the internship is Esther Choi, who it the directing
dietician there.
Literature Review
The topics to be discussed in this literature review are: 1) WICs impact on increasing the
consumption of fruits and vegetables; 2) Breastfeeding outcomes and incentives; 3) Pregnancy
and birth outcomes; 4) Benefits to minority groups; and 5) General effectiveness of the WIC
program. A research article by Dena Herman and colleges found in a controlled study that
participants ate more fruits and vegetables in the program and their increased consumption

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continued for up to half a year after the intervention ended. Additionally, participants increased
their intake by more than one half serving per day (Herman et al., 2008). Another study
published by Brent Langellier, PhD, and colleges discusses how breastfeeding mothers are given
a larger amount of fruits and vegetables when compared to non-breastfeeding mothers
(Langellier et al., 2014). This is a result of the revised food package, which was implemented in
2009 in order to increase availability to healthier foods, including fresh fruits and vegetables.
Part of this revision was aimed at providing greater incentives for mothers to breastfeed by
increasing the quantity and variety of food options for women who fully breastfeed.
In the past, WIC participants were shown to have lower rates of breastfeeding when
compared to the United States as a whole. WIC focused on changing this when revising its food
package. There are four different packages that are dependent on the amount of breast feeding
the mother does. Fully breastfeeding mothers are given better benefits than non-breastfeeding
mothers. For example, fully breastfeeding moms receive food, breastfeeding support and
nutrition education for up to 1 year, whereas non-breastfeeding moms can only receive food and
nutritional education up to 6 months (CDPH, 2016). In addition to the revised food package,
services such as lactation consultant support, peer counseling programs, and hospital-based
lactation support services have been effective in increasing optimal breastfeeding practices
among WIC clients of various racial and ethnic backgrounds. Nevertheless, women of African
American decent may face more challenges when trying to breastfeed than other races. “A
nationally representative survey of WIC participants revealed that African American mothers are
more likely than whites or Hispanics to report barriers to breastfeeding” (Evans, Labbok &
Abrahams, 2011). Following studies showed support for the increased rate of breastfeeding after
the implementation of the new food package, especially when infants are 3 and 6 months old

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(Langelier et al., 2014). On the contrary, in 2012 the USDA reported that WIC mothers
breastfed at lower rates than non WIC participants; however, they did report a positive
association between participation in WIC and breastfeeding initiation (Colman et al., 2012).
The USDA goes on to report that WIC participation is positively associated with
gestational age and mean birth weight concluding that participation in WIC substantially
improves gestational age and birth weight. Another source reports that “WIC mothers are 6-7
percent more likely to have begun prenatal care in the first trimester, and are 2 percent less likely
to bear infants who are below the 25th
percentile of weight given gestational age or to bear
infants of low birth weight” (Bitler & Currie, 2005). However, Bitler and Currie found that
Caucasians received little to no benefit from WIC; however African Americans benefited the
most due to the positive correlation between WIC participation and healthy births. In regards to
the difference in impact across different races and ethnic cultures, Angela Kong, PhD, and
colleges report that Hispanic children benefit the most from WIC participation. “This study
found improvements in intakes of total fat, saturated fat, fiber and overall dietary quality among
Hispanic children. In addition, the prevalence of reduced-fat milk intake significantly increased
for African American and Hispanic children, and the prevalence of whole milk intake
significantly decreased for all groups” (Kong et al., 2014).
Overall effectiveness of the WIC program is debated among different sources. Jessica
Lee, PhD, and colleges suggest that numerous investigations provide evidence that WIC supports
positive health outcomes through the direct nutrition services offered by WIC rather than the
connections to other social and health services (Lee et al., 2004). Kreider, Pepper and Roy go on
to state that the rate at which children experience food insecurity is reduced by 20%. WIC
reduces general food insecurity as well (Krieder, Pepper & Roy, 2016). Despite the positive

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reports on WIC’s effectiveness, one source does provide a counter argument. Besharov and
Germanis suggest that WIC vouchers replace income that would be spent on food and frees up
money for other household purposes instead of providing direct nutrition to its participants,
which would yield optimum results. They don’t disagree that WIC makes at least a small
improvement in the diet and health outcomes of some under privileged women and birth
outcomes. However, they state that in the end participants are in control of how much they want
to utilize the program and may likely not be receiving any nutritional benefit (Bresharov and
Germanis, 2001).
Discussion
It is hard to decipher the degree of benefit WIC has on its participants overall, but it is
evident that it does have some significant attributes. Underprivileged women are far better off
with the services WIC has to offer. Women from low-income households with little education
can greatly benefit from the nutrition education as well as the supplemental food items. Without
WIC, many women and their families would be under nourished and uneducated about some of
the most important health knowledge. I have seen the type of education women can gain from
WIC and the incentives to carry on healthy habits. Clients are encouraged to attend educational
sessions and complete a simple nutrition course online in which they can print out a certificate at
the end. When pregnant women are able to take care of themselves they are already at an
advantage to bear and raise a healthy child. Prenatal care is critical to the health outcome of a
baby. Therefore, mothers who are able to receive prenatal care beginning in the first trimester are
far more likely to bear a healthy child, which can greatly improve health care costs. This could
go along with preventative care, which has proven to drastically decrease the amount of money

22
spent on health care each year. With the rates of obesity on the rise, especially in children, it is
going to be imperative that WIC educates clients on the importance of living a healthy lifestyle
and maintaining a heathy weight. It is common for certain cultures to look favorably on
“chubby” and overweight children as a sign of health, however, this myth needs to be busted and
the detriments or childhood obesity need to be addressed and understood.
Conclusion
In conclusion the WIC program enhances pregnant and postpartum women’s nutritional
health and wellness as well as their young children’s. Based upon the literature reviewed and
experience at the WIC clinic, it can be asserted that WIC is an effective program because it
promotes an increased consumption of fruits and vegetables, promotes breastfeeding and
removes barriers to it, as well as improves pregnancy and birth outcomes. Raising awareness is
always the first step to making a change and the education that WIC provides allows women to
become aware of necessary changes they may need to make to better their lives. Everyone needs
a helping hand in one way or another and WIC provides that hand for many low income women
who would be greatly disadvantaged without them. Women are able to have better birth
outcomes due to the supplemental nutrition given by WIC and are encouraged to breastfeed their
babies. Women can even take home electric breast pumps to ensure their babies are receiving the
best nutrition possible once the mothers return to work. Proper nutrition in the early years sets a
child up for success in the years to follow, which can make all the difference in a child’s life. It
will be interesting to see how the outcome of the presidential election will impact government
funded programs like WIC considering that Donald Trump appears to not favor prolonged

23
federal assistance programs. Considering the impact that WIC has on many low-income and
disadvantaged families, it would be detrimental to revoke such services.
References
Andreyeva, T. (2012). Effects of the revised food packages for women, infants, and children
(wic) in Connecticut. Choices: The Magazine of Food, Farm, and Resources Issues, 27,.
Besharov, D. J., & Germanis, P. (2001). Rethinking WIC: An evaluation of the Women, Infants,
and Children Program. Washington, D.C: AEI Press.
Bitler, M., & Currie, J. (2005). Does wic work? The effects of wic on pregnancy and birth
outcomes. Journal of Policy Analysis and Management, 24(1), 73-91.
Brewer, C. (2014). Effects of special supplemental nutrition program for women, infants, and
children (wic) participation on household food availability.
California Department of Public Health (CDPH). (2016). Your WIC Foods: Healthy Choices
More Variety [Brochure]. Alameda, CA: Author.
Colman, S., Nichols-Barrer, I., Redline, J., Devaney, B., Ansell, S., et al. (2012). Effects of the
special supplemental nutrition program for women, infants, and children (wic): A review
of recent research. IDEAS Working Paper Series from RePEc,.
Evans, K., Labbok, M., & Abrahams, S. (2011). Wic and breasfeeding support services: Does the
mix of services offered vary with race and ethnicity? Breastfeeding Medicine, 6(6), 401.
Herman, D., Harrison, G., Afifi, A., & Jenks, E. (2008). Effect of a targeted subsidy on intake of
fruits and vegetables among low-income women in the special supplemental nutrition
program for women, infants, and children. The American Journal of Public Health, 98(1),
98.
Kong, A., Odoms-Young, A., Schiffer, L., Kim., Berbaum, M., et al. (2014). The 18-month
impact of special supplemental nutrition program for women, infants, and children food
package revisions on diets of recipient families. American Journal of Preventive
Medicine, 46(6), 543-551.
Kreider, B., Pepper, J., & Roy, M. (2016). Identifying the effects of wic on food insecurity
among infants and children. Southern Economic Journal, 82(4), 1106-1122.

24
Langellier, B., Chaparro, M., Wang, M., & Whaley, S. (2014). The new food package and
breastfeeding outcomes among women, infants, and children participants in los angeles
county. American Journal of Public Health, 104(1), S113.
Lee, J., Rozier, R., Norton, E., Kotch, J., & Vann, W. (2004). Effects of wic participation on
children’s use of oral health services. American Journal of Public Health, 94(5), 772.

25
Sample Work #2
Drug Research Paper: Stimulants
Stimulants encompass a wide array of drugs with varying levels of potency and toxicity.
All major stimulants, commonly referred to as uppers, are often used to increase alertness and
can evoke excitement and euphoria. “Stimulants historically were used to treat asthma and other
respiratory problems, obesity, neurological disorders, and a variety of other ailments” (“What
About Stimulants”). The Substance Abuse and Mental Health Services Administration states that
“the first widespread use of powerful stimulants began in the 1880s with the introduction of pure
cocaine to the American market. Cocaine was not discovered in that decade. Its isolation from
coca leaves took place 20 years earlier, but it was in the 1880s when substantial production of
cocaine got underway” (Musto). Additionally, “the first amphetamine was synthesized by the
German pharmacologist L. Edeleano in 1887, but it was not until 1910 that this and several
related compounds were tested in laboratory animals” (Hanson, Venturelli & Fleckenstein 308).
A few decades prior to the discovery of these stimulants, the minor stimulant, caffeine, was
discovered in the early 1820s by French and German scientists and was originally extracted from
green coffee beans.
Today, various uses for stimulants exists. Minor stimulants are often enjoyed for pleasure
enhancing effects and to increase alertness while some of the major stimulants are used for
pharmaceutical purposes which can be misused and abused. “The dramatic increases in stimulant
prescriptions over the last 2 decades have led to their greater environmental availability and
increased risk for diversion and abuse. For those who take these medications to improve properly
diagnosed conditions, they can be transforming, greatly enhancing a person's quality of life.
However, because they are perceived by many to be generally safe and effective, prescription

26
stimulants, such as Concerta or Adderall, are increasingly being abused to address nonmedical
conditions or situations” (“What are Stimulants”). Ritalin, a methylphenidate related to
amphetamines, is one of the drugs used to treat attention deficit disorder in adults and children as
well as narcolepsy. In the past this drug was used to alleviate depression but new research
suggests it is not very beneficial for that ailment. Due to the addictive nature of certain
stimulants, medical personnel may hesitate in prescribing doses large enough to actually curve
their patient’s pain or treat the ailment. “Now, stimulants are prescribed to treat only a few health
conditions, including ADHD, narcolepsy, and occasionally depression—in those who have not
responded to other treatments” (“What are Stimulants”).
Some of the most common stimulants known today are cocaine, nicotine, caffeine and
amphetamines which include: Ecstasy, Methylphenidate and Methamphetamine. Street names
for cocaine include: blow, nose candy, snowball, tornado, and wicky stick (“Drug Use & Abuse).
Traditionally, cocaine was used to relieve fatigue by chewing the coca leaves or brewed into a
tea for refreshment. Cocaine was used recreationally to increase alertness, relieve fatigue, feel
stronger and more decisive and is abused for its intense euphoric effects (NHTSA). People often
misuse cocaine in efforts to self-medicate their psychiatric disorders, such as anxiety, depression
and attention deficit disorders (Hanson, Venturelli & Fleckenstein 329). Nicotine is an alkaloid
derived from the tobacco plant and is one of the many chemicals found in the smoke of tobacco
products. Many consume it for the effect it has on the central nervous system and the feelings of
pleasure nicotine can entice. The world’s most frequently used stimulant, however, is caffeine.
Caffeine belongs to a family of drugs called Xanthines. Of the three members in this family
(theobromine, theophylline and caffeine) caffeine is the most potent CNS stimulant. Caffeine is
most often used to prevent drowsiness and increase mental activity (Hanson, Venturelli &

27
Fleckenstein 339). The last group of stimulants discussed in this paper are amphetamines.
“Amphetamines are potent synthetic central nervous system (CNS) stimulants capable of causing
dependence due to their euphorigenic properties and ability to eliminate fatigue. Despite their
addicting effects, amphetamines can be legally prescribed by physicians for appetite control in
weight-loss programs, narcolepsy, and hyperactivity disorders” (Hanson, Venturelli &
Fleckenstein 308). Illegal forms of amphetamines are methamphetamine, street names ice and
speed, and MDMA (Ecstasy). Lastly, methylphenidate (Ritalin) is a special amphetamine that
has been used to alleviate depression but is a relatively mild CNS stimulant. It is more
commonly used to aid focused attention in children and adults dealing with ADHD. “Although it
is not used much on the street by hard-core drug addicts, there are increasingly more frequent
reports of use by high school and college students because of claims that it helps them to “study
better”, “party harder”, and enhance their “performance” in general (Hanson, Venturelli &
Fleckenstein 321).
Considering there are a wide variety of stimulants, there are also a variety in the methods
of administration. “Prescription stimulants come in tablets or capsules. When abused, they are
swallowed, injected in liquid form or crushed and snorted” (“The Truth about Prescription
Drugs”). The form of administration for cocaine, in particular, is important in determining the
likelihood of toxicity, its abuse liability and the intensity of effects. “Cocaine can be snorted
while in the powered form, injected into the veins after dissolving in water, or smoked. It is also
used to produce crack, which is smoked, producing a short, intense high” (“Stimulants”).
However cocaine can be “topically applied for use as a local anesthetic. Recreationally, coca
leaves can be chewed, however, cocaine abusers typically smoke “crack” in a glass pipe or inject
the hydrochloride salt intravenously. Cocaine hydrochloride can be smoked to some effect but

28
this is very inefficient as the powder tends to burn rather than vaporize. Snorting
(insufflation/intranasal) is also popular. Subcutaneous injection (skin-popping) is rarely used”
(NHTSA) Nicotine is often consumed through smoking tobacco products like cigarettes, pipes
and cigars. However, when tobacco is chewed or dipped, nicotine is absorbed through the
mucous lining of the mouth. Likewise, nicotine gum allows for the rapid absorption of nicotine
through the mucous membranes of the mouth. Other methods of administration include nicotine
patches, nasal spray, inhalers and lozenges (Hanson, Venturelli & Fleckenstein 366). Caffeine is
most commonly consumed through beverages such as coffee, tea and soda. Chocolate is another
source of caffeine, although the main stimulant in chocolate is theobromine. Caffeine can also be
administered in the pill form and is found heavily in some over-the-counter (OTC) products such
as Anacin and Excedrin. Approved uses of amphetamines are administered orally but there are
various methods of administration for misuse and abuse. Speed is available as a white, odorless,
bitter-tasting crystalline powder for injection and ice is a smokable for of methamphetamine
(Hanson, Venturelli & Fleckenstein 311). “Regular methamphetamine is a pill or powder, while
crystal methamphetamine takes the form of glass fragments or shiny blue-white “rocks” of
different sizes. Meth is taken orally, smoked, injected, or snorted. To increase its effect, users
smoke or inject it, or take higher doses of the drug more frequently” (“Stimulants”).
The purity of available forms of different stimulants varies. “Depending on the
demographic region, street purity of cocaine hydrochloride can range from 20-95%, while that of
crack cocaine is 20-80%. The hydrochloride powder is often diluted with a variety of substances
such as sugars for bulk (lactose, sucrose, inositol, mannitol), other CNS stimulants (caffeine,
ephedrine, phenylpropanolamine), or other local anesthetics (lidocaine, procaine, benzocaine)”
(NHTSA). “Purity of methamphetamine is currently very high, at 60-90%, and is

29
predominantly d-methamphetamine which has greater CNS potency than the l-isomer or the
racemic mixture” (NHTSA).
Every stimulant has the commonality of increasing alertness, excitation and euphoria.
Stimulants increase blood pressure and heart rate, constrict blood vessels, increase blood
glucose, and open up breathing passages (“What are Stimulants”). However, exactly how each
stimulant effects the body and mind is dependent on the type, method of administration and
amount of the stimulant being used. When cocaine is administered orally it has the least potent
effects because most of the drug is destroyed in the liver or stomach before it reaches the brain.
Snorting, on the other hand, yields higher concentrations of the drug entering the brain more
quickly and delivers a more rapid, yet shorter lasting, and more intense high. After snorting,
approximately 100 milligrams of cocaine passes through the mucosal tissues in the blood stream
and stimulates the CNS substantially within several minutes and persists 30 to 40 minutes before
subsiding (Hanson, Venturelli & Fleckenstein 329). “The faster the absorption the more intense
and rapid the high, but the shorter the duration of action. Injecting cocaine produces an effect
within 15-30 seconds. A hit of smoked crack produces an almost immediate intense experience
and will typically produce effects lasting 5-15 minutes” (NHTSA). Nicotine also has a direct
effect on the brain and at low dose levels, increases the rate of respiration by stimulating the
receptors in the carotid artery, which monitors the need for oxygen. Higher concentrations can be
very toxic and result in difficulty breathing, diarrhea, mental confusion, vomiting and sweating.
Although it is a minor stimulant, caffeine can have a large effect on the CNS, cardiovascular
system and rate of respiration. “In general 100 to 200 milligrams of caffeine enhances alertness,
causes arousal and diminishes fatigue… tolerance to the cardio vascular effects occurs with
frequent use. With lower does (100-200 milligrams), heart activity can either increase, decrease

30
or do nothing; at higher doses (more than 500 milligrams), the rate of contraction of the heart
increases” (Hanson, Venturelli & Fleckenstein 339). Seizures, respiratory failure and death can
result from extremely high doses (5 to 10 grams). Lastly, “Amphetamines readily cross the
blood-brain barrier to reach their primary sites of action in the brain. The acute administration of
amphetamine produces a wide range of dose-dependent behavioral changes, including increased
arousal or wakefulness, anorexia, hyperactivity, perseverative movements, and, in particular, a
state of pleasurable affect, elation, and euphoria, which can lead to the abuse of the drug.
Adverse effects listed in drug labels of prescription amphetamines include disturbances of mood
and behavior in addition to cardiac and gastrointestinal effects. Most of these adverse events are
considered “time-limited”, resolving rapidly after discontinuation of stimulant exposure. The
most common drug-related effects are loss of appetite, insomnia, emotional lability, nervousness
and fever 23
. The American Academy of Pediatrics 24
also lists jitteriness and social withdrawal
as common side-effects of amphetamines in children (Berman et al 5).
One of the most common neurotransmitters affected by stimulants is dopamine, due to its
pleasure enhancing properties. Nevertheless several other neurotransmitters are also affected
depending on the drug administered. “Most of the pharmacological effects of cocaine use stem
from enhanced activity of the catecholamine (dopamine, noradrenaline, adrenaline) and serotonin
transmitters. It is believed that the principal action of the drug is to block the reuptake and
inactivation of these substances following their release from neurons” (Hanson, Venturelli &
Fleckenstein 331). Nicotine is primarily responsible for activating the release of dopamine and
ignites the so-called reward or pleasure pathways of the brain. Additionally, “Stimulants, such as
dextroamphetamine (Dexedrine and Adderall) and methylphenidate (Ritalin and Concerta), act in
the brain similarly to a family of key brain neurotransmitters called monoamines, which include

31
norepinephrine and dopamine. Stimulants enhance the effects of these chemicals in the brain.
The associated increase in dopamine can induce a feeling of euphoria when stimulants are taken
nonmedically” (“What are Stimulants”).
The margin of safety, potency and toxicity varies for each stimulant. Commonly abused
doses of cocaine range from 10-120mg. “In ear, nose and throat surgery cocaine is commercially
supplied as the hydrochloride salt in a 40 or 100 mg/mL solution” (NHTSA). For those using
nicotine, 1 to 2 milligrams is enough to produce a feeling of pleasure. 60 milligrams is the fatal
dose for adults but “it is virtually impossible to overdose, in part because a smoker feels the
effects before any lethal amount can accumulate in the body” (Hanson, Venturelli &
Fleckenstein 361). 100 to 200 milligrams of caffeine is what is usually needed to obtain desired
results. Extremely high doses ranging from 5 to 10 grams can be fatal. Depending on the specific
amphetamine, pharmaceutical doses can range anywhere from 5-60mg capsules with doses not
exceeding 60mg/day. Amphetamine abusers commonly administer doses of 10-30 milligrams
(Hanson, Venturelli & Fleckenstein 311). In regards to half-life, it can be noted that
“Methamphetamine has a substantially longer half-life in the body than cocaine (which quickly
metabolizes), thus leading to more intense and protracted withdrawal” (“Stimulants”).
Acute side effects of stimulants include “exhaustion, apathy and depression—the “down”
that follows the “up.” It is this immediate and lasting exhaustion that quickly leads the stimulant
user to want the drug again” (“The truth about drugs”). Short term withdrawal symptoms of
cocaine include inability to experience pleasure, agitation, craving for the drug and depression
(Hanson, Venturelli & Fleckenstein 333). “Repeated high doses of some stimulants over a short
period can lead to feelings of hostility or paranoia. Such doses may also result in dangerously
high body temperatures and an irregular heartbeat” (“The Truth about Prescription Drugs”).

32
Chronic side effects can be more extreme than acute side effects. For example, “With
continued, escalating use of cocaine, the user becomes progressively tolerant to the positive
effects while the negative effects, such as a dysphoric, depressed state, steadily intensify.
Prolonged use may result in adverse physiological effects involving the respiratory,
cardiovascular, and central nervous systems. Cocaine use may also result in overdose and death”
(“Stimulants”). Chronic cocaine users are also 60 times more likely to commit suicide than
nonusers (Hanson, Venturelli & Fleckenstein 333). Additionally, chronic use of
methamphetamine can have many damaging effects. “Heavy users show progressive social and
occupational deterioration. Research has shown that prolonged methamphetamine use may
modify behavior and change the brain in fundamental and long-lasting ways… Chronic
methamphetamine users may have episodes of violent behavior, paranoia, anxiety, confusion,
and insomnia. Heavy users show progressive social and occupational deterioration. Research has
shown that prolonged methamphetamine use may modify behavior and change the brain in
fundamental and long-lasting ways” (“Stimulants”). Long term risks of chronic use has varying
effects on the mind and body as well. “The physiological effects of methamphetamine are
generally similar to those of cocaine: increased heart rate, elevated blood pressure and body
temperature, and an increased respiratory rate… The psychological effects of methamphetamine,
again similar to cocaine, include an increased sense of well-being or euphoria, increased
alertness and energy, and decreased food intake and sleep” (“Stimulants”).
In conclusion, stimulants come in many forms and potencies. They can be very beneficial
for pharmaceutical purposes but can often be misused and abused. Some of the historical uses of
stimulants are still used today, however, new research has guided physicians as to how to best
prescribe and administer different stimulants for therapeutic purposes. Of course there are some

33
stimulants, like caffeine, that do not need a prescription to be enjoyed, however even caffeine
can be overused. It is important to understand the different effects and side effects of stimulants
before partaking in any of them.
Reference List:
Berman, Steven M. et al. “Potential Adverse Effects of Amphetamine Treatment on Brain and
Behavior: A Review.” Molecular psychiatry 14.2 (2009): 123–142.PMC. Web. Retrieved
13 July 2016 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670101/.
Drug Enforcement Act. "Drug Fact Sheet." DEA. N.p., n.d. Web. Retrieved 13 July 2016 from
https://www.dea.gov/druginfo/drug_data_sheets/Stimulants.pdf.
"Drug Use & Abuse: Stimulants." Doctors, Patient Care, Health Education, Medical Research.
Ed. Nancy Brown. Sutter Health, Oct. 2013. Web. 13 July 2016.
Hanson, Glen R., PhD, DDS, Peter J. Venturelli, and Annette E. Fleckenstein, PhD. Drugs and
Society. 12th ed. Burlington: Jones & Bartlett Learning, 2015. Print.
Musto, David F., M.D. "The National Methamphetamine Drug Conference - ONDCP." The
National Methamphetamine Drug Conference - ONDCP. N.p., n.d. Web. 11 July 2016.
National Highway Traffic Safety Administration (NHTSA). "Drugs and Human Performance
FACT SHEETS - Methylenedioxymethamphetamine (MDMA, Ecstasy)." Drugs and
Human Performance FACT SHEETS - Methylenedioxymethamphetamine (MDMA,
Ecstasy). N.p., n.d. Web. Retrieved 13 July 2016 from
http://www.nhtsa.gov/people/injury/research/job185drugs/cocain.htm.
"Stimulants." Substance Abuse and Mental Health Services Administration (SAMHSA), 2 Mar.
2016. Web. 11 July 2016.
"The Truth about Prescription Drugs: Stimulants." Foundation for a Drug-Free World. N.p.,
2016. Web. 11 July 2016.
"What Are Stimulants?" National Institute on Drug Abuse (NIDA). N.p., Nov. 2014. Web. 11
July 2016.

34
Sample Work #3
Policy Memo
Course: HSC 3350_01
Name: Alissa Piazza
Instructor: Suhaila Khan
Date: February 14, 2016
To: Diana S. Dooley
Secretary of the California Health and Human Services Agency
From: Alissa Piazza,
Undergraduate Health Science Student at California State University: East Bay
Re: The Patient Protection and Affordable Care Act (ACA) should increase access to
preventative screening and follow up care for African American women.
Introduction:
Despite the passage of the Patient Protection and Affordable Care Act (PPACA), cancer health
disparities are still prevalent among African Americans. Although African American women
residing in the United States have a lower incidence rate of breast cancer than Caucasian women,
they are still more likely to die from it than their Caucasian counterparts (Garcia et al., 2012).

35
“This difference has been largely attributed to longer intervals between mammograms and lack
of timely follow-up of suspicious results.” (American Cancer Society, 2013).
Method
For this policy memo six full peer reviewed journal articles were read along with six other
scholarly sources. These resources were obtained through google scholar, ScienceDirect, and the
CSUEB library.
Findings and Discussion
African American women are less likely to be diagnosed with breast cancer, yet are more
likely to die from it. “Researchers suggest this is due to higher rates of uninsurance, unequal
access to improvements in cancer treatments, and barriers to early detection and screening
among African American women” (Robinson and Finegold, 2012). The aim of the Affordable
Care Act is to expand coverage to minorities and increase their access to quality care. It was
estimated that 3.8 million African Americans would gain coverage under the Affordable Care
Act (Robinson and Finegold, 2012). Despite the increased access to care, breast cancer is still a
leading cause of death in African American women and they “continue to experience the poorest
breast cancer specific survival of all ethnic groups in the US” (Maskarinec, Sen, Koga and
Conroy, 2012). Ironically, screening rates between African American and Caucasian women
have been relatively similar the past few years. The difference between survival rates can be
attributed to “both later stage at detection and poorer stage-specific survival among African
American women. Only about half (51%) of breast cancers diagnosed among African American
women are at local stage, compared to 61% among white women” (American Cancer Society,
2013). Additionally, longer intervals between mammograms could contribute to a higher death

36
rate among African American women, as well as a lack of prompt follow-up after skeptical
results.
When compared to Caucasian breast cancer survivors, African American’s are less likely
to receive critical care and follow-up. “This care includes early detection of recurrence and new
primary cancers, to evaluate and monitor late and long-term effects from treatment, and provide
ongoing physical and psychosocial support” (Palmer et al., 2015). “Although [the Patient
Protection and Affordable Care Act] PPACA mandates that insurers cover preventative services
receiving an A or B rating from the [United States Preventative Services Task Force] USPSTF
without deductibles or copays, PPACA does not expressly require insurers to cover follow-up
testing of abnormalities found during a cancer screening examination (Moy et al., 2011). The
PPACA also lacks a clear intention to improve cancer survivorship, which is a contributing
factor to lack of cancer care after diagnosis. Nevertheless, follow-up care is not the only barrier
faced by African American women in relation to breast cancer survival and preventative
measures.
Many African American women reported barriers in care such as: high medical expenses,
lack of transportation, and anxiety of seeing a doctor. “A study by Peek and colleagues found
that African American women were afraid to get screened for breast cancer because they: (1)
feared the results, (2) had previous negative experiences with the health care system, (3) had
fatalistic views about cancer, and (4) used denial of symptoms as a coping mechanism” (Palmer
et al., 2015). Additional factors contributing towards survival differences are related to
Socioeconomic Status and include: obesity, poverty and lifestyle choices. “For example, poverty
may directly be responsible for lack of screening but also indirectly affect tumor biology because

37
obesity, smoking, and poor nutrition may promote the development of tumors with adverse
characteristics” (Maskarinec et al., 2011).
The Patient Protection and Affordable Care Act (PPACA) signed into law in 2010 by
President Obama, expanded coverage to individuals with incomes up to 133% of the federal
poverty level (FPL)and reduced about 59% of the uninsured by adding 16 million to 20 million
recipients to the Medicaid roster (Moy et al., 2011). Provisions such as the essential health
benefits package, public health workforce recruitment and retention programs and state health-
care workforce development grants were put in place to increase access to health-care providers
and services by removing common barriers such as cost (Miller, King, Joseph, and Richardson,
2012). However, “Medicaid coverage does not significantly improve individuals’ access to
quality cancer care and some health care providers may be unable to accept additional Medicaid
patients because of low reimbursement levels, leading to lower access to health care” (Moy et al.,
2011). “Specifically, between 69% and 79% of community health centers (CHCs) that do not
have affiliations with hospitals for referrals to specialists report problems with obtaining
specialty care for their Medicaid fee-for-service patients” (Moy et al., 2011). Fortunately
programs like The National Breast and Cervical Cancer Early Detection Program (NBCCEDP)
have been established to extend care to women who remain uninsured. “The NBCCEDP
contributes to reduced breast cancer death rates, reduces time from cancer diagnosis to Medicaid
enrollment, expands women’s treatment options, and changes the timing of diagnosis” (Levy,
Bruen and Ku, 2012). However, there are still low-income women left without coverage and
care, especially since Medicaid expansion varies by state. “Although CDC funds screening and
diagnostic services for uninsured and underinsured women through the Breast and Cervical
cancer Early Detection Program, evidence suggests limited success reaching the targeted

38
population. Differences across states in Medicaid coverage under the ACA may lead to a
widening of racial and income disparities in cancer between states that expand and those that do
not” (Sabik, Tarazi, and Bradley, 2015).
A study was conducted in Georgia to better understand the experiences of women
enrolled in the Women’s Health Medicaid Program (WHMP), Georgia’s Breast and Cervical
Cancer Prevention and Treatment Act Program, and how the experiences varied by race and
location. Results were positive and “once women enrolled in WHMP, women reported gaining
access to equitable breast cancer treatment regardless of race or location” (Johnson, Blake,
Andes, Chien and Adams, 2014). In California, low-income women are covered for treatment of
breast cancer but in order to be eligible they must be screened and diagnosed as part of the
CDC’s National Breast and Cancer Early Detection Program. “The federal guidelines for the
CDC program establish and eligibility baseline to target services to uninsured and underinsured
women at or below 250 percent of the FPL” (National Women’s Law Center, 2010).
In conclusion, beneficial provisions to the ACA have been put in place but there is still
the need for further expansion of health coverage and care especially when it comes to African
American women. “Cancer health disparities are persistent reminders that state-of-the-art cancer
prevention, diagnosis, and treatment are not equally effective and accessible to all Americans”
(Zonderman, Ejiogu, Norbeck, and Evans, 2014). Despite the advancements in expansion in
health care coverage African American women are at a disadvantage when it comes to follow up
care and preventative measures in addition to mammograms.
Policy Recommendation

39
In order to decrease the death of African American women due to breast cancer, three actions
should be taken:
1. A provision should be added to the ACA that requires insurers to cover follow up testing
of abnormalities found during a cancer screening evaluation.
2. More incentives should be established to encourage more health care providers to take
Medicaid patients
3. Health educators should be prompted to go into African American communities to
promote awareness of preventative screening and dispel misconceptions as well as
promote healthy behaviors that can lessen the risks of breast cancer.
Bibliography (APA style)
American Cancer Society. (2013). Cancer Facts & Figures for African Americans 2013-2014.
American Cancer Society, 10-15 (ACS Publication No. 861413). Retrieved from
http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acsp
c-036921.pdf
Garcia, R. Z., Carvajal, S. C., Wilkinson, A. V., Thompson, P. A., Nodora, J. N., Komenaka, I.
K.,... Martinez, M. E. (2012). Factors That Influence Mammography Use and Breast Cancer
Detection Among Mexican-American and African American Women. Cancer Causes Control,
23, 165-173. doi:10.1007/s10552-011-9865-x
Johnson, E. M., Blake, S. C., Andes, K. L., Chien, L. & Adams, K. (2014). Breast Cancer
Treatment Experiences by Race and Location in Georgia’s Women’s Health Medicaid Program.
Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 24(2),
219-229. doi:10.1016/j.whi.2014.01.002

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46(3), 87-97. doi:10.1016/j.amepre.2013.10.026

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ALISSA PIAZZA
apiazza8@gmail.com
December 6, 2016
Dear Director of Chapter Services,
I'm contacting you regarding the consultant position with Tri Sigma. One of my advisors, Cindy Harms,
recommended I apply. After reviewing the job description, I am very interested in becoming a Tri Sigma
consultant.
I recently graduated from California State University: East Bay with a B.S. in Health Science. I am a self-
starter, very organized and can work on multiple projects simultaneously. My undergraduate experience
and membership in Tri Sigma has enhanced my leadership, team work, organization and time
management skills. My volunteer experience as a young adult group coordinator strengthened my
ability to communicate and work with various groups of people. This role also strengthened my
leadership skills as well as my ability to problem solve quickly in a calm manner. Also of note is my most
recent volunteer position as client advocate at Options for Women, a pregnancy resource center. In this
role I have been responsible for meeting with clients, writing reports, entering client files, and additional
administrative tasks. Lastly, my experience as an intern at Women, Infants and Children (WIC) aided my
proficiency with Microsoft Office and other publication software programs. I was responsible for
creating and presenting material that would be used for client education, which enhanced my ability to
facilitate and lead discussion based presentations. Overall, I am a diligent and enthusiastic worker who
strives for excellence on an individual and group level.
With my skill set and experience, I can be a valuable addition to Tri Sigma. I can be reached for an
interview at your convenience.
Sincerely,
Alissa Piazza
(916)626-9395
apiazza8@gmail.com

46
ALISSA PIAZZA
apiazza8@gmail.com 1232 Rolling Hill Ct.
(916)626-9395 Martinez, CA 94553
OBJECTIVE
Recent undergraduate seeking work as an enthusiastic consultant for Tri Sigma.
EDUCATION
California State University: East Bay, Hayward, CA
B.S. in Health Science, Anticipated Graduation: December 2016, GPA: 3.67
Sierra College, Rocklin, CA
A.S. in Biological Studies with Honors, Graduation: June 2014, GPA: 3.59
COMPUTER SKILLS
Computer Software: WordPerfect 12, Publisher, Power Point, Microsoft Word, Excel
EMPLOYMENT HISTORY
Personal Assistant, Mary Kay Director, Pleasant Hill, CA
October 2014 - present
Bar tending/waitressing, The Bistro, Hayward, CA
October 2014 - present
Sales, Justice, Roseville, CA
October 2010 - September 2014
Swim instructor, California Family Fitness, Rocklin, CA
Summer 2012, 2013
VOLUNTEER / INTERNSHIP
Options for Women of California (OFW), Concord, CA
January 2016 - present
 Council women experiencing a crisis pregnancy / provide resources
 Enter client files and additional administrative tasks
Alameda County WIC, Hayward, CA
September 2016 – December 2016
 Created and edited educational presentations and brochures
 Presented material to lead dieticians
Confirmation Group Leader, All Saints Parish, Hayward, CA
September 2014 – May 2016
 Facilitated small group discussion / Taught lessons
 Assisted with the planning of retreats
EDGE Leader, St. Joseph Marello Parish, Granite Bay, CA
 Facilitated small group discussion / Taught lessons
 Assisted with the planning of retreats and other events
ACHIEVEMENTS / ACTIVITIES
Member of Sigma Sigma Sigma National Sorority, CSUEB, Hayward, CA
 Served as Panhellenic Chair and planned fundraising events

47
 Exemplified leadership, team work, organization and time management
skills
Young Adult Group Coordinator, St. Joseph Marello Parish, Granite Bay, CA
 Established young adult group / Developed and lead lesson plans
 Networked with other young adult groups and planned events
REFERENCES
Blayne Wittig, Executive Director of OFW, Concord CA
(925)348-6515
Vic Kraul, Owner of The Bistro, Hayward CA
(510)209-9077
Annie Guest, Mary Kay Director, Pleasant Hill CA
(408)529-0735
Anne Lyons, Counselor at Center High School, Antelope CA
(916)872-3274

48
Personal Essay
When I started college I thought I was going to become a nurse. I took the nursing pre
recs at my junior college and managed to survive chemistry, microbiology, anatomy and
physiology. Although it was excruciatingly hard I enjoyed my difficult sciences classes. I liked
studying the body and work well with others and knew I wanted to go into a profession where I
had a lot of human contact and interaction. After completing my Associates in biological studies,
I applied for several nursing programs. When I was informed that I hadn’t been accepted into the
program of my dreams at USF, I had already passed up several offers for other schools and
realized that if I wanted to continue my studies the following semester I need to change my
major. After some consideration I changed my major to health science. It was a good transition. I
had already taken the harder science classes so I just had to complete the rest of my general
education and upper division courses. I am happy with my decision and realize nursing is not the
place for me, at least for the time being. I still enjoy working with people and am fascinated by
science but I would be happy to obtain any job where I am a part of a team and working with
others. I have developed skills in leadership, team work, organization, and time management. I
have become more proficient with Microsoft and other presentation software programs. I have
refined my public speaking skills and am comfortable leading discussions and presenting
material to large groups. As my undergraduate career comes to an end I look forward to
transitioning into the next phase in my life and obtaining a full time job. I am not looking for a
specific area of work, rather a position that utilizes the skills I have and continues to refine them
as well as build new skills. I know that a position that requires me to a lot of individual work
with little interaction is not fitting. Outside of that I am open to many possibilities.

50
Description of Chart
The system analysis chart I have provided depicts the Alameda County Department Child
Support Services (ACDCSS). The department is divided under the director between operations
and administrations. There is also a secretary directly under the director. There are more
positions that are covered under operations than administration. Operations consist of Intake/Pre-
Order, Court Support/SWAT, Child Support attorneys, Post-Order, Client Services, Office
Support and Human Resources. Administration consists only of Facilities & Budget and
Performance, Training and Technology. Beyond that, each department has cascading teams that
support them.

53
Legacy Role
I have questioned the usefulness of general classes from time to time. Particularly while
in the middle of writing a history paper that I know has absolutely nothing to do with what I
want to do in life. However, it is through these general classes that students learn discipline
for their studies. It’s the beginner classes that build us despite what we aspire to study. On a
personal note, I never would have made it through my upper division science classes if I
hadn’t taken all of the 101 classes first. Outside of creating structure and discipline, general
education classes create more well-rounded students. How smart would a mathematician
really be if all he could do was solve mathematical equations? General education classes are
the building blocks to gaining knowledge. They serve as the premise to higher education.
In regards to health science classes, I believe they are of extreme importance. I have
learned so much as a health science major and wish everyone was able to share the same
knowledge. Health is a large component of life and is relatable to everyone, which is one
reason why it is important. I also enjoy health because of its complexity. There is nearly an
infinite amount of study that can be done on the subject. Something new and exciting is
always waiting to be discovered. As I reflect on my education thus far, I am appreciative of
what I have learned and the skills I have acquired. Because of my learning experiences I will
continue to cultivate my knowledge and perception of the world around me.
Although I am at the end of my undergraduate career, I am still unsure of the career I
want to go into. Originally I thought I wanted to work in a clinical field but most of
everything in that field requires a certificate or higher degree. I’ve thought about going into a
sector of community health, such as working for a non-profit or a federal program, but have
not yet determined if that is a good fit for me. Nevertheless, whatever I end up doing will be
fueled by the education and knowledge I’ve received thus far.
In closing, if I could do anything differently I would study more, and build better
sleeping habits. Getting a full night’s rest and having a regular sleep schedule can greatly
enhance multiple areas of a person’s life, especially when it comes to learning. A tired brain
is far less effective than an alert one. Therefore, if I ever give students’ advice it would be to
schedule their time wisely and get to enough sleep.

55
Alumni Role Paper
For the Alumni Role Paper, I chose to volunteer at a local agency. The agency I chose
was Options for Women of California (OFW), which is a pregnancy resource center located in
Concord. I worked on a couple different projects during my time there but the main project
consisted of inputting data into a new program the center is using to keep track of their
volunteers. OFW is a non-profit organization that runs entirely off of donations, and has only a
few paid positions, so volunteers are a huge component to the clinic’s functioning. The program
I used was called eTapestry. I began by going down a long list of various volunteers and
checking whether they are a current, past or an interested volunteer. Once that was complete, I
would go into a different field and state what area of volunteering they were interested in and
what skills they may have. For example, someone who was a photographer and had
photographed last year’s gala would be listed as a current volunteer, who had the skills of
photography and was interested in volunteering at events only.
There are many different areas of volunteering that the clinic needs covered. I was also
given the task of following up with clients to see how they were doing and how their pregnancy
may be progressing. The clinic does it’s best to keep in touch with clients and make sure they are
receiving the resources they need. In addition to making phone calls, I entered client files. Client
files contain the client’s demographic information like address, living situation, student status,
employer and other important information that relays what kinds of resources they may need. I
used a program called Cool Focus to enter this information, which was a little easier to navigate
than eTapestry. I enjoyed the tasks I was given and plan to continue volunteering at OFW. I
enjoy the ability to accomplish multiple tasks and meet new clients each time.

56
Working on my project at Options for Women, Concord CA.

57
Handout given by Options for Women

58
F. Statement of my Philosophy

59
My Statement
I believe that health is a multifaceted word that encompasses many different areas of a person’s
life. It is hard to define “health” because it is so broad, however, to say that someone is healthy
would mean they are not suffering any ailments and their body is functioning as it should be. I
believe that happiness goes along with healthiness. When we are healthy we feel our best. And
feeling good can yield positive results in multiple areas of our lives. Preventative health is of
extreme importance because it can save so many people from the ailments of disease. I am very
upset with the way our current medical system treats illness. Instead of finding the root of the
problem and going from there, physicians simply prescribe drug after drug, until their patient’s
problem appears to be gone. This does not cure the problem, it only masks the pain. This is one
reason I strive to maintain health and avoid disease. For those seeking to do the same I have a
couple recommendations. Living a healthy life can be quite simple, you just have to build
healthy habits. Make physical activity a daily routine. Whether it be taking a walk at your lunch
break or scheduling time to go to the gym; getting up and staying active does wonders for your
physical health. Controlling portion sizes is important for maintaining a healthy weight. Being
aware of the amount of food you are consuming is a great way to prevent over eating and excess
weight gain. Getting enough sleep is also very important. When the body is tired it is not
functioning at its prime and chronic tiredness can lead to a weakened immune system. Do your
best to get enough sleep and wake up at the same time each day. Lastly, taking time to relax and
clear your mind is very necessary for maintaining health. When we are constantly stressed out
the body responds by releasing cortisol, which can lead to disease and great ailments. Taking just
five minutes a day to sit in silence and clear your mind can make a world of difference.

60
G. NIH Office of Extramural Research

61
CertificateofCompletion
TheNationalInstitutesofHealth(NIH)OfficeofExtramuralResearchcertifiesthat
AlissaPiazzasuccessfullycompletedtheNIHWeb-basedtrainingcourse
"ProtectingHumanResearchParticipants".
Dateofcompletion:11/06/2016.
CertificationNumber:2217132.

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