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Is The Positive Association Between Middle-Income And Rich Household Wealth And Adult Sub-Saharan African Women's Overweight Status Modified By The Level Of Education Attainment? A Cross-Sectional Study Of 22 Countries, Ifeoma Ozodiegwu, Henry V. Doctor, Megan Quinn, Laina D. Mercer, Ogbebor Enaholo Omoike, Hadii M. Mamudu

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BACKGROUND: Previous studies show a positive association between household wealth and overweight in sub-Saharan African (SSA) countries; however, the manner in which this relationship differs in the presence of educational attainment has not been well-established. This study examined the multiplicative effect modification of educational attainment on the association between middle-income and rich household wealth and overweight status among adult females in 22 SSA countries. We hypothesized that household wealth was associated with a greater likelihood of being overweight among middle income and rich women with lower levels of educational attainment compared to those with higher levels of educational attainment. METHODS: …

Smokefree Home Rules And Cigarette Smoking Intensity Among Smokers In Different Stages Of Smoking Cessation From 20 Low-And-Middle Income Countries, Daniel Owusu, Megan Quinn, Kesheng Wang, Faustine Williams, Hadii M. Mamudu

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Smokefree environment created by smokefree policies is associated with smoking reduction; however, there is paucity of literature on the relationship between smokefree home rules and smoking intensity in low-and-middle income countries (LMICs), and how smokefree policy affects smoking behavior of smokers at different stages of smoking cessation. This study examined the relationship between smokefree home rules and average number of cigarettes smoked per day (CPD) among daily smokers at different stages of the transtheoretical model (TTM) of change. Data from 18,718 current daily cigarette smokers from the Global Adult Tobacco Survey (GATS) conducted from 2011 to 2017 in 20 LMICs …

Pap Utilization Survey In Nueva Vida, Nicaragua: Professional And Health Promotoras Partnership, Olushola O. Ogunleye, Bethesda J. O'Connell, Megan Quinn, Lea C. Florence, Kaitlyn Shirely

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Cervical cancer is the second most common cancer affecting women in developing countries and accounted for 84% of the global incidence of cervical cancer in 2012. Nicaragua is one country illustrating this disparity, with an annual cervical cancer mortality six times the U.S. rate. This may be explained by lack and poor utilization of effective screening programs, especially the Papanicolaou, or Pap, smear. This study resulted from a partnership formed by faculty and students from two U.S. universities and a Nicaraguan nonprofit organization to conduct projects to benefit a community in Nicaragua. To promote a free Pap smear program provided …

The Influence Of Immigrant Generation On Obesity Among Asian Americans In California From 2013 To 2014, Shaoqing Gong, Kesheng Wang, Ying Li, Arsham Alamian

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Objectives We aimed to examine the association between immigrant generation and obesity among Californian adults and Asian Americans. Results Overall, 23.3% of the Asian population was obese, and 40.0% was overweight. The percentage of 1st, 2nd, and 3rd generation were 72.7%, 22.6%, and 4.6%, respectively. Overall, 1st generation of Asians had lower odds of being obese compared to Whites (OR = 0.34, 95%CI = 0.26–0.45). Multiple logistic regression analyses showed that overall, 2nd generation (OR = 1.69, 95%CI = 1.10–2.60) and 3rd generation (OR = 2.33, 95%CI = 1.29–4.22) Asians had higher odds of being obese compared to 1st generation …

A Qualitative Research Synthesis Of Contextual Factors Contributing To Female Overweight And Obesity Over The Life Course In Sub-Saharan Africa, Ifeoma Ozodiegwu, Mary Ann Littleton, Christian Nwabueze, Oluwaseun Famojuro, Megan Quinn, Rick L. Wallace, Hadii M. Mamudu

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Objective: Adult women are disproportionately affected by overweight and obesity in Sub-Saharan African (SSA) countries. Existing evidence on the sociocultural context remains unconsolidated. In this qualitative research synthesis, we aggregate research literature on contextual factors that potentially predispose adult women and adolescent girls to overweight and obesity to inform research, policies and programs over the life course.

Methods: PubMed, CINAHL, PsychInfo, ProQuest Central, EMBASE, and Web of Science were searched to locate qualitative research articles conducted in SSA countries beginning in the year 2000. After assessment for eligibility and critical appraisal, 17 studies were included in the synthesis. Textual data …

Playing To Live: Outcome Evaluation Of A Community-Based Psychosocial Expressive Arts Program For Children During The Liberian Ebola Epidemic, Caroline A. Decosimo, J. Hanson, Megan Quinn, P. Badu, E. G. Smith

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Background. This paper reviews the efficacy of a community psychosocial arts program focused on building mental health capacity within post-Ebola Liberia. The aim of this paper was to evaluate the outcome effects of two groups using pre- and post-treatment data. We hypothesized that there would be a difference in symptoms pre- and post-treatment, and the longer program would yield more significant results.

Methods. There was a total of 870 child participants. Of 40 sites, 24 were selected for a 5-month treatment (TG1) while the remaining 16 sites received 3 months of treatment (TG2). Paired t tests and a mixed-model analysis …

The Influence Of Maternal Body Mass Index And Physical Activity On Select Cardiovascular Risk Factors Of Preadolescent Hispanic Children, Basil A. Alhassan, Ying Liu, Deborah Slawson, Jonathan M. Peterson, Jo-Ann Marrs, William A. Clark, Arsham Alamian

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Background. Maternal obesity and physical inactivity have been identified as correlates of overweight and obesity and physical inactivity in older preadolescents; however, no study has explored this relationship in Hispanic preadolescents. Furthermore, the relation between maternal physical activity (PA) and blood pressure (BP) in Hispanic preadolescents has not been examined. Purpose. This study aimed to assess the associations between Hispanic mothers’ PA and body mass index (BMI) and their preadolescents’ PA, screen time, BP, and BMI. Methods. Data of 118 mother-child (aged 2–10 years) dyads enrolled in a crosssectional study of metabolic syndrome in Hispanic preadolescents at a community health …

Geographic Differences In Obesity Prevalence And Its Risk Factors Among Asian Americans: Findings From The 2013–2014 California Health Interview Survey, Shaoqing Gong, Kesheng Wang, Ying Li, Arsham Alamian

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Geography disparities exist in obesity and obesity related conditions. This study aimed to examine the geographic differences in obesity prevalence and its risk factors among Asian Americans in California. Data (n = 4,000) from the 2013–2014 California Health Interview Survey were used. Obesity (≥27.5 kg/m2) was defined according to the World Health Organization Asian body mass index cut points in Asian groups. Results suggest that 66.5% of Asians lived in urban areas. Among Asian adults, obesity prevalence was highest in Filipinos (33.8%) and lowest in Koreans (12.8%). Compared to rural Vietnamese, obesity prevalence was higher for urban Vietnamese (8.3% vs. …

Harm Reduction Panel, Billy Brooks

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Objectives are (1) Describe HIV/HCV prevalence in TN and Central Appalachia; (2) Understand syringe access in pharmacy settings. Identify and refer clients to local syringe service programs.

Assessing Heat-Related Mortality Risks Among Rural Populations: A Systematic Review And Meta-Analysis Of Epidemiological Evidence, Emmanuel A. Odame, Ying Li, Shimin Zheng, Ambarish Vaidyanathan, Ken Silver

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Most epidemiological studies of high temperature effects on mortality have focused on urban settings, while heat-related health risks in rural areas remain underexplored. To date there has been no meta-analysis of epidemiologic literature concerning heat-related mortality in rural settings. This study aims to systematically review the current literature for assessing heat-related mortality risk among rural populations. We conducted a comprehensive literature search using PubMed, Web of Science, and Google Scholar to identify articles published up to April 2018. Key selection criteria included study location, health endpoints, and study design. Fourteen studies conducted in rural areas in seven countries on four …

The Adipokine C1q Tnf Related Protein 3 (Ctrp3) Is Elevated In The Breast Milk Of Obese Mothers, Megan R. Kwon, Eileen M. Cress, W. Andrew Clark, Arsham Alamian, Yongke Lu, Jonathan M. Peterson

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Background C1q TNF related protein 3 (CTRP3) is a relatively novel hormonal factor primarily derived from adipose tissue and has anti-diabetic properties. To determine if CTRP3 could play a role in early childhood development, the purpose of this study was to establish the presence of CTRP3 in breast milk (BM) and to determine whether CTRP3 levels were correlated with pregravid obesity status of the mother. Methods Breast milk was collected from breast-feeding mothers who had a pregravid body mass index (BMI) classification of normal weight (BMI 18–25 kg/m2, n = 23) or obese (BMI > 30 kg/m2, n = 14). Immunoprecipitation …

Stratified Multilevel Logistic Regression Modeling For Risk Factors Of Adolescent Obesity In Tennessee, Shimin Zheng, Sheryl Strasser, Nicole Holt, Megan Quinn, Ying Liu, Casey Morrell

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Background: US adolescent obesity rates have quadrupled over the past 3 decades. Research examining complex factors associatedwith obesity is limited.Objectives: The purpose of this study was to utilize a representative sample of students (grades 6 - 8) in Tennessee to determine theco-occurrence of risk behaviors with adolescent obesity prevalence and to analyze variations by strata. Methods: The 2010 youth risk behavior survey dataset was used to examine associations of obesity with variables related to sampledemographics, risk and protective behaviors, and region. Hierarchical logistic regression analyses stratified by demographics andregion were conducted to evaluate variation in obesity risk occurring on three …

Prevalence Of And Trends In Diabetes Among Veterans, United States, 2005–2014, Ying Liu, Sonica Sayam, Xiaonan Shao, Kesheng Wang, Shimin Zheng, Ying Li, Liang Wang

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Diabetes is a highly prevalent chronic disease among US adults, and its prevalence among US veterans is even higher. This study aimed to examine the prevalence of and trends in diabetes in US veterans by using data from the US National Health and Nutrition Examination Survey from 2005 through 2014. The overall prevalence of diabetes and undiagnosed diabetes was 20.5% and 3.4%, respectively, and increased from 15.5% in 2005–2006 to 20.5% in 2013–2014 (P = .04). Effective prevention and intervention approaches are needed to lower diabetes prevalence among US veterans and ultimately improve their health status.

Comparing Urban And Rural Vulnerability To Heat-Related Mortality: A Systematic Review And Meta-Analysis, Ying Li, Emmanuel A. Odamne, Ken Silver, Shimin Zheng

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Studies of the adverse impacts of high temperature on human health have primarily focused on urban areas, due in part to urban centers generally having higher population density and often being warmer than surrounding rural areas (the “urban heat island” effect). As a result, urban areas are often considered to be more vulnerable to summer heat. However, heat vulnerability may not only be determined by heat exposure, but also by other population characteristics such as age, education, income, baseline health status, and social isolation. These factors are likely to increase vulnerability among rural populations compared to urban populations. In this …

Retrospective Cohort Study Of The Efficacy Of Azithromycin Vs. Doxycycline As Part Of Combination Therapy In Non-Intensive Care Unit Veterans Hospitalized With Community-Acquired Pneumonia, Justin Spivey, Heather Sirek, Robert Wood, Kalpit Devani, Billy Brooks, Jonathan Moorman

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The IDSA Community-Acquired Pneumonia (CAP) Guideline recommends ceftriaxone in combination with doxycycline as an alternative to combination therapy with ceftriaxone and azithromycin for non-intensive care unit (ICU) patients hospitalized with CAP. This is an attractive alternative regimen due to recent concerns of increased cardiovascular risk associated with azithromycin. The objective of this study was to compare the clinical outcomes of azithromycin and doxycycline each in combination with ceftriaxone for non-ICU Veterans hospitalized with CAP.

The Use Of Vital Statistics Data For Research Of Consequence: Birth Outcomes And Population Health In A Rural Region, Claudia Kozinetz, Shimin Zheng, Eunice Mogusu

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Objective: The Affordable Care Act (ACA) has influenced increasing interests in population health and population health outcomes. The purpose of this study was to exemplify the importance of using existing vital statistics data for understanding and monitoring health outcomes and consequentially health disparities at the population level. Data from birth records for two geographic regions from 2009-2014 were compared; low birth weight (LBW) and preterm delivery (PD) were used as surrogates for population health outcomes.

Methods: A population-based, multi-year, cross-sectional study design using a pooled dataset of birth records from Tennessee (TN) was the framework for the analyses. …

A Process Description Of Playing To Live! A Community Psychosocial Arts Program During Ebola, C. Alexis Decosimo, Jessi E. Hanson, Catherine Reilly Boland, Deborah L. Slawson, Mary Ann Littleton, Megan Quinn

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From 2014 to 2015, Liberia experienced the largest Ebola epidemic in world history. The impact of this disease was not only physical; it created fear, loss, and trauma throughout the country. This article will describe the process of three phases of a community-based psychosocial expressive arts program, which used theory from the fields of expressive arts therapy to build mental health capacity during and after the epidemic. This article will highlight the background of Ebola virus disease and the Ebola virus disease epidemic, provide an overview of current theory and research for expressive arts therapy and the impact of trauma, …

Analysis Of The Liberian Ebola Survivors Support System (Esss), Jessi Hanson, Patrick Seeco Faley, Megan Quinn

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A systems theoretical analysis to capture the evolution and transition of the network systems supporting Ebola survivors and their affected communities, during the 2014-15 Ebola outbreak and recovery phases. The qualitative analysis includes a literature review, archival review, and interviews with representatives of key actors operating in strategic action fields. This paper uses a series of Diagrams that visually illustrate the various complex phases and their network changes that occurred and were established during the outbreak. This case analysis provides crucial phase information that both captures the historical events that informed the systems changes, including the development of the Ebola …

Ethnic Differences In Risk Factors For Obesity Among Adults In California, The United States, Liang Wang, Jodi L. Southerland, Kesheng Wang, Beth A. Bailey, Arsham Alamian, Marc A. Stevens, Youfa Want

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Little attention has been given to differences in obesity risk factors by racial/ethnic groups. Using data from the 2011-2012 California Health Interview Survey, we examined differences in risk factors for obesity among Whites, Latinos, Asians, and African Americans among 42,935 adults (24.8% obese). Estimates were weighted to ensure an unbiased representation of the Californian population. Multiple logistic and linear regression analyses were used to examine the differences in risk factors for obesity. Large ethnic disparities were found in obesity prevalence: Whites (22.0%), Latinos (33.6%), African Americans (36.1%), and Asians (9.8%). Differences in risk factors for obesity were also observed: Whites …

Infant Sleep Problems And Childhood Overweight: Effects Of Three Definitions Of Sleep Problems, Arsham Alamian, Liang Wang, Amber M. Hall, Melanie Pitts, Joseph Ikekwere

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Sleep problems have been defined using a variety of definitions. No study has assessed the longitudinal association between infant sleep problems and childhood overweight or obesity using existing definitions of sleep problems. This study used longitudinal data (n=895) from the multi-site Study of Early Child Care and Youth Development (SECCYD) to investigate the effects of infant sleep problems on childhood weight status in Grade 6. Infants with sleep problems in Phase I (1991) and with complete data through Phase III (2004) of SECCYD were included. Sleep problems were assessed using maternal reports of night wakings and duration of a waking …

Prevalence Of And Risk Factors For Adolescent Obesity In Tennessee Using The 2010 Youth Risk Behavior Survey (Yrbs) Data: An Analysis Using Weighted Hierarchical Logistic Regression, Shimin Zheng, Nicole Holt, Jodi L. Southerland, Yan Cao, Trevor Taylor, Deborah L. Slawson, Mark Bloodworth

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Background: The rate of adolescent overweight and obesity has more than quadrupled over the past few decades, and has become a major public health problem [1]. In 2011, 55% of 12-19 year olds in the United States (U.S.) were overweight or obese [2]. Adolescence is a pivotal time in which many health risk behaviors such as tobacco, alcohol, and drug use are initiated. Such health risk behaviors have been significantly associated with overweight and obesity among adolescents.

Objective: The purpose of this study is to evaluate the relationship between obesity and the health risk behaviors most commonly associated with premature …

Predictors Of Neonatal Abstinence Syndrome In Buprenorphine Exposed Newborn: Can Cord Blood Buprenorphine Metabolite Levels Help?, Darshan Shah, Stacy Brown, Nick Hagemeier, Shimin Zheng, Amy Kyle, Jason Pryor, Nilesh Dankhara, Piyuesh Singh

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Background

Buprenorphine is a semi-synthetic opioid used for the treatment of opioid dependence. Opioid use, including buprenorphine, has been increasing in recent years, in the general population and in pregnant women. Consequently, there has been a rise in frequency of neonatal abstinence syndrome (NAS), associated with buprenorphine use during pregnancy. The purpose of this study was to investigate correlations between buprenorphine and buprenorphine-metabolite concentrations in cord blood and onset of NAS in buprenorphine exposed newborns.

Methods

Nineteen (19) newborns who met inclusion criteria were followed after birth until discharge in a double-blind non-intervention study, after maternal consent. Cord blood and …

Alignment Of Epidemiology Practice And Academic Competencies Through Effective Collaboration, Kimberly R. Glenn, Paula R. Masters, Megan Quinn

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Background: Online learning has recently garnered increased attention as technology use in the classroom grows. However, most of the published approaches regarding this topic in postgraduate education centers on clinical environments. Models of partnerships between applied public health agencies and academic centers to produce mutually beneficial online learning opportunities for graduate-level public health courses have not been explored in the literature.

Methods: East Tennessee State University (ETSU) and the Tennessee Department of Health (TDH) partnered to build three online, asynchronous epidemiology modules for an interdisciplinary audience of graduate students. The goals of the modules were to (1) introduce students to …

Diminished Quality Of Life Among Women Affected By Ebola, Jessi Hanson, Alexis Decosimo, Megan Quinn

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This article analyzes data collected from Liberian women afflicted by the Ebola virus disease, survivors of the virus and noninfected persons living in Ebola-affected homes. This research is one of the first statistical analyses examining factors diminishing quality of life: negative experiences, stigma, and psychosocial symptoms among females affected by the virus after the outbreak. The research presents a thorough literature review, including research related to other infectious diseases like HIV/AIDS, to inform the gap in studies on Ebola’s effects on quality of life. Women who are Ebola virus disease survivors demonstrate significant differences in stigma and psychosocial stress when …

Associations Of Perfluoroalkyl Substances (Pfass) With Lower Birth Weight: An Evaluation Of Potential Confounding By Glomerular Filtration Rate Using A Physiologically Based Pharmacokinetic Model (Pbpk), Marc-André Verner, Anne E. Loccisano, Nils-Halvdan Morken, Miyoung Yoon, Huali Wu, Robin Mcdougall, Mildred Maisonet, Michele Marcus, Reiko Kishi, Chihiro Miyashita, Mei-Huei Chen, Wu-Shiun Hsieh, Melvin E. Andersen, Harvey J. Clewell Iii, Matthew P. Longnecker

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Background: Prenatal exposure to perfluoroalkyl substances (PFAS) has been associated with lower birth weight in epidemiologic studies. This association could be attributable to glomerular filtration rate (GFR), which is related to PFAS concentration and birth weight.

Objectives: We used a physiologically based pharmacokinetic (PBPK) model of pregnancy to assess how much of the PFAS–birth weight association observed in epidemiologic studies might be attributable to GFR.

Methods: We modified a PBPK model to reflect the association of GFR with birth weight (estimated from three studies of GFR and birth weight) and used it to simulate PFAS concentrations in maternal and cord …

Prenatal Exposure To Perfluoroalkyl Acids And Serum Testosterone Concentrations At 15 Years Of Age In Female Alspac Study Participants, Mildred Maisonet, Antonia M. Calafat, Michele Marcus, Jouni J.K. Jaakkola, Hany Lashen

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Background: Exposure to perfluorooctane sulfonic acid (PFOS) or to perfluorooctanoic acid (PFOA) increases mouse and human peroxisome proliferator–activated receptor alpha (PPARα) subtype activity, which influences lipid metabolism. Because cholesterol is the substrate from which testosterone is synthesized, exposure to these substances has the potential to alter testosterone concentrations.

Objectives: We explored associations of total testosterone and sex hormone–binding globulin (SHBG) concentrations at age 15 years with prenatal exposures to PFOS, PFOA, perfluorohexane sulfonic acid (PFHxS), and perfluoronanoic acid (PFNA) in females.

Methods: Prenatal concentrations of the perfluoroalkyl acids (PFAAs) were measured in serum collected from pregnant mothers at enrollment (1991–1992) …

College Students As Facilitators In Reducing Adolescent Obesity Disparity In Southern Appalachia: Team Up For Healthy Living, Deborah Slawson, William T. Dalton, Taylor Mckeehan Dula, Jodi Southerland, Liang Wang, Mary Ann Littleton, Diana Mozen, George Relyea, Karen Schetzina, Elizabeth F. Lowe, James M. Stoots, Tiejian Wu

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The proportion of obese adolescents in Southern Appalachia is among the highest in the nation. Through funding from the National Institute on Minority Health and Health Disparities — National Institutes of Health, the Team Up for Healthy Living project was a cluster-randomized trial targeting obesity prevention in adolescents through a cross-peer intervention. The specific aims of the project were to: 1) develop a peer-based health education program focusing on establishing positive peer norms towards healthy eating and physical activity (PA) among high school students, 2) test program efficacy, and 3) explore mechanisms underlying the program. The study was guided by …

Noroviruses As A Cause Of Diarrhea In Immunocompromised Pediatric Hematopoietic Stem Cell And Solid Organ Transplant Recipients, X. Ye, J. N. Van, F. M. Munoz, P. A. Revell, Claudia A. Korinetz, R. A. Krance, R. L. Atmar, M. K. Estes, H. L. Koo

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Case reports describe significant norovirus gastroenteritis morbidity in immunocompromised patients. We evaluated norovirus pathogenesis in prospectively enrolled solid organ (SOT) and hematopoietic stem cell transplant (HSCT) patients with diarrhea who presented to Texas Children's Hospital and submitted stool for enteric testing. Noroviruses were detected by real-time reverse transcription polymerase chain reaction. Clinical outcomes of norovirus diarrhea and non-norovirus diarrhea patients, matched by transplanted organ type, were compared. Norovirus infection was identified in 25 (22%) of 116 patients, more frequently than other enteropathogens. Fifty percent of norovirus patients experienced diarrhea lasting ≥14 days, with median duration of 12.5 days (range 1–324 …

Alcohol Consumption, Depression, Insomnia And Colorectal Cancer Screening: Racial Differences, Daniel Owusu, Megan Quinn, Ke Sheng Wang

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Background: Mortality from colorectal cancer (CRC) can be reduced drastically by early detection and early treatment. However, uptake of CRC screening is relatively low, about 50% for those whom the test is highly recommended.

Objectives: We examined the influence of and racial differences in depression, insomnia, alcohol use, and tobacco use on CRC screening uptake in the US.

Patients and Methods: Analysis of the 2012 National Health Information Survey data was conducted. Both weighted univariate and multiple logistic regression analyses were performed in SAS to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs). A total …

Prevalence And Correlates Of Indoor Tanning And Sunless Tanning Product Use Among Female Teens In The United States, Megan Quinn, Arsham Alamian, Joel J. Hillhouse, Colleen Scott, Rob Turrisi, Katie Baker

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Background

Indoor tanning (IT) before the age of 35 increases melanoma risk by 75%. Nevertheless, IT and sunless tanning product (STP) use have gained popularity among youth. However, there are limited data on the prevalence and sociodemographic correlates of both IT and STP use in a representative sample of American teens.

Methods

Teenage females (N = 778) aged 12–18 years were recruited as part of an on-going longitudinal study conducted between May 2011 and May 2013. Descriptive statistics explored IT and STP usage in teen females at baseline. Logistic regression was used to determine sociodemographic correlates of IT and STP …