Medicine and Health Sciences Commons^™

Community Paramedicine In Central Oregon: A Promising Model To Reduce Non-Urgent Emergency Department Utilization Among Medically Complexmedicaid Beneficiaries, Jessica Currier, Neal Wallace, Keshia Bigler, Maggie O’Connor, Paige E. Farris, Jackilen Shannon

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community-based health care settings. Outreach through community paramedicine to patients with a history of high hospital emergency department (ED) use and chronic health conditions has been found to reduce ED use. This study examined the effect of community paramedicine implemented in 2 rural counties in reducing nonemergent ED use among a sample of Medicaid beneficiaries with complex medical conditions and a history of high ED utilization.

Methods

A cluster randomized trial approach with a stepped wedge design was …

Engaging Public Health Critical Race Praxis In Local Social Determinants Of Health Research: The Youth Health Equity And Action Research Training Program In Portland, Or—Yheartpdx, Ryan J. Petteway, Lourdes Gonzalez

OHSU-PSU School of Public Health Faculty Publications and Presentations

The social determinants of health (SDH) have long been considered a core mechanism through which racial health inequities are (re)produced and incubated in the U.S. Moreover, scholars have expressly—and appropriately—named structural racism as a precursor to inequities associated with SDH. However, while research on racial health inequities—SDH-related or otherwise—continues to grow, communities of color remain grossly underrepresented as public health researchers and practitioners. Additionally, although SDH are experienced in a very local sense, much research and practice fails to more deeply and thoroughly engage and center local community knowledges. Thus, much work around SDH and racial health inequities presents, ironically, …

Facilitators And Barriers To Healthy Eating Among American Indian And Alaska Native Adults With Type 2 Diabetes: Stakeholder Perspectives, Sarah Stotz, Nertila Bregaj, Kelly Gonzales, Luciana E. Hebert, Kelly R. Moore

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: American Indian and Alaska Native (AI/AN) adults have a higher prevalence of type 2 diabetes (T2D) and related complications than non-AI/AN adults. As healthy eating is a cornerstone of diabetes self-management, nutrition education plays an important role in diabetes self-management education.

Objective: To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D in order to inform the cultural adaptation of an existing diabetes nutrition education curriculum.

Methods: Individual interviews were conducted with 9 national content experts in diabetes nutrition education (e.g. registered dietitians, diabetes educators, experts on AI/AN food insecurity) and 10 community-based …

Gut Carriage Of Antimicrobial Resistance Genes In Women Exposed To Small-Scale Poultry Farms In Rural Uganda: A Feasibility Study, Ana A. Weil, Meti D. Debela, Daniel M. Muyanja, Bernard Kakuhikire, Charles Baguma, David Bangsberg, Alexander C. Tsai, Peggy S. Lai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Antibiotic use for livestock is presumed to be a contributor to the acquisition of antimicrobial resistance (AMR) genes in humans, yet studies do not capture AMR data before and after livestock introduction.

Methods: We performed a feasibility study by recruiting a subset of women in a delayed-start randomized controlled trial of small-scale chicken farming to examine the prevalence of clinically-relevant AMR genes. Stool samples were obtained at baseline and one year post-randomization from five intervention women who received chickens at the start of the study, six control women who did not receive chickens until the end of the study, …

Annual Wellness Visits And Influenza Vaccinations Among Older Adults In The Us, Terese Sara Hoj Jørgensen, Heather G. Allore, Miriam R. Elman, Corey L. Nagel, Mengran Zhang, Sheila Markwardt, Ana R. Quiñones

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives

Investigate whether combinations of sociodemographic factors, chronic conditions, and other health indicators pose barriers for older adults to access Annual Wellness Visits (AWVs) and influenza vaccinations.

Methods

Data on 4999 individuals aged ≥65 years from the 2012 wave of the Health and Retirement Study linked with Medicare claims were analyzed. Conditional Inference Tree (CIT) and Random Forest (CIRF) analyses identified the most important predictors of AWVs and influenza vaccinations. Multivariable logistic regression (MLR) was used to quantify the associations.

Results

Two-year uptake was 22.8% for AWVs and 65.9% for influenza vaccinations. For AWVs, geographical region and wealth emerged as …

Strong Men, Strong Communities: Design Of A Randomized Controlled Trial Of A Diabetes Prevention Intervention For American Indian And Alaska Native Men, Ka‘Imi Sinclair, Cara Carty, Kelly L. Gonzales, Cassandra Nikolaus, Lucas Gillespie, Dedra Buchwald

OHSU-PSU School of Public Health Faculty Publications and Presentations

Type 2 diabetes is a serious global epidemic that disproportionately affects disadvantaged populations. American Indians and Alaska Natives (AIs/ANs) have the highest rates of diabetes in the nation with a prevalence of 14.7% in 2018, more than twice that of non-Hispanic Whites. AI/AN men have the highest prevalence of diagnosed type 2 diabetes (14.5%) compared to non-Hispanic Black (11.4%), non-Hispanic Asian (10.0%), and non-Hispanic White (8.6%) men. Several landmark clinical trials have shown that lifestyle interventions can effectively prevent or delay the onset of diabetes among those at risk, including in AIs/ANs. Despite positive outcomes for AIs/ANs in these studies, …

“Little Tablets Of Gold”: An Examination Of The Psychological And Social Dimensions Of Prep Among Lgbtq Communities, Christina J. Sun, Kirsten M. Anderson, Kim Toevs, Dayna Morrison, Caitlin Wells, Christina Nicolaidis

OHSU-PSU School of Public Health Faculty Publications and Presentations

There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users’ experiences were shaped by multiple forms of stigma. Participants …

Impacts Of An Opioid Overdose Prevention Intervention Delivered Subsequent To Acute Care, Caleb J. Banta-Green, Phillip O. Coffin, Joseph O. Merrill, Jeanne M. Sears, Chris Dunn, Norbert D. Yanez, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background Opioid overdose is a major and increasing cause of injury and death. There is an urgent need for interventions to reduce overdose events among high-risk persons.

Methods Adults at elevated risk for opioid overdose involving heroin or pharmaceutical opioids who had been cared for in an emergency department (ED) were randomised to overdose education combined with a brief behavioural intervention and take-home naloxone or usual care. Outcomes included: (1) time to first opioid overdose-related event resulting in medical attention or death using competing risks survival analysis; and (2) ED visit and hospitalisation rates, using negative binomial regression and adjusting …

Exploring The Extent Of The Hikikomori Phenomenon On Twitter: Mixed Methods Study Of Western Language Tweets, Pereira-Sanchez, Miguel Angel Alvarez-Mon, Angel Asunsolo Del Barco, Melchor Alvarez-Mon, Alan R. Teo

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Hikikomori is a severe form of social withdrawal, originally described in Japan but recently reported in other countries. Debate exists as to what extent hikikomori is viewed as a problem outside of the Japanese context. Objective: We aimed to explore perceptions about hikikomori outside Japan by analyzing Western language content from the popular social media platform, Twitter. Methods: We conducted a mixed methods analysis of all publicly available tweets using the hashtag #hikikomori between February 1 and August 16, 2018, in 5 Western languages (Catalan, English, French, Italian, and Spanish). Tweets were first classified as to whether they described …

Relative Wealth, Subjective Social Status, And Their Associations With Depression: Cross-Sectional, Population-Based Study In Rural Uganda, Meghan L. Smith, Bernard Kakuhikire, C. Baguma, Justin D. Rasmussen, David Bangsberg, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Depression is a leading cause of disability worldwide, and has been found to be a consistent correlate of socioeconomic status (SES). The relative deprivation hypothesis proposes that one mechanism linking SES to health involves social comparisons, suggesting that relative SES rather than absolute SES is of primary importance in determining health status. Using data from a whole-population sample of 1,620 participants residing in rural southwestern Uganda, we estimated the independent associations between objective and subjective relative wealth and probable depression, as measured by the depression subscale of the Hopkins Symptom Checklist (HSCLD). Objective relative wealth was measured by an asset …

Portrayals Of Mental Illness, Treatment, And Relapse And Their Effects On The Stigma Of Mental Illness: Population-Based, Randomized Survey Experiment In Rural Uganda, Justin D. Rasmussen, Bernard Kakuhikire, C. Baguma, Scholastic Ashaba, Christine E. Cooper-Vince, Jessica M. Perkins, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

Mental illness stigma is a fundamental barrier to improving mental health worldwide, but little is known about how to durably reduce it. Understanding of mental illness as a treatable medical condition may influence stigmatizing beliefs, but available evidence to inform this hypothesis has been derived solely from high-income countries. We embedded a randomized survey experiment within a whole-population cohort study in rural southwestern Uganda to assess the extent to which portrayals of mental illness treatment effectiveness influence personal beliefs and perceived norms about mental illness and about persons with mental illness.

Methods and findings

Study participants were randomly assigned …

Barriers And Facilitators To Recruitment And Enrollment Of Hiv-Infected Individuals With Opioid Use Disorder In A Clinical Trial, Kim Hoffman, Robin Baker, Lynn Elizabeth Kunkel, Elizabeth Needham Waddell, Paula J. Lum, Dennis Mccarty, P. Todd Korthuis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

The CTN-0067 CHOICES trial tests implementation of extended-release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for opioid use disorders (OUD) in HIV clinics to improve HIV viral suppression. The study team investigated recruitment strategies to elucidate the barriers and facilitators to recruitment and enrollment in the study.

Main text

Methods: Semi-structured, in-depth, digitally recorded interviews were completed with study recruitment-related staff and medical providers (n = 26) from six participating HIV clinics in the fall of 2018. Interviews probed 1) factors that might prevent prospective participants from engaging in study recruitment and enrollment procedures and 2) strategies used by study …

Internalized Hiv Stigma, Art Initiation And Hiv-1 Rna Suppression In South Africa: Exploring Avoidant Coping As A Longitudinal Mediator, Valerie A. Earnshaw, Laura M. Bogart, Jean-Philippe Laurenceau, Brian T. Chan, Brendan G. Maughan-Brown, Janan Dietrich, Ingrid Courtney, Gugu Tshabalala, Catherine Orrell, Glenda E. Gray, David Bangsberg, Ingrid T. Katz

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: Cross‐sectional evidence suggests that internalized HIV stigma is associated with lower likelihoods of antiretroviral therapy (ART) initiation and HIV‐1 RNA suppression among people living with HIV (PLWH). This study examined these associations with longitudinal data spanning the first nine months following HIV diagnosis and explored whether avoidant coping mediates these associations.

Methods: Longitudinal data were collected from 398 South African PLWH recruited from testing centres in 2014 to 2015. Self‐report data, including internalized stigma and avoidant coping (denying and distracting oneself from stressors), were collected one week and three months following HIV diagnosis. ART initiation at six months and …

Reaching Those At Risk For Psychiatric Disorders And Suicidal Ideation: Facebook Advertisements To Recruit Military Veterans, Alan R. Teo, Samuel B.L. Liebow, Benjamin Chan, Steven K. Dobscha, Amanda L. Graham

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Younger military veterans are at high risk for psychiatric disorders and suicide. Reaching and engaging veterans in mental health care and research is challenging. Social media platforms may be an effective channel to connect with veterans.

Objective: This study tested the effectiveness of Facebook advertisements in reaching and recruiting Iraq and Afghanistan-era military veterans in a research study focused on mental health.

Methods: Facebook ads requesting participation in an online health survey ran for six weeks in 2017. Ads varied imagery and headlines. Validated instruments were used to screen for psychiatric disorders and suicidality. Outcomes included impressions, click-through rate, …

Social Network Correlates Of Ipv Acceptance In Rural Honduras And Rural Uganda, Holly B. Shakya, Jessica M. Perkins, Margaret Traeger, Alexander C. Tsai, David Bangsberg, Bernard Kakuhikire, Nicholas A. Christakis

OHSU-PSU School of Public Health Faculty Publications and Presentations

We investigated the household-level social network correlates of acceptance of intimate partner violence (IPV) in rural, agrarian settings of Honduras and Uganda, two low-income countries with unequal access to resources based upon gender. We collected complete social network data in each location (Honduras in 2014 and Uganda in 2012), across a diverse range of relationships, and then created a measure of household cohesion by calculating the degree to which members of a household nominated each other as important social connections. Our measure of IPV acceptance was based on 4 questions from the Demographic Health Survey to assess the conditions under …

Food Insecurity, Social Networks And Symptoms Of Depression Among Men And Women In Rural Uganda: A Cross-Sectional, Population-Based Study, Jessica M. Perkins, Viola N. Nyakato, Bernard Kakuhikire, Alexander C. Tsai, Sv Subramanian, David Bangsberg, Nicholas A. Christakis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: To assess the association between food insecurity and depression symptom severity stratified by sex, and test for evidence of effect modification by social network characteristics.

Design: A population-based cross-sectional study. The nine-item Household Food Insecurity Access Scale captured food insecurity. Five name generator questions elicited network ties. A sixteen-item version of the Hopkins Symptom Checklist for Depression captured depression symptom severity. Linear regression was used to estimate the association between food insecurity and depression symptom severity while adjusting for potential confounders and to test for potential network moderators.

Setting: In-home survey interviews in south-western Uganda. Subjects: All adult residents …

Diagnostic Performance Of Blood Inflammatory Markers For Tuberculosis Screening In People Living With Hiv, Katherine Farr, Resmi Ravindran, Luke Strnad, Emily Chang, Leah H. Chaisson, Christina Yoon, William Worodria, Alfred Andama, Irene Ayakaka, Priscilla Bbosa Nalwanga, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

Approaches to screening for active tuberculosis (TB) among people living with HIV are inadequate, leading to missed diagnoses and poor implementation of preventive therapy.

Methods

Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between June 2011 and July 2013 with a cough ≥ 2 weeks were enrolled. Patients underwent extensive evaluation for pulmonary TB. Concentrations of 43 cytokines/chemokines were measured at the same time point as C-reactive protein (CRP) in banked plasma samples using commercially-available multiplex kits. Advanced classification algorithms were used to rank cytokines/chemokines for their ability to identify TB, and to model the specificity of the …

Household Water Insecurity, Missed Schooling, And The Mediating Role Of Caregiver Depression In Rural Uganda, Christine E. Cooper-Vince, Bernard Kakuhikire, Dagmar Vořechovská, Amy Q. Mcdonough, Jessica M. Perkins, Atheendar S. Venkataramani, Rumbidzai Mushavi, Charles Baguma, Scholastic Ashaba, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: School attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children’s water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations.

Method: We conducted a population-based, cross-sectional study of female household heads (N = 257) and …

Measuring Personal Beliefs And Perceived Norms About Intimate Partner Violence: Population-Based Survey Experiment In Rural Uganda, Alexander C. Tsai, Bernard Kakuhikire, Jessica M. Perkins, Dagmar Vořechovská, Amy Q. Mcdonough, Elizabeth L. Ogburn, Jordan M. Downey, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Demographic and Health Surveys (DHS) conducted throughout sub-Saharan Africa indicate there is widespread acceptance of intimate partner violence, contributing to an adverse health risk environment for women. While qualitative studies suggest important limitations in the accuracy of the DHS methods used to elicit attitudes toward intimate partner violence, to date there has been little experimental evidence from sub-Saharan Africa that can be brought to bear on this issue.

Methods and Findings: We embedded a randomized survey experiment in a population-based survey of 1,334 adult men and women living in Nyakabare Parish, Mbarara, Uganda. The primary outcomes were …

Psychosocial Challenges Facing Women Living With Hiv During The Perinatal Period In Rural Uganda, Scholastic Ashaba, Angela Kaida, Jessica N. Coleman, Bridget F. Burns, Emma Dunkley, Kasey O'Neil, Jasmine Kastner, Naomi Sanyu, Cecilia Akatukwasa, David R. Bangsberg, Lynn T. Matthews, Christina Psaros

OHSU-PSU School of Public Health Faculty Publications and Presentations

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum.

We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and …

Short Message Service (Sms) Reminders And Real-Time Adherence Monitoring Improve Antiretroviral Therapy Adherence In Rural Uganda, Jessica E. Haberer, Angella Musimenta, Esther Atukunda, Nicholas Musinguzi, Monique A. Wyatt, Norma C. Ware, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: To explore the effects of four types of short message service (SMS) plus realtime adherence monitoring on antiretroviral therapy (ART) adherence: daily reminders, weekly reminders, reminders triggered after a late or missed dose (delivered to patients), and notifications triggered by sustained adherence lapses (delivered to patient-nominated social supporters).

Design: Pilot randomized controlled trial.

Methods: Sixty-three individuals initiating ART received a real-time adherence monitor and were randomized (1 : 1 : 1): (1) Scheduled SMS reminders (daily for 1 month, weekly for 2 months), then SMS reminders triggered by a late or missed dose (no monitoring signal within 2 h …

High Medication Adherence During Periconception Periods Among Hiv-1–Uninfected Women Participating In A Clinical Trial Of Antiretroviral Pre-Exposure Prophylaxis, Lynn T. Matthews, Renee Heffron, Nelly R. Mugo, Craig R. Cohen, Craig W. Hendrix, Connie Celum, David Bangsberg, Jared M. Baten

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: Pre-exposure prophylaxis (PrEP) may be an important safer conception strategy for HIV-1–uninfected women with HIV-1–infected partners. Understanding medication adherence in this population may inform whether PrEP is a feasible safer conception strategy.

Methods: We evaluated predictors of pregnancy and adherence to study medication among HIV-1–uninfected women enrolled in a randomized placebo-controlled trial of PrEP among African HIV-1– serodiscordant couples. Participants were counseled on HIV-1 risk reduction, contraception, and adherence and tested for pregnancy at monthly study visits. Pill counts of dispensed drug were performed and, at a subset of visits, plasma was collected to measure active drug concentration.

Results: …

Decreases In Self-Reported Alcohol Consumption Following Hiv Counseling And Testing At Mulago Hospital, Kampala, Uganda, Judith A. Hahn, Robin Fatch, Rhoda K. Wanyenze, Steven Baveewo, Moses R. Kamya, David Bangsberg, Thomas J. Coates

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Alcohol use has a detrimental impact on the HIV epidemic, especially in sub-Saharan Africa. HIV counseling and testing (HCT) may provide a contact opportunity to intervene with hazardous alcohol use; however, little is known about how alcohol consumption changes following HCT.

Methods: We utilized data from 2056 participants of a randomized controlled trial comparing two methods of HCT and subsequent linkage to HIV care conducted at Mulago Hospital in Kampala, Uganda. Those who had not previously tested positive for HIV and whose last HIV test was at least one year in the past were eligible. Participants were asked at …

Us Medical Specialty Global Health Training And The Global Burden Of Disease, Vanessa B. Kerry, Rochelle P. Walensky, Alexander C. Tsai, Regan W. Bergmark, Brian A. Bergmark, Chaturia Rouse, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Rapid growth in global health activity among US medical specialty education programs has lead to heterogeneity in types of activities and global health training models. The breadth and scope of this activity is not well chronicled.

Methods: Using a standardized search protocol, we examined the characteristics of US medical residency global health programs by number of programs, clinical specialty, nature of activity (elective, research, extended curriculum based field training), and geographic location across seven different clinical medical residency education specialties. We tabulated programmatic activity by clinical discipline, region and country. We calculated the Spearman's rank correlation coefficient to estimate …

Harnessing Poverty Alleviation To Reduce The Stigma Of Hiv In Sub-Saharan Africa, Alexander C. Tsai, David Bangsberg, Sheri D. Weiser

OHSU-PSU School of Public Health Faculty Publications and Presentations

HIV is highly stigmatized throughout sub-Saharan Africa. In studies conducted among general population samples, stigma has been shown to impede uptake of HIV testing and increase sexual risktaking behavior. Among HIV-infected persons, stigma has also been associated with inhibited serostatus disclosure to sexual partners and potential treatment supporters, delays in HIV antiretroviral therapy (ART) initiation, and ART nonadherence. The stigma of HIV also intensifies the poverty, stress, and insecurity endemic to many resource-limited settings, resulting in worsened mental health, itself an important determinant of AIDS-related mortality. Until we can better understand how to effectively intervene to reduce the stigma of …