Medicine and Health Sciences Commons^™

"The Land That Feminism Forgot": Birthzillas, Madwives, And The Politics Of Chilbirth, Amber Vayo

Doctoral Dissertations

“The Land that Feminism Forgot” is an in-depth exploration of the politics of childbirth that draws together qualitative and quantitative evidence to theorize the connections between treatment in childbirth and maternal mortality. Situating the qualitative research in the larger national context, the second chapter offers a State Reproductive Autonomy Index that provides an overview of the reproductive policy landscape at the national level. The dissertation then explores the role of institutionalized childbirth, medical mistrust, and obstetric violence in the U.S.’s longstanding maternal mortality crisis and offers policy suggestions in key public health areas. Through 120 qualitative interviews with people who …

Timing Of Hospital Admission At First Childbirth: A Prospective Cohort Study, Kristen H. Kjerulff, Laura B. Attanasio, Jennifer Vanderlaan, Kristin K. Sznajder

Health Promotion and Policy Faculty Publication Series

Background and aims

It is difficult for women in labor to determine when best to present for hospital admission, particularly at first childbirth. While it is often recommended that women labor at home until their contractions have become regular and ≤ 5-minutes apart, little research has investigated the utility of this recommendation. This study investigated the relationship between timing of hospital admission, in terms of whether women’s labor contractions had become regular and ≤ 5-minutes apart before admission, and labor progress.

Methods

This was a cohort study of 1,656 primiparous women aged 18–35 years with singleton pregnancies who began labor …

Dietary Fat Quality And Serum Androgen Concentrations In Middle-Aged Men, Miika M. Wynne-Ellis, Jaakko J. Mursu, Tomi-Pekka Tuomainen, Elizabeth Bertone-Johnson, Jukka T. Salonen, Jyrki K. Virtanen

Health Promotion and Policy Faculty Publication Series

Average testosterone concentrations in men have declined over the last few decades. The reasons for this are not fully known, but changes in dietary fat quality have been suggested to have a role. This study aimed to investigate the associations of different dietary fatty acids with serum androgen concentrations.

The Massachusetts Public Health Data Warehouse And The Opioid Epidemic: A Qualitative Study Of Perceived Strengths And Limitations For Advancing Research, Elizabeth A. Evans, Elizabeth Delorme, Karl D. Cyr, Kimberly H. Geissler

Health Promotion and Policy Faculty Publication Series

Due to the opioid overdose epidemic, Massachusetts created a Public Health Data Warehouse, encompassing individually-linked administrative data on most of the population as provided by more than 20 systems. As others seek to assemble and mine big data on opioid use, there is a need to consider its research utility. To identify perceived strengths and limitations of administrative big data, we collected qualitative data in 2019 from 39 stakeholders with knowledge of the Massachusetts Public Health Data Warehouse. Perceived strengths included the ability to: (1) detect new and clinically significant relationships; (2) observe treatments and services across institutional boundaries, broadening …

Transitions In Health Insurance During The Perinatal Period Among Patients With Continuous Insurance Coverage, Chanup Jeung, Laura B. Attansio, Kimberly H. Geissler

Health Promotion and Policy Faculty Publication Series

Importance Although health insurance continuity is important during the perinatal period to improve birth outcomes and reduce maternal morbidity and mortality, insurance disruptions are common. However, little is known about insurance transitions among insurance types for individuals who remained insured during the perinatal period.

Objective To examine insurance transitions for birthing individuals with continuous insurance, including those with Medicaid and Medicaid managed care coverage, before, during, and after pregnancy.

Design, Setting, and Participants This cohort study used January 1, 2014 to December 31, 2018 data from the Massachusetts All-Payer Claims Database. The sample included deliveries from January 1, 2015, to …

Evaluating Public Masking Mandates On Covid-19 Growth Rates In U.S. States, Angus K. Wong

Masters Theses

U.S. state governments have implemented numerous policies to help mitigate the spread of COVID-19. While there is strong biological evidence supporting the wearing of face masks or coverings in public spaces, the impact of public masking policies remains unclear. We aimed to evaluate how early versus delayed implementation of state-level public masking orders impacted subsequent COVID-19 growth rates. We defined “early” implementation as having a state-level mandate in place before September 1, 2020, the approximate start of the school-year. We defined COVID-19 growth rates as the relative increase in confirmed cases 7, 14, 21, 30, 45, 60-days after September 1. …

Hospital Assessment And Response To Environmental Pollution As A Population Health Need: Identifying Prevalence And Predictors In Community Benefit Practices, Sarah Valentine

Doctoral Dissertations

Hospitals have a growing role in improving population health. Environmental pollution is an important determinant of health with disproportionate effects on Communities of Color. This warrants hospital action. To advance such action, it is important to take stock of current hospital engagement with environmental pollution and to identify factors associated with such engagement. I investigated the following. To what extent do New York State (NYS) non-profit hospitals assess, identify, and respond to environmental pollutants as part of community benefit practices? Do factors previously reported as associated with hospital engagement of social determinants predict engagement with environmental pollution as a community …

Dental Fluoride Varnish Application During Medical Visits Among Children Who Are Privately Insured, Kimberley H. Geissler Phd, Andrew W. Dick Phd, Sarah L. Goff Phd, Christopher Whaley Phd, Ashley M. Kranz Phd

Health Promotion and Policy Faculty Publication Series

Fluoride varnish is effective at reducing tooth decay, which affects nearly a quarter of US children ages 2 to 5 years and more than half of children ages 6 to 8 years.^1,2 To increase young children’s receipt of preventive oral health services, the US Preventive Services Task Force recommends medical providers apply fluoride varnish to young children’s teeth during well-child visits through 5 years of age.² Offering fluoride varnish in medical settings may increase young children’s receipt of this service because 89% of children younger than 6 years of age had a preventive medical visit in …

Family Support And Readiness To Consider Smoking Cessation Among Chinese And Vietnamese American Male Smokers, Joan A. Daniel, Jin E. Kim-Mozeleski, Krishna C. Poudel, Angela Sun, Nancy J. Burke, Janice Y. Tsoh

Health Promotion and Policy Faculty Publication Series

Introduction. Smoking prevalence is disproportionately high among Asian American immigrant men with limited English proficiency. Understanding the role of family support may provide insights into culturally acceptable strategies to promote smoking cessation. Aims. This study examined how family support was associated with readiness to consider smoking cessation among Chinese and Vietnamese American male daily smokers. Methods. We analyzed baseline data (N = 340) from a cluster randomized trial of a family-based healthy lifestyle intervention. We assessed the frequency of receiving family support in various forms (encouraging use of cessation resources, praising efforts, checking in, and reminding of familial role). Multiple …

Evaluating Epidemic Forecasts In An Interval Format, Johannes Bracher, Evan L. Ray, Tilmann Gneiting, Nicholas G. Reich

Biostatistics and Epidemiology Faculty Publications Series

For practical reasons, many forecasts of case, hospitalization, and death counts in the context of the current Coronavirus Disease 2019 (COVID-19) pandemic are issued in the form of central predictive intervals at various levels. This is also the case for the forecasts collected in the COVID-19 Forecast Hub (https://covid19forecasthub.org/). Forecast evaluation metrics like the logarithmic score, which has been applied in several infectious disease forecasting challenges, are then not available as they require full predictive distributions. This article provides an overview of how established methods for the evaluation of quantile and interval forecasts can be applied to epidemic forecasts in …

Pubertal Development And Risk Of Premenstrual Disorders In Young Adulthood, Donghao Lu, Jurate Alenaviciute, Ragnar Bjarnason, Unnur A. Valdimarsdóttir, Elizabeth R. Bertone-Johnson

Health Promotion and Policy Faculty Publication Series

STUDY QUESTION

Is pubertal timing associated with risk of premenstrual disorders (PMDs) in young adulthood? SUMMARY ANSWER

Late pubertal development is associated with decreased premenstrual symptom burden and risk of PMDs in young adulthood. WHAT IS KNOWN ALREADY

PMDs, including premenstrual syndrome and premenstrual dysphoric disorder, may begin during the teenage years. Few risk factors in early life have been identified for PMD development. STUDY DESIGN, SIZE, DURATION

A prospective cohort study of 6495 female participants during 1996–2013. PARTICIPANTS/MATERIALS, SETTING, METHODS

We included participants from the Growing Up Today Study (GUTS). Pubertal development was indicated by the timing of menarche, …

Shifting To Virtual Cbpr Protocols In The Time Of Corona Virus/Covid-19, Elizabeth Salerno Valdez, Aline Gubrium

Health Promotion and Policy Faculty Publication Series

COVID-19 has upended community based participatory research (CBPR) projects across the United States and globally. COVID-19 disproportionately impacts historically disenfranchised communities and communities of color, the very communities that CBPR is meant to engage, elevate, and support. In-person activities that help develop rapport and research protocols, build capacity, conduct collaborative data collection and analysis, disseminate findings to the community, and engage in sustainability planning are an impossible practice during the COVID-19 pandemic. The purpose of this article is to describe the challenges and facilitators of shifting to a virtual/online CBPR protocol with a Massachusetts community disproportionately affected by COVID19, as …

Incidence Of Pediatric Cannabis Exposure Among Children And Teenagers Aged 0 To 19 Years Before And After Medical Marijuana Legalization In Massachusetts, Jennifer M. Whitehill, Calla Harrington, Cheryl J. Lang, Michael Chary, Waqaas A. Bhutta, Michael D. Burns

Health Promotion and Policy Faculty Publication Series

Importance Pediatric health care contacts due to cannabis exposure increased in Colorado and Washington State after cannabis (marijuana) policies became more liberal, but evidence from other US states is limited.

Objective To document the incidence of pediatric cannabis exposure cases reported to the Regional Center for Poison Control and Prevention (RPC) before and after medical marijuana legalization (MML) in Massachusetts.

Design, Setting, and Participants Cross-sectional comparison of pediatric cannabis exposure cases 4 years before and after MML in Massachusetts. The exposure cases included those of 218 children and teenagers aged between 0 and 19 years, as reported to the RPC …

Searching For The Fulcrum: Can Accountable Care Organizations Lower Spending By Balancing Specialists-To-Primary Care Providers?, Vishal Shetty

Masters Theses

Background:

While value-based payment models emphasizing care coordination have been widely implemented to improve quality and lower expenditures, supporting empirical evidence is sparse. Our objective was to quantify the impact of specialist-to-primary care physician involvement within accountable care organization (ACO) and its association with lower spending.

Methods:

We conducted a retrospective cohort study of Medicare Shared Savings Program ACOs from 2012-2016 using publicly available data provided by the Centers for Medicare and Medicaid Services at the ACO level. We examined the association between the proportion of primary care services delivered by specialists versus other types of care providers and ACO …

Outreach Strategies To Recruit Low-Income African American Men To Participate In Health Promotion Programs And Research: Lessons From The Men Of Color Health Awareness (Mocha) Project, Louis F. Graham, Lamont Scott, Erus Lopeyok, Henry Douglas, Aline Gubrium, David Buchanan

Health Promotion and Policy Faculty Publication Series

African American men continue to bear a disproportionate share of the burden of disease. Engaging these men in health research and health promotion programs—especially lower-income, African American men who are vulnerable to chronic disease conditions such as obesity and heart disease—has historically proven quite difficult for researchers and public health practitioners. The few effective outreach strategies identified in the literature to date are largely limited to recruiting through hospital clinics, churches, and barbershops. The Men of Color Health Awareness (MOCHA) project is a grassroots, community-driven initiative that has developed a number of innovative outreach strategies. After describing these strategies, we …

Transformative Learning Facilitated Dialogue: As A Tool For Social Change An Autoethnography, Leslie A. Saulsberry

Doctoral Dissertations

It is my goal, through this autoethnography, to take you through a reflective journey and present to you my personal theory of how facilitated dialogue in the context of transformative learning, critical reflection, systems thinking, shared vision, and holarchy can create a paradigm shift in our personal consciousness, decisions, behaviors, practice, and social policies—social change. My objective is to show how each theory is like a stepping-stone in the path towards social change. The purpose of this living work is to offer an alternative way of creating a healthy and whole society by exploring how facilitated dialogue can lead to …

Delays In Antiretroviral Therapy Initiation Among Hiv-Positive Individuals: Results Of The Positive Living With Hiv Study, Krishna C. Poudel, David R. Buchanan, Kalpana Poudel-Tandukar

Health Promotion and Policy Faculty Publication Series

Background: Lack of early initiation of antiretroviral therapy (ART) remains a major health concern due to increased risk of premature mortality and further HIV transmission. This study explored CD4+ cell count monitoring in relation to delays in ART initiation among HIV-positive individuals in the Kathmandu Valley, Nepal, where ART coverage was only 23.7% in 2011.

Design: We recruited a total of 87 ART-naïve, HIV-positive individuals aged 18 to 60 years through the networks of five non-government organizations working with HIV-positive individuals. We collected data on the history of ART initiation, CD4+ cell count monitoring, socio-demographic variables, perceived family …

Associations Between The Patient-Centered Medical Home And Preventive Care And Healthcare Quality For Non-Elderly Adults With Mental Illness: A Surveillance Study Analysis, Jennifer J. Bowdoin, Rosa Rodriguez-Monguio, Elaine Puleo, David Keller, Joan Roche

Health Promotion and Policy Faculty Publication Series

Background

Patient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness, but the extent to which PCMHs are associated with preventive care and healthcare quality for this population is largely unknown. Our study addresses this gap by assessing the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness.

Methods

This surveillance study used self-reported data for 6,908 non-elderly adults with mental illness participating in the 2007–2012 Medical Expenditure Panel Survey. Preventive care and healthcare quality measures included: participant rating of all healthcare; cervical, breast, and …

Examining Implementation Of The Massachusetts Act Relative To Safety Regulations For School Athletic Programs (Sessions Laws: Chapter 166 Of The Acts Of 2010): A Multiple-Case Study, Mitchell L. Doucette

Masters Theses

Background/Purpose: Reducing the incidence and negative consequences of concussion among youth athletes is a public health priority. Fifty states have adopted legislation addressing the problem of sports-related concussions among youth-athletes. In 2010, Massachusetts adopted legislation based on Washington State’s Lystedt Law, enacting state-wide requirements for high school athletic programs. This study explored how the legislation has been implemented within Massachusetts schools and school-districts and identified factors influential to local implementation.

Methods: A qualitative multiple-case study approach was utilized. US Census data concerning the household median income and population size of the school-district’s representative town(s) were used to purposively recruit cases. …

Parents' Gender Ideology And Gendered Behavior As Predictors Of Children's Gender-Role Attitudes: A Longitudinal Exploration, Hillary Paul Halpern

Masters Theses

This longitudinal study examined the association between parents’ early and concurrent gender ideology and gendered behaviors and their children’s gender-role attitudes at age six. Specifically, parents' global beliefs about women's and men's "rightful" roles in society, as well as their work preferences for mothers, were considered in relation to the gender-role attitudes held by their first-graders. In addition, parents’ gendered behaviors, including their division of household and childcare tasks, division of paid work hours, and job traditionality were examined as predictors of children’s gender-role attitudes. Based on previous research, it was hypothesized parents’ early and concurrent behavior and ideology would …

Interpreting, Stephanie Jo Kent

Doctoral Dissertations

What do community interpreting for the Deaf in western societies, conference interpreting for the European Parliament, and language brokering in international management have in common? Academic research and professional training have historically emphasized the linguistic and cognitive challenges of interpreting, neglecting or ignoring the social aspects that structure communication. All forms of interpreting are inherently social; they involve relationships among at least three people and two languages. The contexts explored here, American Sign Language/English interpreting and spoken language interpreting within the European Parliament, show that simultaneous interpreting involves attitudes, norms and values about intercultural communication that overemphasize information and discount …

Understanding Health Issues Among Adolescent Females In A Northeast Province Of Afghanistan, Amina Davlatshoeva

Doctoral Dissertations

The purpose of this study is to develop a deeper understanding of the health issues facing adolescent females (ages 18-21) in rural, northeastern Afghanistan. Incorporating participant observations, in-depth interviews, and narrative inquiries, this study seeks to illustrate adolescent females’ perspectives on health issues. To achieve this goal, ten adolescent females were interviewed in rural, northeastern Afghanistan during 2010. The participants were between 18- and 21-years old. The one-on-one interviews were conducted in a multiple-response format and were structured around three research questions:

• How does a young female’s understanding of health issues shape her identity in northeastern Afghanistan?
• In what ways …

Do Black-White Racial Disparities In Breastfeeding Persist In The Military Community?, Jennifer H. Lundquist, Zhun Xu, Wanda Barfield, Irma Elo

Dr. Jennifer H. Lundquist

Objective: We conduct a comparative analysis of breastfeeding behavior between military and civilian-affiliated mothers. Our focus is on African American mothers among whom breastfeeding rates are lowest. The military context may mitigate conditions associated with low breastfeeding prevalence by a) providing stable employment and educational opportunities to populations who face an otherwise poor labor market and b) providing universal healthcare that includes breastfeeding consultation. Methods: Using Pregnancy Risk Assessment Monitoring System (PRAMS) data for which we received special permission from each state to flag military affiliation, we analyze civilians and military affiliate in breastfeeding initiation using logistic regression and breastfeeding …

Policy Alternatives To Increase Access To Early Childhood Education And Care In Massachusetts, Meghan Lemay

Masters Theses 1911 - February 2014

Access to early childhood education not only leads to improved social, academic, and health outcomes for children, but can also carry the same benefits into adulthood. Early education and care programs can work against some of the negative effects of social factors such as socioeconomic status, discrimination, social support, and work demands which have been linked to physical and mental health outcomes. Early education programs could intervene not only in the life of a child, but also impact parents, families, and populations. This thesis will review the research showing early childhood education leads to better social and health outcomes and …

Determinants Of Health Care Use Among Rural, Low-Income Mothers And Children: A Simultaneous Systems Approach To Negative Binomial Regression Modeling, Swetha Valluri

Masters Theses 1911 - February 2014

The determinants of health care use among rural, low-income mothers and their children were assessed using a multi-state, longitudinal data set, Rural Families Speak. The results indicate that rural mothers’ decisions regarding health care utilization for themselves and for their child can be best modeled using a simultaneous systems approach to negative binomial regression. Mothers’ visits to a health care provider increased with higher self-assessed depression scores, increased number of child’s doctor visits, greater numbers of total children in the household, greater numbers of chronic conditions, need for prenatal or post-partum care, development of a new medical condition, and …

A Photovoice Participatory Evaluation Of A School Gardening Program Through The Eyes Of Fifth Graders, Catherine Sands, Krista Harper, Lee Ellen Reed, Maggie Shar

Anthropology Department Faculty Publication Series

In the springtime, fifth grade students at the Williamsburg Elementary School in rural Western Massachusetts ask to snack on sorrel and chives from the school garden, between planting potatoes and building a shade structure for their outdoor classroom. They are members of the first cohort of the curriculum-integrated program initiated by Fertile Ground, a grassroots organization in western Massachusetts. The children’s delight in the fresh greens they have grown marks a national phenomenon: the farm-to-school movement. With limited resources, parents, teachers, students, administrators, and community activists are developing inroads to better school food and food education, by constructing school teaching …

The Association Between Bully Victimization And Risky Behaviors Among Youth, Shane Nives Isaiah Fernando

Masters Theses 1911 - February 2014

In 2005, the Massachusetts Youth Risk Behavior Survey reported 21.9% of males and 26.1% of females were bullied in schools. Little research has been conducted into showing an association between childhood bully victimization and risky behaviors. In addition, knowledge is limited about the connection between victimization and risky behaviors among different ethnic groups. We propose to assess the association between victimization and risky behaviors, using the Massachusetts Youth Risk Behavior Survey among 3,116 students in grades 9 through 12 in 2007. Data was obtained by self-administered questionnaire, and victimization was considered as a single dichotomous variable. Victimization was assessed as …

A Photovoice Participatory Evaluation Of A School Gardening Program Through The Eyes Of Fifth Graders, Catherine Sands, Krista Harper, Lee Ellen Reed, Maggie Shar

Krista M. Harper

In the springtime, fifth grade students at the Williamsburg Elementary School in rural Western Massachusetts ask to snack on sorrel and chives from the school garden, between planting potatoes and building a shade structure for their outdoor classroom. They are members of the first cohort of the curriculum-integrated program initiated by Fertile Ground, a grassroots organization in western Massachusetts. The children’s delight in the fresh greens they have grown marks a national phenomenon: the farm-to-school movement. With limited resources, parents, teachers, students, administrators, and community activists are developing inroads to better school food and food education, by constructing school teaching …

Middlefield Open Space And Recreation Project, Center For Economic Development

Center for Economic Development Technical Reports

Over one thousand acres of farmland, open space, and wetlands are converted to residential or commercial development each week in New England. In Massachusetts, nearly two acres of open space land is lost to development every hour. Current development trends suggest that this building pattern, referred to as sprawl, is likely to continue into the near future. Because the negative consequences of sprawl development are highly visible, residents of Massachusetts are becoming increasingly concerned about its impact on their communities. Residents see the unique character of their communities being transformed by uncontrolled residential and commercial development. Green fields and open …

City Of Gardner, Massachusetts Inventory Of Existing And Removed Tanks, Center For Economic Development

Center for Economic Development Technical Reports

The purpose of this project is to provide the City of Gardner with a list of contaminated sites in the Rear Main Street Area. During the past month, I have been researching potential brownfield locations within this corridor, and inputting them into a working database. Overall, the problem identified is that the city has little knowledge of how much land is contaminated within its city. Therefore, the goal of my project was to identify the parcels in the Rear Main Street Area that have been contaminated with hazardous materials.