Medicine and Health Sciences Commons^™

Two-Stage Optimal Designs With Survival Endpoint When The Follow-Up Time Is Restricted, Guogen Shan, Hua Zhang

Public Health Faculty Publications

Background: Survival endpoint is frequently used in early phase clinical trials as the primary endpoint to assess the activity of a new treatment. Existing two-stage optimal designs with survival endpoint either over estimate the sample size or compute power outside the alternative hypothesis space. Methods: We propose a new single-arm two-stage optimal design with survival endpoint by using the one-sample log rank test based on exact variance estimates. This proposed design with survival endpoint is analogous to Simon’s two-stage design with binary endpoint, having restricted follow-up. Results: We compare the proposed design with the existing two-stage designs, including the two-stage …

Geographic And Socio-Economic Variation In Markers Of Indoor Air Pollution In Nepal: Evidence From A Nationally-Representative Data, Saruna Ghimire, Shiva Rah Mishra, Abhishek Sharma, Adugna Siweya, Nipun Shrestha, Bippin Adhikari

Public Health Faculty Publications

Background: In low-income countries such as Nepal, indoor air pollution (IAP), generated by the indoor burning of biomass fuels, is the top-fourth risk factor driving overall morbidity and mortality. We present the first assessment of geographic and socio-economic determinants of the markers of IAP (specifically fuel types, cooking practices, and indoor smoking) in a nationally-representative sample of Nepalese households. Methods: Household level data on 11,040 households, obtained from the 2016 Nepal Demographic and Health Survey, were analyzed.Binary logistic regression analyses were conducted to assess the use of fuel types, indoor cooking practices, indoor smoking and IAP with respect to socio-economic …

A Qualitative Study On Parental And Community Stakeholder Views Of The Link Between Full-Day Kindergarten And Health In Southern Nevada, Courtney Coughenour, Jennifer Pharr, Maxim Gakh Jd, Mph, Sheila Clark, Prescott Cheong

Public Health Faculty Publications

Studies show that children who attend full-day kindergarten (FDK) experience both academic and developmental benefits compared to children who attend half-day programs. Sectors outside of health, such as education, can have important intended and unintended impacts on health. The purpose of this qualitative study was to understand perceptions of parental and other stakeholders in Southern Nevada (USA) about the education–health link, and to understand priorities regarding how FDK access could affect health. Two 90-minute focus groups were conducted with 14 adult stakeholder participants representing parents, current and former teachers, and community members. Transcripts were analyzed using conventional content analysis. Eight …

Analysis Of Self-Reported Walking For Transit In A Sprawling Urban Metropolitan Area In The Western U.S., Courtney Coughenour, Hanns De La Fuente-Mella, Alexander Paz

Public Health Faculty Publications

Walkability is associated with increased levels of physical activity and improved health and sustainability. The sprawling design of many metropolitan areas of the western U.S., such as Las Vegas, influences their walkability. The purpose of this study was to consider sprawl characteristics along with well-known correlates of walkability to determine what factors influence self-reported minutes of active transportation. Residents from four neighborhoods in the Las Vegas Metropolitan Area, targeted for their high and low walkability scores, were surveyed for their perceptions of street-connectivity, residential-density, land-use mix, and retail–floor-area ratio and sprawl characteristics including distance between crosswalks, single-entry-communities, high-speed streets, shade, …

Practice And Lived Experience Of Menstrual Exiles (Chhaupadi) Among Adolescent Girls In Far Western Nepal. December 2018, Prabisha Amatya, Saruna Ghimire, Karen E. Callahan, Binaya Kumar Baral, Krishna C. Poudel

Public Health Faculty Publications

Background: Menstrual exile, also known as Chhaupadi, is a tradition of “untouchability” in far-western Nepal. Forbidden from touching other people and objects, women and girls are required to live away from the community, typically in a livestock shed, during menstruation. We assessed the lived experiences of Chhaupadi among Nepalese adolescent girls in the far-western Achham district of Nepal, observed the safety and sanitation of their living spaces during Chhaupadi, and assessed the perceptions of local adult stakeholders towards the practice of Chhaupadi. Methods: We collected data from 107 adolescent girls using a self-administered survey in two local schools in Achham. …

Healthy Food Options At Dollar Discount Stores Are Equivalent In Quality And Lower In Price Compared To Grocery Stores: An Examination In Las Vegas, Nv, Courtney Coughenour, Timothy J. Bungum, M. Nikki Regalado

Public Health Faculty Publications

Food deserts indicate limited access to and affordability of healthy foods. One potential mediator is the availability of healthy food in non-traditional outlets such as dollar-discount stores, stores selling produce at the fixed $1 price. The purpose of this study was to compare availability, quality, price differences in ‘healthier’ versus ‘regular’ food choices, price per each food item, and summary score in dollar-discount stores to grocery stores in Las Vegas using the NEMS-S; a protocol consisting of three subscores—availability, quality, price of healthier versus regular food, and a summary score. [...] see article for full abstract

Perceived Walkability, Social Capital, And Self-Reported Physical Activity In Las Vegas College Students, Melissa Bartshe, Courtney Coughenour, Jennifer Pharr

Public Health Faculty Publications

College students are an understudied, vulnerable population, whose inactivity rates exceed those reported by U.S. adults. Walkability in sprawling cities, such as Las Vegas, is challenged due to automobile-oriented development. The purpose of this study was to assess the relationship between perceived neighborhood walkability, social capital, and meeting physical activity recommendations among University of Nevada-Las Vegas college students. Of the 410 participants, 42.2% met physical activity recommendations, 77.1% were female, 37.3% were white, and 79.5% owned a vehicle. Logistic regression showed that social capital (odds ratio (OR) = 1.25, p = 0.04) and gender... (see full text for full abstract

Limited Contribution Of Health Behaviours To Expanding Income-Related Chronic Disease Disparities Based On A Nationwide Cross-Sectional Study In China, Qing Wang, Jay J, Shen, Kaitlyn Frakes

Public Health Faculty Publications

This study estimated the association of income and prevalence of cardiovascular diseases (CVD) and hypertension, and then quantified the contribution of health behaviors to the association in China. Using the 2013 survey of the China Health and Retirement Longitudinal Study (CHARLS), a logit model was applied to examine income-related health disparities in relation to CVD and hypertension. A four-step regression method was then constructed to measure the role of health behaviors in income-related health disparities. Using indirect effects, mediation by health behaviors was examined. Income-related health disparities in chronic diseases were found to exist in China. Specifically, individuals in the …

Bibliometric Analysis Of Gaps In Research On Asbestos-Related Diseases: Declining Emphasis On Public Health Over 26 Years, Ro-Ting Lin, Matthew John Soeberg, Lung-Chang Chien, Scott Fisher, Jukka Takala, Richard Lemen, Tim Driscoll, Ken Takahashi

Public Health Faculty Publications

Objectives The global burden of asbestos-related diseases (ARDs) is significant, and most of the world’s population live in countries where asbestos use continues. We examined the gaps between ARD research and suggestions of WHO and the International Labour Organization on prevention. Methods From the Web of Science, we collected data on all articles published during 1991–2016 and identified a subset of ARD-related articles. We classified articles into three research areas—laboratory, clinical and public health—and examined their time trends. For all and the top 11 countries publishing ARD-related articles, we calculated the proportions of all ARD-related articles that were in each …

Nonlinear Associations Between Working Hours And Overwork-Related Cerebrovascular And Cardiovascular Diseases (Ccvd), Ro-Ting Lin, Lung-Chang Chien, Ichiro Kawachi

Public Health Faculty Publications

Long working hours are recognized as a risk factor for cerebrovascular and cardiovascular diseases (CCVD). We investigated the relationship between working hours and different CCVD severity outcomes—death, disability, and illness—across industries in Taiwan from 2006 to 2016. We applied a generalized additive mixed model to estimate the association between working hours and the rate of each severity outcome, adjusted for salary, unemployment rate, time, and a random intercept. Industry-average working hours were significantly associated with each outcome level of overwork-related CCVD, especially when monthly working hours increased from 169 (relative risk [RR] = 1.46, 95% confidence interval [CI] 1.002–2.12) to …

Pediatric To Adult Healthcare Transitioning For Adolescents Living With Hiv In Nigeria: A National Survey, Okikiolu A. Badejo, William A. Menson, Nadia A. Sam-Agudu, Jennifer Pharr, Salome Erekaha, Tamara Bruno, Gift Nwanne, Olabanjo Ogunsola, Jude Ilozumba, Olusegun Busari, Echezona E. Ezeanolue

Public Health Faculty Publications

Introduction The period of transition from pediatric to adult care has been associated with poor health outcomes among 10–19 year old adolescents living with HIV (ALHIV). This has prompted a focus on the quality of transition services, especially in high ALHIV-burden countries. Due to lack of guidelines, there are no healthcare transition standards for Nigeria’s estimated 240,000 ALHIV. We conducted a nationwide survey to characterize routine transition procedures for Nigerian ALHIV. Materials and methods This cross-sectional survey was conducted at public healthcare facilities supported by five local HIV service implementing partners. Comprehensive HIV treatment facilities with ≥1 year of HIV …

Life Satisfaction Among Elderly Patients In Nepal: Associations With Nutritional And Mental Well-Being. Health And Quality Of Life Outcomes, Saruna Ghimire, Binaya Kurmar Baral, Isha Karmacharya, Karen E. Callahan, Shiva Raj Mishra

Public Health Faculty Publications

Nepal’s demography is aging rapidly, yet few studies to date have examined how this has affected the health and well-being of the elderly, defined as those above 60 years in Nepal’s Senior Citizen Act (2006). Our study, abbreviated NepEldQOLII, aims to assess perceived life satisfaction, and evaluate its relationship with nutritional health and mental well-being among the burgeoning Nepalese elderly population...(See full text for complete abstract)

Birth History As A Predictor Of Adverse Birth Outcomes: Evidence From State Vital Statistics Data, Dejun Su, Kaeli Samson, Ashvita Garg, Corrine Hanson, Ann L. Anderson Berry, Ge Lin Kan, Ming Qu

Public Health Faculty Publications

One of the most important predictors of preterm births (PTBs) or low-birth-weight births (LBWBs) is whether a mother has had a history of these birth outcomes. This study examined how different characterizations of birth history (e.g., any previous incidence of PTBs or LBWBs, immediate previous birth that was preterm or of low birth weight, and number of previous PTBs or LBWBs) were associated with PTBs or LBWBs. Based on birth records (n = 98,776) reported to the vital statistics electronic registration system in Nebraska from 2005 to 2014, mothers with a history of PTBs or LBWBs were more likely to …

Does Exam-Targeted Training Help Village Doctors Pass The Certified (Assistant) Physician Exam And Improve Their Practical Skills? A Cross-Sectional Analysis Of Village Doctors' Perspectives In Changzhou In Eastern China, Xiaohong Li, Jay J. Shen, Fang Yao, Chunxin Jiang, Fengshui Chang, Fengfeng Hao, Jun Lu

Public Health Faculty Publications

Background Quality of health care needs to be improved in rural China. The Chinese government, based on the 1999 Law on Physicians, started implementing the Rural Doctor Practice Regulation in 2004 to increase the percentage of certified physicians among village doctors. Special exam-targeted training for rural doctors therefore was launched as a national initiative. This study examined these rural doctors’ perceptions of whether that training helps them pass the exam and whether it improves their skills. Methods Three counties were selected from the 4 counties in Changzhou City in eastern China, and 844 village doctors were surveyed by a questionnaire …

Lagged Influence Of Fine Particulate Matter And Geographic Disparities On Clinic Visits For Children’S Asthma In Taiwan, Lung-Chang Chien, Yu-An Chen, Hwa-Lung Yu

Public Health Faculty Publications

Recent studies have revealed the influence of fine particulate matter (PM2.5) on increased medication use, hospital admission, and emergency room visits for asthma attack in children, but the lagged influence of PM2.5 on children’s asthma and geographic disparities of children’s asthma have rarely been discussed simultaneously. This study investigated the documented diagnosis of children’s asthma in clinic visits for children aged less than 15 years old that were associated with PM2.5 in two counties located in west-central Taiwan during 2005–2010. The result shows that PM2.5 had a significant lagged effect on children’s asthma for up to 6 days. A significantly …

Predictors Of Swimming Ability Among Children And Adolescents In The United States, Jennifer Pharr, Carol Irwin, Todd Layne, Richard Irwin

Public Health Faculty Publications

Swimming is an important source of physical activity and a life skill to prevent drowning. However, little research has been conducted to understand predictors of swimming ability. The purpose of this study was to understand factors that predict swimming ability among children and adolescents in the United States (US). This was a cross-sectional survey conducted between February and April of 2017 across five geographically diverse cities. Participants were accessed through the Young Christian Men’s Association (YMCA) and included parents of children aged 4–11 years old and adolescents aged 12–17 years old. Independent t-test, analysis of variance (ANOVA), and univariate and …

Reliability Of Self-Reported Mobile Phone Ownership In Rural North-Central Nigeria: Cross-Sectional Study, William Nii Ayitey Menson Md, Phd, John Olajide Olawepo Msc, Md, Tamara Bruno Mph, Semiu Olatunde Gbadamosi Md, Mph, Nannim Fazing Nalda Mph, Victor Anyebe Md, Amaka Ogidi Med, Chima Onoka Mph, Phd, Md, John Okpanachi Oko Md, Echezona Edozie Ezeanolue Md, Mph

Public Health Faculty Publications

Background: Health practitioners seek to leverage the ubiquity of the mobile phone to increase the impact and robustness of their interventions, particularly in resource-limited settings. However, data on the reliability of self-reported mobile phone access is minimal. Objective: We sought to ascertain the reliability of self-reported ownership of and access to mobile phones among a population of rural dwellers in north-central Nigeria. Methods: We contacted participants in a community-based HIV testing program by phone to determine actual as opposed to self-reported mobile phone access. ...(Please see full text for complete abstract)

Biomedical Informatics Applications For Precision Management Of Neurodegenerative Diseases, Justin B. Miller, Guogen Shan, Joseph Lombardo, Gustavo Jimenez-Maggoria

Public Health Faculty Publications

Modern medicine is in the midst of a revolution driven by “big data,” rapidly advancing computing power, and broader integration of technology into healthcare. Highly detailed and individualized profiles of both health and disease states are now possible, including biomarkers, genomic profiles, cognitive and behavioral phenotypes, high-frequency assessments, and medical imaging. Although these data are incredibly complex, they can potentially be used to understand multi-determinant causal relationships, elucidate modifiable factors, and ultimately customize treatments based on individual parameters. Especially for neurodegenerative diseases, where an effective therapeutic agent has yet to be discovered, there remains a critical need for an interdisciplinary …

Statistical Advances In Clinical Trials And Clinical Research, Guogen Shan, Sarah Banks, Justin B. Miller, Aaron Ritter, Charles Bernick, Joseph Lombardo, Jeffrey L. Cummings

Public Health Faculty Publications

Introduction New treatments for neurodegenerative disease are urgently needed, and clinical trial methods are an essential component of new drug development. Although a parallel-group study design for neurological disorder clinical trials is commonly used to test the effectiveness of a new treatment as compared to placebo, it does not efficiently use information from the on-going study to increase the success rate of a trial or to stop a trial earlier when the new treatment is indeed ineffective. Methods We review some recent advances in designs for clinical trials, including futility designs and adaptive designs. Results Futility designs and noninferiority designs …

Insights Into How Hias Are Characterized In The Press: Findings From A Media Analysis Of Widely Circulated United States Newspapers, Max Gakh, Courtney Coughenour, Jennifer Pharr, Aaliyah Goodie, Samantha To

Public Health Faculty Publications

Background: Health impact assessments (HIAs) are burgeoning tools in the policy arena, where media plays an important role by focusing attention on issues, informing the public, and influencing positions. Examining how media portrays HIAs is critical to understanding HIAs in the policy context. Methods: This study considered how widely circulated, U.S. newspapers represent HIAs. After searching newspaper databases, we used a qualitative document analysis method consisting of open and axial coding to examine specific phrases of HIA depictions. Results: In coding over 1,000 unique phrases from the 62 documents generated in our search, we found an uptick in HIA-related publications …

The Relationship Between Sport Participation And Chronic Diseases Among Men In The Usa: An Examination Of The Behavioral Risk Factor Surveillance System, Jennifer Pharr, Nancy L. Lough

Public Health Faculty Publications

Sport participation has been associated with lower rates of chronic diseases when compared to other forms of physical activity (PA) among women. However, we do not know if this relationship holds true for men. The purpose of this study was to examine the relationship between sport participation and men’s health and chronic diseases in the USA. This study was a secondary data analysis of the 2015 national Behavioral Risk Factor Surveillance System (BRFSS) survey. Participants were questioned extensively about their PA behaviors. Seventy-six different activities were identified and these activities were categorized as sport, conditioning exercise, recreation, or household tasks …

Nutritional Assessment Of Community-Dwelling Older Adults In Rural Nepal, Saruna Ghimire, Binaya Kurmar Baral, Karen E. Callahan

Public Health Faculty Publications

Demographic transition in Nepal, like in many developing countries, has resulted in a burgeoning elderly population whose health status is not currently monitored. One pillar of health is adequate nutrition. Yet, little is known about the nutritional health status of the elderly in Nepal. The financial, material, and personnel limitations in Nepal’s health delivery services necessitate health screening instruments that require minimal clinical staff and resources. To our knowledge, no such nutritional assessment tool has been validated in Nepal. Therefore, our aims are two-fold: To assess the nutritional status of the elderly population in one typical Nepali village, Okharpauwa, in …

Childhood Health Status And Adulthood Cardiovascular Disease Morbidity In Rural China: Are They Related?, Qing Wang, Jay Shen

Public Health Faculty Publications

Cardiovascular diseases (CVDs) are among the top health problems of the Chinese population. Although mounting evidence suggests that early childhood health status has an enduring effect on late life chronic morbidity, no study so far has analyzed the issue in China. Using nationally representative data from the 2013 China Health and Retirement Longitudinal Study (CHARLS), a Probit model and Two-Stage Residual Inclusion estimation estimator were applied to analyze the relationship between childhood health status and adulthood cardiovascular disease in rural China. Good childhood health was associated with reduced risk of adult CVDs. Given the long-term effects of childhood health on …

Unemployment Rate, Smoking In China: Are They Related?, Qing Wang, Jay Shen, Christopher R. Cochran

Public Health Faculty Publications

Background: Studies on the relationship between unemployment rate and smoking have yielded mixed results. The issue in China has not been studied. This study aims to examine the influence of unemployment rate on smoking in China. Methods: Logit model and two-stage least squares (2SLS) estimation were used to estimate the effects. Estimations were done for 4585 individual over 45 using data from China Health and Retirement Longitudinal Study conducted in Zhejiang and Gansu provinces in 2008 and 2012. Results: A percent increase in the unemployment rate resulted in the increase in the likelihood of smoking by a combined 9.1 percent …

Culture, Caregiving, And Health: Exploring The Influence Of Culture On Family Caregiver Experiences, Jennifer Pharr, Carolee Dodge Francis, Christine Terry, Michele Clark

Public Health Faculty Publications

Ethnic minorities are expected to experience a greater demand for family caregiving than non-Latino Whites due to their projected population growth. Although the consensus of researchers on caregiving and culture finds that the caregiving experience differs significantly among cultural/ethnic groups, the question remains as to how cultural values and norms influence the caregiver experiences. We conducted an interpretative, phenomenological qualitative analysis of focus group transcripts from four groups (African American, Asian American, Hispanic American, and European American) for cultural influences on caregiving. Data were collected in Nevada between December 7, 2009, and August 20, 2010. Thirty-five caregivers participated in this …

Household Catastrophic Medical Expenses In Eastern China: Determinants And Policy Implications, Xiaohong Li, Jay J. Shen, Jun Lu, Mei Sun, Chengyue Li, Fengshui Chang, Mo Hao

Public Health Faculty Publications

Background: Much of research on household catastrophic medical expenses in China has focused on less developed areas and little is known about this problem in more developed areas. This study aimed to analyse the incidence and determinants of catastrophic medical expenses in eastern China.

Methods: Data were obtained from a health care utilization and expense survey of 11,577 households conducted in eastern China in 2008. The incidence of household catastrophic medical expenses was calculated using the method introduced by the World Health Organization. A multi-level logistic regression model was used to identify the determinants.

Results: The incidence of household catastrophic …

Financial Position And Adoption Of Electronic Health Records: A Retrospective Longitudinal Study, Jay J. Shen, Gregory O. Ginn

Public Health Faculty Publications

AIM: Financial barriers are a major factor of slow electronic health record (EHR) adoption among US hospitals. All existing literature focuses on relationships between current or short-term financial position and EHR adoption. This study examines relationship between financial position in previous years and the current level of EHR adoption.

METHODS: Retrospective longitudinal data were extracted from (1) the 2009 American Hospital Association (AHA) EHR implementation survey; (2) the 2002 and 2006 Centers for Medicare & Medicaid Cost Reports; and (3) the 2002 and 2006 AHA Annual Survey containing organizational and operational data. The final sample was 2,701 acute care hospitals …

Health Effects Associated With Foreclosure: A Secondary Analysis Of Hospital Discharge Data, Nancy N. Menzel, Sheniz Moonie, Melva V. Thompson-Robinson

Public Health Faculty Publications

Objectives. The purpose of this study was to assess the health effects of high home foreclosure rates in an area of the United States of America and the utility of hospital discharge data for this purpose. Methods.We analyzed hospital discharge data from three postal zip codes using the principal diagnosis for 25 Diagnostic Related Groups associated with stress. Descriptive statistics were used to characterize hospital discharge rates for each condition by year and zip code. To test for differences across time, the Cochran-Armitage trend test was performed. Results. Most conditions did not demonstrate a statistical change between 2005 and 2008. …

The Impact Of Unemployment On Mental And Physical Health, Access To Health Care And Health Risk Behaviors, Jennifer Renee Pharr, Sheniz Moonie, Timothy J. Bungum

Public Health Faculty Publications

The purpose of this study was to examine the impact of employment status and unemployment duration on perceived health, access to health care, and health risk behaviors. Data from Nevada's 2009 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. We compared participants who were unemployed (greater than and less than one year) to those who were employed and those who were voluntarily out of the labor force (OLF). Unemployed participants had significantly worse perceived mental health profiles, were more likely to delay health care services due to cost, and were less likely to have access to health care than employed …

Health Disparities Experienced By People With Disabilities In The United States: A Behavioral Risk Factor Surveillance System Study, Jennifer Renee Pharr, Timothy J. Bungum

Public Health Faculty Publications

The Americans with Disabilities Act became law in 1990; since then research has shown that people with disabilities continue to experience barriers to health care. The purpose of this study was to compare utilization of preventive services, chronic disease rates, and engagement in health risk behaviors of participants with differing severities of disabilities to those without disabilities. This study was a secondary analysis of 2010 data collected in the Behavioral Risk Factor Surveillance System national survey in the United States. Rao Chi square test and logistic regression were employed. Participants with disabilities had significantly higher adjusted odds ratios for all …