Medicine and Health Sciences Commons^™

Language Services For Populations With Limited English Proficiency (Lep) And The Necessity For Proper Medical Interpretation With A Focus In South Carolina, Elizabeth Pung

Senior Theses

Linguistically appropriate healthcare is a cornerstone of providing quality patient care. Provider-patient communication is imperative to achieving linguistically appropriate healthcare; unfortunately, language barriers introduced by different spoken languages of patients to their providers hinders this communication. Patients with limited English proficiency (LEP) are ensured accessible healthcare under federal regulations such as the National Standards for Culturally and Linguistically Appropriate Services (CLAS standards); however, a gap between patients with LEP and the healthcare system remains. Not only is there a gap in communication for patients with LEP to their providing physician, but there is a nationwide epidemic resulting in poor health …

The Associations Of Built Environments On College Students' Physical Activity Levels, Catherine M. Neel

Senior Theses

The issues with American physical activity infrastructure have been causing The United States to have lower levels of physical activity compared to other developed countries. The social and physical built environments of college students typically provide more access for students to be able to be active; however most students still do not meet the recommended amount of physical activity. The purpose of this study was to determine what in their physical and social environment that students utilize in order to participate in physical activity and what aspects of their environment discourage physical activity or limit access to being active. This …

Issue Of Data Imbalance On Low Birthweight Baby Outcomes Prediction And Associated Risk Factors Identification: Establishment Of Benchmarking Key Machine Learning Models With Data Rebalancing Strategies, Yang Ren, Dezhi Wu, Yan Tong, Ana Lopez-De Fede

Publications

Background: Low birthweight (LBW) is a leading cause of neonatal mortality in the United States and a major causative factor of adverse health effects in newborns. Identifying high-risk patients early in prenatal care is crucial to preventing adverse outcomes. Previous studies have proposed various machine learning (ML) models for LBW prediction task, but they were limited by small and imbalanced data sets. Some authors attempted to address this through different data rebalancing methods. However, most of their reported performances did not reflect the models’ actual performance in real-life scenarios. To date, few studies have successfully benchmarked the performance of ML …

Association Of Hospital Incentive Care Management Partnerships For Uninsured Patients With Emergency Department Utilization, Sarah Gareau, Ana Lopez-De Fede, Zhimin Chen, Nathaniel Bell

Publications

IMPORTANCE The South Carolina (SC) Healthy Outcomes Plan (HOP) program aimed to expand access to health care to individuals without insurance; it remains unknown whether there is an association between the SC HOP program and emergency department (ED) use among patients with high health care costs and needs. OBJECTIVES To determine whether participation in the SC HOP was associated with reduced ED utilization among uninsured participants. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 11 684 HOP participants (ages 18-64 years) with at least 18 months of continuous enrollment. Generalized estimating equations and segmented regression of interrupted time-series analyses …

Determinants Of Hiv Treatment Disparities In The Latino Population Of South Carolina, Elizabeth G. Caulk

Senior Theses

The Latino population in the United States faces a heightened risk in terms of contracting HIV/AIDS and experiencing negative health outcomes from said infection. HIV/AIDS continues to disproportionately impact ethnic/racial minorities, and the Latino population exemplifies this unfortunate trend, with Latino Americans making up around 18.4% of the national population, but nearly 30% of the HIV/AIDS infections (US Office of Minority Health, 2021). More enduring changes to the current resources available to this population will need to be made in order to address this disparity. Thus, the current study examined social determinants, how they increase risk of infection, and how …

Superfund And Society Benumbed: An In-Depth Look At Environmental Justice In South Carolina, Sydney A. Hampton

Senior Theses

This thesis investigates the relationship between superfund sites in minority communities and their public health through the lens of social vulnerability. Various demographic parameters were used to assess the risk associated with minority communities and exposure to hazardous waste. After investigating the history of the Environmental Justice movement, three superfund sites of interest in South Carolina, and demographic and public health data; each community was analyzed to determine association between exposure to hazardous waste and minority status. Each examined community exhibited characteristics contributing to heightened social vulnerability, potentially causing increased susceptibility to negative health outcomes from exposure to hazardous waste.

The Problem Of The Color Line: Spatial Access To Hospital Services For Minoritized Racial And Ethnic Groups, Jan M. Eberth, Pelvin Hung, Gabriel A. Benavidez, Janice Probst, Whitney E. Zahnd, Mary-Katherine Mcnatt, Ebony Toussaint, Melinda A. Merrell, Elizabeth L. Crouch

Faculty Publications

Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being …

Geographic Proximity To Primary Care Providers As A Risk-Assessment Criterion For Quality Performance Measures, Nathaniel Bell, Ana Lopez-De Fede, Bo Cai, John Brooks

Publications

Importance Previous studies have found a mixed association between Patient-Centered Medical Home (PCMH) designation and improvements in primary care quality indicators, including avoidable pediatric emergency department (ED) encounters. Whether these associations persist after accounting for the geographic locations of providers relative to where patients reside is unknown. Objective To examine the association between geographic proximity to primary care providers versus hospitals and risk of avoidable and potentially avoidable ED visits among children with pre-existing diagnosis of attention-deficit/hyperactivity disorder or asthma. Methods Retrospective cohort study of a panel of pediatric Medicaid claims data from the South Carolina from 2016–2018 for 2,959 …

The Individual Water Insecurity Experiences (Iwise) Scale: Reliability, Equivalence And Validity Of An Individual-Level Measure Of Water Security, Sera L. Young, Hilary J. Bethancourt, Zacchary R. Ritter, Edward A. Frongillo Jr.

Faculty Publications

Objective: The lack of a validated and cross-culturally equivalent scale for measuring individual-level water insecurity has prevented identification of those most vulnerable to it. Therefore, we developed the 12-item Individual Water InSecurity Experiences (IWISE) Scale to comparably measure individual experiences with access, use, and stability (reliability) of water. Here, we examine the reliability, cross-country equivalence, and cross-country and within-country validity of the scale in a cross-sectional sample.

Methods: IWISE items were implemented by the Gallup World Poll among nationally representative samples of 43 970 adults (15 y) in 31 low-income and middle-income countries (LMICs). Internal consistency was assessed …

Analysis Of Contraceptive Use Among Immigrant Women Following Expansion Of Medicaid Coverage For Postpartum Care, Maria I. Rodriguez, Megan Skye, Stephan Lindner, Aaron B. Caughey, Ana Lopez-Defede

Publications

Importance: Access to postpartum care is restricted for low-income women who are recent or undocumented immigrants enrolled in Emergency Medicaid. Objective: To examine the association of a policy extending postpartum coverage to Emergency Medicaid recipients with attendance at postpartum visits and use of postpartum contraception. Design, setting, and participants: This cohort study linked Medicaid claims and birth certificate data from 2010 to 2019 to examine changes in postpartum care coverage on postpartum care and contraception use. A difference-in-difference design was used to compare the rollout of postpartum coverage in Oregon with a comparison state, South Carolina, which did not cover …

Association Of Expanded Prenatal Care Coverage For Immigrant Women With Postpartum Contraception And Short Interpregnancy Interval Births, Maria I. Rodriguez, Menolly Kaufman, Stephan Lindner, Aaron B. Caughey, Ana Lopez-De Fede

Publications

Importance Access to prenatal and postpartum care is restricted among women with low income who are recent or undocumented immigrants enrolled in Emergency Medicaid. Objective To examine the association of extending prenatal care coverage to Emergency Medicaid enrollees with postpartum contraception and short interpregnancy interval births. Design, Setting, and Participants This cohort study used a difference-in-differences design to compare the staggered rollout of prenatal care in Oregon with South Carolina, a state that does not cover prenatal or postpartum care. Linked Medicaid claims and birth certificate data from 2010 to 2016 were examined for an association between prenatal care coverage …

Disparities In Postpartum Contraceptive Use Among Immigrant Women With Restricted Medicaid Benefits, Maria I. Rodriguez, K. John Mcconnell, Megan Skye, Menolly Kaufman, Aaron B. Caughey, Ana Lopez-De Fede

Publications

BACKGROUND: The Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as Traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in Traditional Medicaid. By federal law, Emergency Medicaid covers care for life-threatening emergencies or a hospital admission for childbirth. No prenatal or postpartum care is covered. Most of the women enrolled in Emergency Medicaid are Latina. OBJECTIVE: We assessed postpartum visits and receipt of postpartum contraception and compared the outcomes for Emergency (restricted benefit) Medicaid recipients with those of Traditional (full-benefit) Medicaid recipients in Oregon and South Carolina, 2 …

Examining Parental Perceptions And Decisions To Uptake Child Influenza Immunizations: Assessing Pandemic And Policy Impacts On Vaccination Rates Following The H1n1 Pandemic, And The Acip Laiv Preferential Recommendation Revocation, Amir H. Mehrabi

Theses and Dissertations

Introduction

2009 H1N1 Pandemic: The historical 2009 H1N1 Influenza pandemic, which had a CDC estimated accrued disease burden of 100.5 million illnesses, 936,000 hospitalizations, and 75,000 deaths from 2009 to 2018, resulted in a declared state of emergency nationally, with ensuing diminished vaccine confidence and amplified fears of infection, prompting some to pursue flu vaccination, and others to forego. Although the Centers for Disease Control and Prevention (CDC), and its Advisory Committee on Immunization Practices (ACIP) recommend an annual flu vaccine for individuals 6 months of age and older as the “first and best” defense against influenza, a low percentage …

Differences In Food Spending On Groceries And Eating Out Between Two Dietary Groups: The New Soul Study, Carly Fassler

Senior Theses

Background: Heart disease is now the leading cause of death for both men and women in the United States. Obesity, high blood pressure, and high cholesterol are all risk factors for heart disease. Research has shown that increasing consumption of plant-based foods may be effective in reducing risk factors for chronic disease, especially heart disease. A plant-based diet consists of nutrient-dense plant foods and minimizes the consumption of processed animal products. High costs of eating a healthier diet are a commonly cited barrier that prevents individuals from making dietary changes that could potentially decrease their chronic disease risk.

Objective: To …

Treatment Of Chronic Pain In U.S. Veterans: The Effectiveness Of Interdisciplinary Programs, Morgan L. Compton

Senior Theses

Chronic pain is a prevalent issue amongst US veterans. Experts suggest that interdisciplinary pain treatment is the most effective method of treating chronic pain, specifically due to targeting functioning and quality of life. These programs combine cognitive behavioral therapy and physical therapy by utilizing a variety of exercise and education regimens. The pain department at Columbia VA Health Care System offers both a comprehensive interdisciplinary treatment, Outpatient Interdisciplinary Pain Program (OIPP), and a flexible, multidisciplinary option (OIPP-Lite) for veterans suffering from chronic pain. The goal of this program is to improve knowledge for coping with chronic pain and to create …

First Aid And Emergency Preparedness: Improving Health Outcomes Among Aging Adults, Anna J. Kulangara

Senior Theses

As the United States population demographic shifts and the baby boomer population enters seniority, the health sector must adjust and prepare to provide efficient and adequate healthcare to the people. The Silver Tsunami, a metaphor for the expected wave of aging adults, will inevitably strain healthcare professionals and can be partly relieved by promoting risk-minimizing behavior in baby boomers before severe conditions develop. Through this effort, a health education course, titled First Aid and Emergency Preparedness, was developed and taught twice at a local senior center to target senior citizens and promote proactivity and healthy behaviors. Course development founded largely …

The Role Of A Community-Driven, Structured Exercise Program On Children's And Adolescent's Quality Of Life, Padgett Singley Powe

Senior Theses

Childhood obesity is a long-standing epidemic in the United States as of 2020, and the problem is continuing to worsen. Childhood obesity has been shown to have many unhealthy effects, such as increasing prevalence of cardiovascular disease, depression, and social anxiety, which all can contribute to a worsened quality of life. Research suggests that summer is the most critical time period to combat childhood obesity is because children’s lives are less structured over the summer, which can lead to increased unhealthy behaviors, obesity, and a decrease in quality of life. The current study, the Skybrook Swim Team Study, aimed to …

Explainable Ai Using Knowledge Graphs, Manas Gaur, Ankit Desai, Keyur Faldu, Amit Sheth

Publications

During the last decade, traditional data-driven deep learning (DL) has shown remarkable success in essential natural language processing tasks, such as relation extraction. Yet, challenges remain in developing artificial intelligence (AI) methods in real-world cases that require explainability through human interpretable and traceable outcomes. The scarcity of labeled data for downstream supervised tasks and entangled embeddings produced as an outcome of self-supervised pre-training objectives also hinders interpretability and explainability. Additionally, data labeling in multiple unstructured domains, particularly healthcare and education, is computationally expensive as it requires a pool of human expertise. Consider Education Technology, where AI systems fall along a …

Association Of Patient-Centered Medical Home Designation And Quality Indicators Within Hrsa-Funded Community Health Center Delivery Sites, Nathaniel Bell, Rebecca Wilkerson, Kathy Mayfield-Smith, Ana Lopez-De Fede

Publications

Background: Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes. Methods: Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were regressed …

Community Social Determinants And Health Outcomes Drive Availability Of Patient-Centered Medical Homes, Nathaniel Bell, Rebecca Wilkerson, Kathy Mayfield-Smith, Ana Lopez-De Fede

Publications

The collaborative design of America’s patient-centered medical homes places these practices at the forefront of emerging efforts to address longstanding inequities in the quality of primary care experienced among socially and economically marginalized populations. We assessed the geographic distribution of the country’s medical homes and assessed whether they are appearing within communities that face greater burdens of disease and social vulnerability. We assessed overlapping spatial clusters of mental and physical health surveys; health behaviors, including alcohol-impaired driving deaths and drug overdose deaths; as well as premature mortality with clusters of medical home saturation and community socioeconomic characteristics. Overlapping spatial clusters …

A Policy Analysis Of South Carolina Drug Court Legislation: H. 3322 § 302: Drug Court Program Act (2019), Mae Chinnes

Senior Theses

The purpose of this thesis is to examine a piece of drug court legislation currently being considered by the South Carolina Legislature, H. 3322 § 302. An overview of drug criminalization in the United States, its impact, and drug courts are provided. This is followed by a review of the literature on the key programmatic components of drug court best practices, including: target population, incentives and sanctions, management team, and duration. An example analysis of Florida’s Thirteenth Judicial Circuit Drug Court Program policies proceeds the analysis of H. 3322. Parameters of successful drug court legislation and program outcomes are defined …

Activist Framing Of Abortion And Use For Policy Change In Peru, Cynthia Beavin, Deborah L. Billings, Susana Chávez

Faculty Publications

Identifying how activists frame the topic of abortion is key to unpacking their understanding of “abortion” in Peru. It is important to explore how and why certain frames are privileged in attempts to shift policy and social norms. In 2016, the authors conducted qualitative interviews with 10 activists in Lima, Peru to develop a deep understanding of these issues. Activists worked through different approaches and lenses, including law, medicine, sociology, psychiatry, journalism, non-governmental organisational management, LGBTQ rights, and indigenous rights. Four common frames emerged through the analysis and those frames shifted based on whether activists were speaking to the general …

Diagnosed Diabetes Prevalence And Risk Factor Rankings, By State, 2014-2016: A Ring Map Visualization, Ana Lopez-De Fede, John E. Stewart

Publications

Background In the United States, diabetes is a leading cause of adult-onset blindness, kidney failure, and death (1). Efforts to prevent and control diabetes must consider geographic variation in disease prevalence and risk factors such as obesity, sedentary lifestyle, and low educational attainment (2). Maps are essential to our understanding of geographic differences in population health and disease vulnerability. Comparing geographic patterns of disease and population risk across multiple maps, however, can be cumbersome. Ring mapping is an innovative geovisualization method that permits the display of multiple spatially referenced variables on a single map (3). We used a ring map …

The Importance Of Person And Place In Predicting Prostate Cancer Incidence And Mortality Among United States Veterans Seeking Veterans Health Administration Care, Peter Georgantopoulos

Theses and Dissertations

T Introduction: There are several unique characteristics in the epidemiology of prostate cancer (PrCA) that make it an interesting and important cancer to study. The first is that while prostate cancer is the most common cancer that men develop, it is one of the least common cancers that men die from. This indolent nature of PrCA has led to the idiom among health scientists that “men are more likely to die with PrCA than due to PrCA”. Just like other cancers, several individual-level risk factors (e.g., family history of the disease, age, and race) are well established for both PrCA …

Precision Of Provider Licensure Data For Mapping Member Accessibility To Medicaid Managed Care Provider Networks., Nathaniel Bell, Ana Lopez-De Fede, Rebecca C. Wilkerson, Kathy Mayfield-Smith

Publications

Background: In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. There have been few published studies of whether there is accurate geographic information on primary care providers to monitor network adequacy. Methods: We analyzed a sample of nurse practitioner (NP) and physician address data registered in the state labor, licensing, and regulation (LLR) boards and the National Provider Index (NPI) using employment location data contained in the patient-centered medical home (PCMH) data file. Our main outcome measures were address discordance (%) at the …

Examining Infant Health Outcomes Impacted By South Carolina's Regionalized System Of Perinatal Care, Michael Grady Smith

Theses and Dissertations

Perinatal regionalization systems have been shown to reduce the risk of neonatal mortality when very low birth weight infants are delivered in Level III hospitals with neonatal intensive care units, sub-specialist staffing, and adequate experience caring for high-risk pregnancies and neonates. However, studies to date examining the association between delivery in Level III hospitals and neonatal mortality have not accounted for censoring due to fetal deaths. Furthermore, studies of perinatal regionalization to date have not adequately assessed the association between delivery hospital level of care and the infant’s hospital length of stay. This dissertation examined 8,594 very low birth weight …

Smoking-Related Stigma: A Public Health Tool Or A Damaging Force ?, Paula A. Lozano

Theses and Dissertations

Cigarette smoking is the leading cause of preventable death in the world. In an effort to address the tobacco epidemic, the World Health Organization’s Framework Convention on Tobacco Control (FCTC) has formulated a number of policies that are thought to reduce cigarette consumption by making smoking socially unacceptable. It is possible that tobacco control policies that aim to make smoking socially unacceptable may also result in the stigmatization of smokers. Social factors such as social norms and socioeconomic status may also influence the development of smoking-related stigma. While some researchers suggest that smoking-related stigma may be an important public health …

Comparison Of Small-Area Deprivation Measures As Predictors Of Chronic Disease Burden In A Low-Income Population, Ana Lopez-De Fede, John E. Stewart, James W. Hardin, Kathy Mayfield-Smith

Publications

Background: Measures of small-area deprivation may be valuable in geographically targeting limited resources to prevent, diagnose, and effectively manage chronic conditions in vulnerable populations. We developed a census-based small-area socioeconomic deprivation index specifically to predict chronic disease burden among publically insured Medicaid recipients in South Carolina, a relatively poor state in the southern United States. We compared the predictive ability of the new index with that of four other small-area deprivation indicators. Methods: To derive the ZIP Code Tabulation Area-Level Palmetto Small-Area Deprivation Index (Palmetto SADI), we evaluated ten census variables across five socioeconomic deprivation domains, identifying the combination of …

Small-Area Variation In Hypertension Prevalence Among Black And White Medicaid Enrollees, Kellee White, John E. Stewart, Ana Lopez-De Fede, Rebecca C. Wilkerson

Publications

Objectives: To examine within-state geographic heterogeneity in hypertension prevalence and evaluate associations between hypertension prevalence and small-area contextual characteristics for Black and White South Carolina Medicaid enrollees in urban vs rural areas.

Design: Ecological.

Setting: South Carolina, United States.

Main outcome measures: Hypertension prevalence.

Methods: Data representing adult South Carolina Medicaid recipients enrolled in fiscal year 2013 (N=409,907) and ZIP Code Tabulation Area (ZCTA)-level contextual measures (racial segregation, rurality, poverty, educational attainment, unemployment and primary care physician adequacy) were linked in a spatially referenced database. Optimized Getis-Ord hotspot mapping was used to visualize geographic clustering of hypertension prevalence. Spatial regression …

Association Between Electronic Prescribing Among Ambulatory Care Providers And Adverse Drug Event Hospitalizations In Older Adults, Grishma Patel Bhavsar

Theses and Dissertations

Purpose.

This dissertation research sought to determine whether the proportion of physicians using electronic prescribing (e-prescribing) was associated with the hospitalization rate for adverse drug events (ADEs) among patients aged 65 and older in 2011. Additionally, we sought to determine whether increases in the proportion of e-prescribing physicians in a county were associated with decreases in the hospitalization rate for ADE among older adults.

Methods.

Two study designs were used, a cross-sectional study using 2011 data and a pre-post- study using 2008 and 2011 data. Data from the 2008 and 2011 State Inpatient Databases, the Office of the National …