Community Health and Preventive Medicine Commons^™

The Influence Of The Urban Food Environment On Diet, Nutrition And Health Outcomes In Low-Income And Middle-Income Countries: A Systematic Review, Susannah Westbury, Iman Ghosh, Helen Margaret Jones, Daniel Mensah, Folake Samuel, Ana Irache, Nida Azhar, Lena Al-Khudairy, Romaina Iqbal, Oyinlola Oyebode

Community Health Sciences

Introduction: Diet and nutrition are leading causes of global morbidity and mortality. Our study aimed to identify and synthesise evidence on the association between food environment characteristics and diet, nutrition and health outcomes in low-income and middle-income countries (LMICs), relevant to urban settings, to support development and implementation of appropriate interventions.
Methods: We conducted a comprehensive search of 9 databases from 1 January 2000 to 16 September 2020 with no language restrictions. We included original peer-reviewed observational studies, intervention studies or natural experiments conducted in at least one urban LMIC setting and reporting a quantitative association between a characteristic of …

Anti-Vaxxers: Parents Fighting Science, Katie West

Symposium of Student Scholars

Immunizing children helps protect the health of our community, especially those people who cannot be immunized. Yet, since 1996 after a study was released that linked autism to vaccinations, there has been a trend of parents refusing to vaccinate their children. What are the demographics of the parents who believe their children are better off without vaccines? By knowing where these parents live and what decisions they make for their children’s education, counties and medical professionals can provide education and address their concerns.

My research involves data on 116,141 kindergarten classes from 2000-2015 in California. The two vaccine exemption options …

Factors Associated With Voluntary Refusal Of Emergency Medical System Transport For Emergency Care In Detroit During The Early Phase Of The Covid-19 Pandemic, Nicholas E. Harrison, Robert R. Ehrman, Andrea Curtin, Damon Gorelick, Alex B. Hill, Erin Brennan, Robert Dunne

Urban Studies and Planning Faculty Research Publications

Importance
Emergency department (ED) and emergency medical services (EMS) volumes decreased during the COVID-19 pandemic, but the amount attributable to voluntary refusal vs effects of the pandemic and public health restrictions is unknown.

Objective
To examine the factors associated with EMS refusal in relation to COVID-19 cases, public health interventions, EMS responses, and prehospital deaths.

Design, Setting, and Participants
A retrospective cohort study was conducted in Detroit, Michigan, from March 1 to June 30, 2020. Emergency medical services responses geocoded to Census tracts were analyzed by individuals’ age, sex, date, and community resilience using the Centers for Disease Control and …

Opening Pandora’S Box From Readmissions To Transitional Care Patient-Centered Outcome Measures, Mathew J. Reeves, Michele C. Fritz, Ifeyinwa Osunkwo, Corita R. Grudzen, Lewis L. Hsu, Jing Li, Raymona H. Lawrence, Janet Prvu Bettger

Department of Health Policy and Community Health Faculty Publications

Background:

Measuring the effectiveness of transitional care interventions has historically relied on health care utilization as the primary outcome. Although the Care Transitions Measure was the first outcome measure specifically developed for transitional care, its applicability beyond the hospital-to-home transition is limited. There is a need for patient-centered outcome measures (PCOMs) to be developed for transitional care settings (ie, TC-PCOMs) to ensure that outcomes are both meaningful to patients and relevant to the particular care transition. The overall objective of this paper is to describe the opportunities and challenges of integrating TC-PCOMs into research and practice.

Methods and Results:

This …

Implementation Of Complex Interventions Lessons Learned From The Patient-Centered Outcomes Research Institute Transitional Care Portfolio, Sabina B. Gesell, Janet Prvu Bettger, Raymona H. Lawrence, Jing Li, Jeanne Hoffman, Barbara J. Lutz, Corita R. Grudzen, Anna M. Johnson, Jerry A. Krishnan, Lewis Hsu, Dorien Zwart, Mark V. Williams, Jeffrey L. Schnipper

Department of Health Policy and Community Health Faculty Publications

Background:

Despite the well-documented risks to patient safety associated with transitions from one care setting to another, health care organizations struggle to identify which interventions to implement. Multiple strategies are often needed, and studying the effectiveness of these complex interventions is challenging.

Objective:

The objective of this study was to present lessons learned in implementing and evaluating complex transitional care interventions in routine clinical care.

Research Design:

Nine transitional care study teams share important common lessons in designing complex interventions with stakeholder engagement, implementation, and evaluation under pragmatic conditions (ie, using only existing resources), and disseminating findings in outlets that …

Assessment Of The Financial Health Of Rural Hospitals After Implementation Of The Georgia Rural Hospital Tax Credit Program, Bettye A. Apenteng, Samuel T. Opoku, Charles Owens, Emmanuel Akowuah, Linda Kimsey, Angela Peden

Department of Health Policy and Community Health Faculty Publications

Importance In 2016, Georgia implemented the Rural Hospital Tax Credit Program, which allows taxpayers to receive a tax credit for contributions to qualifying rural hospitals in the state. Empirical evidence of the program’s association with the viability of the state’s rural hospitals is needed.

Objective To examine the association of the tax credit program with the financial health of participating rural hospitals.

Design, Setting, and Participants This longitudinal cross-sectional study used hospital financial data from the Centers for Medicare & Medicaid Services for 2015 to 2019. A difference-in-differences analytic approach was used to examine the association of the tax credit …

Review Of Sexual Health Issues Linked With Cardiovascular Disease And Type 2 Diabetes Mellitus In Aboriginal And Torres Strait Islander Males, Veronica Collins, Tamara J. Swann, Jane Burns, Tim Moss, Mick Adams

Australian Indigenous HealthBulletin

There are well established links between male sexual health conditions and chronic disease, particularly cardiovascular disease (CVD) and type 2 diabetes (T2DM). Erectile dysfunction (ED) and low testosterone are two sexual health conditions that are relatively common among the wider male population. However, there is a lack of data specifically about these sexual problems among Aboriginal and Torres Strait Islander males.

One of the most important findings of research regarding the links between sexual health and chronic disease is that ED can be a risk marker for future CVD or undiagnosed T2DM. Understanding these links can lead to more holistic …

Personal Mastery And All-Cause Mortality Among Older Americans Living With Diabetes, Ho-Jui Tung, Ming-Chin Yeh, Randall Ford, Gulzar H. Shah

Department of Health Policy and Community Health Faculty Publications

Introduction: Higher personal mastery is associated with better physical functioning, wellbeing, and longevity among older populations. However, few studies have focused on whether personal mastery is protective against mortality among older adults living with diabetes over time.
Methods: A total of 1,779 participants were identified from an off-year survey of the Health and Retirement Study. Proportional Hazard Models were used to evaluate the significance of selected variables in predicting the survival of participants over a 13-year period.
Results: A substantial proportion (46.7%) of the diabetic patients had survived by the end of 2016. Adults with lower mastery …

Perceived Benefits Matter The Most In Covid-19 Preventive Behaviors: Empirical Evidence From Okara District, Pakistan, Gulzar H. Shah, Ansar Ali Faraz, Hina Khan, Kristie Cason Waterfield

Department of Health Policy and Community Health Faculty Publications

The 2019 coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus has affected the social determinants of health, worsening health inequities and deteriorating healthcare capacities around the globe. The objective of this study is to investigate the COVID-19 prevention behaviors within the framework of the Health Belief Model in the city of Depalpur in the Okara District of Pakistan in May 2020. Using an observational, cross-sectional, and quantitative study design, a faceto- face field survey was conducted during the epidemic of COVID-19 in district Okara, Pakistan. A sample of 500 adults was selected from the city of Depalpur the in Okara …

Student Loans And Health-Related Financial Hardship, Sophia T. Anong, Robin Henager

Journal of Student Financial Aid

Research has shown that student loan borrowers in repayment exhibit physical and mental health problems. These can be exacerbated by and contribute to health-related financial hardship. We use the 2015 U.S. National Financial Capability Study to examine the likelihood of having past due medical bills and of avoiding health care services by not purchasing prescribed medication, skipping tests or follow-up with a doctor or not seeking care for a medical problem. Borrowers on income-driven repayment plans and those who made late payments are found to be more likely to have unpaid medical bills and to have avoided required medical attention. …

The Use Of Mobile Apps To Increase Physical Activity Level: A Systematic Review, Dziyana Nazaruk, Kelli Rouser

Department of Health Policy and Community Health Faculty Publications

Background: About 82% of the U.S. adult population owns a smartphone. More than half of that population downloaded a fitness or health app to increase the physical activity level. The current review included studies that have utilized mobile apps in conjunction with other intervention strategies to increase physical activity levels. Methods: The search was conducted in five electronic databases. Studies were included if they were randomized controlled trials, utilized mobile apps, physical activity was the primary outcome, written in English, and conducted between the years of 2007 and 2019. Results: Thirteen studies were included in the final review. Results indicated …

Disparities In Hiv Clinical Stages Progression Of Patients At Outpatient Clinics In Democratic Republic Of Congo, Raimi Ewetola, Gulzar H. Shah, Lievain Maluantesa, Gina D. Etheredge, Kristie C. Waterfield, Astrid Mulenga, Apolinaire Kilundu

Department of Health Policy and Community Health Faculty Publications

Context: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients’ clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment delivery, the research evidence explaining factors associated with patients’ clinical stages is needed. Objectives: The primary objective of this study was to produce such scientific evidence by analyzing the most recent data for patients at outpatient clinics in the provinces of Kinshasa and Haut-Katanga and to examine the patient characteristics associated with WHO stages of disease progression. Methods: Using a …

Risk Factors For Tb/Hiv Coinfection And Consequences For Patient Outcomes: Evidence From 241 Clinics In The Democratic Republic Of Cong, Gulzar H. Shah, Raimi Ewetola, Gina D. Etheredge, Lievain Maluantesa, Kristie C. Waterfield, Elodie Engetele, Apolinaire Kilundu

Department of Health Policy and Community Health Faculty Publications

(1) Background: In resource-limited countries, patients with tuberculosis (TB)/HIV coinfection commonly face economic, sociocultural, and behavioral barriers to effective treatment. These barriers manifest from low treatment literacy, poverty, gender inequality, malnutrition, societal stigmas regarding HIV, and an absence of available care. It is critical for intervention programs to understand and assist in overcoming these barriers and any additional risks encountered by patients with TB/HIV coinfection. This study analyzes variation in TB/HIV coinfection and risks of negative outcomes among patients with TB/HIV coinfection compared to those without coinfection. (2) Methods: This quantitative study used data from 49,460 patients receiving ART from …

Increasing Mississippi’S Hpv Vaccination Rate: A Proposal Based On Providers’ Insights, Madison N. Thornton

Honors Theses

Despite high childhood vaccination rates for required vaccinations for kindergarten, including the MMR vaccine, Mississippi has the lowest HPV vaccination rate in the nation. This is so even though the HPV vaccine can prevent multiple cancers, including cervical cancer, of which Mississippi has the nation’s highest mortality rate. This study seeks to understand the factors surrounding Mississippi’s low HPV vaccination rate as well as potential policy solutions to increase this rate. To accomplish this, the author conducted interviews with 13 Mississippi physicians in various specialties to gather qualitative data. As a result of these interviews, the author found that the …

Disparities In Access To After-Hours Care In The U.S.: A National Study, Kavita Mosalpuria, Fernando A. Wilson, Mohammad Siahpush

Journal of Health Disparities Research and Practice

After-hours care provides timely access to continuity of care for chronic illnesses and episodic care for acute illness. Lack of timely access to primary care services is one of the main drivers of emergency department overuse. Our aim was to examine disparities in access to after-hours care based on race, income, geographic location, type of insurance, and health care setting. We used data from the 2010 Health Tracking Household Survey. Multivariable logistic regression was used to assess disparities in access to after-hours care. We found disparities by type of insurance, geographic location, and type of health care setting. People with …

Public Health Employees’ Perceptions About The Impact Of Emerging Public Health Trends On Their Day-To-Day Work: Effects Of Organizational Climate And Culture, Kristie Cason Waterfield, Gulzar H. Shah, Linda Kimsey, William A. Mase, Jingjing Yin

Department of Health Policy and Community Health Faculty Publications

Objective: The purpose of this research was to assess the workforce characteristics associated with public health employees’ perceived impact of emerging trends in public health on their day-to-day work. Methods: Multinomial logistic regression was performed to analyze data from the 2017 PH WINS, a cross-sectional survey utilizing a nationally representative sample of the United States public health workforce. Results: More than 55% of the public health workforce perceived that their day-to-day work was impacted by the emerging public health trends. Workplace environment was significantly associated with the perception of their day-to-day work being impacted by emerging public health trends such …

Consequences Of Covid-19 Crisis For Persons With Hiv: The Impact Of Social Determinants Of Health, Kristie Cason Waterfield, Gulzar H. Shah, Gina D. Etheredge, Osaremhen Ikhile

Department of Health Policy and Community Health Faculty Publications

Background

With the indiscriminate spread of COVID-19 globally, many populations are experiencing negative consequences such as job loss, food insecurity, and inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative equipment. Some of the most disadvantaged in the COVID-19 era are people living with HIV/AIDS and other autoimmune diseases.

Discussion

As the number of new HIV infections decrease globally, many subpopulations remain at high risk of infection due to lack of or limited access to prevention services, as well as clinical care and treatment. For persons living with HIV or at higher …

Retention And Predictors Of Attrition Among Children Living With Hiv On Antiretroviral Therapy (Art) In Côte D’Ivoire Between 2012 And 2016, F. Traore-Toure, Gina D. Etheredge, Gulzar H. Shah, C. Brennan

Department of Health Policy and Community Health Faculty Publications

Background: In Côte d’Ivoire a retrospective national-level cohort study conducted in 2009 indicated that 77%, 72% and 75% of children living with HIV (CLHIV) remained in care at 12, 36, and 48 months after starting ART, respectively. The CDC-sponsored Improving HIV Surveillance and Program Evaluation in Côte d’Ivoire project assessed retention progress since that study.

Methods and materials: A retrospective review of medical records was conducted using 2-stage cluster sampling. HIV care and treatment centers (CTC) were sampled based on patient caseload, then records of patients under 15 years of age who initiated ART between 2012–2016 were randomly …

Hiv Clinical Stage Progression Of Patients At 241 Outpatient Clinics In Democratic Republic Of Congo: Disparities By Gender, Tb Status And Rurality, Gina D. Etheredge, Raimi Ewetola, Gulzar H. Shah, L. Maluantesa, Kristie C. Waterfield, A. Mulenga, A. Kilundu

Department of Health Policy and Community Health Faculty Publications

Background: HIV clinical care programs are increasingly cognizant of the importance of customizing services according to patients’ clinical stage progression (WHO's four-tiered staging) and other risk assessments. Understanding factors associated with Persons Living with HIV (PLHIV) patients’ progression through the treatment cascade and clinical stages is essential for programs to provide patient-centered, evidence-based services.

Methods and materials: To analyze patient characteristics associated with disease progression stages for PLHIV on antiretroviral therapy (ART), this quantitative study used data, from January 2014–June 2019, from 49,460 PLHIV on ART from 241 HIV/AIDS outpatient clinics in 23 health zones in Haut-Katanga and …

Tb/Hiv Coinfection And Patient Outcomes: Evidence From 241 Clinics In The Democratic Republic Of Congo, Gulzar H. Shah, Raimi Ewetola, Gina D. Etheredge, L. Maluantesa, Kristie C. Waterfield, L.-K. Lukusa

Department of Health Policy and Community Health Faculty Publications

Background: To provide efficient, equitable, patient-centered, and evidence-based services to people living with HIV/AIDS (PLWH), it is critical for the intervention programs to understand the nature of barriers to effective treatment and additional risks faced by PLWH with tuberculosis (TB) coinfection. This study analyzes two aspects of TB coinfection in PLWH: (a) variation in TB/HIV coinfection by demographic and clinical characteristics of patients; and (b) risks of negative outcomes such as death, loss to follow up, and higher viral load among PLWH with TB coinfection compared to those without such coinfection.

Methods and materials: This quantitative study used …

Adios 2020 And Welcome 2021, Srinivasan Ragothaman

Creative Work

This is a short ballad about current health policy and practice regarding the Coronavirus. As vaccines are being administered, this poem points out that light is at the end of the tunnel. At the same time it urges caution, vigilance, masking and common sense. It praises science and scientists. It also calls for unity, cooperation and healing!

Advancing And Promoting Community Health: Opportunities For Accountable Communities For Health And Community Health Centers, Helen Mittmann, Jeffrey Levi, Janet Heinrich, Feygele Jacobs, Rebecca Morris, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Executive Summary:

Accountable Communities for Health (ACHs) are multi -sector, community-based partnerships that aim to address community health and social needs, and Community Health Centers (CHCs) provide important community-based healthcare services for underserved and medically vulnerable populations. Given the critical role that both ACHs and CHCs play in addressing health-related social needs and social determinants of health, a survey of ACHs on CHC engagement was conducted to better understand opportunities and challenges for CHC participation in ACHs. This survey, along with follow-up conversations with ACH and CHC representatives, confirmed that ACHs and CHCs are natural partners in the effort to …

From The Legal Literature: Covid And The Criminal Law, Francesca Laguardia

Department of Justice Studies Faculty Scholarship and Creative Works

No abstract provided.

Neither “Post-War” Nor Post-Pregnancy Paranoia: How America’S War On Drugs Continues To Perpetuate Disparate Incarceration Outcomes For Pregnant, Substance-Involved Offenders, Becca S. Zimmerman

Pitzer Senior Theses

This thesis investigates the unique interactions between pregnancy, substance involvement, and race as they relate to the War on Drugs and the hyper-incarceration of women. Using ordinary least square regression analyses and data from the Bureau of Justice Statistics’ 2016 Survey of Prison Inmates, I examine if (and how) pregnancy status, drug use, race, and their interactions influence two length of incarceration outcomes: sentence length and amount of time spent in jail between arrest and imprisonment. The results collectively indicate that pregnancy decreases length of incarceration outcomes for those offenders who are not substance-involved but not evenhandedly -- benefitting white …

Strategic Implications Of Covid-19: Considerations For Georgia’S Rural Health Providers, Bettye A. Apenteng, Linda Kimsey, Charles Owens, Samuel T. Opoku, Angela Peden, William Mase

Department of Health Policy and Community Health Faculty Publications

Whether rural hospitals and providers have seen a surge in COVID-19 cases or a reduction in patients seeking care since the pandemic began, their financial condition has been negatively impacted. Many providers have now received some emergency funding through the Coronavirus Aid, Relief, and Economic Security Act and the Payroll Protection Program but these are likely only short-term fixes. For many, the crisis has exacerbated already existing problems. Notable among these problems are volume declines, supply chain disruptions, and workforce concerns. While these problems require immediate action, two longer-term systemic changes to rural healthcare delivery are needed to address them. …

Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori

Capstone Showcase

Opioid Use Disorder is patterns of opioid use leading to withdrawal, giving up important life events in order to use opioids, and excessive time spent using opioids, to name a few diagnostic criteria. The clinical progression of the disorder involves periods of acute exacerbation and remission that are cyclic in nature. Treatment is most effective when it includes both pharmacological and psychosocial modalities, referred to as medication assisted therapy (MAT). Three drugs used commonly in MAT-based treatment for OUD from oldest to newest include Methadone, Buprenorphine-naloxone, and Naltrexone. Treatment program models that prioritize total abstinence from the addictive substance attached …

Data On Breastfeeding And State Policies In The United States, Chun Chen, Hong Xue, Qi Zhang

Community & Environmental Health Faculty Publications

Breastfeeding is critically important to maternal and child health in the United States. Examining the relationship between breastfeeding outcomes and state policies requires multidisciplinary efforts to link data from various sources. This article describes an integrated dataset that was used to understand the relationship between participation in a nutrition assistance program and low-income children's breastfeeding outcomes [1]. This dataset merged public health information from the National Immunization Surveys Data from 2006 to 2016 and matching state policy data from the Correlates of State Policy Project (CSPP), the U.S. Department of Agriculture/Economic Research Services (USDA/ERS) Supplemental Nutrition Assistance Program (SNAP) Policy …

How Did We Learn About Sex? —— Sex Education And Sexual Health In Chinese Youth, Yujuan Liu

Theses and Dissertations (Comprehensive)

Attitudes toward sexuality among Chinese youth have become more liberal in recent generations, but sex education remains controversial and limited. Due to the lack of awareness of sexual risks, many Chinese youth engage in unprotected sexual activities resulting in unintended pregnancy, abortions, and STIs. Therefore, understanding successful pathways and unique challenges are crucial to develop adequate sex education for youth’s sexual health in China. The current study used semi-structured in-depth interviews and investigated 28 Chinese youths’ experiences of sex education and sexual health. The results mapped out youth’s sex education experiences by age and sources and demonstrated the impacts of …

Management Of Frequent Ed Users By Community Paramedics Improves Patient Experiences And Reduces Ems Utilization, Oluwakemi Aiyedun Adio, Laura Ikuma, Sonja Wiley

Patient Experience Journal

This study examined a suburban emergency medical system (EMS)-led community paramedicine (CP) program in terms of adherence to protocol, patient-paramedic interactions, patient experience, and cost. Participants (n=57) are frequent emergency department (ED) users (≥ 4 ED visits/year), with a mean age of 59.8±17.6 years and have multiple chronic conditions. Of these, 36 completed a modified Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey at 3- and 6-months following program enrollment. The main outcome measures were adherence to intake goals; types, modes, and frequencies of CP interventions; CG-CAHPS patient experience scores; and cost savings. Cost savings compared …

Availability And Affordability Of Medicines And Cardiovascular Outcomes In 21 High-Income, Middle-Income And Low-Income Countries, Clara Kayei Chow, Tu Ngoc Nguyen, Simone Marschner, Rafael Diaz, Omar Rahman, Alvaro Avezum, Scott A. Lear, Koon Teo, Karen E. Yeates, Khawar Kazmi

Section of Cardiology

Objectives: We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.
Methods: We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types …