Digital Commons Network^™

An Exploration Of Care Coordination And Management For The Medicaid Hiv Population Within Upstate New York Health Homes, Esemikelu Oghenejobo

Legacy Theses & Dissertations (2009 - 2024)

Within the U.S. healthcare system, there has been a renewed focus to improve the delivery of care services, to increase the quality of care, and to decrease costs. The Affordable Care Act introduced the health home (HH) model to serve vulnerable, Medicaid populations who are experiencing difficulty managing their care and navigating complex healthcare systems. The HH was a voluntary state option; of which New York State (NYS) chose to participate. Additionally, NYS was granted a Medicaid 1115 waiver to fully implement an ambitious re-design of NYS’s Medicaid program. NYS invested in the HH as a key model to address …

Understanding Haitian Women’S Health Care In Immokalee, Florida, Usa, Michele Leigh Flippo Bolduc

Theses and Dissertations--Geography

This social science research project takes a critical approach to understanding the health of a population by using the health care system as an entry point through which we can see how large-scale social processes produce a particular health care landscape in the rural, im/migrant farmworker community of Immokalee, Florida, USA. Using a multi-scalar analysis of health care, I investigate how anti-immigrant legislation and neoliberal economics influence the experience of health care for health care providers and Haitian im/migrant women navigating these processes. First, I argue that anti-immigrant and pro-market discourses have been successful in limiting the accessibility to health …

Indigenous Adolescent Girls’ Empowerment Network (Imagen): Adapting The Girl Roster™ For Lakota Communities, Kelly Hallman, Stephanie Martinez

Poverty, Gender, and Youth

This brief reports on a first-of-a-kind meeting between the Population Council’s GIRLCenter and organizations such as the White Buffalo Calf Woman Society (WBCWS) that work locally with Native American communities to understand the specific needs of adolescent girls in Indian Country. This followed an inaugural meeting of the Indigenous Adolescent Girls’ Empowerment Network (IMAGEN) with its wealth of insight concerning the needs of the Native communities they serve, and the GIRL Center’s myriad programmatic tools and resources that have been tried and tested in global settings for several decades. The IMAGEN Approach is an adaptable process that links these two …

Hope Center For Families: Addressing Health Needs Through A Two Generation Model, Brianna Burlock

Master of Public Health Program Student Publications

This project’s objective is to explore how the Two Generation Model of the Hope Center for Families can address the health needs of the zip code 45406 community in order to combat negative health outcomes for impoverished families. The investigator researched studies regarding the Two Generation Model and previous organizational applications of the model. Interviews were held with the partners of Hope Center for Families and with an organization that uses the Two Generation Model. The interviews were analyzed for recurring themes after listening to each of them several times and then transcribed. A logic model for the Hope Center …

Conduct Disorder In Times Of Crisis In The Eastern Mediterranean Region, Ruaa A. Al-Juboori

Master of Public Health Program Student Publications

Background: The Eastern Mediterranean Region (EMR), comprising of 22 countries, has a high burden of conduct disorder (CD) and has the largest burden of displaced populations. Violence and displacement increase the need for mental health services.

Methods: Using descriptive study design, 2015 global CD burden (disability-adjusted life years DALYs per 100,000 populations) was compared to the EMR burden. Across 25 years (1990-2015) trend of CD in 22 EMR countries was graphed and compared with the global CD burden. Association of CD with a) Corruption Perception Index; b) Global Peace Index; c) Human Development Index was assessed using correlation analysis. CD …

An Ecologic Study Of Access To Acute Stroke Care, Mortality And Its Correlates In The Stroke Belt, Jeffrey E. Levy

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Importance: Stroke is leading cause of death in the United States, but quick access to treatment has been shown to result in better outcomes and improved mortality. Among the many barriers to access, geographic proximity to hospitals certified in stroke care may also play a role.

Objectives: To calculate county-level measures of accessibility to certified stroke hospitals using GIS, and to examine its relationship with county stroke mortality while controlling for other county-level potential confounders.

Methods: Ecologic study using county mortality rates and census data to recreate stroke death counts for use in traditional, and a geographically …

Wayne County Board Of Education Adaptation Of Love Notes Curriculum For Adolescent Pregnancy Prevention, Allison Shea Merritt

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

West Virginia has the 8^th highest rate of adolescent pregnancy in the United States and the rate in Wayne County is significantly higher. Adolescent pregnancies cause negative health outcomes for both the baby and the mother. Adolescent mothers are at an increased risk of anemia, preeclampsia, and preterm labor and babies born to adolescent mothers are more likely to have a low birth weight and to have cognitive impairment. To address this burden, the school board has decided to use the ADAPT-ITT framework on the evidence-based Love Notes adolescent pregnancy prevention curriculum to adapt it to be more culturally …

Association Between Acculturation And Body Weight Status Among Migrant Children In Guangzhou, China: A Cross-Sectional Study, Xiaoling Huang, Wen Chen, Yanwei Lin, Qi Zhang, Li Ling

Community & Environmental Health Faculty Publications

Objective To assess the association between acculturation and body weight status among internal migrant children in China. Design, setting and participants A cross-sectional study was conducted among 1154 pairs of migrant children aged 11–17 years and their primary caregivers in Guangzhou, China, from April to May 2016. Measures Migrant children’s body weight status was measured by body mass index. Acculturation was measured by a questionnaire, developed and validated by the research team. The questionnaire had three dimensions with five factors, namely language, social interaction, custom, dressing and diet. Social anxiety was measured by Social Anxiety Scale for Children. Food intake …

Using Prescription Drug Monitoring Data To Inform Population Level Analysis Of Opioid Analgesic Utilization, Huong T. T. Luu

Theses and Dissertations--Epidemiology and Biostatistics

Increased opioid analgesic (OA) prescribing has been associated with increased risk of prescription opioid diversion, misuse, and abuse. States established prescription drug monitoring programs (PDMPs) to collect and analyze electronic records for dispensed controlled substances to reduce prescription drug abuse and diversion. PDMP data can be used by prescribers for tracking patient’s history of controlled substance prescribing to inform clinical decisions.

The studies in this dissertation are focused on the less utilized potential of the PDMP data to enhance public health surveillance to monitor OA prescribing and co-prescribing and association with opioid overdose mortality and morbidity. Longitudinal analysis of OA …

Statistical Analysis Of Rabies Submissions In Kentucky And Weather As A Potential Predictor Of Positive Cases, Hannah Free

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background

The rabies virus is a zoonotic pathogen that is nearly 100 percent fatal once symptoms occur. Because it is still active in wildlife populations in Kentucky, the need for preventive measures and surveillance is critical. Temperature and precipitation have been shown to affect rabies. This study examined rabies submissions in Kentucky, weather and geographical distribution to both describe and predict cases.

Methods

Data from the University of Kentucky Veterinary Diagnostics laboratory were used to assess rabies submissions from 2005 through 2015. These submissions were anonymously submitted by the public and the Florescent Antibody Test was used to determine infection …

Pediatric In-Patient Days Predictive Model, Dana Nicholson Bledsoe

MUSC Theses and Dissertations

The study objective is to develop a predictive model for pediatric inpatient days based on ambulatory outpatient visits and emergency department visits. This model aims to study the relationship between ambulatory visits and inpatient days, and determine if in-patient days can be predicted based on sub-specialty practice. Such a model does not currently exist, and when created and validated such a model could be utilized for various important management decisions, including refined insight into inpatient capacity and operational efficiency for self-governing children’s hospitals with large sub-specialty practices. The data set was a sample of convenience from one health system in …

Adolescent Girls Initiative–Kenya: Midline Results Report, Karen Austrian, Erica Soler-Hampejsek, Joyce Mumah, Beth Kangwana, Yohannes Dibaba Wado, Benta Abuya, Valsa Shah, John A. Maluccio

Poverty, Gender, and Youth

Many adolescent girls in Kenya face considerable risks and vulnerabilities that affect their education status, health, and general well-being. In addition to low educational attainment and health risks, other factors that impact education and health outcomes include household poverty, lack of economic independence, limited income-earning opportunities, illiteracy, violence, and social isolation. Younger adolescent girls who live in environments laden with these vulnerabilities are at risk of experiencing negative outcomes such as school dropout, early sexual initiation, unintended pregnancy, early marriage, and sexual and gender-based violence. The Adolescent Girls Initiative–Kenya (AGI-K) delivered multisectoral interventions to over 6,000 girls aged 11–15 in …

Expanding Contraceptive Choice, Heather Clark, Saumya Ramarao, Catherine Unthank, Kazuyo Machiyama, Nandita Thatte

Reproductive Health

Expanding the range of contraceptive options helps individuals to make choices appropriate to their needs and circumstances, allows them to switch from one method to another if desired, and reflects a program focus on quality and rights. This policy brief outlines policy and program considerations in order to establish and maintain well-functioning supply chains for an expanded choice of contraceptives: introducing new contraceptive technologies to satisfy the diverse preferences of women and their partners; overcoming access barriers to existing methods such as adverse economic and social circumstances, including gender norms; and maximizing the potential of expanded contraceptive choice by ensuring …

Baseline Evaluation Of Project Mesha In Bihar: Factsheet Results 2017-2018, Population Council

Reproductive Health

This fact sheet presents baseline results for an evaluation survey among women who were the primary decisionmakers in the rearing of goats in Bihar, India. The study underpins the Aga Khan Foundation’s implementation of “Project Mesha,” a community-based program to develop the potential of goat farming among women goat rearers in four blocks of Muzaffarpur district. The aim of the project is to increase the income and empowerment of women goat rearers through the implementation of Project Mesha in JEEViKA-run self-help groups. The fact sheet includes data on demographic and household profiles; goat ownership, rearing, income, and productive resources; access …

Asperger's Syndrome In African American Children, Suzette Bailey

Walden Dissertations and Doctoral Studies

The prevalence of autism in the United States is 1 in 68 children. African American children are less likely to receive advance testing to confirm the diagnosis of Asperger's Syndrome (AS) compared to other ethnic groups. The purpose of this study was to determine if demographic factors (parental education level, family annual income, marital status of custodial parent(s), parent ethnicity, number of children in home, other children with disability, family location, mother age at time of birth, gender of child, birth status of child, adoption status and age, child order, and other disability) have any predictive relationship to AS diagnosis …

Hiv Testing Service Utilization Among Men And Women In Dominica, Carol Rosetta Jno.Baptiste-Smith

Walden Dissertations and Doctoral Studies

Voluntary HIV/AIDS testing and counselling (VHTC) is one of the preventive measures used in many countries to decrease the spread of HIV/AIDS. Archived data from National HIV/AIDS Response Program's (NHARP) raw 2016 dataset were used to identify relationships and to assess significant differences between sociodemographic factors and selected sexual risk behaviours versus VHTC practices among adults 18 years and older who resided in Dominica. The health belief model was used as the framework for this cross-sectional study. The sample comprised 982 participants (40% [394] men and 60% [588] women). Logistic regression analysis was used to assess associations between sociodemographic and …

Access To Primary Care In Pennsylvanian Rural Townships, Ann Eneh

Walden Dissertations and Doctoral Studies

Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas's model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using …

Paleoparasitology And Pathoecology In Russia: Investigations And Perspectives, Sergey Slepchenko, Karl Reinhard

Karl Reinhard Publications

Russia, both as the USSR and the Russian federation, provided a source of parasitological theory for decades. A key figure in Russian parasitology was Yevgeny Pavlovsky. He developed the nidus concept, the conceptual basis for the field of pathoecology. He also coined the term “paleoparasitology.” Pathoecology is a foundation concept in archaeological parasitology. Paleoparasitology, as defined by Pavlovsky, is an avenue for understanding of host parasite evolution over very long time periods. These contributions are not fully recognized internationally. Similarly, the long history of Russian paleontological and archaeological investigations are not fully known. Most recently, discoveries from archaeological sites show …

Latent Tuberculosis Infection Treatment Completion And Predictors Of Noncompletion Among Visa Holders In The Rural Setting, Scott Hutton

Walden Dissertations and Doctoral Studies

Latent tuberculosis infection (LTBI), a product of exposure to Mycobacterium tuberculosis (Mtb), can lead to tuberculosis (TB) and further cause death if untreated. Fortunately, TB can be prevented with LTBI treatment. Targeting newly arrived visa holders for LTBI screening and treatment is an effective strategy for decreasing future TB burden. However, LTBI treatment completion rates are low, and researches had primarily focused on the nonrural U.S. setting. This study, using a retrospective cohort design under the epidemiological disease triangle framework evaluated (a) the treatment completion rates for 2 cohorts of visa holders (i.e., immigrants, N = 31 and refugees, N …

Exploring The Relationship Between Social Support, Pharmacy Access And Medication Adherence, Favel Leah Mondesir

All ETDs from UAB

Barriers of medication adherence exist among people with coronary heart disease (CHD) and CHD risk factors, including, poor social support, poor pharmacy access and other patient, social/economic, therapy, condition, and health-care system/health-care team-related factors. However, there are few data on influence of these factors on medication adherence among people with CHD risk factors other than diabetes. Therefore, this dissertation aimed to investigate associations of medication adherence with social support (n=17,113) and pharmacy access (n=8,250) quantitatively using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (black and white adults with CHD or CHD risk factors ≥45 …

Interaction Between Income, Health Insurance, And Self-Rated Health: A Path Analysis., Atalie Ashley West

Electronic Theses and Dissertations

The political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of health, with income being the most consistent predictor. As a result, this study investigated whether earned income is related …

In Case Of Emergency: Local Medical Services And Emergency Air Transportation In Southeast Alaska, Kourtney B. Johnson

Graduate Student Theses, Dissertations, & Professional Papers

Alaska, often referred to as “The Last Frontier”, is a vast, geographically diverse and sparsely settled landscape. Although many popular reality shows tend to exaggerate and dramatize life in Alaska, they do point to an important fact: when an emergency occurs, or someone experiences serious health complications, immediate access to sufficient medical services may not be available. Much of the state’s population faces barriers to accessing needed medical care due to large distances between communities and limited road networks due to coastal locations or challenging terrain.

Using Penchansky and Thomas’s five components of Access Theory (1981), this thesis explores factors …

Effects Of Medicare Reimbursement Policies On The Quality Of Hospital Care, Monica Aswani

All ETDs from UAB

This dissertation is composed of two papers related to the role of social risk factors in the Hospital Readmissions Reduction Program (HRRP). As value-based initiatives like the HRRP become more commonplace, there is growing need to understand the relationship between performance in these programs and social risk factors, such as race and poverty, which are not incorporated in the program’s risk adjustment methodology. To address this gap in the literature, this dissertation specifically focuses on three areas: 1) how hospital and community factors are related to average HRRP penalties, taking the context of geography into account, 2) how hospital and …

Visual, Attentional, And Cognitive Risk Factors For Motor Vehicle Collision Involvement Among Older Adults, Carrie Huisingh

All ETDs from UAB

Motor vehicle collisions are a major public health problem for older adults in the United States. In 2013, there were 5,671 older adults killed and an estimated 222,000 injured in motor vehicle crashes. After adjusting for miles driven, the risk of crashing increases rapidly after age 70, nearly equal to that of younger drivers whose crash rate is the highest among all age groups. Driving is a highly complex task that relies on a variety of visual and cognitive functions. A large body of work has demonstrated that drivers with visual sensory impairments and/or higher-order visual-cognitive processing deficits, those who …

Understanding Parenting Styles Of Second-Generation Parents Of Residential School Survivors Within Treaty 8 Reserves, Judy Kim-Meneen

Walden Dissertations and Doctoral Studies

Approximately 150,000 First Nation, Metis, and Inuit children attended Canadian residential schools from the 1840s to 1996. Most residential school children had negative experiences of physical, verbal, and sexual abuse that led to parenting repercussions once these children became parents. These repercussions of residential schools led to a rate of neglect for First Nation children 12 times higher than non-First Nation children. The purpose of this qualitative phenomenological descriptive study was to explore the lived experiences of second generation parents, who were schooled in residential schools as children and their current parenting styles. The conceptual frameworks of trauma theory and …

Regional Differences In Feto-Infant Mortality In The U.S. - Mexico Border Region: Using The Perinatal Period Of Risk (Ppor) Approach, Dyanne G. Herrera

Open Access Theses & Dissertations

Introduction. Infant mortality (IM) is a critical indicator of the health of communities because societal factors that affect population health directly impact the mortality rate of infants. There is limited infant mortality data for the U.S. side of the U.S.-Mexico Border Region, defined as the areas within 100 km north of the border. Data from 2005-2007 show that the average IM rate for the border states combined was 5.8 infant deaths per 1,000 live births; for the border counties, the rate was 5.4 per 1,000. Although IM rates were lower in the border counties than in the border states, risk …

Complementary And Alternative Medicine Careers Following A Science Academy For Underrepresented Minority Students, Tolulope Oyelowo

Walden Dissertations and Doctoral Studies

Minority groups experience disproportionately worse health outcomes. An identified solution is to increase the number of minorities providing healthcare in their own communities. Primary care complementary and alternative medicine (CAM) providers are a potential resource. Many investigators have demonstrated the efficacy of science-based pipeline programs for increasing the roles of students in allopathic health professions. Whether these programs influence matriculation of minorities into a CAM university is unknown. The main purpose of this study was to gain an understanding of a pre-college science academy at a CAM university and determine whether the experience increased interest in and motivation for CAM …

A Comparison Of Quality Indicators Between Medicare Accountable Care Organizations And Health Maintenance Organizations Using Publicly Available Data, William W. Campbell Iii

Theses and Dissertations

The purpose of this study is to explore differences in quality between Medicare Accountable Care Organizations (ACO) and Health Maintenance Organizations (HMO). Three outcomes measures reported by these plans use different methodologies but possess enough alignment to permit comparison: percent of diabetic patients with last HbA1c > 9.0%, colon cancer screening rate and ER visits per 1,000. These outcomes are the dependent variables (DV). A secondary purpose is to explore differences in quality based on the size of the beneficiary population served, using the same measures.

As the Medicare program faces threats to its solvency in coming decades, with 10,000 baby …

Investigating Drug-Related Violence In Indian Country: The Lumbee Tribe Of North Carolina, Asa Alena Revels

Theses and Dissertations

Drug-related violence (DRV) impacts the over-all wellbeing of communities, with disparate health outcomes observable in many poor, minority communities. The purpose of this study was to better understand the multi-level social and environmental factors influencing elevated rates and prevention of DRV within the Lumbee, a southeastern American Indian Tribe. This was accomplished via in-depth, one-on-one interviews with 37 Lumbee Tribal Members and Key Leaders. The findings align with existing research, revealing the influence of such factors as poor socioeconomic conditions, coping strategies, broken family structures, and the influence of federal policy. Of interest was the substantial influence of the local …

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 …