Digital Commons Network^™

Investigating Barriers To Early Cancer Detection For Rural Indian Women: A Qualitative Analysis Of Cancer Outreach In Dehradun, Uttarakhand, Blair Burnett

Independent Study Project (ISP) Collection

This study examines barriers to early detection for women’s specific cancers in rural India in and around Dehradun, Uttarakhand, within the framework of existing health outreach programs from tertiary hospitals in the state. The burden of cancer mortality within India is disproportionately affecting women living in rural populations considering the current health education and health care infrastructure in place. Barriers of knowledge, access to knowledge, economic condition, geography, and cultural norms are all examined within this study in the context of early cancer detection. National Indian health policy is currently framed to address the burden of cancer within India; however, …

Perceptions Of Potable Water In Rajasthan’S Jodhpur And Barmer Districts, Melissa Spross

Independent Study Project (ISP) Collection

This paper looks at differences and similarities in various populations’ perceptions of safe drinking water (SDW) within Rajasthan (RJ), India, developing suggestions for future initiatives addressing the movement for safe drinking water for all. For this study, surveys were used; the survey was conducted in RJ, India, both in urban Jodhpur and in surrounding rural villages. To analyze the data, all the responses were entered into Excel format to discover patterns, themes and trends within four subtopics: access, storage, quality and cultural significance. The responses indicate that while a distinct water culture spans the geographic area, each different population retains …

Deconstructing Unmade Examining The Capacity Of Ayurveda To Address India’S Mental Health Crisis, Cassie Sutten Coats

Independent Study Project (ISP) Collection

Though India does not have a credible, widespread system in place to recognize and focus on issues of mental health, especially in allopathic treatments, it is imperative to evaluate the existing practices and approaches in regards to mental health alongside the impact that these approaches may have on Indian society. In contrast to Westernized systems of medicine, the traditional Indian system of Ayurveda inherently addresses issues in mental health due to the holistic approach through mind-body medicine. This study evaluates the enormous potential that exists within Ayurvedic philosophy to provide adequate, culturally congruent, treatments and care in mental health, and …

Childhood Cancer Incidence In Georgia: Descriptive Epidemiology, Geographic Trends, And Disparities In Insurance Coverage, And Health Care Access, Florence A. Kanu, Sara Wagner Robb, Rosemary Corriero

Journal of the Georgia Public Health Association

Background: Limited research has been conducted concerning childhood cancer (CC) incidence in Georgia, which is a leading cause of death for children in the US. The purpose of this study was to determine if county-level CC incidence rates differed by geography or race and if health care access disparities exist.

Methods: Incidence data were obtained from the Georgia Comprehensive Cancer Registry for 2000-2011. Age-adjusted incidence rates per 100,000 were analyzed by sex, race, and county. Hotspots and coldspots of CC incidence were analyzed using the Getis-Ord GI* statistic. Health care access data for children under 19 were obtained using US …

The Impact Of Vaccine Hesitancy On The Polio Vaccine In South Asia, Leah Everist

Independent Study Project (ISP) Collection

A disease that paralyzes hundreds of children each year, polio is incurable but also entirely preventable through vaccination. Though part of the reason some children are not reached for immunization is that they are in areas too volatile for healthcare workers to access, vaccine hesitancy is increasingly being recognized as an important player. The objective of this study is to ascertain the degree to which vaccine hesitancy affects polio vaccine campaigns in Afghanistan and Pakistan, the countries in South Asia where polio continues to be endemic, to assess the drivers behind hesitancy in this region, and to present recommendations for …

Effect Of Massachusetts Healthcare Reform On Racial And Ethnic Disparities In Admissions To Hospital For Ambulatory Care Sensitive Conditions: Retrospective Analysis Of Hospital Episode Statistics, Danny Mccormick, Amresh D. Hanchate, Karen E. Lasser, Meredith G. Manze, Mengyun Lin, Chieh Chu, Nancy R. Kressin

Publications and Research

Objectives To examine the impact of Massachusetts healthcare reform on changes in rates of admission to hospital for ambulatory care sensitive conditions (ACSCs), which are potentially preventable with good access to outpatient medical care, and racial and ethnic disparities in such rates, using complete inpatient discharge data (hospital episode statistics) from Massachusetts and three control states.

Design Difference in differences analysis to identify the change, overall and according to race/ethnicity, adjusted for secular changes unrelated to reform.

Setting Hospitals in Massachusetts, New York, New Jersey, and Pennsylvania, United States.

Participants Adults aged 18-64 (those most likely to have been affected …

Perceptions Of Hiv/Aids Testing Among Urban And Rural African American Church Members, Roblena E. Walker

Journal of the Georgia Public Health Association

Background: The prevalence of the human immunodeficiency virus (HIV) continues to affect African Americans (AA) disproportionately. The purpose of this mixed methods study, guided by the health belief model, was to examine associations linking church and ambient social environment with knowledge and perceptions of HIV/AIDS testing amongst urban and rural AA church members.

Methods: Multiple regressions and t tests were used to compare perceptions of HIV/AIDS testing and knowledge of HIV/AIDS among 236 participants selected from two AA churches located in a large city (n = 122) and in a rural town (n =114) in the Southern U.S.

Results: The …

Whom Do You Trust? Doubt And Conspiracy Theories In The 2009 Influenza Pandemic, Shawn Smallman

International & Global Studies Faculty Publications and Presentations

The 2009 pandemic of H1N1 influenza led people around the globe to create narratives about the epidemic defined by the question of trust; these narratives ranged from true conspiracy theories to simply accounts in which mistrust and betrayal formed a motif. In particular, most of these narratives reflected a fear of capitalism and globalization, although in specific regions, other issues—such as religion—played a more central role. These stories were not unique to the H1N1 pandemic but rather have appeared with every contemporary outbreak of infectious disease. This paper will examine conspiracy theories and moral panics related to the H1N1 pandemic …

Identifying Individual Risk Factors And Documenting The Pattern Of Heat-Related Illness Through Analyses Of Hospitalization And Patterns Of Household Cooling, Michael T. Schmeltz, Grace Sembajwe, Peter J. Marcotullio, Jean A. Grassman, David U. Himmelstein, Stephanie Woolhandler

Publications and Research

Background
As climate change increases the frequency and intensity of extreme heat events researchers and public health officials must work towards understanding the causes and outcomes of heat-related morbidity and mortality. While there have been many studies on both heatrelated illness (HRI), there are fewer on heat-related morbidity than on heatrelated mortality.

Objective
To identify individual and environmental risk factors for hospitalizations and document patterns of household cooling.

Methods
We performed a pooled cross-sectional analysis of secondary U.S. data, the Nationwide Inpatient Sample. Risk ratios were calculated from multivariable models to identify risk factors for hospitalizations. Hierarchical modeling was also …

Immigrant Women's Experiences Of Maternity-Care Services In Canada: A Systematic Review Using A Narrative Synthesis, Gina M A. Higginbottom, Myfanwy Morgan, Mirande Alexandre, Yvonne Chiu, Joan Forgeron, Deb Kocay, Rubina Barolia

School of Nursing & Midwifery

Background: Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. …

An Interdisciplinary Approach To Combat Obesity In The Galapagos, Christopher Busack, Bethany Fox

CwiC-PH

Galapagos Background

• Total Population (2010) = 25,124¹
• Largest city = Puerto Ayora (Santa Cruz)
• Average monthly income in Galapagos = $772.03/month²
• Average monthly income in mainland Ecuador = $251.70/month²
• Booming tourism industry contributes to rapid population growth³

4 of 18 main islands (>1km²) open for human residence (Santa Cruz, Isabela, San Cristobal, Floreana)

Risk Factors And Costs Influencing Hospitalizations Due To Heat-Related Illnesses: Patterns Of Hospitalization, Michael T. Schmeltz

Dissertations, Theses, and Capstone Projects

The objective of this dissertation was to identify individual and environmental risk factors, investigate outcomes and hospital resource use, including costs, and document the pattern of heat-related illness hospitalizations in the United States. The main data source for the study population was the 2001-2010 Nationwide Inpatient Sample (NIS). The study population for heat-related illnesses (HRIs) consists of patients in the NIS with at least one diagnosis of a heat-related illness (ICD-9 codes 992.0 - 992.9) from 2001 to 2010. Outcome analysis included a study population of patients who had primary or secondary diagnoses of diabetes, cardiovascular diseases, respiratory illnesses, nephritic …

Preconception And Early Pregnancy Air Pollution Exposures And Risk Of Gestational Diabetes Mellitus, Candace Robledo, Pauline Mendola, Edwina H. Yeung, Tuija Männistö, Rajeshwari Sundaram, Danping Liu, Qi Ying, Seth Sherman, Katherine Grantz

School of Medicine Publications

Background: Air pollution has been linked to gestational diabetes mellitus (GDM) but no studies have evaluated impact of preconception and early pregnancy air pollution exposures on GDM risk.

Methods: Electronic medical records provided data on 219,952 singleton deliveries to mothers with (n=11,334) and without GDM (n=208,618). Average maternal exposures to particulate matter (PM) ≤ 2.5μm (PM2.5) and PM2.5 constituents, PM ≤ 10μm (PM10), nitrogen oxides (NOx), carbon monoxide, sulfur dioxide (SO2) and ozone (O3) were estimated for the 3-month preconception window, first trimester, and gestational weeks 1-24 based on modified Community Multiscale Air Quality models for delivery hospital referral regions. …

Environmental Disparities Present A Challenge For Diabetes Prevention And Management Efforts In Dallas County, Theresa Mendoza, Sushma Sharma, Pamela Daughty, Crystee Cooper, Carol Young, Larry Tubb, Kristin Jenkins, Community Health Collaborative Of North Texas (Chc)

Journal of Health Disparities Research and Practice

The State of Texas is home to nearly 2 million men, women and children with diabetes, over half a million of which reside in the Dallas-Fort Worth (DFW) region. Recognizing the rising need to identify the disparities in implementing the diabetes prevention and management efforts and adopting the healthy life style in high diabetes prevalence areas in Dallas County, we explored the potential of Geographic Information System (GIS) methodology to analyze the data at zip code level from Dallas-Fort Worth Hospital Council (DFWHC) Research Foundation’s data registry. The objectives of this research were to identify the zip codes with the …

Connecting Gender, Race, Class, And Immigration Status To Disease Management, Marie-Anne S. Rosemberg Phd, Mn, Rn, Jenny Hsin-Chun Tsai Phd, Arnp, Pmhcns-Bc

Journal of Health Disparities Research and Practice

Objective: Chronic diseases are the leading causes of death in the United States. Chronic disease management occurs within all aspects of an individual’s life, including the workplace. Though the social constructs of gender, race, class, and immigration status within the workplace have been considered, their connection to disease management among workers has been less explicitly explored. Using a sample of immigrant hotel housekeepers, we explored the connections between these four social constructs and hypertension management.

Methods: This qualitative research study was guided by critical ethnography methodology. Twenty-seven hotel room cleaners and four housemen were recruited (N = 31) and …

Active Management Of The Third Stage Of Labor By Skilled Birth Attendants In A Rural Regional Hospital In Southern Ethiopia: A Qualitative Case Study, Marcella J. Gowan

Doctor of Education (EdD)

In Ethiopia, as in many developing countries, postpartum hemorrhage (PPH) is the leading cause of maternal mortality. PPH can be prevented through a three-step practice called active management of the third stage of labor (AMTSL), which can be learned by a skilled birth attendant (SBA). However, most SBAs have not adopted AMTSL into practice. The purpose of this case study was to investigate the use of AMTSL among SBAs in a rural regional hospital in southern Ethiopia. Six theoretical propositions and a conceptual framework were designed to guide the research and analysis. In-depth interviews were conducted with SBAs who worked …

Environmental Health In Southern Nevada, Courtney Coughenour, Jennifer Pharr, Shawn Gerstenberger

Nevada Journal of Public Health

There are a multitude of environmental factors that influence public health. The purpose of this manuscript is to evaluate the Southern Nevada community with respect to environmental conditions and health, including both positive and negative traits, and develop realistic goals and strategies aimed at improving these conditions. Southern Nevada is located in one of the most arid regions of North America. Since annual rainfall averages less than four inches per year, Southern Nevada depends upon the Colorado River for its water supply. It is predicted that water flow to the area will decrease by 5% to 20% by 2050. As …

Community Health Indicators In Southern Nevada, Courtney Coughenour, Jennifer Pharr, Shawn Gerstenberger

Nevada Journal of Public Health

Community design and access to services are essential components of healthy and sustainable communities. The purpose of this manuscript is to evaluate Southern Nevada with respect to community design and access, including both positive and negative traits, and to suggest realistic changes that could be made to improve these conditions. The region’s network of parks and open space recreation areas is one of its strongest assets. Clark County enjoys over 42 million acres of federal and state lands which offer a large variety of recreational opportunities. The region has an extensive trail system, with a total of 179 miles of …

The Relationship Between Cancer Incidence, Stage, And Poverty In The United States, Francis P. Boscoe, Kevin A. Henry, Recinda L. Sherman, Christopher J. Johnson

Epidemiology & Biostatistics Faculty Scholarship

We extend a prior analysis on the relation between poverty and cancer incidence in a sample of 2.90 million cancers diagnosed in 16 U.S. states plus Los Angeles over the 2005-2009 period by additionally considering stage at diagnosis. Recognizing that higher relative disparities are often found among less-common cancer sites, our analysis incorporated both relative and absolute measures of disparities. Fourteen of the 21 cancer sites analyzed were found to have significant variation by stage; in each instance, diagnosis at distant stage was more likely among residents of high-poverty areas. If the incidence rates found in the lowest-poverty areas for …

Mapping Of Networks To Detect Priority Zoonoses In Jordan, Erin M. Sorrell, Mohammad El Azhari, Nezar Maswdeh, Sarah Kornblet, Claire J. Standley, Rebecca L. Katz, Ibrahim Ablan, Julie E. Fischer

Health Policy and Management Faculty Publications

Early detection of emerging disease events is a priority focus area for cooperative bioengagement programs. Communication and coordination among national disease surveillance and response networks are essential for timely detection and control of a public health event. Although systematic information sharing between the human and animal health sectors can help stakeholders detect and respond to zoonotic diseases rapidly, resource constraints and other barriers often prevent efficient cross-sector reporting. The purpose of this research project was to map the laboratory and surveillance networks currently in place for detecting and reporting priority zoonotic diseases in Jordan in order to identify the nodes …

Calling Science Pseudoscience: Fleck’S Archaeologies Of Fact And Latour’S ‘Biography Of An Investigation’ In Aids Denialism And Homeopathy, Babette Babich

Articles and Chapters in Academic Book Collections

Fleck’s Genesis and Development of a Scientific Fact foregrounds claims traditionally excluded from reception, often regarded as opposed to fact, scientific claims that are increasingly seldom discussed in connection with philosophy of science save as examples of pseudo-science. I am especially concerned with scientists who question the epidemiological link between HIV and AIDS and who are thereby discounted—no matter their credentials, no matter the cogency of their arguments, no matter the sobriety of their statistics—but also with other classic examples of so-called pseudo-science including homeopathy and other sciences, such as cold fusion. The pseudo-science version of the demarcation problem turns …

Cross-Continental Care: Us And Cuban Medical Internationalism In Bolivia, Madeleine Blain

Latin American Studies Honors Projects

How can something as commonplace as going to the doctor influence international politics? In Bolivia, medicine is bound in politics. The political structure of a country both influences the approach to health care, and determines how that approach is most effectively implemented internationally. Building upon a framework of conceptual difference between capitalist and socialist health systems, this paper examines “effective” models of US and Cuban international health care on both a political and individual level. Drawing on fieldwork conducted in a Bolivian hospital, interviews with doctors working internationally, and current literature, I seek to discern what defines “effective” international health …

Dietary Supplement Use Associated With Air Force Fitness And Deployment Health, Michael J. Bell

Master of Public Health Program Student Publications

Objective: This study characterizes supplement use among United States Air Force members as well as attempts to identify an association between supplement use and Air Force Physical Fitness Test (AFPFT) scores or self-reported deployment health.

Methods: The study population (n = 24,020) was comprised of Airmen who completed a Web Based Preventive Health Assessment (WebPHA), Post Deployment Health Assessment (PDHA) and completed an AFPFT within six months of their WebPHA. Binary logistic regression was performed to predict AFPFT scores and deployment health outcomes based on supplement usage. Chi-squared analysis was performed to determine if there is any significant association between …

Descriptive Analysis Of U.S. Air Force Occupational Injuries And Illnesses, Kenneth Mackenthun

Master of Public Health Program Student Publications

Background: Occupational health is a concern in the workplace environment. Cases of occupational illness or injury could lead to lost workdays, a lower quality of life, chronic pain, and sometimes death. Air Force personnel perform unique functions that could have negative effects on their health.

Purpose: Identify the most common occupational illnesses and injuries among active duty United States Air Force (U.S.A.F.) personnel, determine rates of occupational illnesses and injuries in the Air Force by rank, and compare rates across Major Commands (MAJCOMS). Methods: A literature review was conducted on select occupational illnesses and injuries. A descriptive data analysis was …

Association Between Dietary Patterns During Pregnancy And Birth Size Measures In A Diverse Population In Southern Us, Uriyoan Colón-Ramos, Susan B. Racette, Jody M. Ganiban, Thuy G. Nguyen, Mehmet Kocak, Kecia N. Carroll, Eszter Volgyi, Frances A. Tylavsky

Global Health Faculty Publications

Despite increased interest in promoting nutrition during pregnancy, the association between maternal dietary patterns and birth outcomes has been equivocal. We examined maternal dietary patterns during pregnancy as a determinant of offspring’s birth weight-for-length (WLZ), weight-for-age (WAZ), length-for-age (LAZ), and head circumference (HCZ) Z-scores in Southern United States (n = 1151). Maternal diet during pregnancy was assessed by seven dietary patterns. Multivariable linear regression models described the association of WLZ, WAZ, LAZ, and HCZ with diet patterns controlling for other maternal and child characteristics. In bivariate analyses, WAZ and HCZ were significantly lower for processed and processed-Southern compared to healthy …

A Systematic Review And Meta-Regression Analysis Of Lung Cancer Risk And Inorganic Arsenic In Drinking Water., Steven H. Lamm, Hamid Ferdosi, Elisabeth K. Dissen, Ji Li, Jaeil Ahn

Epidemiology Faculty Publications

High levels (> 200 µg/L) of inorganic arsenic in drinking water are known to be a cause of human lung cancer, but the evidence at lower levels is uncertain. We have sought the epidemiological studies that have examined the dose-response relationship between arsenic levels in drinking water and the risk of lung cancer over a range that includes both high and low levels of arsenic. Regression analysis, based on six studies identified from an electronic search, examined the relationship between the log of the relative risk and the log of the arsenic exposure over a range of 1-1000 µg/L. The …

Changes In Malaria Prevention And Incidence Due To Political Restructuring Of Mozambique And South Africa, Nirmala K. Shivakumar

UROP Posters

The UN’s current Millennium Development Goal puts pressure on many countries to decrease malaria incidence by 2015, including Mozambique and South Africa. While Mozambique and South Africa have continually worked to decrease malaria incidence for the last five decades, neither country can claim elimination of disease by UN standards. This study analyzes the changes in political structure and the simultaneous changes in the malaria prevention programs of Mozambique and South Africa after the end of their respective civil wars in 1992 and 1994. This study analyzed public health, historical, and social science journal articles. This study examined political power distribution, …

The Sub-Saharan Water Crisis: An Analysis Of Its Impact On Public Health In Urban And Rural Nigeria, Megan Hannemann 15

Honor Scholar Theses

Today, 11% of the global population still lacks access to clean water, one of humans’ most basic needs. Those who lack a safe water source are largely concentrated in sub-Saharan Africa, where only 61% have access to safe water. Within this region, large disparities exist that hide the severity of the problem for some communities. The term “water crisis” is often used to describe the lack of water access throughout the world and the resulting consequences. In this thesis, the impact the water crisis has on public health in sub-Saharan Africa was analyzed using Nigeria as a model nation. Specific …

Planning For A Community Supported Farmers Market In A Rural Usda Food Desert, Carrie Lynn Engelbright

Walden Dissertations and Doctoral Studies

A community initiative to develop and sustain a farmer's market can address insufficient access to fresh and affordable fruits and vegetables for individuals working and residing in a United States Department of Agriculture (USDA) designated food desert. This project addressed a particular USDA food desert in South Wood County, Wisconsin. The purpose of this project was to develop and plan for implementation and evaluation of a community-supported farmers market in South Wood County, with the goal to increase access to fruits and vegetables. Project objectives included development of a sustainable community infrastructure to support the market, development of policies and …

Disparities In Monoclonal Antibody Treatment Of Elderly Metastatic Colorectal Cancer Patients, Krista Marie Schroeder

Walden Dissertations and Doctoral Studies

Multiple research studies have demonstrated racial, socioeconomic status (SES), and neighborhood disparities in first-line treatment of colorectal cancer patients, including those with metastatic colorectal cancer. However, disparities in adjunct monoclonal antibody treatment disparities have not been explored. The purpose of this study was to assess racial, SES, and neighborhood disparities in adjunct monoclonal antibody treatment of elderly metastatic colorectal cancer patients. The research was rooted in 3 theories: the fundamental cause theory, the diffusion of innovations theory, and theory of health disparities and medical technology. Data from the SEER-Medicare database and logistic regression were used to assess the relationship between …