Digital Commons Network^™

Debunking Medical Myths: Bmi Reliably Measures Body Fat, Michael Melhem, Lillian Baumann, Victoria Kelley, Michael Escobar, Nicholas Pryde, Quynh Liu

Patient Education Projects

No abstract provided.

Debunking Medical Myths: Breakfast Is The Most Important Meal Of The Day, Arsh Kaiser, Erin Madden, Chelsea Yu, Collin Gustafson, Adlai Nelson, Matthew Myhand

Patient Education Projects

No abstract provided.

Debunking Medical Myths: Is Starving Yourself An Effective Way To Lose Weight?, Anuj Kavi, Alexander Buendia, Adrienne-Denise Bilbao, Lana Zalt, Rachel Puentes, Mark Gregory

Patient Education Projects

No abstract provided.

Examining The Perspectives And Experiences Of Nutrition Educators Working With Clients In Substance Use Recovery Settings, Cora Teets, Paula Plonski, Omolola Adedokun, Heather Norman-Burgdolf

Dietetics and Human Nutrition Faculty Publications

Substance use disorder (SUD) is one of the most detrimental health, social, and economic problems in the United States. Limited studies suggest providing tailored nutrition education during SUD treatment correlates with positive recovery outcomes. The University of Kentucky Nutrition Education Program conducted two focus group sessions to explore and determine educators’ instructional and programmatic needs who deliver nutrition education to clients in substance use recovery throughout Kentucky. The study team identified four emerging themes and several subthemes related to Nutrition Education Program educators working with clientele in recovery. The four emerging themes included: (1) current experiences working with the audience, …

Unifying Multi-State Efforts Through A Nationally Coordinated Extension Diabetes Program, Laura Balis, Shari Gallup, Heather Norman-Burgdolf, Julie Buck, Pam Daniels, Dan Remley, Lisa Graves, Margaret Jenkins, Gayle Price

Dietetics and Human Nutrition Faculty Publications

The Cooperative Extension System translates research to practice and “brings the University to the people” throughout the U.S. However, the system suffers from program duplication and is challenged to scale-out effective programs. One program, Dining with Diabetes (DWD), stands out for its dissemination to multiple states. DWD is a community-based program aimed at improving diabetes management, nutrition, and physical activity behaviors. DWD was coordinated through a national working group and implemented by state Extension systems. A pragmatic, quasi-experimental study was conducted to determine the effectiveness of the national coordination model and the overall impact of DWD. Four states reported data …

Meal Timing, Meal Frequency And Metabolic Syndrome, Fatema Alkhulaifi, Charles Darkoh

Faculty, Staff and Student Publications

Individuals with metabolic syndrome have increased risk for developing health conditions, including cardiovascular diseases and stroke. Modifiable risk factors, such as exercise and diet, are key components in the prevention and control of metabolic syndrome. Specifically, dietary patterns and habits are extremely successful in controlling more than one of the metabolic syndrome risk factors. Meal timing and frequency have been associated with type 2 diabetes, cardiovascular diseases, and other chronic conditions. However, there is limited evidence linking metabolic syndrome to meal timing and meal frequency. This review summarizes and discusses how meal timing and frequency impact metabolic outcomes in adults.

Citizenship Matters: Non-Citizen Covid-19 Mortality Disparities In New York And Los Angeles, Jason A. Douglas, Georgiana Bostean, Angel Miles Nash, Emmanuel B. John, Lawrence M. Brown, Andrew M. Subica

Health Sciences and Kinesiology Faculty Articles

U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020–January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. …

Vitamin D Level Testing In An Urban Midwest Clinic: To Test Or Not To Test?, Daniel Mundt, Marianne Klumph, Kayla Heslin, Wajih Askar

Journal of Patient-Centered Research and Reviews

Vitamin D deficiency (VDD) is significantly higher among urban populations in the U.S. Midwest, with African Americans being disproportionately affected. There is ongoing debate surrounding who and how often individuals should be screened for VDD. This study aimed to understand the prevalence of VDD, associated risk factors, and discrepancies in testing at an urban-based internal medicine residency clinic. Data were retrospectively collected on all adult patients seen by the clinic during 2018 and descriptive statistical analysis performed. Among 3976 total patients (mean age: 53 years), 18% (n = 698) had vitamin D levels analyzed, with deficiency found in 71% of …

Emergency Department Antimicrobial Use In A Low-Resource Setting: Results From A Retrospective Observational Study At A Referral Hospital In Liberia, Sojung Yi, Anu Ramachandran, Lane Epps, Alex Mayah, Taylor W Burkholder, Michael Senyu Jaung, Ahson Haider, Paul Whesseh, John Shakpeh, Kayla Enriquez, Corey Bills

Faculty, Staff and Students Publications

OBJECTIVE: Data on antimicrobial use in low-income and middle-income countries (LMICs) remain limited. In Liberia, the absence of local data impedes surveillance and may lead to suboptimal treatment, injudicious use and resistance against antimicrobials. This study aims to examine antimicrobial prescribing patterns for patients in the emergency department (ED) of a large Liberian public hospital. Secondarily, this prescribing was compared with WHO prescribing indicators.

DESIGN: Retrospective observational study.

SETTING: An adult ED of a large public hospital in Monrovia, Liberia.

PARTICIPANTS: A total of 1082 adult patients (>18 years of age) were recorded in the ED, from 1 January …

The Role And Strategies Of Food Manufacturers Towards Obesity And Health Policies, Emem Okpokowuruk

Epsilon Sigma at-Large Research Conference

Introduction & Background: Unhealthy diets and non-communicable diseases such as obesity are on the rise on a national and global scale, and there is an urgent need to initiate interventions. However, research suggests there is a lack of effective initiatives from major processed food manufacturers, which are a major contributor to the cause of these health issues. Thus, this study seeks to examine the role that food manufacturers have in contributing to the obesity epidemic and the strategies that they use to navigate around health policies.

Purpose Statement Question: Is there evidence of a primary role that processed food manufacturers …

Occupational Therapy's Role In Addressing Childhood Obesity In Hispanic Communities, Karina Castro-Ayala

Spring 2022 Virtual OTD Capstone Symposium

Childhood obesity is a growing public health epidemic of the 21st century (Sahoo et al, 2015), in which the Hispanic population is disproportionately an affected population in the U.S for obesity and other health risks (Garcia et al, 2019). Predominantly, 40% of Hispanic children in the U.S. are considered overweight or obese, higher than many other racial and ethnic populations, leading to an increased risk in chronic health conditions, such as Type 2 diabetes, cardiovascular disease, asthma, and decrease in mental well-being. The purpose of this capstone was to develop an occupation-based, health and wellness program through the scope of …

Intake Patterns Of Specific Alcoholic Beverages By Prostate Cancer Status, Hui Yi Lin, Tung-Sung Tseng, Xinnan Wang, Zhide Fang, Arnold H. Zea, Liang Wang, Julio Pow-Sang, Catherine M. Tangen, Phyllis J. Goodman, Alicja Wolk, Niclas Håkansson, Manolis Kogevinas, Javier Llorca, Hermann Brenner, Ben Schöttker, Jose Esteban Castelao, Manuela Gago-Dominguez, Marija Gamulin, Davor Lessel, Frank Claessens, Steven Joniau, Jong Y. Park

School of Public Health Faculty Publications

Background: Previous studies have shown that different alcoholic beverage types impact prostate cancer (PCa) clinical outcomes differently. However, intake patterns of specific alcoholic beverages for PCa status are understudied. The study’s objective is to evaluate intake patterns of total alcohol and the three types of beverage (beer, wine, and spirits) by the PCa risk and aggressiveness status. Method: This is a cross-sectional study using 10,029 men (4676 non-PCa men and 5353 PCa patients) with European ancestry from the PCa consortium. Associations between PCa status and alcohol intake patterns (infrequent, light/moderate, and heavy) were tested using multinomial logistic regressions. Results: Intake …

Suicide Prevention In Bangladesh: The Role Of Family, S M Yasir Arafat, Tamkeen Saleem, Todd M. Edwards, Syeda Ayat-E-Zainab Ali, Murad M. Khan

Department of Psychiatry

Background: Suicide is a public health problem that gets little attention in Bangladesh especially in prevention aspects. Recent studies revealed that a significant portion of risk factors is closely related to family events. However, potential prevention strategies considering the family structure and involving family dynamics of Bangladesh have not been discussed.
Objectives: We aim to highlight areas of family vulnerability and resilience when the threat of suicide is present, as well as the potential roles of family in suicide prevention in Bangladesh.
Methods: We conducted a thorough narrative and focused literature search and synthesized evidence based on available articles discussing …

Evaluating The Dissemination And Implementation Of A Community Health Worker-Based Community Wide Campaign To Improve Fruit And Vegetable Intake And Physical Activity Among Latinos Along The U.S.-Mexico Border, Paul Gerardo Yeh, Belinda M. Reininger, Lisa A. Mitchell-Bennett, Minjae Lee, Tianlin Xu, Amanda C. Davé, Soo Kyung Park, Alma G. Ochoa-Del Toro

Physician Assistant Studies Faculty Publications

This study evaluated the dissemination and implementation of a culturally tailored community-wide campaign (CWC), Tu Salud ¡Si Cuenta! (TSSC), to augment fruit and vegetable (FV) consumption and physical activity (PA) engagement among low-income Latinos of Mexican descent living along the U.S.-Mexico Border in Texas. TSSC used longitudinal community health worker (CHW) home visits as a core vehicle to enact positive change across all socioecological levels to induce behavioral change. TSSC’s reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) was examined. A dietary questionnaire and the Godin-Shepherd Exercise Questionnaire measured program effectiveness on mean daily FV consumption and weekly PA engagement, respectively. …

Qualitative Analysis Of South Dakota Community Health Needs Assessments, Rachel Greiner

Honors Thesis

The supplemental nutrition program of women, infants and children (WIC) is a nationwide program designed to give women and children access to basic nutritional foods, breastfeeding services, and healthcare referrals. WIC has been shown to help prevent some diseases such as nutritional deficiencies or type two diabetes by requiring participants to attend pre- and postnatal appointments and nutritional counseling. The effectiveness of the WIC program is not well known in individual states. The purpose of this research is to identify trends of the WIC program and resources within South Dakota through an analysis of the community health needs assessments. The …

Pro-Inflammatory Diet Pictured In Children With Atopic Dermatitis Or Food Allergy: Nutritional Data Of The Lina Cohort, Olivia Schütte, Larissa Bachmann, Nitin Shivappa Mbbs, Mph, Ph.D., James R. Hébert Scd, Janine F. Felix, Stefan Röder, Ulrich Sack, Michaek Borte, Wieland Kiess, Ana C. Zenclussen, Gabriele I. Stangl

Faculty Publications

Background: Lifestyle and environmental factors are known to contribute to allergic disease development, especially very early in life. However, the link between diet composition and allergic outcomes remains unclear. Methods: In the present population-based cohort study we evaluated the dietary intake of 10-year-old children and analyses were performed with particular focus on atopic dermatitis or food allergy, allergic diseases known to be affected by dietary allergens. Dietary intake was assessed via semi-quantitative food frequency questionnaires. Based on these data, individual nutrient intake as well as children’s Dietary Inflammatory Index (C-DII™) scores were calculated. Information about atopic manifestations during the first …

Mendelian Randomization Supports Bidirectional Causality Between Telomere Length And Clonal Hematopoiesis Of Indeterminate Potential, Tetsushi Nakao, Alexander G Bick, Margaret A Taub, Seyedeh M Zekavat, Md M Uddin, Abhishek Niroula, Cara L Carty, John Lane, Michael C Honigberg, Joshua S Weinstock, Akhil Pampana, Christopher J Gibson, Gabriel K Griffin, Shoa L Clarke, Romit Bhattacharya, Themistocles L Assimes, Leslie S Emery, Adrienne M Stilp, Quenna Wong, Jai Broome, Cecelia A Laurie, Alyna T Khan, Albert V Smith, Thomas W Blackwell, Veryan Codd, Christopher P Nelson, Zachary T Yoneda, Juan M Peralta, Donald W Bowden, Marguerite R Irvin, Meher Boorgula, Wei Zhao, Lisa R Yanek, Kerri L Wiggins, James E Hixson, C Charles Gu, Gina M Peloso, Dan M Roden, Muagututi'a S Reupena, Chii-Min Hwu, Dawn L Demeo, Kari E North, Shannon Kelly, Solomon K Musani, Joshua C Bis, Donald M Lloyd-Jones, Jill M Johnsen, Michael Preuss, Russell P Tracy, Patricia A Peyser, Dandi Qiao, Pinkal Desai, Joanne E Curran, Barry I Freedman, Hemant K Tiwari, Sameer Chavan, Jennifer A Smith, Nicholas L Smith, Tanika N Kelly, Bertha Hidalgo, L Adrienne Cupples, Daniel E Weeks, Nicola L Hawley, Ryan L Minster, Samoan Obesity, Lifestyle And Genetic Adaptations Study (Olaga) Group, Ranjan Deka, Take T Naseri, Lisa De Las Fuentes, Laura M Raffield, Alanna C Morrison, Paul S Vries, Christie M Ballantyne, Eimear E Kenny, Stephen S Rich, Eric A Whitsel, Michael H Cho, M Benjamin Shoemaker, Betty S Pace, John Blangero, Nicholette D Palmer, Braxton D Mitchell, Alan R Shuldiner, Kathleen C Barnes, Susan Redline, Sharon L R Kardia, Gonçalo R Abecasis, Lewis C Becker, Susan R Heckbert, Jiang He, Wendy Post, Donna K Arnett, Ramachandran S Vasan, Dawood Darbar, Scott T Weiss, Stephen T Mcgarvey, Mariza De Andrade, Yii-Der Ida Chen, Robert C Kaplan, Deborah A Meyers, Brian S Custer, Adolfo Correa, Bruce M Psaty, Myriam Fornage, Joann E Manson, Eric Boerwinkle, Barbara A Konkle, Ruth J F Loos, Jerome I Rotter, Edwin K Silverman, Charles Kooperberg, John Danesh, Nilesh J Samani, Siddhartha Jaiswal, Peter Libby, Patrick T Ellinor, Nathan Pankratz, Benjamin L Ebert, Alexander P Reiner, Rasika A Mathias, Ron Do, Nhlbi Trans-Omics For Precision Medicine (Topmed) Consortium, Pradeep Natarajan

Faculty, Staff and Student Publications

Human genetic studies support an inverse causal relationship between leukocyte telomere length (LTL) and coronary artery disease (CAD), but directionally mixed effects for LTL and diverse malignancies. Clonal hematopoiesis of indeterminate potential (CHIP), characterized by expansion of hematopoietic cells bearing leukemogenic mutations, predisposes both hematologic malignancy and CAD.

Changes In Blood Mineral Concentrations And Adhd Symptoms After 8 Weeks Of Micronutrient Supplementation, Elizabeth S. White

OHSU-PSU School of Public Health Annual Conference

Previous studies have discovered associations between nutritional status of children with ADHD and severity of ADHD symptoms. Data from the Micronutrients in ADHD Youth (MADDY) study was analyzed to assess the effectiveness of micronutrient supplementation for ADHD symptoms in children. The MADDY study is a randomized double-blinded three-center clinical trial. Data on the following seven minerals were assessed based on blood measurements from OHSU and OSU: lithium, selenium, copper, zinc, iron, manganese, and magnesium. All of these minerals were contained in the supplement given to subjects who received the active treatment and absent from the placebo supplement given to the …

Association Between Abdominal Aortic Calcification Severity And Depressive Symptoms: Cross-Sectional Study Findings From Nhanes 2013-2014, Shabir Sarwary

OHSU-PSU School of Public Health Annual Conference

Association between Abdominal Aortic Calcification Severity and Depressive Symptoms: Cross-Sectional study findings from NHANES 2013-2014

Shabir Sarwary, MPH

BACKGROUND

Abdominal aortic calcification (AAC) is an asymptomatic condition in which calcium deposits build up in abdominal aorta. AAC is detectable only by imaging. When present, severe AAC increases the risk of developing major coronary heart disease compared to no or minimal AAC. Depression affects nearly 10% of U.S. adults and is often present among those who have experienced a major coronary heart disease event, such as myocardial infarction. It is unknown if the prevalence of depression is elevated in adults who …

Lifetime Smoking History And Prevalence Of Osteoporosis And Low Bone Density In U.S. Adults, Nhanes 2005-2010, Molly Joyce

OHSU-PSU School of Public Health Annual Conference

Background

Osteoporosis and low bone density are common among older adults; women are more likely to have osteoporosis and low bone density than men. The prevalence of osteoporosis and low bone density varies with race/ethnicity, with the greatest prevalence being among non-Hispanic, Asian women. Prior studies identified a negative association between smoking and changes in bone mineral density; however, the association between smoking and osteoporosis or low bone density has not been investigated according to race/ethnicity.

Materials and methods

This study utilized National Health and Nutrition Examination Survey data from 2005-2010. In this study 4,226 U.S. adults aged 50 years …

Effect Of Sin Lek Rice Intervention On Cognitive Function, Dietary Patterns, And Fecal Microbiota Of Elementary School Children In Chiang Rai, Thailand, Angie Setthavongsack, Siam Popluechai, Jackilen Shannon, Justin Denny, Eleni Gentekaki, Kongkiat Kespechara, Lucsame Gruneck, Thomas J. Sharpton, Kullawong Niwed, Lisa K. Marriott

OHSU-PSU School of Public Health Annual Conference

Thailand has struggled with malnutrition rates in young children. Rice is a key component of Southeast Asian diets and a whole grain rice varietal (Sin Lek) may support improved nutrition. Diet can influence cognitive function and human gut microbiota, which were explored in the context of a rice intervention. We conducted a pilot study using a non-randomized, crossover clinical trial of Sin Lek rice versus traditional white rice consumption in elementary school children in Chiang Rai, Thailand. Outcomes related to diet, anthropological factors, cognitive function (e.g., short-term working memory, attention, impulsivity), and gut microbial populations were measured at baseline and …

Effects Of Covid-19 In The Status Of Childhood Obesity In The United States: A Literature Review, Ana Cruz

The Graduate School Posters

Introduction: The main hypothesis is that COVID-19 affects the prevalence of childhood obesity in the United States due the precautions needed to contain the pandemic.

Methods: The methods used in this semi-systematic literature review includes web-based research from the following sources: Centers for Disease Control and Prevention, Google Scholar, ResearchGate, and EBSCOhost. The search was limited to children ages 5 to 19 years old with diagnosed obesity.

Results: The review found that COVID-19 pandemic has greatly increased the rate of childhood obesity in the United States due to changes in diet, increased screen time, and less physical activity.

Discussion: There …

The Food Environment And Its Linkage To An Increased Incidence Of Chronic Illnesses In Predominantly Minority And Low-Income Neighborhoods, Clarenisha Green

The Graduate School Posters

Introduction: Health behaviors and outcomes are greatly influenced by the food environment that individuals reside in and have access to. Poorer health outcomes have been shown to be associated with communities that have a higher ratio of convenience stores and fast-food restaurants in comparison to healthier food store options. The purpose of this study is to explain how the food environment and health inequalities are linked to an increased incidence of chronic diseases in predominantly minority and/or low-income communities.

Methods: A literature review was conducted on databases such as National Institutes of Health, United States Department of Agriculture, Elsevier, American …

Growing Up Healthy: A Study On Young Adults And Their Readiness To Transition To Independent Healthcare, Annabelle Heddell

2022 Awards for Excellence in Student Research and Creative Activity - Documents

Healthcare is a lifelong journey that involves changes, decision making, and awareness of health needs and concerns. As children grow up and age out of the pediatric system, transitioning occurs. Healthcare transitioning (HCT) is a process that assists individuals with the different stages of their health journey. Transition readiness is derived from the concept of health care transitioning, which is generally defined as “the process of shifting from pediatric to adultfocused care” (Kelemen et al., 2014, p. 1062). A more in-depth definition describes health care transitioning as the “process of purposeful, planned movement of adolescents with chronic medical conditions from …

Making Forests, Making Communities: An Ethnography Of Reforestation In Monteverde, Costa Rica, Megan Brown

Anthropology Theses and Dissertations

Reforestation is not just planting trees in the ground. More than net increase in forest cover, reforestation is a complex political endeavor undertaken by both humans and non-humans and a popular climate change mitigation tactic. However, little research has examined the dynamics between selection of specific reforestation strategies, health, and community resilience, particularly with attention to entanglements between the lives of both human and non-human forest dwellers. This ethnographic work, based on six months of in-person fieldwork and six months of digital ethnography, examines reforestation and forest relations in Costa Rica’s Monte Verde zone, a region which experienced widespread deforestation, …

The Relationship Between Screen Time, Weight Status, And Fatty Liver Disease In U.S. Adolescents, A Cross-Sectional Study Using Nhanes, 2017-2018, Becky J. Thomas

Master of Public Health Program Student Publications

Objective: The purpose of this study was to assess if screen time in U.S. adolescents is positively associated with evidence of fatty liver disease (steatosis and/or fibrosis) on FibroScan technology and to test the hypothesis that being overweight or obese mediates this relationship.

Methods: The analysis used cross-sectional data from 12–17-year-old participants (n = 612) in the 2017-2018 National Health and Nutrition Examination Survey (NHANES) to evaluate the association between self-reported average daily screen time and the presence of liver steatosis and/or fibrosis using FibroScan. Adjusted logistic regression analysis was performed to describe the independent association between screen time and …

Medical Necessity Of Residential Treatment For Anorexia: Can Parity Be Achieved?, Abbey Derechin

Northwestern Journal of Law & Social Policy

This Note examines the statutory landscape of mental health parity in the United States. The lens of this Note is through the mental illness of anorexia. Parity laws mandate analogous limitations between mental and physical illness. Therefore, because anorexia has many physical manifestations, it serves as a nice juxtaposition to physical illnesses. This Note will argue for broad interpretation of the Mental Health Parity and Addiction Equity Act (MHPAEA) through comparative analysis of counterpart statute, the California Mental Health Parity Act (CMHPA). It will explore how courts have interpreted the CMHPA broadly to suggest that the MHPAEA should be interpreted …

The Public Health Response To Covid-19 In The Southwest Region Of Missouri, Jennifer Trott Mph, K. Holly Mead Phd, Marie-Anais Benoit, Dora Hughes Md, Mph, Jeffrey Levi Phd, Jacqueline Baños Mph, Semret Seyoum Mph, Marsha Regenstein Phd

Reports on Missouri's Public Health Response to COVID-19

The Public Health Response to COVID-19 in the Southwest Region of Missouri documents efforts by Southwest Missouri’s local public health agencies along with other stakeholders to leverage their partnerships, resources, and expertise to respond to COVID-19. Along with professional stakeholder accounts, the report includes residents’ perspectives and experiences during the COVID-19 response. Professional and resident findings helped identify lessons that could strengthen the public health system’s ability to continue responding to COVID-19 and face future crisis with greater resources, coordination, equitable strategies, modernized infrastructure and public trust. The findings in this report center on the period of the pandemic from …

The Public Health Response To Covid-19 In The St. Louis Region Of Missouri, Marsha Regenstein Phd, K. Holly Mead Phd, Jennifer Trott Mph, Semret Seyoum Mph, Jacqueline Baños Mph, Hope Van Bronkhorst, Marie-Anais Benoit, Dora Hughes Md

Reports on Missouri's Public Health Response to COVID-19

The Public Health Response to COVID-19 in the St. Louis Region of Missouri documents efforts by St. Louis Missouri’s local public health agencies along with other stakeholders to leverage their partnerships, resources, and expertise to respond to COVID-19. Along with professional stakeholder accounts, the report includes residents’ perspectives and experiences during the COVID-19 response. Professional and resident findings helped identify lessons that could strengthen the public health system’s ability to continue responding to COVID-19 and face future crisis with greater resources, coordination, equitable strategies, modernized infrastructure and public trust. The findings in this report center on the period of the …

Facilitators To Becoming And Remaining Open Defecation Free In Uganda: Implications For Community-Led Total Sanitation Programming, Danette Lee Cagnet

Electronic Theses and Dissertations

Poor sanitation behaviors, including open defecation, present risks for diarrhea, which is credited with 600,000 deaths a year in children under age five. Although CLTS is a solution to ending open defecation, more than half of the investment in producing open defecation free (ODF) communities is lost during the maintenance phase. The purpose of this qualitative, case study was to understand stakeholder perceptions of the facilitators and hindrances to becoming ODF certified and maintaining ODF status and sanitary behaviors in a small village community located in Uganda, East Africa. The researcher held individual interviews and in-person focus group discussions to …