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College of Public Health: News & Publications

• Georgia Southern: Researchers Look at On Kernel-Based Mode Estimation Using Different Stratified Sampling Designs

Rethinking Health Services Measurement For Indigenous Populations, Angela Mashford-Pringle, Ian Ring, Fadwa Al-Yaman, John Waldon, Michelle Chino

School of Public Health Faculty Research

Indigenous people around the world experience shorter life expectancy, poorer health outcomes, and on average have less social capital, than non-Indigenous people in their respective countries. While national goals are to lower mortality and morbidity rates of Indigenous people, much evidence exists that indicates there is almost no Indigenous involvement in data collection, policy development, program implementation and development and measurement of services. A more holistic and culturally relevant framework is presented to improve services and outcomes for Indigenous populations.

Rethinking Health Services Measurement For Indigenous Populations, Michelle Chino Dr, Angela Mashford-Pringle, Ian Ring, Fadwa Al-Yaman, John Waldon

School of Public Health Faculty Research

Indigenous people around the world experience shorter life expectancy, poorer health outcomes, and on average have less social capital, than non-Indigenous people in their respective countries. While national goals are to lower mortality and morbidity rates of Indigenous people, much evidence exists that indicates there is almost no Indigenous involvement in data collection, policy development, program implementation and development and measurement of services. A more holistic and culturally relevant framework is presented to improve services and outcomes for Indigenous populations.

Factors Associated With Anemia Among Women Of The Reproductive Age Group In Thatta District: Study Protocol, Sumera Aziz Ali, Zahid Abbasi, Anam Feroz, K Michael Hambidge, Nancy F. Krebs, Jamie E. Westcott, Sarah Saleem

Community Health Sciences

Background: Maternal anemia is a leading public health issue placing pregnant women at higher risk of low birth weight, preterm birth, perinatal mortality, and neonatal mortality. Women in developing countries are at higher risk of anemia which could be either due to micronutrient deficiencies, hemoglobinopathies, infections or other socio-demographic factors. Thus, it is highly essential to explore the factors of anemia among women of the reproductive age group in order to design suitable interventions. The primary objective of this study is to assess the biological and socio-demographic factors that are associated with anemia among the women of the reproductive age …

Food Insecurity And Violence In A Prospective Cohort Of Women At Risk For Or Living With Hiv In The U.S., Amy A. Conroy, Mardge H. Cohen, Edward A. Frongillo Jr., Alexander C. Tsai, Tracey E. Wilson, Eryka L. Wentz, Adaora A. Adimora, Daniel Merenstein, Ighovwerha Ofotokun, Lisa Metsch, Mirjam-Colette Kempf, Adebola Adedimeji, Janet M. Turan, Phyllis C. Tien, Sheri D. Weiser

Faculty Publications

Background Food insecurity and violence are two major public health issues facing U.S. women. The link between food insecurity and violence has received little attention, particularly regarding the temporal ordering of events. The present study used data from the Women’s Interagency Human Immunodeficiency Virus Study to investigate the longitudinal association of food insecurity and violence in a cohort of women at risk for or living with HIV.

Methods Study participants completed six assessments from 2013–16 on food insecurity (operationalized as marginal, low, and very low food security) and violence (sexual or physical, and psychological). We used multi-level logistic regression, controlling …

“What I Hadn’T Realized Is How Difficult It Is, You Know?”: Examining The Protective Factors And Barriers To Breastfeeding In The Uk, Cheyenne R. Wagi

USF Tampa Graduate Theses and Dissertations

The international recommendation for breastfeeding is that a baby should be exclusively breastfed for six months. Breastfeeding should be continued for up to two years and beyond with complementary foods (WHO, 2016). The United Kingdom exhibits some of the lowest breastfeeding rates in the world (HSCIC, 2012). The percentage of mothers who breastfed in the United Kingdom falls below 34% at six months, with only 1% of mothers breastfeeding exclusively at this point (HSCIC, 2012:31). This study sought to examine the protective factors and barriers for breastfeeding in the UK. Mums (n=28), their partners (n=6), and facilitators at breastfeeding support …

A Mentor-Led Text-Messaging Intervention Increases Intake Of Fruits And Vegetables And Goal Setting For Healthier Dietary Consumption Among Rural Adolescents In Kentucky And North Carolina, 2017, Alison A. Gustafson, Stephanie B. Jilcott Pitts, Kristen Mcquerry, Oyinlola Babtunde, Janet Mullins

Dietetics and Human Nutrition Faculty Publications

Introduction—Text-messaging interventions hold promise for successful weight loss interventions. However, there is limited research on text-messaging interventions to improve dietary intake among rural adolescents, who are at greater risk for obesity and related risk factors. The goal of this study was to test an eight-week, mentor-led text-messaging intervention among 14–16-year-old rural adolescents: the “Go Big and Bring It Home” Project to improve fruit and vegetable and healthy beverage intake. Methods and Materials—Eight rural high schools in eastern Kentucky and eastern North Carolina participated (n = 4 were randomized as intervention schools and n = 4 were randomized as control …

Medicaid Work Requirements: State-Based Innovation Or Punitive Policymaking?, Diane Sherwin

Honors Program: Senior Projects (Public)

In March 2017, officials appointed to the Center for Medicare and Medicaid Services by President Donald Trump signaled to state governments their intent to support states who would choose to utilize Medicaid’s Section 1115 waiver provision to alter their state’s Medicaid program by introducing a work requirement. As of October 1, 2018, 13 states have heeded this signal and proposed a work requirement component for their Medicaid programs. The purpose of this paper is to determine if Medicaid work requirements are an innovative policy approach to improve independence among Medicaid enrollees, or if these requirements are a punitive, partisan approach …

Treating Latent Tuberculosis Infection In Newly Arriving Refugees: An Advanced Practice Nurse Initiative At The University Of Louisville Global Health Center, Linda Goss, Dawn Balcom, Karen Mutsch, Ruth Carrico, Rahel Bosson

Journal of Refugee & Global Health

Background: A review of newly arriving refugees referred to the local health department for latent tuberculosis infection (LTBI) treatment during 2013-2015 revealed a treatment gap of 73%, supporting the need to identify new approaches to treat vulnerable populations and mirrored results in the literature.

Objectives: 1) Describe an advanced practice registered nurse (APRN) led alternative approach to LTBI treatment in the refugee population; and 2) evaluate the impact of a 12-week regimen for LTBI on treatment acceptance, adherence and completion.

Methods: During the initial health screening visit, treatment options were provided for those identified with LTBI consisting of either a …

Development And Validation Of The Policies, Opportunities, Initiatives And Notable Topics (Points) Audit For Campuses And Worksites., Tanya M Horacek, Marlei Simon, Elif Dede Yildirim, Adrienne A White, Karla P Shelnutt, Kristin Riggsbee, Melissa D. Olfert, Jesse Stabile Morrell, Anne E Mathews, Wenjun Zhou, Tandalayo Kidd, Kendra Kattelmann, Geoffrey Greene, Lisa Franzen-Castle, Sarah Colby, Carol Byrd-Bredbenner, Onikia Brown

Health and Nutritional Sciences Faculty Publications

Background: Workplace or campus wellness/obesity-prevention policies and initiatives can improve health. Research tools to assess worksite or campus policies/initiatives are scarce. Thus, the aim of this research is to develop and validate the policies, opportunities, initiatives, and notable topics (POINTS) audit. Methods: POINTS was developed and refined via expert review, pilot-testing, and field testing. Trained researchers completed a web-based review from a student-focus or employee-focus regarding 34 health-promoting topics for colleges. Each topic was evaluated on a 0⁻2 scale: 0 = no policy/initiative, 1 = initiatives, 2 = written policy. When a written policy was detected, additional policy support questions …

Perceptions Of Physical Activity While Breastfeeding: 
A Mixed Methods Approach, Kailey Snyder

UNO Student Research and Creative Activity Fair

Background: Being physically active and breastfeeding can greatly support a new mother’s physiological and psychological health. However, within the United States, only 35% of women are maintaining their pre-pregnancy physical activity after childbirth and only 31% of infants are being breastfed at 12 months of age. Preliminary investigations suggest barriers such as lack of time and knowledge hinder a breastfeeding woman’s ability to be physically active however more research is needed. Purpose: The purpose of this study was to explore women’s perceptions of physical activity while breastfeeding. Methods: This mixed methods study utilized quantitative (survey) and qualitative (interview) measures, both …

Feeling Green: The Benefits Of Green Space On Urbanites' Mental Health, Kathryn A. Hoagland

Liberal Arts and Engineering Studies

This investigation intends to determine the best methods for incorporating public green space into dense urban areas, for the betterment of residents' mental health. Data from studies showing differences in the prevalence of anxiety and depression in urban and rural areas are discussed alongside data from studies looking at the effect that certain types of green space might have on mental health. While there is no exact consensus on the extent to which nature has positive effects on mental health there is enough of a correlation to argue for the implementation of public green spaces in urban design, in order …

An Implementation Toolkit For Increasing Breastfeeding Sustainability, Regina Kirwin

Doctoral Projects

Introduction: African American women have the lowest rates of breastfeeding in the United States compared to other racial and ethnic groups (DHHS, 2016). Peer support increases breastfeeding rates (Shakya, 2017). An evidence-based implementation toolkit will provide key stakeholders the information and skill development needed to successfully implement and sustain peer support programs geared toward increasing breastfeeding rates for African American women in West Michigan. The purpose of this paper is to disseminate the quality improvement process used to develop an evidence-based toolkit guided by a secondary data analysis from research data collected in a previously implemented peer mentor program.

Objective: …

Prevalence Of Anaemia And Associated Factors Among Oraon Females Of North 24 Parganas, West Bengal, India, Tanaya Kundu Chowdhury, Subrata K. Roy

Journal Articles

Low haemoglobin level or anaemia is a health problem worldwide especially in developing countries like India. Anaemia is generally higher among indigenous groups compared to general population globally and females are specifically more prone to anaemia. However, studies are inadequate on indigenous groups of India. The aims of the study are to determine the prevalence of anaemia among the female Oraons of North 24 Parganas and to study the association between anaemia and concomitants like socio-demographic and food habit variables. Data have been collected on demographic, socio-economic and food habit variables using well-tested questionnaire from 309 Oraon females living in …

An Iterative Process For Training Design And Implementation Increased Health Workers' Knowledge For Taking Nutrition Behavior Change To Scale, Wendy Gonzalez, Anabelle Bonvecchio Arenas, Armando García-Guerra, Mireya Vilar-Compte, Alejandría Villa De La Vega, Laura Quezada, Cynthia Rosas, Ana Lilia Lozada-Tequeanes, Amira Hernández

Department of Public Health Scholarship and Creative Works

The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The …

Joint Association Of Urinary Sodium And Potassium Excretion With Cardiovascular Events And Mortality: Prospective Cohort Study, Martin O'Donnell, Andrew Mente, Sumathy Rangarajan, Matthew J. Mcqueen, Neil O'Leary, Lu Yin, Xiaoyun Liu, Sumathi Swaminathan, Rasha Khatib, Romaina Iqbal

Community Health Sciences

Objective: To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults.
Design: International prospective cohort study.
Setting: 18 high, middle, and low income countries, sampled from urban and rural communities.
Participants: 103 570 people who provided morning fasting urine samples.
Main outcome measures: Association of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category …

Allergen Sensitization And Asthma Outcomes Among World Trade Center Rescue And Recovery Workers, Belen Rojano, Erin West, Emily Federmann, Steven Markowitz, Denise Harrison, Laura Crowley, Paula Busse, Alex D. Federman, Juan P. Wisnivesky

Publications and Research

A large number of World Trade Center (WTC) rescue and recovery workers are affected by asthma. While physical and mental health comorbidities have been associated with poor asthma control in this population, the potential role of allergen sensitization is unknown. This study examined the association of indoor sensitization and exposure as a risk factor for increased asthma morbidity in WTC workers. We used data from a prospective cohort of 331 WTC workers with asthma. Sensitization to indoor allergens was assessed by measurement of antigen-specific serum immunoglobulin E (IgE) levels. We used validated tools to evaluate the exposure to indoor allergens. …

The Salt Between The Beans: A Qualitative Study Of The Role Of Auxiliary Midwives In A Hard-To-Reach Area Of Myanmar, Kyu Kyu Than, Stanley Luchters, Khaing Nwe Tin, Thazin La, James Beeson, Alison Morgan

Population Health, East Africa

Background: Auxiliary Midwives (AMWs) are unpaid volunteer health workers assisting qualified paid midwives in maternal and child health care mainly in hard-to-reach areas of Myanmar. This paper describes the relationship between AMWs and the health system in providing maternal and child services as perceived by the community, AMWs themselves and health care providers in one remote township of Myanmar.

Method: A qualitative study was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, AMWs, community members and mothers were conducted. Ten key informant interviews were performed with national, district and township level health planners and …

Influence Of Decentralization And Type Of Patient On Loss To Follow-Up Among Multidrug-Resistant Tuberculosis Patients In Indonesia From 2014 To 2015, Noerfitri Noerfitri, R. Sutiawan, Tri Yunis Miko Wahyono, Pratiwi Ayuningtyas Hartono

Kesmas

Drug-resistant tuberculosis (TB) patients have a greater risk of loss to follow-up (LTFU) than drug-sensitive TB patients, due to their longer treatment duration. This study aimed to determine the influence of decentralization and patient type on LTFU among multidrug-resistant TB (MDR-TB) patients in Indonesia. A retrospective cohort study was conducted at all MDR-TB treatment healthcare facilities in Indonesia from 014 to 2015. Using total sampling technique, 961 patients were examined and sampled. Of these patients, 86.03% were decentralized. Patients were classified into types as follows: 35.17% were “relapse” patients, 5.52% were “new,” 13.94% were classified as “after LTFU” patients, 23.10% …

Knowledge And Practice In Household Waste Management, Agnes Fitria Widiyanto, Suratman Suratman, Nisrina Alifah, Tri Murniati, Oktafiani Catur Pratiwi

Kesmas

Declining environmental quality is one of population caused by household consumption behavior. Some of the highest contaminant contributions are domestic waste, waste, and company waste. Waste contamination will lead to dead fish, decreased water quality and disease transmission. Community approach can be done to solve the waste problem, especially at the household level. This study uses quantitative methods to analyze the effect of intervention and waste management training on changes in household waste management knowledge and practices. This type of research uses quasi experiment with one group of pre and post test design. The results showed that there was an …

Exclusive Breastfeeding And Decrease Of Upper Respiratory Infection Incidence Among Infants Aged 6-12 Months In Kampar District, Riau Province, Musfardi Rustam, Renti Mahkota, Nasrin Kodim

Kesmas

Upper Respiratory Infection (URI) is a major cause of morbidity and mortality of infants and toddlers in developing countries. The high infant morbidity and mortality rates in Indonesia are associated with the low exclusive breastfeeding ability. Breast milk is a natural drink for newborns in the first month of life that is beneficial not only for the babies, but also for mothers. The aim of study was to determine exclusive breastfeeding and decrease in incidence of URI among infants aged 6-12 months. This study was conducted by using case control design. Samples were taken by using cluster random sampling. Subject …

The Consumption Of Fresh Vegetables From Street Food And Sanitation Of Street Stalls At Four Locations In Bogor City, Donna Fujie Rahaditha Utami, Winiati P. Rahayu, Lilis Nuraida

Kesmas

The consumption of fresh vegetables at the stalls needs serious attention. This research aimed to estimate the exposure probability due to fresh vegetables consumption of street food consumers, to measure sanitation level of street stalls that serving fresh vegetables, and to recommend a mentoring program for the stalls at four locations in Bogor City. This research was conducted at 16 stalls located at four locations in Bogor City. The number of respondents surveyed was 293 people and determined by stratified sampling method. Food frequency questionnaire was used as a tool in the survey. The survey showed that men consumed more …

Perception Of People Living With Hiv/Aids On Social Stigma Of Hiv/Aids In Sukoharjo District, Titik Haryanti, Wartini Wartini

Kesmas

The stigma of wrong society about HIV / AIDS is one of the obstacles to prevention and control of HIV / AIDS in Sukoharjo District. This study aims to determine the relationship of characteristics, causal factors and duration of HIV / AIDS with the perception of people living with HIV to the stigma of society about HIV / AIDS in Sukoharjo District. The research used is analytical descriptive with cross sectional approach. The population is all people with HIV / AIDS until April 2016 amounted to 256 with a sample of 156 people with sampling technique quota sampling. Bivariate analysis …

Prediction Models For Descreasing Visual Acuity In Wig Makers, Nur Ulfah, Siti Harwanti, Ngadiman Ngadiman

Kesmas

One of the occupational diseases that can arise for workers with high accuracy is a decrease in their visual acuity. Therefore, it is necessary to study the risk factors of decreasing visual acuity in workers with high accuracy, such as in wig makers. This study aimed to examine the correlation between age, working period, lighting intensity, fatigue, and nutritional status with visual acuity, and to observe the main risk factors that can be used as a reference for predicting decreasing visual acuity. This study was an observational study that used a cross-sectional design. The population number for this study was …

Relationship Model For Occupational Safety And Health Climate To Prevent Needlestick Injuries For Nurses, Ketut Ima Ismara, Adi Heru Husodo, Yayi Suryo Prabandari, Widodo Hariyono

Kesmas

The risk of accidents and disease transmission when working at hospitals is quite high, especially in Indonesia. This study aimed to analyze the relationship model between the Occupational Safety and Health (OSH) climate and behavior intention in OSH performance to prevent needlestick injuries (NSI) based on a theory of planned behavior. A mixed approach using qualitative and quantitative methods was applied. Data were obtained from Structural Equation Model questionnaires, observation, and documentation, and interviews were analyzed qualitatively. The population was 1,042 nurses at Dr. Sardjito General Hospital in Yogyakarta. The sample consisted of 289 respondents determined by purposive random sampling …

Effect Of Condom Utilization On Sexuall Transmitted Infection Among Female Sex Workers, In Tulungagung District, East Java, Indonesia, Ainun Hanifah, Ari Natalia Probandari, Eti Poncorini Pamungkasari

Kesmas

One effective strategy for preventing sexually transmitted infection (STI) incidence and providing protection for female sex workers (FSWs) from their sexual partners is correct and consistent condom use behavior. This study examined the effect of condom use on STI among FSWs in Tulungagung District, East Java. This analytic and observational study using a cohort prospective design was conducted at Ngujang ex- prostitution area and Gunung Bolo prostitution area, Tulungagung District, from November to January 2017. The total sample selected was 90 FSWs. Data was collected through a set of questionnaires and tracking condom use in a diary. Data were analyzed …

Can An Exercise-Based Educational And Motivational Intervention Be Durably Effective In Changing Compliance To Physical Activity And Anthropometric Risk In People With Type 2 Diabetes? A Follow-Up Study, Francesca Gallè, Jesse C. Krakauer, Nir Krakauer, Giuliana Valerio, Giorgio Liguori

Publications and Research

Aims. A nine-month motivational exercise-based intervention was previously offered to subjects with type 2 diabetes (T2D). A year after the end of the intervention, compliance to physical activity (PA) and anthropometric indices of participants were analyzed to evaluate the durability of its effects. Methods. PA levels, expressed as total energy expenditure per week, were assessed with the International Physical Activity Questionnaire (IPAQ). Changes in Body Mass Index (BMI), A Body Shape Index (ABSI), Hip Index (HI) z-scores, the relative mortality risk related to each of these measures, and a combined Anthropometric Risk Index (ARI) were also evaluated. Results. Of a …

Translating Antimicrobial Resistance: A Case Study Of Context And Consequences Of Antibiotic-Related Communication In Three Northern Thai Villages, Nutcha Charoenboon, Marco J. Haenssgen, Penporn Warapikuptanun, Thipphaphone Xayavong, Yuzana Khine Zaw

Goal 16: Peace, Justice and Strong Institutions

Antimicrobial resistance (AMR) threatens to cause ten million deaths annually by 2050, making it a top item on the global health agenda. The current global policy response is multi-faceted, wherein behavioural dimensions like people’s medicine use are being predominantly addressed with education and communication campaigns. The social sciences literature suggests that cross-contextual translation of medical knowledge in global awareness campaigns can create misunderstandings and adverse behavioural responses. However, the consequences of AMR communication in low-income and middle-income contexts remain largely undocumented. In response to the empirical knowledge gap, this study presents the case study of educational activity in three northern …

An Exome-Wide Sequencing Study Of The Goldn Cohort Reveals Novel Associations Of Coding Variants And Fasting Plasma Lipids, Xin Geng, Marguerite R. Irvin, Bertha Hidalgo, Stella Aslibekyan, Vinodh Srinivasasainagendra, Ping An, Alexis C. Frazier-Wood, Hemant K. Tiwari, Tushar Dave, Kathleen Ryan, Jose M. Ordovas, Robert J. Straka, Mary F. Feitosa, Paul N. Hopkins, Ingrid Borecki, Michael A. Province, Braxton D. Mitchell, Donna K. Arnett, Degui Zhi

Epidemiology and Environmental Health Faculty Publications

Background: Associations of both common and rare genetic variants with fasting blood lipids have been extensively studied. However, most of the rare coding variants associated with lipids are population-specific, and exploration of genetic data from diverse population samples may enhance the identification of novel associations with rare variants.

Results: We searched for novel coding genetic variants associated with fasting lipid levels in 894 samples from the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) with exome-wide sequencing-based genotype data. In single variant tests, one variant (rs11171663 in ITGA7) was associated with fasting triglyceride levels (P = 7.66E-08), …

The Influence Of Immigrant Generation On Obesity Among Asian Americans In California From 2013 To 2014, Shaoqing Gong, Kesheng Wang, Ying Li, Arsham Alamian

ETSU Faculty Works

Objectives We aimed to examine the association between immigrant generation and obesity among Californian adults and Asian Americans. Results Overall, 23.3% of the Asian population was obese, and 40.0% was overweight. The percentage of 1st, 2nd, and 3rd generation were 72.7%, 22.6%, and 4.6%, respectively. Overall, 1st generation of Asians had lower odds of being obese compared to Whites (OR = 0.34, 95%CI = 0.26–0.45). Multiple logistic regression analyses showed that overall, 2nd generation (OR = 1.69, 95%CI = 1.10–2.60) and 3rd generation (OR = 2.33, 95%CI = 1.29–4.22) Asians had higher odds of being obese compared to 1st generation …