Digital Commons Network^™

Prevalence Of Adhd In Publicly Insured Adults, Yanmin Zhu, Wie Liu, Yan Li, Xi Wang, Almut G. Winterstein

United States Food and Drug Administration: Publications

Objective: To estimate the prevalence of adult ADHD diagnosis and treatment in U.S. Medicaid beneficiaries. Method: Using outpatient, inpatient, and pharmacy billing records for patients eligible for Medicaid fee-for-service benefits within 29 states from 1999 to 2010, we estimated the annual prevalence of ADHD diagnosis and treatment. Results: The prevalence of ADHD diagnosis increased from 2.20 per 1,000 patients in 1999 to 10.57 in 2010. Likewise, prevalence of ADHD treatment increased from 1.95 per 1,000 patients in 1999 to 13.16 in 2010. Between 40% and 65%, patients had ADHD drug prescription fills 6 months after ADHD diagnosis, whereas 45% to …

Ten Years Of Food Policy Governance In New York City: Lessons For The Next Decade, Nicholas Freudenberg, Nevin Cohen, Janet Poppendieck, Craig Willingham

Publications and Research

No abstract provided.

Development And Validation Of A Simple Convenience Store Shelf Audit, Tanya M. Horacek, Elif Dede Yildrim, Erin Kelly, Adrienne A. White, Karla P. Shelnutt, Kristin Riggsbee, Melissa D. Olfert, Jesse Stabile Morrell, Anne E. Mathews, Terezie T. Mosby, Tandalayo Kidd, Kendra Kattelmann, Geoffrey Greene, Lisa Franzen-Castle, Sarah Colby, Carol Bryd- Bredbenner, Onikia Brown

Faculty & Staff Scholarship

Background This paper describes the development, reliability, and convergent validity of a practical tool—the Convenience Store Supportive Healthy Environment for Life-Promoting Food (SHELF) Audit. Methods Audit items included: a variety of fresh, processed, and frozen fruits and vegetables; low-fat dairy products; healthy staples and frozen meals; healthy food incentive programs; items sold in check-out areas; portion/cup sizes; and pricing. Each audit item was scored using a five-point semantic-differential scale (1 = provides little or no support for healthful foods to 5 = provides high support for healthful foods). Convergent validity was examined by comparing the SHELF audit to Ghirardelli et …

Multilevel Structural Equation Modeling Of Students’ Dietary Intentions/Behaviors, Bmi, And The Healthfulness Of Convenience Stores, Tanya Horacek, Elif Dede Yildirim, Kendra Kattelmann, Carol Byrd-Bredbenner, Onikia Brown, Sarah Colby, Geoffrey Greene, Sharon Hoerr, Tandalayo Kidd, Mallory Koenings, Jesse Morrell, Melissa D. Olfert, Beatrice Phillips, Karla Shelnutt, Adrienne White

Faculty & Staff Scholarship

Background: When dietary behaviors are habitual, intentions are low, and environmental cues, such as the consumer food environment, might guide behavior. How might intentions to eat healthily and ultimately actual dietary behaviors, be influenced by the consumer food environment (including the availability and affordability of healthy foods) in convenience stores? This study will determine pathways between the healthfulness of convenience stores and college students’ dietary intentions/behaviors, and body mass index (BMI). Methods: Through multilevel structural equation modeling, a comparison was made of students’ healthful meal intentions (HMI); intake (fruits/vegetables, %kcal/fat, sugar-sweetened beverages (SSBs) and whole-grains); and measured BMI; as well …

Co-Occurrence Of Tobacco Product Use, Substance Use, And Mental Health Problems Among Youth: Findings From Wave 1 (2013–2014) Of The Population Assessment Of Tobacco And Health (Path) Study, Kevin P. Conway, Victoria R. Green, Karin A. Kasza, Marushka L. Silveira, Nicolette Borek, Heather L. Kimmel, James D. Sargent, Cassandra A. Stanton, Elizabeth Lambert, Nahla Hilmi, Chad J. Reissig, Kia J. Jackson, Susanne E. Tanski, David Maklan, Andrew J. Hyland, Wilson M. Compton

United States Food and Drug Administration: Publications

Introduction: Cigarette use is associated with substance use and mental health problems among youth, but as- sociations are unknown for non-cigarette tobacco product use, as well as the increasingly common poly-tobacco use.

Methods: The current study examined co-occurrence of substance use and mental health problems across tobacco products among 13,617 youth aged 12–17 years from Wave 1 (2013–2014) of the nationally representative Population Assessment of Tobacco and Health (PATH) Study. Participants self-reported ever cigarette, e-cigar- ette, smokeless tobacco, traditional cigar, cigarillo, filtered cigar, hookah, and other tobacco product use; al- cohol, marijuana, and other drugs; and lifetime substance use, internalizing …

Trends And Economic Drivers For United States Naloxone Pricing, January T 2006 To February 2017, Matthew Rosenberg, Grace Chai, Shekhar Mehta, Andreas Schick

United States Food and Drug Administration: Publications

Anecdotal evidence indicates that naloxone prices have risen in recent years, but limited research has examined the magnitude of these increases and potential causes. We contribute nationally representative evidence to help answer each of these questions, including wholesale pricing data from a proprietary drug sales database span- ning January 2006 to February 2017. We find that all formulations of naloxone increased in price since 2006 except for Narcan Nasal Spray. These cumulative increases totaled 2281% for the 0.4 MG single-dose products, 244% for the 2 MG single-dose products, 3797% for the 4 MG multi-dose products, and 469% for the 0.4 …

Social Medicine And International Expert Networks In Latin America, 1930–1945, Eric D. Carter

Faculty Publications

This paper examines the international networks that influenced ideas and policy in social medicine in the 1930s and 1940s in Latin America, focusing on institutional networks organised by the League of Nations Health Organization, the International Labour Organization, and the Pan-American Sanitary Bureau. After examining the architecture of these networks, this paper traces their influence on social and health policy in two policy domains: social security and nutrition. Closer scrutiny of a series of international conferences and local media accounts of them reveals that international networks were not just ‘conveyor belts’ for policy ideas from the industrialised countries of the …

Hiv Related Stigma, Perceived Social Support And Risk Of Premature Atherosclerosis In South Asians, Travis Bergmann, Shantanu Sengupta, Milind P. Bhrushundi, Hemant Kulkarni, Partho P. Sengupta, Icilma Fergus

Faculty & Staff Scholarship

Objective: This study sought to determine the association between social support and stigma experienced by HIV-positive patients and presence of subclinical cardiovascular disease. Methods: We implemented a cross sectional study in 67 HIV-positive patients and 52 controls from a community health care center in central India. The participants underwent an in-depth survey and a clinical and laboratory assessment of cardiovascular risk. Carotid-intimal thickness (CIMT) was used as a marker of subclinical cardiovascular disease.

Results: On comparing the HIV and age and sex-matched control population, HIV patients had lower body weight (P=<0.001), and lower systolic blood pressures (P = 0.002). Despite the lack of higher cardiac risk factor prevalence and lower lipid abnormalities, HIV patients had higher right, left and average CIMT values than controls (P < 0.001 for all). HIV patients also showed higher prevalence of abnormal CIMT (! 0.9 mm) than controls (32% vs. 0%, P < 0.001). HIV patients with increased CIMT (n = 37) in comparison with those with normal CIMT (n = 30) were more frequently males (P = 0.023), had higher systolic blood pressures (P = 0.002), lower CD4 counts (P = 0.033) and experienced higher enacted stigma (P = 0.044). On multivariable stepwise logistic regression, systolic blood pressure (odds ratio:1.06, P = 0.002) and stigma score > 25th percentile value (odds ratio:3.84, P = 0.037) were …

Project Spraoi: The Effectiveness Of A Nutrition And Physical Activity Intervention On The Dietry Intake, Dietary Patterns, Nutritional Knowledge And Markers Of Health Of Irish Primary School Children, Alison Merrotsy

PhDs

Aim: To implement and evaluate the effectiveness of a nutrition and physical activity (PA) intervention (Project Spraoi) on dietary intake (DI), dietary patterns (DP), nutritional knowledge (NK), cardiorespiratory fitness (CRF), blood pressure (BP) and markers of health of Irish children in one primary school in Cork. The relationship between DP and NK, CRF, BP and anthropometric data will also be examined.

Design: Cross-sectional and longitudinal study. Food diary, NK questionnaire and 550m walk/run test were used to assess DI, DP, NK and CRF, respectively. BP, body mass index (BMI) and waist to height ratio (WHtR) were also calculated.

Setting: Two …

Cuba: Coronary Heart Disease, Michaela Loizzi

Global Public Health

Cuba has a strong health care system with universal health care for their citizens over 40 years old. Despite the strong health care system Cuba lacks the resources necessary to treat coronary heart disease, the leading cause of death in the country. The country’s whole population is affected by coronary heart disease however the most affected is the lower class due unaffordable treatment. The primary causes of coronary heart disease includes their daily lifestyle such as, physical inactivity, diet, and excessive smoking. It is important to note that the major factors in Cuba leading to coronary heart disease are all …

The Effect Of Urinary Triclosan On Serumthyroxine In Us Population: 2011-2012 Nhanes Data, Katie M. Clark

Master of Public Health Program Student Publications

Background: Triclosan is an antibacterial agent that is added to personal care products to prevent bacterial growth. The FDA banned the use of triclosan in soap in 2016 due to safety concerns. Triclosan is considered an endocrine disruptor and had reported effects on the body, including changes in thyroid function.

Purpose: The purpose of this study was to assess the relationship between urinary triclosan and serum thyroxine in U.S adults. Methods: Data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were analyzed (N =1,476). Linear regression analyses were performed to assess the relationship between log transformed triclosan and …

How Household Healthcare Expenditures Redistribute Disposable Income? An Analysis Using Bangladesh Household Income And Expenditure Survey, 2010., Azahar Molla Md, Phd, Mph, Msc, Chunhuei Chi Mph, Sc.D.

Faculty & Staff Research and Creative Activity

Essential healthcare is a civil right. Payments toward healthcare is a moral compulsion, and no less strong than legal compulsion like income tax. Healthcare payments can redistribute disposable income. Redistribution may be vertical (from rich to poor or opposite) and horizontal (from men to women or from households without children to households with children). Health planners are interested in degrees to which redistribution occurs. In this paper, we aim to analyze how well different forms of healthcare payments in Bangladesh redistribute disposable income. Our data comes from Bangladesh Household Income and Expenditure Survey, 2010. Using the methods developed by Aronson …

Better Bone Health: Health Community Clinic, Naijah Hughes, Dakota Turnage, Kintara Williams, Christopher Fangna

DC Health and Academic Prep Program (DC HAPP)

Osteoporosis affects the quality of life, the ability to work, and basic activities of daily living. Osteoporosis is a disease marked by reduced bone strength leading to an increase in fractures. Every day, our body breaks down old bone and puts new bone in its place. As we get older, our bones break down more bone than they put back. If you do not take the steps to keep your bones healthy, you may lose too much bone and osteoporosis may develop. Men and women are both affected by osteoporosis. In the United States, an estimated 5.3 million people aged …

Project Anacostia, Lapoldeon Williams, Abenezer Lemma, Janae Thomas, Kafoued Ouedraogo

DC Health and Academic Prep Program (DC HAPP)

Objectives Project Anacostia aims to [1] help meet the Healthy People 2020 goal of reducing the disease burden of diabetes mellitus (DM) and improving the quality of life for all persons who have, or are at risk for, DM as outlined by the U.S. Department of Health and Human Services. [2] To increase community awareness of the social determinants of health related to obesity and diabetes. [3] Increase access to recreational facilities and healthy food options in Wards 7 &8 and [4] promote healthy lifestyle choices among youth in the Anacostia community.

Methods Our intervention is comprised of three progressive …

Widening The Disparity Gap: Differences In Outcomes For Racial And Ethnic Groups In Youth Substance Abuse Prevention Programming, Changsoo Song, Jennifer N. Rutt, Mindy Anderson-Knott

UNL Office of Research and Innovation, Social/Behavioral Sciences Research Consortium

This study examined racial and ethnic differences in the outcomes of a universal evidence-based program targeted to children and adolescents. Using data collected in 2015 and 2016 from the Alcohol: True Stories Hosted by Matt Damon program (N = 925), the study found the outcome of perceptions on risk of harm from alcohol use significantly different between the group of White respondents and the group of non-White respondents, and between the group of Hispanic respondents and the group of non-Hispanic respondents. Program effectiveness was found only among White and non-Hispanic respondents, widening the already existing gap between these populations.

Pre- And Post-Diagnosis Physical Activity, Television Viewing, And Mortality Among Hematologic Cancer Survivors., Daniela Schmid, Gundula Behrens, Hannah Arem, Christina Hart, Wolfgang Herr, Carmen Jochem, Charles E Matthews, Michael F Leitzmann

Epidemiology Faculty Publications

PURPOSE: The associations of physical activity and television (TV) viewing with mortality risk among individuals with hematologic malignancies remain unclear.

METHODS: We examined the relations of physical activity and TV viewing time before and after diagnosis with mortality among 5182 U.S. adults aged 50-71 years from the NIH-AARP Diet and Health Study cohort who survived a first primary hematologic cancer between 1995-1996 and 2011.

RESULTS: For the pre- and post-diagnosis analyses, we confirmed 2606 and 613 deaths respectively. In multivariable-adjusted Cox proportional hazard regression models, comparing high (≥4 hrs/wk) versus low (/wk) activity levels, pre-diagnosis physical activity was associated with …

An Epidemiological Study Of Invasive Pneumococcal Disease In A South Texas-Mexico Border Metropolitan Community, Steven Daniel Hinojosa

Graduate Research Theses & Dissertations

This research study examines the epidemiology of invasive pneumococcal disease in Hidalgo County, Texas. Invasive pneumococcal disease is a bacterial infection, causing severe types of clinical manifestations, including bacteremia and meningitis. Hidalgo County is the largest metropolitan statistical area along the Texas-Mexico border. Supporting a 2016 census population estimate of nearly 850,000, this community facilitates frequent bi-national travel, providing unique attributes towards disease transmission. This study aims to identify if population characteristics for infection aligned with current Advisory Committee for Immunization Practice recommendations for vaccination against pneumococcal disease. This includes identifying if the general healthy adult healthy population has an …

Piloting Very Early Infant Diagnosis Of Hiv In Lesotho: Acceptability And Feasibility Among Mothers, Health Workers And Laboratory Personnel., Michelle M Gill, Lynne M Mofenson, Mamakhetha Phalatse, Vincent Tukei, Laura Guay, Matsepeli Nchephe

Epidemiology Faculty Publications

INTRODUCTION: Mortality associated with in-utero HIV infection rises rapidly within weeks after birth. Very early infant diagnosis of HIV (VEID)-testing within 2 weeks of birth-followed by immediate initiation of antiretroviral therapy has potential to avert mortality associated with in-utero transmission. However, our understanding of acceptability and feasibility of VEID is limited.

METHODS: VEID was piloted in an observational prospective cohort of HIV-positive pregnant women and their infants in 13 Lesotho health facilities. Between March-July 2016, semi-structured interviews were conducted with HIV-positive women attending 6-week or 14-week postnatal visits and health workers (HWs) in 8 study facilities in 3 districts as …

Why It Worked: Participants' Insights Into An Mhealth Antiretroviral Therapy Adherence Intervention In China., Lora L Sabin, Lauren Mansfield, Mary Bachman Desilva, Taryn Vian, Zhong Li, Xie Wubin, Allen L Gifford, Yiyao Barnoon, Christopher J Gill

Global Health Faculty Publications

Background: Few Antiretroviral Therapy (ART) adherence trials investigate the reasons for intervention success or failure among HIV-positive individuals.

Objectives: To conduct qualitative research to explore the reasons for effectiveness of a 6-month mHealth (mobile health) trial that improved adherence among ART patients in China. The intervention utilized Wireless Pill Containers (WPCs) to provide, real-time SMS reminders, WPC-generated adherence reports, and report-informed counseling.

Methods: We conducted in-depth interviews with 20 intervention-arm participants immediately following the trial. Sampling was purposeful to ensure inclusion of participants with varied adherence histories. Questions covered adherence barriers and facilitators, and intervention experiences. We analyzed data in …

Local Attitudes And Prevention Around The Nicaraguan Sugarcane Worker With Chronic Renal Disease, Matt Cyr

Theses and Graduate Projects

An epidemic of chronic kidney disease (CKD) in Central America and Nicaragua is referred to as Mesoamerican nephropathy (MeN). It’s estimated that the death toll for MeN over the past two decades has reached at least 20,000. Nicaragua is included in the 10 highest overall mortality rate from kidney disease in the world. MeN disproportionately affects young, male agricultural workers who do not exhibit traditional risk factors for CKD such as hypertension and diabetes. A consistent risk factor for MeN is heavy manual labor in the heat, often temperatures over 35 °C with high humidity. Many reasons have been proposed …

Tackling Stunting And Anemia In Egypt, Abeer Alanwar, Hend Ahmed, Sabreen Mahmoud, Wessam Adly

Papers, Posters, and Presentations

Stunting and anemia rates in children between the age of 0-24 months (0-2 years) have been two of the most persistent public health problems facing the Egyptian society and government. Based on the researchers' analysis of the problem, current policies, and on the opportunities Egypt has, this policy paper targets the Egyptian Ministry of Health and Population and recommends reformulating a specific nutrition policy to tackle stunting and anemia as well providing awareness and education about the appropriate IYCF and to give high priority to strengthening the health provision of the required micronutrients in family care units (FCU), as well …

Effects Of School Meal Consumption On School-Related Factors In Elementary School-Aged Children, Megan Reynolds

Honors Undergraduate Theses

The purpose of this study was to examine teacher perception of student school meal preferences in an elementary school setting. This was a cross-sectional mixed-methods study that is part of a larger study to develop a nutrition education program for elementary school children. Focus groups and surveys were administered to faculty at a charter school in downtown Orlando to gain insight into the types of food offered at school and student response to these food items. All members of the faculty were invited to participate in the study, and seven teachers volunteered to take part in this study. Focus groups …

The Effects Of Wearable Fitness Devices On Pediatric Obesity: An Integrative Literature Review, Kevin Sabina

Honors Undergraduate Theses

Childhood obesity is a foremost concern throughout the health care community. Approximately 17.6% of the pediatric population meet the criteria for obesity, which can lead to health disparities later in life, such as hypertension, type 2 diabetes mellitus, and metabolic syndrome. Emerging mobile and wearable lifestyle tracking devices can be a viable solution to the challenging problem of childhood obesity through behavior changes, feasibility, and adherence. The purpose of this literature review was to determine the effect that mobile and wearable activity tracking devices have on the obese pediatric population. A centralized review of the literature was conducted using various …

Benchmark Assessment Of Orphaned And Vulnerable Children In Areas Of The Zambia Family (Zamfam) Project—Brief, Michael Mbizvo, Paul C. Hewett

HIV and AIDS

The US Agency for International Development and US President’s Emergency Plan for AIDS Relief (PEPFAR) are supporting the Zambia Family (ZAMFAM) project to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV/AIDS (OVC) in the Lusaka, Copperbelt, Southern, and Central Provinces of Zambia. To inform that effort, Project SOAR conducted a benchmark survey among beneficiaries in the four provinces of the ZAMFAM program. The benchmark survey measured the status and conditions of OVC and their families. This brief provides a summary of the findings outlined in the final report on the needs …

Benchmark Assessment Of Orphaned And Vulnerable Children In Areas Of The Zambia Family (Zamfam) Project, Michael Mbizvo, Paul C. Hewett, Nkomba Kayeyi, Lyson Phiri, Saziso N. Mulenga, Bwalya Mushiki, Mwelwa Chibuye

HIV and AIDS

The US Agency for International Development and US President’s Emergency Plan for AIDS Relief (PEPFAR) are supporting the Zambia Family (ZAMFAM) project to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV/AIDS (OVC) in the Lusaka, Copperbelt, Southern, and Central Provinces of Zambia. To inform that effort, Project SOAR conducted a benchmark survey among beneficiaries in the four provinces of the ZAMFAM program. The benchmark survey measured the status and conditions of OVC and their families. The findings provide a deeper understanding of the needs of OVC families and the gaps in …

Health And Socioeconomic Well-Being Of Young People Living With Hiv In Zambia: Evaluating The Zamfam Project, Project Soar

HIV and AIDS

The US Agency for International Development and US President’s Emergency Plan for AIDS Relief are supporting the Zambia Family (ZAMFAM) project to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV/AIDS in the Lusaka, Copperbelt, Southern, and Central Provinces of Zambia. Project SOAR is conducting a three-year prospective cohort study of young people living with (YPLHIV) and their primary caregivers/guardians in Central Province where the ZAMFAM project is being implemented, and in Eastern Province where there are no ongoing ZAMFAM activities for comparison. The information collected in the study focused on key …

Relationship Between Diet And Learning Differences In Children, Amelia Hamilton, Ramona Stone

Public Health Sciences Student Work

There is growing recognition that learning disabilities are associated with a variety of factors, including diet. Prior research showed that children in need of special education services eat less home prepared meals and more non-home-prepared meals, which can lead to obesity, inadequate diet, and lethargy. Additional research along with parental health education to promote healthy nutritional decisions and skills for preparing meals is necessary.

Overweight And Underserved In Children: A Contemporary American Paradox, Elyse J. Barletta-Sherwin, Ramona Stone

Public Health Sciences Student Work

• Childhood overweight and obesity trends are serious problems placing children at greater risks for adverse health outcomes and developmental issues.

• Between 2011 and 2014, obesity prevalence hovered near 17% for children 6-12 years.

• As of 2014, an estimated 14% of U.S. households were labeled food insecure, with 7.9 million children living within these underserved domains. In recent years, there has been growing concern that food insecurity and overweight and obesity conditions may be associated with each other, especially amongst children.

Health Literacy As A Measure To Reduce Cost, Improve Health And Access, Vivian Dee

Walden Dissertations and Doctoral Studies

The United States dedicates greater than 17% of its gross national product to healthcare. This percentage is expected to go up to 20% by 2018. Despite the high cost of care, the health care system remains inefficient and ineffective. Barriers include reduced access to care related to low health literacy. Complicating low health literacy is the high readability score of patient education materials. The high readability score is in part due to tools that are not standardized and measure different aspects of education materials creating varying readability scores. The purpose of this quality improvement project was to adopt a tool, …

Social Influences Of Suburban Black Residents Food Purchasing Decisions Using Snap Benefits, Carolyn Mccummings

Walden Dissertations and Doctoral Studies

In low-income, suburban Black communities, the prevalence of diet-related chronic illnesses is alarming. Various influences often increase diet-related illnesses among this population. One influence is the use of SNAP benefits to purchase food. In this study, the influences of SNAP as well as other influences affecting food purchase decisions among the study population was examined. A qualitative multicase study approach was used and, face-to-face interviews were conducted, to understand the experiences of 20 low-income, current recipients of SNAP who were Black and lived in suburban, New York. The data indicated the most significant influence, communicated by the participants, was that …