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Understanding Behavioral Health And Treatment Engagement With Former Users Of Prenatal Substances: A Strengths-Focused Mixed Methods Inquiry, Jennifer G. Benson, Peggy Maclean, Andrew Hsi, Sarah J. Erickson

Psychology ETDs

Accessible services for users of prenatal substances are lacking, and treatment engagement is poor with services that are available. Furthermore, legal consequences are often punitive, which ultimately damages the well-being of mother and child. Milagro and FOCUS are two New Mexico programs that provide comprehensive, coordinated care, including medication-assisted treatment, to former users of prenatal substances during pregnancy (in the Milagro Program) and for three years post-birth (in the FOCUS Program). This mixed methods study explored the lived experiences of women from this complex, high-risk population, using a high-engagement sample of women who utilized services at both Milagro and FOCUS. …

Relationships Between Complex Pediatric Health Conditions And The Built, Physical And Social Environments, Brittany Corley

Theses & Dissertations

The relationship between human health and the environment is complex and overall poorly understood. The environment has a lasting impact on health, and the processes appear to start at conception. Thus, this dissertation examines the potential relationship between pediatric health and the environment.

The first relationship examined was between the built environment and comorbid Attention Deficient Hyperactivity Disorder and Autism Spectrum Disorder. Many publications have reported the relationship between socioeconomic disadvantage, Attention Deficient Hyperactivity Disorder, and Autism Spectrum Disorder. However, the link between the built environment and Attention Deficient Hyperactivity Disorder and Autism Spectrum Disorder symptom severity is poorly understood. …

Implementation Of A Fruit And Vegetable Voucher Program In San Francisco, Alexandra Kambur

Master's Projects and Capstones

Chronic disease has emerged as the predominant public health challenge of the 21st century. Chronic diseases like cardiovascular disease, cancer, type 2 diabetes and obesity have maintained their top positions as the leading causes of poor health, disability, death, and high health-care expenditures for over a decade. Health and hunger go hand-in-hand. Today over 15 million households in the United States struggle with food insecurity, meaning they do not have sufficient access to food that meets their dietary needs for an active and healthy life. The issue of food insecurity in cities like San Francisco, California is exacerbated by the …

Oh Baby! Evaluating The Impact Of Blossom's Natural Childbirth Prep Course On Women's Childbirth Experience, Florence Oxenham

Master's Projects and Capstones

The United States has some of the highest rates of maternal morbidity and mortality among developed countries. Comprehensive childbirth education is an important component of improving maternal health outcomes. This project was a pilot evaluation of a childbirth education course offered by Blossom Birth Services, a community-based non-profit organization providing resources for new and expectant families in the San Francisco Bay Area. A 41-item survey questionnaire was developed and administered to explore the impact of Blossom’s Natural Childbirth Prep course on women’s knowledge, feelings, and sense of self-efficacy regarding childbirth. Likert scales were used and thematic analysis of qualitative data …

Lessons Learned From Cuba: Using Healthcare Systems And Stillbirth Rate Example, Ravi Patel

Master's Projects and Capstones

Cuba and the U.S. have different health care systems but similar health outcomes. In 2015 U.S. and Cuba had the same stillbirth rate. Cuba is a prevention-based system that is free for all, while the U.S. is a treatment-based system that uses a fee for service system. Cuba has ratified international laws that hold it accountable for improving health outcomes especially for women and children. The U.S. can learn from Cuba when it comes to improving health outcomes. The U.S. can improve their health outcomes by including more preventative based interventions and ratifying international law that will hold the U.S. …

Health Starts In The Home: An Assessment Of Efforts To Improve Occupant Health Through Healthy Building Materials In San Francisco’S Affordable Housing, Staci Hoell

Master's Projects and Capstones

Americans spend 90% of their lives indoors, and much of this time is spent at home, surrounded by building materials that typically have added chemicals like flame retardants, highly fluorinated compounds, and antimicrobials. Recent research has linked these chemicals to adverse health outcomes such as asthma, endocrine disruption, cancer, neurodevelopmental issues, and reproductive problems (Bayer et al., n.d.; Green Science Policy Institute). Furthermore, these chronic health conditions disproportionately affect low-income populations. Fortunately, substantial efforts in research, practice, and policy are working to reduce the use of these potentially harmful chemicals in building materials, particularly in San Francisco’s affordable housing sector. …

A Novel Model Of “Remedy And Elimination Of Tuberculosis”, Akanksha Mishra

Master's Theses

Tuberculosis (TB), is one of the top ten causes of death worldwide. TB is commonly linked to poverty and creates poverty as it is the single largest cause of death in the 15-49-year-old age group in South-East Asia (WHO, 2017). It is also linked to the HIV population, and its leading cause of death. TB is effected by socio-economic factors, cultural factors, and health policy. My goal of this dissertation is to identify systematic approaches that shall support the mission set by World Health Organization (WHO): to eliminate TB globally by the year 2050. Measures might include addressing social barriers …

A Roadmap For The Journey Home - A Supplemental Tool Guiding Patients From Hospital To Home, Michelle Basco

Master's Projects and Capstones

Centers for Medicare and Medicaid (CMS) have recognized readmission rates as a public health problem. CMS incentivizes hospitals to reduce readmission rates and reduce payments for hospitals with high readmission rates (Berry et al., 2013). Patient education and discharge planning are associated with decreased readmission rates. I gained fieldwork experience at Children’s Health System of Texas in Dallas. Children’s Health, a pediatric non-profit, is the 8th largest pediatric health care provider in the U.S. Prior to discharge patient education occurs on topics related to their diagnosis, plus patients are provided discharge instructions including their diagnosis, medications, and simple instructions for …

Prevalence Of And Trends In Diabetes Among Veterans, United States, 2005–2014, Ying Liu, Sonica Sayam, Xiaonan Shao, Kesheng Wang, Shimin Zheng, Ying Li, Liang Wang

ETSU Faculty Works

Diabetes is a highly prevalent chronic disease among US adults, and its prevalence among US veterans is even higher. This study aimed to examine the prevalence of and trends in diabetes in US veterans by using data from the US National Health and Nutrition Examination Survey from 2005 through 2014. The overall prevalence of diabetes and undiagnosed diabetes was 20.5% and 3.4%, respectively, and increased from 15.5% in 2005–2006 to 20.5% in 2013–2014 (P = .04). Effective prevention and intervention approaches are needed to lower diabetes prevalence among US veterans and ultimately improve their health status.

Obesity And Diabetes: Evaluating The Impact Of Promotores As A Prevention And Intervention Strategy In The Latino Community, Jessica Castaneda

Master's Projects and Capstones

This paper aims to examine obesity and diabetes among the Latino population as a health problem. As the largest minority racial group in the U.S, Latino rates of obesity and diabetes are greatly higher than whites. The prevalence of obesity in Latinos is 45% compared to that of whites at 34.5% (CDC, 2015). The disproportionate rates at which Latinos are affected by obesity and diabetes have prompted numerous programs to combat this health problem. Promotores or Latino community health workers have been able to provide the important piece of culturally and linguistically appropriate education for the population. Evidence shows Promotores …

Patient-Provider Relationship And Perceived Provider Weight Bias Among American Indians And Alaska Natives, Kelly L. Gonzales, Ginny Garcia, Michelle M. Jacob, C. Muller, Lonnie A. Nelson, Spero M. Manson

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective The objective of this study was to examine patient–provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health.

Methods Among a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north-west region of the USA, ordinary least squares regression analysis was completed to examine associations.

Results Better working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated …

Social Marketing For A Farmer's Market In An Underserved Community: A Needs Assessment, Meg Skizim, Melinda Sothern, Ondrej Blaha, Tung-Sung Tseng, Lauren Griffiths, Jonathan Joseph, Henry Nuss

School of Public Health Faculty Publications

The aim of the present paper is to assess local residents' awareness of utilizing Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fresh produce at local farmers' markets, and to determine internet use and media preferences of study participants prior to implementation of a social marketing campaign. A needs assessment was conducted to collect baseline data in an underserved neighbourhood in New Orleans (La, USA). The study was carried out August 2014-May 2015. The assessment revealed that 73% of the respondents were unaware that the SNAP benefits could be used to purchase food in farmers' markets; 63% of low-income participants …

Community Development Projects In Moldova, Berkend Pura

Capstone Collection

This Independent Practitioner Inquiry Capstone (IPIC) aims to provide relevant information, from a Peace Corps (PC) Volunteer (PCV) standpoint, on a renovation project that was implemented in the village of Vorniceni, Republic of Moldova. At its core, this was a community development project that involved the active participation of the community of Vorniceni, providing local resources and knowledge towards the goal of building a healthier sanitation facility on the second floor of the local kindergarten.

The results of this effort indicate that the involvement of the client (people) is crucial to sucess in implementing projects, and it also shows that …

Beyond The End Line - Putting The Mental Health Of Female Athletes First, Katherine Scholten

Honors Projects

Currently one in five adults are affected by mental illness. Student-athletes are a population that is under diagnosed for mental illness. In the world of college athletics, mental pain is as regular as physical pain. Coaches often push their athletes to suffer in silence for the betterment of the team. The NCAA has recognized the importance of mental health in college athletics, yet there is still much work to be done among universities across the country. This document is to serve as a resource and a guide on the effects of mental health among female student athletes and the best …

Introduction Of Iodised Salt Benefits Infants’ Mental Development In A Community-Based Cluster-Randomised Effectiveness Trial In Ethiopia, Karim Bougma, Frances E. Aboud, Tizita M. Lemma, Edward A. Frongillo Jr., Grace S. Marquis

Faculty Publications

The effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4–6 months later. The primary outcome was children’s mental development scores on the Bayley Scales. This was an intention-to-treat analysis using …

Impacts Of Active School Design On Schooltime Sedentary Behavior And Physical Activity: A Pilot Natural Experiment, Jeri Brittin, Leah Frerichs, John R. Sirard, Nancy M. Wells, Beth M. Myers, Jeanette Garcia, Dina Sorensen, Matthew J. Trowbridge, Terry Huang

Interior Design Program: Faculty Scholarly and Creative Activity

Background Children spend a significant portion of their days in sedentary behavior (SB) and on average fail to engage in adequate physical activity (PA). The school built environment may influence SB and PA, but research is limited. This natural experiment evaluated whether an elementary school designed to promote movement impacted students' school-time SB and PA.

Methods Accelerometers measured SB and PA at pre and post time-points in an intervention group who moved to the new school (n = 21) and in a comparison group experiencing no school environmental change (n = 20). Difference-in-difference (DD) analysis examined SB and PA outcomes …

Protocol For Project Impact (Improving Millions Hearts For Provider And Community Transformation): A Quasi-Experimental Evaluation Of An Integrated Electronic Health Record And Community Health Worker Intervention Study To Improve Hypertension Management Among South Asian Patients, Priscilla M. Lopez, Jennifer Zanowiak, Keith Godfeld, Katarzyna Wyka, Ahmad Masoud, Susan Beane, Rashi Kumar, Phoebe Laughlin, Chau Trinh-Shevrin, Lorna Thorpe, Nadia Islam

Publications and Research

Background: The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building …

Doula Services Within A Healthy Start Program: Increasing Access For An Underserved Population, Mary-Powel Thomas, Gabriela Ammann, Ellen Brazier, Philip Noyes, Aletha Maybank

Publications and Research

Purpose: Women of color in the United States, particularly in high-poverty neighborhoods, experience high rates of poor birth outcomes, including cesarean section, preterm birth, low birthweight, and infant mortality. Doula care has been linked to improvements in many perinatal outcomes, but women of color and low-income women often face barriers in accessing doula support.

Description: To address this issue, the New York City Department of Health and Mental Hygiene’s Healthy Start Brooklyn introduced the By My Side Birth Support Program in 2010. The goal was to complement other maternal home-visiting programs by providing doula support during labor and birth, along …

Effect Of Total Body Iron On Metabolic Dysfunction Among U.S. Females In The Nhanes 2003-2010, Aged 12-49., Joseph Michael Carhart

Electronic Theses and Dissertations

Experimental and epidemiological studies have reported positive associations between iron parameters and metabolic dysfunction including: Type 2 diabetes mellitus (T2DM) (1-6), metabolic syndrome (7-15), non-alcoholic fatty liver disease (NAFLD) (16-22) and insulin resistance (23,24) with a number of studies showing that reductions in total body iron via dietary modification (e.g., reducing red meat intake) or phlebotomy lead to increases in insulin sensitivity (25), decreases in insulin resistance (26), and reductions in the prevalence of complications associated with T2DM (5, 27), metabolic syndrome (28) and NAFLD (22, 29). Moreover, the risk associated with these outcomes and total body iron differ between …

Analysis Of Food Security, Snap Benefit Duration, Income Level And The Relationship With Depression In Households With Children In Omaha., Tatiana Tchouankam

Capstone Experience: Master of Public Health

Food insecurity is defined as a lack of access to “sufficient, safe, and nutritious food that meets individuals’ dietary needs and preferences for an active and healthy life.” From 2015 to 2016, the number of people undernourished increased from 777 million to 815 million worldwide. Food insecurity affected 12.3 % of Nebraskans and 13.8% of the residents in Douglas County during the same year. There is evidence of associations between food insecurity, income level, and several adverse health outcomes, specifically with regards to mental health. The objective of this study was to examine food security, SNAP benefit duration (i.e., how …

Multilevel Worksite Wellness Intervention To Improve Individual Behaviors And The Worksite Environment, Mariah Morgan

Capstone Experience: Master of Public Health

Due to increasing obesity rates, public health approaches must focus on improving healthy behaviors and reducing the risk of obesity-related health problems (“Nebraska State Nutrition Profile,” 2012; “State of Obesity,” 2016). Worksites offer opportunities to stimulate behavior change through environmental supports and provide natural structures for social support; therefore, worksites are ideal locations for teaching and implementing health promotion programs (Beresford et al., 2001; Salinardi et al., 2013; Sorensen et al., 1996; Touger-Decker et al., 2008). The Social Ecological Model (SEM), which illustrates that various factors are intertwined at multiple levels to influence behaviors, has been shown to produce significant …

Examination Of Collaborative Efforts Of Central District To Achieve Success Of The Community Health Improvement Plan, Liene Topko

Capstone Experience: Master of Public Health

This was a quality improvement project that helped Central District Health Department (CDHD) work more closely with their community partners to identify the activities and programs that are currently in place to address priority health needs that were included in the 2016 Comprehensive Community Health Needs Assessment (CHNA). The purpose of this project is to identify the specific activities and programs that are being implemented by the health department and community partners in relation to the priority needs. These activities and programs were identified by conducting a survey of the major community partners. The findings from the survey helped to …

Primary Care Provider’S Perspectives Of Integrating Public Health Into The Prevention And Management Of Type Ii Diabetes Mellitus In Rural Nebraska, Emma Frost-Briley

Capstone Experience: Master of Public Health

Through the 2011 Community Health Needs Assessment, the Four Corners Health Department has identified type II diabetes mellitus as one of the communities top concerns within their communities. The goals of this project were: to develop a survey to assess the state of current practices of primary care providers on type II diabetes mellitus in the health department district, to identify primary care providers views on prevention, treatment, and management of type II diabetes mellitus in the health department district, and to examine primary care providers and local health department’s views on how primary care and public health can be …

Employee Wellness At Private Clinic In Omaha, Ne: Social Marketing And Health Communications Perspective, Olivia Chambers

Capstone Experience: Master of Public Health

Midwest Gastrointestinal Associates (MGI) is a private clinic in Omaha, Nebraska that reached out to the College of Public Health for assistance in the clinic’s employee wellness program. An MPH student with a background in health and wellness provided MGI with a health promotion intervention to increase employee participation rates. A change was made to the wellness program in 2017 away from monthly health challenges and points—to small gifts distributed to all employees to increase engagement and morale. An initial program evaluation was performed to understand employee understanding and needs. Discovered was the need for an outlet employees could turn …

The Exploration Of Historical, Cultural, And Healthcare Utilization Factors When Clinically Treating Refugee Patients: Healthcare Providers’ View, Kandy Do

Capstone Experience: Master of Public Health

The objective of this project is to explore historical, cultural, and healthcare utilization factors that are significant to healthcare providers in their practice to clinically treat refugee patients holistically and equitably. Semi-structured interviews supported by a pre-interview questionnaire were conducted with 14 healthcare providers, who have experience in working with refugee patients. Purposive and snowball sampling method was used to recruit 14 healthcare providers. Thematic analysis was used to analyze qualitative data. Descriptive analysis was performed on the pre-interview questionnaire results. To our knowledge, there is limited research exploring historical, cultural, and healthcare utilization factors that are relevant for providing …

The Development Of A School Lunch Observation Measure To Assess School District Lunch Menu Implementation, Mariam Taiwo

Capstone Experience: Master of Public Health

Background: The most recent estimate of the prevalence of child and adolescent obesity in the United States is 17% (Ogden, Carroll, Lawman, & et, 2016). Based on evidence that the availability of healthy food at schools can significantly impact the nutrition behaviors of children, the Healthy and Hunger Free-Kids Act sets policy for the United States Department of Agriculture (USDA), which includes the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) (USDA, 2017a). School food authorities (SFAs) are responsible for administering school feeding programs (Byker, Pinard, Yaroch, & Serrano, 2013). In other words, local school authorities (school …

Survey Of Indoor Air Quality In Residences Of Wic Participants In Lincoln, Nebraska, Eun Hee Kwon

Capstone Experience: Master of Public Health

Since 1992, Women, Infants, and Children at the Lincoln Lancaster County Health Department has provided supplemental food benefits, nutrition information, breastfeeding support, immunization referrals, and dental services to support low-income families and their children. However, statewide, the retention rate has been dropping since 2009, and if this continues, it can result in adverse health outcomes. As part of the Service Learning activities, this study aims to evaluate current services on clients’ experiences and improve their satisfaction by conducting the WIC participant-centered services survey. This cost-effective intervention program has been working successfully, however it does not provide the information of environmental …

Consult Management At The Va Palo Alto Health Care System: Has The Implementation Of Business Rules Improved Consult Management, And Did It Help Measure Performance For Select Services?, Christine Poblete

Master's Projects

This research project was developed to determine whether the new business rules implemented at the VA Palo Alto Health Care System have resulted in an improvement in the delivery of critical health care services through consults; and whether this process can be used as a Key Performance Indicator (KPI) for measuring performance of clinical services by health care administrators.

The Relationship Between Bmi & Mandated Physical Education Requirements Of Elementary Schools, Kathryn Fairlamb

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The physical activity policies of elementary schools in Arkansas and correlations between physical activity requirements and body mass index have been studied. Examination of the policies at the individual school, district, or state level were noted. The statewide BMI database was consulted. Interviews with physical education teachers was conducted to assess policy implementation. Results may provide schools and policy makers with insight on future physical activity policies.

Santa Clara County Senior Nutrition Program Evaluation Report, Tae Hwan Ihm

Master's Projects

Santa Clara County conducts a Senior Nutrition Program (SNP) in conjunction with the City of San Jose, the Outreach Paratransit Program and local community-based organizations (CBOs) like Sourcewise (Lam, 2015). These programs combined represent a significant investment of public funds, with more than 45% of the SNP program’s funding coming from the county General Fund (Lam, 2015). Such a large financial commitment needs to demonstrate some benefit to the participants, and some positive outcomes from the current program design. This study evaluated the SNP’s effectiveness in achieving its primary goals. Primary goals of the SNP are to promote senior citizens’ …