Digital Commons Network^™

Social Franchising And A Nationwide Mass Media Campaign Increased The Prevalence Of Adequate Complementary Feeding In Vietnam: A Cluster-Randomized Program Evaluation, Rahul Rawat, Phuong Hong Nguyen, Lan Mai Tran, Nemat Hajeebhoy, Huan Van Nguyen, Jean Baker, Edward A. Frongillo Jr., Marie T. Ruel, Purnima Menon

Faculty Publications

Rigorous evaluations of health system-based interventions in large-scale programs to improve complementary feeding (CF) practices are limited. Alive & Thrive applied principles of social franchising within the government health system in Vietnam to improve the quality of interpersonal counseling (IPC) for infant and young child feeding combined with a national mass media (MM) campaign and community mobilization (CM). We evaluated the impact of enhanced IPC + MM + CM (intensive) compared with standard IPC + less-intensive MM and CM (nonintensive) on CF practices and anthropometric indicators. A cluster-randomized, nonblinded evaluation design with cross-sectional surveys ( = ∼500 children aged 6-23.9 …

Pre-Pregnancy Body Mass Index Is Associated With Dietary Inflammatory Index And C-Reactive Protein Concentrations During Pregnancy, Dayeon Shin, Junguk Hur, Eun-Hee Cho, Hae-Kyung Chung, Nitin Shivappa, Michael D. Wirth, James R. Hébert, Kyung Won Lee

Faculty Publications

There have been a limited number of studies examining the association between pre-pregnancy body mass index (BMI) and dietary inflammation during pregnancy. Our aim is to examine the association between pre-pregnancy BMI and the Dietary Inflammatory Index (DII)™ and C-reactive protein (CRP) concentrations during pregnancy. The study included 631 pregnant American women from the National Health and Nutrition Examination Survey (NHANES) cross-sectional examinations from 2003 to 2012. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. The cut-offs of <18.5 (underweight), 18.5–24.9 (normal), 25.0–29.9 (overweight), and ≥30 kg/m2 (obese) were used to categorize the weight status of pregnant women prior to pregnancy. The DII, a literature-based dietary index to assess the inflammatory properties of diet, was estimated based on a one-day 24-h recall. Multivariable linear and logistic regressions were performed to estimate beta coefficients and the adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) on the association of pre-pregnancy BMI categories with the DII and CRP concentrations during pregnancy. After controlling for variables including: race/ethnicity, family poverty income ratio, education, marital status, month in pregnancy, and smoking status during pregnancy; women who were obese before pregnancy (n = 136) had increased odds for being in the highest tertile of the DII and CRP concentrations compared to women with normal weight (AORs 2.40, 95% CIs 1.01–5.71; AORs 24.84, 95% CIs 6.19–99.67, respectively). These findings suggest that women with pre-pregnancy obesity had greater odds of reporting higher DII and having elevated CRP. In conclusion, high pre-pregnancy BMI was associated with increased odds of pro-inflammatory diet and elevated CRP levels during pregnancy in the USA.

The Benefits Of Breastfeeding, Annagrace E. Anderson

Senior Honors Theses

Breast milk is the gold standard for infant nutrition. In the past, infant formula was promoted as equal or superior to breast milk. However, research has shown that breastfeeding is the superior form of infant nutrition except in rare circumstances. Breast milk provides for all of a newborn’s caloric needs and has the correct balance of nutrients to promote proper development. In addition, breast milk provides protection against illnesses, supports an infant’s immune system, and promotes life-long health for the newborn. Mothers also experience personal benefits by breastfeeding such as decreased cancer risks, bonding with their babies, and faster postpartum …

Physician Role In Physical Activity For African-American Males Undergoing Radical Prostatectomy For Prostate Cancer, Faustine Williams, Kellie R. Imm, Graham A. Colditz, Ashley J. Housten, Lin Yang, Keon L. Gilbert, Bettina F. Drake

ETSU Faculty Works

Purpose

Physical activity is recognized as a complementary therapy to improve physical and physiological functions among prostate cancer survivors. Little is known about communication between health providers and African-American prostate cancer patients, a high risk population, regarding the health benefits of regular physical activity on their prognosis and recovery. This study explores African-American prostate cancer survivors’ experiences with physical activity prescription from their physicians.

Methods

Three focus group interviews were conducted with 12 African-American prostate cancer survivors in May 2014 in St. Louis, MO. Participants’ ages ranged from 49 to 79 years, had completed radical prostatectomy, and their time out …

Association Of Depressive Symptomology And Psychological Trauma With Diabetes Control Among Older American Indian Women: Does Social Support Matter?, R. Turner Goins, Carolyn Noonan, Kelly Gonzales, Blythe Winchester, Vickie L. Bradley

OHSU-PSU School of Public Health Faculty Publications and Presentations

Aims—Among older American Indian women with type 2 diabetes (T2DM), we examined the association between mental health and T2DM control and if social support modifies the association.

Methods—Survey data were linked to T2DM medical record information. Mental health measures were the Center for Epidemiologic Studies – Depression Scale and the National Anxiety Disorders Screening Day instrument. T2DM control was all HbA1c values taken post mental health measures.

Results—There was not a significant association between depressive symptomatology and higher HbA1c although increased depressive symptomatology was associated with higher HbA1c values among participants with low social support. There was a significant association …

Children’S Exposure To Environmental Toxins: Socioeconomic Factors And Subsequent Effects On Mental Health And Function, Dorothy L. Mcleod

Center for the Human Rights of Children

The physical environment in which children live, including the air they breathe and the water they drink, has a profound influence on their development. While children need many chemicals and nutrients to physically grow and develop normally, others, such as those deemed environmental toxins (e.g. pesticides, lead, mercury, and illicit substances) act instead as a threat to healthy development. These chemicals may have highly toxic effects, and while they are a threat to all individuals, they affect infants and children most severely. In order to provide an introduction to the issue of toxin exposure and mental health outcomes, to highlight …

Causal Pathways From Enteropathogens To Environmental Enteropathy: Findings From The Mal-Ed Birth Cohort Study, Margaret N. Kosek, Zulfiqar Ahmed Bhutta, Anita K. M. Zaidi, Imran Ahmed, Syed Asad Ali, Muneera Rasheed, Sajid Bashir Soofi, Ali Turab, Didar Alam, Shahida Qureshi

Department of Paediatrics and Child Health

Background: Environmental enteropathy (EE), the adverse impact of frequent and numerous enteric infections on the gut resulting in a state of persistent immune activation and altered permeability, has been proposed as a key determinant of growth failure in children in low- and middle-income populations. A theory-driven systems model to critically evaluate pathways through which enteropathogens, gut permeability, and intestinal and systemic inflammation affect child growth was conducted within the framework of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) birth cohort study that included children from eight countries. …

The Association Between Dental Coverage And Self-Reported Health In Older Adults Jgpha, Frances M. Yang, Solon T. Kao, Jordan S. Lundeen

Journal of the Georgia Public Health Association

Background: For the older population of the United States, lack of dental insurance coverage is a substantial health problem. The purpose of the present study was to examine the longitudinal relationship between dental coverage and self-reported health among older adults.

Methods: The Health and Retirement Study (HRS), a nationally representative biennial cohort study of community-dwelling individuals, includes 19,595 adults (aged 50 and older) living in the United States. For the 2010, 2012, and 2014 waves, the independent variable of dental coverage and the outcome of self-reported health were examined.

Results: At each time point, dental coverage for older adults had …

Expectations For Treatment In Pediatric Weight Management And Relationship To Attrition., Erinn T. Rhodes, Richard E. Boles, Kimberly Chin, Amy Christison, Elizabeth Getzoff Testa, Kimberly Guion, Mary Jane Hawkins, Carter R. Petty, Bethany Sallinen Gaffka, Melissa Santos, Laura Shaffer, Jared Tucker, Sarah Hampl

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/guardian treatment expectations and attrition.

PATIENTS AND METHODS: A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months.

RESULTS: From January to August 2013, …

Cuba’S Use Of Medical Diplomacy: Establishing Global Significance And Influence, Juan Herzberg

Independent Study Project (ISP) Collection

This research project aims to assess the importance of medical diplomacy as a foreign policy strategy for Cuba, as well as a means by which the small island nation has managed to gain geopolitical prominence in the current international political sphere. Through the analysis of Cuba’s medical internationalism, its impact on the health of populations across the world, its oil-for-doctors trade agreements with Venezuela, and its involvement in initiatives like the Bolivarian Alternative for the Americas (ALBA), it becomes easier to see the link between medical diplomacy and geopolitical power, which Cuba has been successfully garnering since its 1959 Revolution …

Health Literacy Skills Of Aging Populations And Its Impact On The Prevention Of Cardiovascular Disease, Peter Gorman

Independent Study Project (ISP) Collection

Cardiovascular disease (CVD) represents a threat to both the economic and social well being of Switzerland. Cardiovascular disease is easily a preventable disease, yet continues to take over the world. One’s ability to read and comprehend health information from medical professionals is a vital component of maintaining and improving an individuals’ overall health. Health literacy can have an impact on the effectiveness of preventive interventions in health behaviors and the success of health outcomes. Studies have shown that well-educated and financially improved persons have a higher health competence than lower educated persons.1 Given that cardiovascular disease is the number one …

The Jagori Rural Charitable Trust Model: Menstrual Education Of Women And Adolescent Girls In The Villages Of Rural Dharamsala, Madelon Morford

Independent Study Project (ISP) Collection

Reproductive rights and education of women in rural communities is of lesser importance in India’s patriarchal society. Reproductive health is a conversation that is rarely discussed, and the health status of women is of little priority behind that of men and children’s health. Education about the health and hygiene of menstruation allows for women and adolescent girls to play a role in their own health maintenance, as well as normalizes the discussion of menstruation and reproductive health. Studying Jagori Rural Charitable Trust’s efforts to disseminate knowledge about reproductive health, with specific focus on menstruation, allows for an understanding of the …

Equity And Community-Based Health Insurance: How Does Insurance Coverage Affect Health Seeking Behavior Among Disadvantaged Groups In India?, Hazel Hering

Independent Study Project (ISP) Collection

The objective of this study is to examine how Community-Based Health Insurance (CBHI) can promote equity by improving health seeking behavior across gender and geography. Using a CBHI scheme from the Self-Employed Women’s Association (SEWA) as a case study, trends in claims filed between October 2016 and March 2017 are compared to the distribution of memberships in order to investigate whether health insurance coverage positively impacts health seeking behavior among disadvantaged groups, and what barriers to access exist when the burden of medical costs are reduced. This study concludes that the number of male and female claims in the sample …

Access To Information And Services Regarding Maternal Health And Healthcare Within Tribal Communities Around Udaipur, Rajasthan, Arista Jhanjee

Independent Study Project (ISP) Collection

The following study seeks to investigate access to antenatal and delivery-related services and information among women residing in rural, tribal communities around Udaipur, Rajasthan, and to analyze determinants that affect such access. More specifically, it seeks to evaluate one determinant in particular: that of association with and use of the services provided by the nonprofit organization Seva Mandir, which works with rural communities throughout southern Rajasthan in order to facilitate the improvement of health and development activities and outcomes. Methods used for the collection of the data upon which the study draws were qualitative: interviews were conducted with 27 women …

Water, Sanitation And Hygiene In Rwamwanja Refugee Settlement, Katelyn Bergl

Independent Study Project (ISP) Collection

No abstract provided.

Comparison Of Multiple Obesity Indices For Cardiovascular Disease Risk Classification In South Asian Adults: The Carrs Study., Shivani A. Patel, Mohan Deepa, Roopa Shivashankar, Mohammed K. Ali, Deksha Kapoor, Ruby Gupta, Dorothy Lall, Nikhil Tandon, Viswanathan Mohan, Muhammad Masood Kadir, Zafar Fatmi, Dorairaj Prabhakaran, K. M. Venkat Narayan

Community Health Sciences

BACKGROUND:

We comparatively assessed the performance of six simple obesity indices to identify adults with cardiovascular disease (CVD) risk factors in a diverse and contemporary South Asian population.

METHODS:

8,892 participants aged 20-60 years in 2010-2011 were analyzed. Six obesity indices were examined: body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), log of the sum of triceps and subscapular skin fold thickness (LTS), and percent body fat derived from bioelectric impedance analysis (BIA). We estimated models with obesity indices specified as deciles and as continuous linear variables to predict prevalent hypertension, diabetes, and high cholesterol …

Increasing Breastfeeding Duration And Exclusivity In A Sample Of Rural Women: A Pilot Study, Joanne Chopak-Foss, Felicia Yeboah

Journal of the Georgia Public Health Association

Background: Increasing breastfeeding exclusivity and duration is an objective of Maternal and Child Health (MICH-21.4 and 21.5) of the Healthy People 2020 initiative. Breastfeeding rates differ considerably between high-income and low-income women.

Methods: This was a pilot project conducted to assess the feasibility of an intervention to increase breastfeeding practices overall and to improve exclusive breastfeeding rates among a sample of rural women enrolled in the Special, Supplemental Nutrition Program for Women, Infants and Children (WIC) in a rural Georgia county. Participants were recruited from the local regional hospital (n=27). Support group meetings were offered over a four-week period and …

Community Engagement To Address Socio-Ecological Barriers To Physical Activity Among African American Breast Cancer Survivors, Selina A. Smith, Mary S. Whitehead, Joyce Q. Sheats, Brittney Chubb, Ernest Alema-Mensah, Benjamin E. Ansa

Journal of the Georgia Public Health Association

Background: With high rates of obesity, low levels of physical activity (PA), and lack of adherence to physical activity guidelines (PAGs) among African American (AA) breast cancer survivors (BCSs), culturally appropriate interventions that address barriers to participation in PA are needed.

Methods: To develop intervention content, members of an AA breast cancer support group participated in four 1-hour focus group discussions (related to the barriers to PA, strategies for overcoming them, and intervention content), which were audiotaped, transcribed, and analyzed.

Results: The support group collaborated with researchers to construct the Physical Activity Intervention Developed (PAID) to Prevent Breast Cancer, a …

Cis-Eqtl-Based Trans-Ethnic Meta-Analysis Reveals Novel Genes Associated With Breast Cancer Risk, Joshua Hoffman, Rebecca Graff, Nima Emami, Caroline Tai, Michael Passarelli

Dartmouth Scholarship

Breast cancer is the most common solid organ malignancy and the most frequent cause of cancer death among women worldwide. Previous research has yielded insights into its genetic etiology, but there remains a gap in the understanding of genetic factors that contribute to risk, and particularly in the biological mechanisms by which genetic variation modulates risk. The National Cancer Institute's "Up for a Challenge" (U4C) competition provided an opportunity to further elucidate the genetic basis of the disease. Our group leveraged the seven datasets made available by the U4C organizers and data from the publicly available UK Biobank cohort to …

Evaluating Value-Based Frameworks Used For Relapsed Or Refractory Multiple Myeloma Regimens: Icer Report, Asco Value Framework, And Nccn Evidence Blocks, Laurence M. Djatche, Pharmd, Joseph Goble, Pharmd, Grace Chun, Pharmd, Stefan Varga, Pharmd

College of Population Health Posters

BACKGROUND: With the continuous rise in costs for oncology drugs, the Institute for Clinical and Economic Review (ICER), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have developed value-based frameworks (VBFs) to assist stakeholders in formulary and treatment decisionmaking. While emerging VBFs have the potential to significantly impact therapeutic options for patients, it is important to understand the differences associated with those VBFs within a therapeutic area. OBJECTIVE: To compare ICER, ASCO, and NCCN VBFs across three therapeutic options for relapsed or refractory multiple myeloma (RRMM).

METHODS: The values of carfilzomib (CFZ), elotuzumab (ELO), …

First Year Physical Activity Findings From Turn Up The Heat (Healthy Eating And Activity Time) In Summer Day Camps, Robert Weaver, Keith Brazendale, Jessica L. Chandler, Gabrielle Turner-Mcgrievy, Justin B. Moore, Jennifer L. Huberty, Dianne S. Ward, Michael W. Beets

Faculty Publications

Background Summer day camps (SDCs) serve 14 million children yearly in the U.S. and aim to provide participating children with 60 minutes of moderate-to-vigorous physical activity (MVPA). This study evaluated an intervention designed to increase the percent of children meeting this MVPA guideline.

Design Two-group, pre-post quasi-experimental.

Setting/Participants Twenty SDCs serving 1,830 children aged 5–12 years were assigned to MVPA intervention (n = 10) or healthy eating attention control (n = 10).

Intervention

The STEPs (Strategies to Enhance Practice) intervention is a capacity-building approach grounded in the Theory of Expanded, Extended and Enhanced Opportunities. Camp leaders and staff receive training …

How Could Repealing Key Provisions Of The Affordable Care Act Affect Community Health Centers And Their Patients?, Sara J. Rosenbaum, Jessica Sharac, Thao-Chi Tran, Anne Rossier Markus, David Reynolds, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Analyses of repeal of the Affordable Care Act (ACA) have tended to focus on coverage. This study, which gauges the potential effects of repealing certain ACA provisions, looks at the question of primary health care access itself, with a focus on medically underserved communities. A survey developed and fielded in early 2017 asked community health centers to estimate the impact of ending the Health Centers Fund established under the ACA as well as ending expanded Medicaid coverage and subsidies designed to make private insurance affordable for lower income patients. Forty-one percent of health centers responded; 69 percent were located in …

Inflammatory Potential Of Diet, Weight Gain, And Incidence Of Overweight/Obesity: The Sun Cohort, Alyson Haslam, Sara Wagner Robb, James R. Hébert, Hanwen Huang, Michael David Wirth, Nitin Shivappa, Mark H. Ebell

Faculty Publications

Objective

The Dietary Inflammatory Index (DII)TM, which was developed to characterize the inflammatory potential of a person’s diet, has been shown to be associated with inflammatory conditions such as cancer. The present study aimed to investigate the association between DII scores and colorectal adenoma (CRA), a pre-cancerous condition.

Design

Responses to baseline dietary questionnaires were used calculate DII scores. In a cross-sectional study design, the association between DII scores and CRA prevalence was determined in men and women separately using logistic regression models.

Setting

Ten cancer screening centres across the USA.

Subjects

Participants were those included in the screening arm …

Lactational Stage Of Pasteurized Human Donor Milk Contributes To Nutrient Limitations For Infants., Christina J Valentine, Georgia Morrow, Amanda Reisinger, Kelly A Dingess, Ardythe L Morrow, Lynette K Rogers

Women’s Health Articles

BACKGROUND: Mother's own milk is the first choice for feeding preterm infants, but when not available, pasteurized human donor milk (PDM) is often used. Infants fed PDM have difficulties maintaining appropriate growth velocities. To assess the most basic elements of nutrition, we tested the hypotheses that fatty acid and amino acid composition of PDM is highly variable and standard pooling practices attenuate variability; however, total nutrients may be limiting without supplementation due to late lactational stage of the milk.

METHODS: A prospective cross-sectional sampling of milk was obtained from five donor milk banks located in Ohio, Michigan, Colorado, Texas-Ft Worth, …

Caregiving Among Community-Dwelling Grandparents In Jamaica, Julian Gm Mckoy Davis, Douladel Willie-Tyndale, Kathryn Mitchell-Fearon, Desmalee Holder-Nevins, Kenneth James, Denise Eldemire-Shearer

GrandFamilies: The Contemporary Journal of Research, Practice and Policy

Grandparents play invaluable caregiving roles in the general upbringing of grandchildren. The objective of the present study is to provide a profile of grandparents providing care to co-resident grandchildren younger than 18 years old in Jamaica. A subsample of 451 grandparents providing care to co-resident grandchildren under than 18 years old was derived from a larger nationally-representative community-based study of 2943 older adults residing in Jamaica. Data pertaining to caregiving, demography, health, socioeconomic status, and social participation were analysed using bivariate and multivariate analyses. Seventy one percent of grandparents were involve in regular care of their grandchildren. Hypertension (65.9%), arthritis …

Identifying Inequities In Maternal And Child Health Through Risk Stratification To Inform Health Systems Strengthening In Northern Togo, Katharine J. Mccarthy, Sandra Braganza, Kevin Fiori, Christophe Gbeleou, Vivien Kpakpo, Andrew Lopez, Jennifer Schechter, Alicia Singham Goodwin, Heidi E. Jones

Publications and Research

Objective
In Togo, substantial progress in maternal and child health is needed to reach global development goals. To better inform clinic and community-based health services, this study identifies factors associated with maternal and child health care utilization in the Kara region of Northern Togo.

Methods
We conducted a population-representative household survey of four health clinic catchment areas of 1,075 women of reproductive age in 2015. Multivariable logistic regression was used to model individual and structural factors associated with utilization of four maternal and child health services. Key outcomes were: facility-based delivery, maternal postnatal health check by a health professional within …

Longitudinal Associations Between Body Mass Index, Physical Activity, And Healthy Dietary Behaviors In Adults: A Parallel Latent Growth Curve Modeling Approach, Youngdeok Kim, Jung-Min Lee, Jungyoon Kim, Emily Dhurandhar, Ghada Soliman, Nizar K. Wehbi, James Canedy

Publications and Research

Background Physical activity (PA) and healthy dietary behaviors (HDB) are two well-documented lifestyle factors influencing body mass index (BMI). This study examined 7-year longitudinal associations between changes in PA, HDB, and BMI among adults using a parallel latent growth curve modeling (LGCM).

Methods We used prospective cohort data collected by a private company (SimplyWell LLC, Omaha, NE, USA) implementing a workplace health screening program. Data from a total of 2,579 adults who provided valid BMI, PA, and HDB information for at least 5 out of 7 follow-up years from the time they entered the program were analyzed. PA and HDB …

Lactose Intolerance: An Overview Of The Facts And Their Implications, Noelle M. Yeo

Honors Program: Senior Projects (Public)

Lactose intolerance is often blamed for the symptoms such as bloating, diarrhea, gas, abdominal pain, and nausea, that ail many people. Patients often do not seek proper diagnosis from a physician and create their own treatment plans, severely restricting lactose intake, without professional guidance. Even those who do seek the care of a physician find that diagnosis is complicated by less-than ideal testing and confusion due to the symptoms common to many other conditions. The misconceptions and inability to confirm a diagnosis of lactose intolerance can cause nutrient deficiencies in these patients, as well as begin a pattern of unnecessary …

Reducing Caregiver Burden: Fostering Healthy Aging And Social Support, Maria A. Rodriguez

USF Tampa Graduate Theses and Dissertations

Over 43.5 million Americans provide informal care to a fast-growing elderly population in the United States. Informal care allows care-recipients to remain functional members of society. However, research suggests that the demands of informal care can negatively impact the health of caregivers. For example, caregiver burden increases the risk for poor health in caregivers compared to non-caregivers. Caregiving research is on the rise, but the dynamics of informal care in active retirement communities remains widely unexplored. To provide adequate services to lessen caregiver burden and improve the Quality of Life (QoL) of informal caregivers, the various settings in which informal …

Community Health News, Georgia Southern University

Health Policy & Community Health: News & Publications (2011-2018)

• Understanding Obesity and Self-Esteem: What Your Weight in Middle School Says about You Now
• Georgia Southern study shows number of obese adults trying to lose weight is decreasing