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Pubh 3331 - Stress Theory/Management, Jamie S. Cromley Apr 2015

Pubh 3331 - Stress Theory/Management, Jamie S. Cromley

College of Public Health: Faculty Syllabi (2014-2021)

Explores issues related to the etiology of stress and stressors with emphasis on environmental, organizational, interpersonal and individual patterns of stress in various health promotion settings. Competency in the active management of stress and mobilizing support in health settings will be evaluated.


Confronting Cultural Challenges For Migrant Healthcare In Switzerland, Rebecca Weiss Apr 2015

Confronting Cultural Challenges For Migrant Healthcare In Switzerland, Rebecca Weiss

Independent Study Project (ISP) Collection

Switzerland is home to many migrants, and migration exacerbates health risks. In addition to physical health problems, migrants are more likely than Swiss nationals to face mental health challenges and cultural barriers, which complicate their experiences seeking healthcare. Similarly, clinicians encounter numerous challenges related to the special circumstances of migrant patients. As a response to the specific health needs of migrants, hospital networks and migrant support organizations promote the migrant health situation. However, these services are not ubiquitous in Switzerland, partly due to the partial freedoms of each canton to create its own health policy. This paper explores the barriers …


Comparing Lung Function Of Textile Workers With The Healthy Pakistani Population, Unaib Rabbani, Asaad Ahmed Nafees Apr 2015

Comparing Lung Function Of Textile Workers With The Healthy Pakistani Population, Unaib Rabbani, Asaad Ahmed Nafees

Community Health Sciences

Background: The purpose of this study was to compare lung function of textile workers with healthy Pakistani population, compare predicted values based on the European Respiratory Society (ERS) equations with those based on the Pakistani equations, and to develop predictor equations for textile workers in Pakistan.
Methods: This was a secondary analysis of data from two previous surveys where lung function of textile workers was compared with healthy Pakistani men. Spirometry was performed according to the American Thoracic Society guidelines. Independent sample t-test was used to compare the lung function parameters and multivariate linear regression was used to develop predictor …


Babies First: Ensuring Proper Infant Nutrition During Emergencies, Abigail M. Alonso Apr 2015

Babies First: Ensuring Proper Infant Nutrition During Emergencies, Abigail M. Alonso

Independent Study Project (ISP) Collection

Background: Breastfeeding is the best source of nutrition for an infant, living in all regions and cultures. Recommendations apply across the board, from developed nations to refugee camps, from women with HIV to those with time constraints regarding feeding. There also exists a complex relationship between corporations that provide BMS and the NGOs working to promote breastfeeding in emergency situations amongst vulnerable populations.

Objective: The objective of this paper is to expose breastfeeding promotion, using the Dadaab camps in Northeastern Kenya as a case study of IYCF programs and support of breastfeeding among low-literacy populations with an emphasis on women …


Chbe 9230 - Community-Based Public Health Program Planning And Evaluation, Moya L. Alfonso Apr 2015

Chbe 9230 - Community-Based Public Health Program Planning And Evaluation, Moya L. Alfonso

College of Public Health: Faculty Syllabi (2014-2021)

This course introduces students to the theory and application of community-based program planning and evaluation. Concepts in community assessment, organization, and mobilization for the purposes of addressing identified public health concerns will serve as the foundation for the public health planning process. Appropriate techniques of partnership building, planning strategies, data collection, data analysis, and evidence-based decision-making will also be introduced.


Epid 7131 - Epidemiology Of Chronic Disease, Jian Zhang Apr 2015

Epid 7131 - Epidemiology Of Chronic Disease, Jian Zhang

College of Public Health: Faculty Syllabi (2014-2021)

This course is designed to introduce the student to the ever-expanding area of chronic disease epidemiology. Students will be introduced to the current status of chronic disease and control programs, methods used in chronic disease surveillance, intervention methods, and modifiable risk factors. Some of the major chronic diseases such as cancer, cardiovascular disease, chronic lung disease, diabetes and arthritis will be discussed in detail.


Introduction To Aims Special Issue “Obesity And Food Intake In Vulnerable Populations”, Junfeng Jiao Apr 2015

Introduction To Aims Special Issue “Obesity And Food Intake In Vulnerable Populations”, Junfeng Jiao

Research Collection College of Integrative Studies

With global obesity on the rise, the need for research concerning the complexity of risk factors is more important than ever. While the increase of the high-calorie, low-nutrient food supply correlates with rising weights, new studies across disciplines reveal the intricacy of the environmental and circumstantial phenomena that influence obesity rates and behaviors for at-risk individuals. AIMS Public Health is pleased to present this special issue entitled “Obesity and Food Intake in Vulnerable Populations” in support of this research. This edition contains two research reviews, a research study, and a brief report related to obesity and human behavior.


86th Annual Georgia Public Health Association Meeting & Conference Report, Selina A. Smith, Regina Abbott, Christy Sims Apr 2015

86th Annual Georgia Public Health Association Meeting & Conference Report, Selina A. Smith, Regina Abbott, Christy Sims

Journal of the Georgia Public Health Association

The 86th annual meeting of the Georgia Public Health Association (GPHA) and joint conference with the Southern Health Association was held in Atlanta, Georgia, on April 13-14, 2015, with pre-conference (April 12th) and post-conference (April14th) Executive Board meetings. As Georgia’s leading forum for public health researchers, practitioners, and students, the annual meeting of the GPHA brings together participants from across the state to explore recent developments in the field and to exchange techniques, tools, and experiences. Historically, the GPHA conference has been held in Savannah (n=24); Jekyll Island (n=20); Atlanta (n=16); Augusta (n=4); and Gainesville (n=1). There was no annual …


Advocating For Pregnant Women In Prison: Georgia Can Do Better, Nancy Webb, Madison Gates Apr 2015

Advocating For Pregnant Women In Prison: Georgia Can Do Better, Nancy Webb, Madison Gates

Journal of the Georgia Public Health Association

Background: Women are the fastest growing segment of the U.S. prison populace and approximately 1 in 25 were pregnant when they were incarcerated. However, women, including pregnant women, are receiving unacceptable health care in correctional systems. Further, many correctional systems lack policies to protect the best interest of incarcerated women, mothers and their children.

Methods: We reviewed the literature on pregnant women in prison and found that corrections has been slow in making changes and adapting facilities for women, especially related to pregnancy, parenting skills and nurseries. It has been suggested the parent-infant attachment and the involvement incarcerated parents have …


Community-Based Participatory Research Principles For The African American Community, Selina A. Smith, Mary S. Whitehead, Joyce Q. Sheats, Benjamin E. Ansa, Steven S. Coughlin, Daniel S. Blumenthal Apr 2015

Community-Based Participatory Research Principles For The African American Community, Selina A. Smith, Mary S. Whitehead, Joyce Q. Sheats, Benjamin E. Ansa, Steven S. Coughlin, Daniel S. Blumenthal

Journal of the Georgia Public Health Association

Background: Numerous sets of principles have been developed to guide the conduct of community-based participatory research (CBPR). However, they tend to be written in language that is most appropriate for academics and other research professionals; they may not help lay people from the community understand CBPR.

Methods: Many community members of the National Black Leadership Initiative on Cancer assisting with the Educational Program to Increase Colorectal Cancer Screening (EPICS) had little understanding of CBPR. We engaged community members in developing culturally-specific principles for conducting academic-community collaborative research.

Results: We developed a set of CBPR principles intended to resonate with African-American …


Shining The Spotlight On Diabetes, Rodney Richmond Mar 2015

Shining The Spotlight On Diabetes, Rodney Richmond

Faculty Research ​and Publications

No abstract provided.


The Impact Of The Veterans Health Administration's Home Based Primary Care On Health Services Use, Expenditures, And Mortality, Melissa Castora-Binkley Mar 2015

The Impact Of The Veterans Health Administration's Home Based Primary Care On Health Services Use, Expenditures, And Mortality, Melissa Castora-Binkley

USF Tampa Graduate Theses and Dissertations

Background: Among patients with multiple chronic conditions, care coordination and integration remains one of the major challenges facing the U.S. health care system. A home-based, patient-centered primary care program has been offered through the Veterans Health Administration (VHA) since the 1970s for frail veterans who have difficulty accessing VHA clinics. The VHA Home Based Primary Care (VHA HBPC) aims to integrate primary care, rehabilitation, disease management, palliative care, and coordination of care for frail individuals with complex, chronic diseases within their homes. Early research suggested that VHA HBPC was associated with positive outcomes (e.g., reduced resource use and patient satisfaction). …


The Benefits Of Breastfeeding, Helen L. Byers Mar 2015

The Benefits Of Breastfeeding, Helen L. Byers

Senior Honors Theses

It is important to educate women of childbearing age, their families, and society of the benefits that breastfeeding has over bottle-feeding and formula-feeding. The benefits of breastfeeding are in three main categories. First, the developmental, physical, emotional, and spiritual benefits of the baby will be discussed. Then the physical, emotional, and spiritual benefits for the mother will be talked about along with possible contraindications or difficulties. Finally, the financial benefits of breastfeeding over feeding an infant from the bottle will be discussed as it relates to the family and government. The goal is to persuade that breastfeeding is a superior …


The Role Of Zinc And Iron-Folic Acid Supplementation On Early Child Temperament And Eating Behaviors In Rural Nepal: A Randomized Controlled Trial, Pamela J. Surkan, Mary Katherine Charles, Joanne Katz, Emily H. Siegel, Subarna K. Khatry, Steven C. Leclerq, Rebecca J. Stoltzfus, James M. Tielsch Mar 2015

The Role Of Zinc And Iron-Folic Acid Supplementation On Early Child Temperament And Eating Behaviors In Rural Nepal: A Randomized Controlled Trial, Pamela J. Surkan, Mary Katherine Charles, Joanne Katz, Emily H. Siegel, Subarna K. Khatry, Steven C. Leclerq, Rebecca J. Stoltzfus, James M. Tielsch

Global Health Faculty Publications

Child eating behaviors play an important role in nutrient intake, ultimately affecting child growth and later outcomes in adulthood. The study assessed the effects of iron-folic acid and zinc supplementation on child temperament and child eating behaviors in rural Nepal. Children (N = 569) aged 4–17 months in Sarlahi district, southern Nepal were randomized to receive daily supplements of placebo, iron-folic acid, zinc, or zinc plus iron-folic acid and followed for approximately 1 year. At baseline and four follow-up visits mothers completed questionnaires including information on demographic characteristics and child temperament and eating behaviors. The main effects of zinc and …


The Significance Of Whole Grain Teff For Improving Nutrition: From Injera To Ready To Eat Porridge By Using Extrusion Cooking Technology, Helen T. Zewdie, Mammo Muchie Mar 2015

The Significance Of Whole Grain Teff For Improving Nutrition: From Injera To Ready To Eat Porridge By Using Extrusion Cooking Technology, Helen T. Zewdie, Mammo Muchie

International Journal of African Development

Teff (EragrostisTef) is a fascinating grain, ancient, minute in size, packed with nutrition and used for centuries as the principal ingredient of the Ethiopian population diet. The micro- and macronutrients level of teff grainis apparently higher than that of barley, wheat and sorghum and the amino acid composition comparable to that of egg protein, except for its lower lysine content. In Ethiopia, it has been using as a staple food by making flat bread called Injera. Teff can be diversified from its current provision of Injera to other forms like instant porridge to improve the nutritional quality and it may …


Food Insecurity And Hunger Experiences And Their Impact On Food Pantry Clients In The Tampa Bay, Nora Brickhouse Arriola Mar 2015

Food Insecurity And Hunger Experiences And Their Impact On Food Pantry Clients In The Tampa Bay, Nora Brickhouse Arriola

USF Tampa Graduate Theses and Dissertations

Since 1999, there has been a significant increase in the number of food insecure individuals in the United States. The Great Recession (2007-2009) and slow economic recovery has led to additional increases in rates of food insecurity and the usage of emergency food assistance programs. Thirty qualitative interviews with individuals seeking emergency food assistance at a Tampa Bay food pantry were conducted. Interviews focused on collecting the life experiences of participants, the barriers they face in having food security, their strategies to cope with limited food budgets, and how food insecurity impacts their household's overall health and wellbeing. Recommendations for …


Alternate Payment Models For Ryan White Hiv/Aids Program Funded Services: Strategies Used By Nine Grantees, Naomi Seiler, Scott Dafflitto, Rosalind Fennell, Julia Hidalgo, Katie Horton, Mary-Beth Malcarney Mar 2015

Alternate Payment Models For Ryan White Hiv/Aids Program Funded Services: Strategies Used By Nine Grantees, Naomi Seiler, Scott Dafflitto, Rosalind Fennell, Julia Hidalgo, Katie Horton, Mary-Beth Malcarney

Health Policy and Management Faculty Publications

The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) offers Ryan White HIV/AIDS Program (RWHAP) Part A and Part B grantees some flexibility in determining the method used for paying subgrantees for core medical and support services. Many Part A and Part B grantees use a traditional “cost-based reimbursement” approach, in which subgrantees submit budgets that include personnel costs, other direct costs related to the provision of funded services, and capped indirect costs (IDCs). Some grantees, however, have developed alternative reimbursement models for core medical and/or support services. This report summarizes the reimbursement approaches taken by nine RWHAP grantees. …


Practice-Based Research Networks For Next-Generation Public Health, Glen P. Mays Mar 2015

Practice-Based Research Networks For Next-Generation Public Health, Glen P. Mays

Health Management and Policy Presentations

U.S. public health agencies face an existential imperative to transform their work from a collection of discrete programs and policies into a coherent enterprise for population-wide health improvement. Practice-based research networks (PBRNs) and the advancing science of public health delivery systems can help to achieve this transformation.


Melding Data Collection Methodology With Community Assistance: Benefits To Both Researchers And The Indigenous Groups They Study, Douglas S. London Mar 2015

Melding Data Collection Methodology With Community Assistance: Benefits To Both Researchers And The Indigenous Groups They Study, Douglas S. London

Journal of Ecological Anthropology

I present a description of a model of melding data collection with community aid in the form of health educator training that emerged in the process of research collaboration during 2009-2011 with the Kawymeno Waorani foragers of Amazonian Ecuador. Some guidelines are suggested as to how benefits to both parties might be achieved when collecting data with indigenous populations. In this article I describe some of the advantages and pitfalls of melding data collection and community aid with research when collaborating with vulnerable indigenous groups.


Associations Between Physical Activity And Weight Status With Grade-School Performance, Taylor Panfil Mar 2015

Associations Between Physical Activity And Weight Status With Grade-School Performance, Taylor Panfil

Theses and Dissertations

Physical activity and weight control are predictive of childhood health, but more recent research suggests they may also be associated with academic success.

PURPOSE: To explore the relationships between physical activity, weight status, and academic performance in children.

METHODS: 614 third-to-fifth grade children (53.9% female, age 9.6 ± 0.9 years) from two Midwestern communities participated. Physical activity was assessed using a Digiwalker 200-SW pedometer worn for seven consecutive days. Teachers provided an estimate of general academic performance, and children were categorized into three performance groups (high, moderate, low). School behavior (attentiveness, staying on task, interruptive behavior) was assessed by the …


Environmental Justice And Community-Based Participatory Research In Texas Borderland Colonias, Adelita G. Cantu, Margaret A. Graham, Ann V. Millard, Isidore Flores, Meaghan K. Mugleston, Iris Y. Reyes, Ester C. Carbajal Mar 2015

Environmental Justice And Community-Based Participatory Research In Texas Borderland Colonias, Adelita G. Cantu, Margaret A. Graham, Ann V. Millard, Isidore Flores, Meaghan K. Mugleston, Iris Y. Reyes, Ester C. Carbajal

Anthropology Faculty Publications

Objective

An innovative academic-community partnership studied daily decisions in communities of mostly Spanish-speaking, low-income residents of colonias in Hidalgo County, TX, about risk of exposure to fish contaminated by PCBs at an Environment Protection Agency (EPA) Superfund site.

Design and Sample

The team used focus group interviews with colonia residents and content analysis to assess knowledge of risk related to the Superfund site, the Donna Reservoir and Canal System.

Results

(1) many lacked knowledge of the Superfund site contamination; (2) a few participants fished at the lake, knew people who did so, and consumed the catch, but most participants feared …


Puppets On A String? How Young Adolescents Explore Gender And Health In Advertising, Deborah L. Begoray, Elizabeth M. Banister, Joan Wharf Higgins, Robin Wilmot Mar 2015

Puppets On A String? How Young Adolescents Explore Gender And Health In Advertising, Deborah L. Begoray, Elizabeth M. Banister, Joan Wharf Higgins, Robin Wilmot

Journal of Media Literacy Education

This article presents qualitative research on young adolescents’ abilities in communicating and evaluating health messages in advertising especially how they understand and create gendered identities. A group of grade 6-8 students learned about media techniques and movie making. In groups divided by gender, they created iMovie advertisements for health activities in their school. They represented themselves in these advertisements by creating stick puppets. Observations during lessons, examination of movies and puppets, and interviews with students and their teacher revealed that young adolescents were neither completely manipulated by media nor were they completely in charge of their responses to media’s messages …


Prevalence Of Obesity And Estimated Medical And Work Loss Costs Attributable To High Bmi: The Baptist Health South Florida Employee Study, Khurram Nasir, Emir Veledar, Chukwuemeka Osondu, Ehimen Aneni, Oluseye Ogunmoroti, Sankalp Das, Maribeth Rouseff, Thinh Tran, Don Parris, Leah Holzwarth, Henry Guzman, Theodore Feldman, Michael Ozner, Jonathan Fialkow, Bernie Fernandez, Jack Ziffer, Arthur Agatston Mar 2015

Prevalence Of Obesity And Estimated Medical And Work Loss Costs Attributable To High Bmi: The Baptist Health South Florida Employee Study, Khurram Nasir, Emir Veledar, Chukwuemeka Osondu, Ehimen Aneni, Oluseye Ogunmoroti, Sankalp Das, Maribeth Rouseff, Thinh Tran, Don Parris, Leah Holzwarth, Henry Guzman, Theodore Feldman, Michael Ozner, Jonathan Fialkow, Bernie Fernandez, Jack Ziffer, Arthur Agatston

All Publications

No abstract provided.


Early Childhood Overweight And Obesity In Multigenerational Households, Chelsea O. Mckinney Mar 2015

Early Childhood Overweight And Obesity In Multigenerational Households, Chelsea O. Mckinney

GrandFamilies: The Contemporary Journal of Research, Practice and Policy

This study investigates grandmothers’ role in the health of their grandchildren. The relationship between child weight status from ages three to nine and grandmothers’ coresidence up to age nine is examined using data from The Fragile Families and Wellbeing Study, a large nationally representative dataset of urban low-income families in the United States. Logistic regression estimates the association between grandmother coresidence and child unhealthy weight status. Analyses adjust for child and mother characteristics, culture, race/ethnicity, SES, parenting practices, and built environment. Children who have ever lived with a grandmother by age three are at increased odds of unhealthy weight at …


Obesity And Metabolic Phenotypes (Metabolically Healthy And Unhealthy Variants) Are Significantly Associated With Prevalence Of Elevated C-Reactive Protein And Hepatic Steatosis In A Large Healthy Brazilian Population, Sameer Shaharyar, Lara Roberson, Omar Jamal, Adnan Younus, Shozab Ali, Arthur Agatston, Khurram Nasir Baptist Health Medical Group Mar 2015

Obesity And Metabolic Phenotypes (Metabolically Healthy And Unhealthy Variants) Are Significantly Associated With Prevalence Of Elevated C-Reactive Protein And Hepatic Steatosis In A Large Healthy Brazilian Population, Sameer Shaharyar, Lara Roberson, Omar Jamal, Adnan Younus, Shozab Ali, Arthur Agatston, Khurram Nasir Baptist Health Medical Group

All Publications

BACKGROUND:Among the obese, the so-called metabolically healthy obese (MHO) phenotype is thought to confer a lower CVD risk as compared to obesity with typical associated metabolic changes. The present study aims to determine the relationship of different subtypes of obesity with inflammatory-cardiometabolic abnormalities.METHODS:We evaluated 5,519 healthy, Brazilian subjects (43 ± 10 years, 78% males), free of known cardiovascular disease. Those with (MRF) were considered metabolically healthy, and those with BMI ≥ 25 kg/m(2) and/or waist circumference meeting NCEP criteria for metabolic syndrome as overweight/obese (OW). High sensitivity C reactive protein (hsCRP) was measured to assess underlying inflammation and hepatic steatosis …


Identifying Individual Risk Factors And Documenting The Pattern Of Heat-Related Illness Through Analyses Of Hospitalization And Patterns Of Household Cooling, Michael T. Schmeltz, Grace Sembajwe, Peter J. Marcotullio, Jean A. Grassman, David U. Himmelstein, Stephanie Woolhandler Mar 2015

Identifying Individual Risk Factors And Documenting The Pattern Of Heat-Related Illness Through Analyses Of Hospitalization And Patterns Of Household Cooling, Michael T. Schmeltz, Grace Sembajwe, Peter J. Marcotullio, Jean A. Grassman, David U. Himmelstein, Stephanie Woolhandler

Publications and Research

Background
As climate change increases the frequency and intensity of extreme heat events researchers and public health officials must work towards understanding the causes and outcomes of heat-related morbidity and mortality. While there have been many studies on both heatrelated illness (HRI), there are fewer on heat-related morbidity than on heatrelated mortality.

Objective
To identify individual and environmental risk factors for hospitalizations and document patterns of household cooling.

Methods
We performed a pooled cross-sectional analysis of secondary U.S. data, the Nationwide Inpatient Sample. Risk ratios were calculated from multivariable models to identify risk factors for hospitalizations. Hierarchical modeling was also …


Choices: A Family-Based Childhood Obesity Intervention For Low Income Minority Children, Cynthia Williams Brown, Claudia Warren, Marian Booker Mar 2015

Choices: A Family-Based Childhood Obesity Intervention For Low Income Minority Children, Cynthia Williams Brown, Claudia Warren, Marian Booker

National Youth Advocacy & Resilience Conference

The objective of this presentation is to discuss the effectiveness of a 6-week summer childhood obesity intervention for low-income minority children ages 10-12. Topics will include strategies and best practices for effective summer programming for youth. The target audience includes practitioners, educators, and researchers interested in childhood obesity interventions involving families and communities.


Becoming Baby-Friendly, Harvard Law School Mississippi Delta Project Mar 2015

Becoming Baby-Friendly, Harvard Law School Mississippi Delta Project

Delta Directions: Publications

This report is written in collaboration with the Mississippi State Health Department’s Office of Preventative Health in order to assist them in their mission to increase breastfeeding rates in the state of Mississippi. The health department has received a grant from the Center for Disease Control and Prevention, in order to increase breastfeeding rates in the state of Mississippi through the use of the Baby-Friendly Hospital model. The Baby-Friendly Hospital Initiative is an initiative created by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage hospitals to promote and become a supportive environment for breastfeeding.3 …


Perceived Barriers To Utilizing Maternal And Neonatal Health Services In Contracted-Out Versus Government-Managed Health Facilities In The Rural Districts Of Pakistan, Atif Riaz, Shehla Zaidi, Asif Raza Khowaja Mar 2015

Perceived Barriers To Utilizing Maternal And Neonatal Health Services In Contracted-Out Versus Government-Managed Health Facilities In The Rural Districts Of Pakistan, Atif Riaz, Shehla Zaidi, Asif Raza Khowaja

Community Health Sciences

Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users’ perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted).

Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two …


Patterns And Predictors Of Local Health Department Accreditation In Missouri, Kate E. Beatty, Jeffrey Mayer, Michael Elliott, Ross C. Brownson, Safina Abdulloeva, Kathleen Wojciehowski Mar 2015

Patterns And Predictors Of Local Health Department Accreditation In Missouri, Kate E. Beatty, Jeffrey Mayer, Michael Elliott, Ross C. Brownson, Safina Abdulloeva, Kathleen Wojciehowski

ETSU Faculty Works

Background: The Healthy People 2020 goal for the public health system is “to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services.” To address this goal, Missouri established the first statewide, voluntary accreditation program of local health departments (LHDs) and began accrediting the LHDs in 2003. The purpose of this study was to identify organizational, structural, and workforce factors related to accreditation status of LHDs in Missouri.

Methods: Using data from the National Association of County & City Health Officials (2010) and the Missouri Department of Health …