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Designing The Primary Care Assessment Tool For Physician Performance Tracking In Indonesia; A Program Planning, Donni -. Hendrawan Don

Public Health Theses

Designing the Primary Care Assessment Tool for Physician Performance Tracking in Indonesia;

A Program Planning

Primary care within the Indonesia health care system is key to maintain health of Indonesians. To ensure its function, it is very important to know how Indonesian primary care providers are meeting minimal standards of performance based on key health indicators. This can be measured by using the transcultural adapted tool known as Primary Care Assessment Tool (PCAT). The focus of this capstone is to design a program plan to establish a culturally-sensitive PCAT tool for use in Indonesia. The program plan will include an …

An Evaluation Of Pregnancy-Associated Morbidity Among Georgia's Usda Designated Food Deserts, 2009-2010, Yonte Burnam, Dajun Dai, Lisa Casanova

Public Health Theses

Objective: To assess the affect of pregnant women residing in a USDA designated food desert on the development of pregnancy-associated morbidities

Results: Living in a USDA food desert is not significantly associated with the development of pregnancy-associated morbidity [OR=0.973; CI: 0.835-1.134; p-value=0.728]. Backward stepwise regression showed all proposed potential confounders were significantly associated with the development of pregnancy-associated morbidity. These potential confounders include maternal age, regular exercise routine or previous diagnosis of diabetes or hypertension (p-values < 0.02).

Conclusion: Residing in a USDA designated food desert is not associated with the development of pregnancy-related morbidity. This analysis suggests other sociodemographic risk factors, …

Investigating The Health Profile And Quality Of Life Of Adult Marijuana Users In The United States: Analysis Of Self-Reported Nhanes 2007-2010 Data, Crystal A. Lane

Public Health Theses

Background: Marijuana is the most widely used illicit substance in the United States. Public approval of marijuana has driven its legalization in twenty states and the District of Columbia for medical use; and, this year alone (2013), two states have legalized recreational use of the drug. Despite the nation’s growing trend towards marijuana acceptance, the evidence regarding the health effects of its use remains vague. This study was designed to evaluate the health profile of marijuana users by determining the association of marijuana use with quality of life, defined in terms of perceived overall health and as self-reported medical conditions. …

Trends In Vibriosis Transmission Among The Top Four Vibrio Species, United States, 1988-2012, Amanda Conrad

Public Health Theses

Background

Vibrio infection (vibriosis) results from consuming contaminated seafood or exposing skin directly to marine waters or raw seafood. The Centers for Disease Control and Prevention (CDC) estimates that 80,000 illnesses occur each year in the United States. Four species, V. parahaemolyticus, V. vulnificus, V. alginolyticus, and V. cholerae (excluding toxigenic O1 and O139), are responsible for most cases. Understanding foodborne and non-foodborne transmission routes is important for describing epidemiological trends and for directing prevention efforts.

Methods

Demographic, clinical, and epidemiological data for cases reported between 1988 and 2012 were extracted from CDC’s Cholera and Other Vibrio …

Introducing An Innovative Brain And Spinal Cord Injury Prevention Curriculum To Adolescents: Evaluation Results, Sandy K. Templeton

Public Health Theses

ABSTRACT

SANDY TEMPLETON

Introducing an Innovative Brain and Spinal Cord Injury Prevention Curriculum to Adolescents: Evaluation Results

(Under the direction of Sheryl Strasser, Ph.D.)

Introduction

In the U.S., injuries account for over half of all deaths among persons age 1-44 which is more deaths than non-communicable and infectious diseases combined. Adolescents and males are disproportionately affected.

Objective

The aim of this study was to evaluate the effectiveness of an injury prevention curriculum for adolescents.

Methods

A curriculum employing indirect instructional strategies was implemented with 7th graders in four local middle schools in Cobb County, Georgia. A 45-item test assessing 6 …

Mic Distributions And Epidemiological Cut-Off Values For Azithromycin In Neisseria Gonorrhoeae As Determined By Agar Dilution, Kathryn A. Lupoli

Public Health Theses

Background: Clinical breakpoints and epidemiological cut-off values for N. gonorrhoeae azithromycin antimicrobial susceptibility testing have not been established. This study utilized existing minimum inhibitory concentration (MIC) data from CDC’s Gonococcal Isolate Surveillance Project (GISP) to establish epidemiological cut-off values for azithromycin and N. gonorrhoeae as determined by agar dilution.

Methods: MIC distributions for the pooled dataset and each data year (2005-2012) were constructed. Epidemiological cut-off values were calculated using two methods. Method 1 considers the wild-type MIC distribution, the modal MIC for the distribution, and the inherent variability of the test (±1 twofold-dilution). Method 2 defines the epidemiological …

Evaluation Of The Risk Factors For Antibiotic Resistance In Streptococcus Pneumoniae Cases In Georgia, Bethany Laclair

Public Health Theses

Introduction: Streptococcus pneumoniae is the main bacterial cause of pneumonia, bacteremia and meningitis. Incidence rates have decreased since the initiation of pneumococcal vaccines, but antibiotic resistant strains continue to emerge and place a heavy burden on healthcare systems to treat such serious resistant infections. This study looks at risk factors that increase a patients probability of contracting a drug resistant strain of S. pneumo.

Methods: Confirmed cases of S. pneumo were acquired through the Active Bacterial Core Surveillance program from 2009-2012 for the state of Georgia. Cumulative incidence rates, odds ratios and Pearson’s chi square were calculated to test …

Systematic Review Of Infection Prevention And Control Policies And Nosocomial Transmission Of Drug-Resistant Tuberculosis, Aida Estebesova

Public Health Theses

Emerging multidrug-resistant tuberculosis (MDR/XDR-TB) has become a major public health problem, placing millions at risk. Further, nosocomial transmission of MDR/XDR-TB places both patients and healthcare workers at an even higher risk. Effective tuberculosis (TB) infection prevention and control (IPC) policies in high-risk settings must use evidence-based science and should be customized to the setting. However, the growing incidence of MDR/XDR-TB in some global settings raises questions about whether adequate healthcare-related TB IPC policies are in place and whether they are implemented effectively. The purpose of this systematic literature review was to catalogue healthcare-related TB IPC policy research conducted in high-prevalence …

Rotavirus Vaccination Rate Disparities Seen Among Infants With Acute Gastroenteritis (Age), Trisha Chan

Public Health Theses

Background: Rotavirus is one of the most common diarrheal diseases in children less than 5 years of age. Rotavirus vaccines have greatly reduced this burden in the United States. An examination was conducted to determine possible disparities in RV vaccination rates compared to DTaP.

Methods: Children were actively enrolled during two rotavirus seasons from January-June of 2010 and 2011 in the Emergency Departments (ED) and inpatient floors from all Children's Healthcare of Atlanta (CHOA) sites (Scottish Rite, Egleston, and Hughes Spalding) with acute gastroenteritis (AGE). Data and a stool sample were collected from enrolled children and samples were tested for …

Racial /Ethnic Differences Metabolic Profiles Of American Women Diagnosed Diabetes Mellitus, Nta E. Henshaw Md

Public Health Theses

ABSTRACT

Background: Evidence suggests that gestational diabetes mellitus (GDM) is associated with various metabolic conditions including elevated cholesterol, low HDL, elevated LDL, elevated triglycerides and obesity. However, comparative data on the association between GDM and various metabolic conditions across racial/ethnic groups are rare. This study focuses on differences in metabolic profiles among pregnant Non-Hispanic (NH) Whites, NH-Blacks, Mexican-Americans and women of other races/ethnicities with prediabetes and diabetes.

Method: Available data from the 1999 to 2010 survey waves of the National Health and Nutrition Examination Survey (NHANES) was used for this study. NHANES uses a stratified multistage probability sample of the …

A Common Monitoring & Evaluation Framework Guided By The Collective Impact Model: Recommendations To Enhance The Tobacco Control Effort In Sub-Saharan Africa, Meenu Anand

Public Health Theses

Background: Tobacco use is one of the most ubiquitous causes of death and disability worldwide. In sub-Saharan Africa, despite the rising trend the use of tobacco in generally low among adults - less than 10% in men and around 2% in women. As a result the region is viewed as being in the early stages of the four stage tobacco epidemic model. Projections suggest that the tobacco epidemic, if unchecked, can peak in Sub-Saharan Africa in the middle of this century. This offers the public health community an extraordinary opportunity – not only is the epidemic predicted so far …

An Analysis Of Selected Predictive Factors Associated With Adolescent Hpv Vaccination Initiation And Completion Rates In The United States: 2011 National Immunization Survey - Teen, Kristen Oliver

Public Health Theses

Background

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, and adolescents have the highest incidence. To decrease the burden of HPV and HPV-associated cancers, two vaccines were developed and require a 3 dose series. This study assesses factors that may predict whether a teen will either initiate or complete the vaccine series.

Methods

National Immunization Survey -Teen 2011 data was used to assess demographic (age, sex, and race/ethnicity) and socioeconomic (poverty and insurance status) factors as they related to vaccine initiation and completion. Bivariate and multivariate analyses were used to determine strength of association. …

Hiv In African American Women: Evidence That Elevated Rate Of Infection Cannot Be Explained Solely On The Basis Of Known Individual Risk Behaviors., Bermann Francois

Public Health Theses

Objective: To compare known individual risk behaviors in African American, Whites, and Hispanic women as found in the literature and support those findings by analyzing data available through NHANES in order to find out if the higher rate of HIV infection in African American women is a direct result of higher risk behaviors. Those risk behaviors include lower rates of condom use, higher rates of drug use including those taken intravenously, higher rates of risky sex habits, higher number of sexual partners over their lifetime, and a more extensive history of sexually transmitted infections. This study also aims to …

A Systematic Review Of Health Literacy Interventions And Policies And The Effect On The Health Outcomes Of Limited English Proficient (Lep) Patients, Melissa T. Duong

Public Health Theses

Limited English Proficient (LEP) patients are subject to low patient health outcomes due to limited health literacy. Cultural and linguistic barriers prohibit the obtainment and comprehension of health information and services. This systematic review will present the complications of healthcare experienced by LEP patients and will provide an analysis of interventions and policies that will be a gateway to better health outcomes for the LEP patient population.

Examining The Effects Of A Motion Comic Intervention On Hiv-Stigma Among A Sample Of Adolescent Men Who Have Sex With Men, Kristen M. Nichols

Public Health Theses

INTRODUCTION: HIV disproportionately affects African Americans, Latinos, and gay and bisexual men of all racial and ethnicity groups. People living with HIV/AIDS experience stigma related to their disease. HIV/AIDS stigma can have detrimental effects on HIV prevention, testing and treatment. Entertainment-education is a health communication strategy that can be used to influence behavioral and social change in the population.

AIM: The purpose of this study is to evaluate whether a Motion Comic intervention, an EE strategy, can decrease H/A stigma in a sample of MSM adolescents aged 15-24.

METHODS: Participants were recruited from GA, FL, NY and CA using convenience …

Income Payment Structure And Its Influence On Food Security And Fruit Consumption, Shelley M. Mays

Public Health Theses

Background: Despite the growing evidence of the positive effects of fruit consumption on health, many individuals do not consume the recommended dietary guideline amounts. It has been suggested that socioeconomic status and income have an influence on food choices and consumption. The aim of this study is not only to examine whether payment structure has an association with food choices but also to assess fruit consumption independent of vegetables in the US.

Methods: The 2011 Behavioral Risk Factor Surveillance System was utilized and the study design led to a sample size that was n= 19,122 respondents. Variables that were selected …

Intimate Partner Violence Prevention In Africa: What Has Been Done And What Still Needs To Be Done, Melissa Cyril

Public Health Theses

Intimate partner violence (IPV) is defined as any violent or ill intended behavior that could cause harm to the other person within the confines of an intimate relationship. IPV has very serious consequences for the individual, the community, and the larger society. Much of what is known about IPV comes from studies conducted in the U.S. or other Western countries. However, women who live in developing countries have an increased risk of experiencing IPV because of poor living conditions and different social norms. Yet, little is known about specific risk factors and intervention approaches for IPV conducted in developing countries. …

A Comparison Of Health Care Reform In Taiwan, China, And United States, Nai-Wen Chang, Nai-Wen Chang

Public Health Theses

Health care reform is important in order to modify health care systems so that they operate more efficiently. There are various studies that compare the reforms of different countries to understand how these countries adjust their systems. This capstone introduces the health care system in Taiwan, China, and the United States, discusses the challenges they meet, and offers a comparison of recent reforms.

The health care systems are introduced through three sections: collection of funds, pooling of funds and purchasing of services, and providing of services and exemptions. All three countries face the financing burden of health expenditure. To offer …

Cannabis Use And Its Health Consequences In Afghanistan: Implication For Intervention And Prevention, Mohammad Ajmal Yasin

Public Health Theses

Cannabis is the most widely used illicit drug, worldwide and also in Afghanistan. According to United Nation Office for Drug and crime (UNODC) Afghanistan Cannabis survey (2009), more than half of all drug users interviewed in Afghanistan had used cannabis in their life time. In this survey around 630,000 people, mostly men, were documented as cannabis users. On the other hand, cannabis life time use amongst regular female drug user was 40%. The annual prevalence of cannabis use was 8.1 percent in male and 0.2 percent in female populations (UNODC Afghanistan Cannabis survey 2009). In Afghanistan cannabis is most commonly …

Factors Associated With Hiv Among Heterosexual African American Adults Aged 50 Years And Older In Ten Zip Codes Of Atlanta, Georgia, 2005-2011, Grace Marriott

Public Health Theses

INTRODUCTION: The fastest growing segment of the U.S. population is among individuals aged 50 and older. However, advanced age is not protective against HIV.

AIM: The purpose of this study is to examine individual characteristics (gender, age, education) as well as environmental and behavioral factors (doctor visits and IDU) that may be linked with HIV status among older heterosexual African American adults. The factors associated with HIV status that were examined include education level, IDU within the last six months, non-injected drugs that were used within the last six months and the length of time since the last doctor visit. …

Preventing Post - Treatment Relapse Among African American Adolescents And Young Adult Marijuana Users Through Effective Treatment Interventions: A Proposed Intervention For Metro-Atlanta, Charlotte E. Robinson Ms

Public Health Theses

INTRODUCTION: Marijuana use, although illegal in the majority of states, is increasingly becoming acceptable for use in the United States. There are dangerous public health consequences associated with marijuana use—including: impaired driving, loss of productivity in workplaces and school settings, as well as mental health impacts. In Atlanta, the majority of residents (54.0%) are African American. Emergency room use is double for African American Fulton County residents compared to their Caucasian counterparts and approximately 1/5 of the total population receiving public health treatment identify marijuana as the primary drug of use, with 57% of those being African Americans. Despite these …

An Examination Of Parental Skill Acquisition Resulting From A State-Wide Dissemination Of Safecare®, Erin A. Mcfry Ms.

Public Health Theses

Family level data was collected from those served in a state-wide rollout of SafeCare® in Georgia between January of 2010 and November of 2011. Families who received SafeCare were trained in the intervention’s three modules: Parent-Child or Parent-Infant Interaction, Home Safety, and Child Health. The purpose of this study was to measure changes in parental skill demonstration by analyzing pre- and post-training assessments. Additionally, parental demographic characteristics were also assessed for associations with skill acquisition within each module. Follow-up analysis concluded that families displayed increases in parenting skills among all SafeCare modules. Moderator analysis showed that those with only one …

Calcium Intake Patterns In Association With Demographic And Socioeconomic Factors In Us Population 2-69 Years Of Age: A Cross-Sectional Study, Farah Raoof

Public Health Theses

Background: Calcium is important to various aspects of health and is necessary for life. Inadequate calcium intake has serious consequence on health, such as osteoporosis, impaired muscle and nerve functions and obesity. Similarly, excessive intake is associated with cardiovascular risks and urinary tract stone formation. Therefore a balanced calcium intake is of utmost importance especially knowing that maximum calcium storage potential in bones is reached roughly in late 20s of age and starts gradually declining thereafter.

Objective: The objective of this study is to explore calcium intake patterns in the United States population in association with a number of selected …

Risk Of Asthma Due To Obesity Among American Children: An Examination Of Nhanes Data Regarding Childhood Obesity And Asthma, Oluwole Theophilus Sanni

Public Health Theses

ABSTRACT

Background: Obesity and asthma are significant public health problems and epidemics among children. From 1980 to 1994 the prevalence of self reported asthma in children increased 75% while the prevalence of childhood obesity increased by 100%. Studies have demonstrated a complex, but poorly understood association between obesity and childhood asthma. This study further examines the relationship between obesity and asthma in children and adolescents.

Methods: Using secondary data from National Health and Nutrition Examination Survey NHANES 2005-2006, univariate analysis was used to examine the association between obesity and selected independent variables and current asthma status. Multivariate analysis was also …

Tobacco-Free Georgia State University: A Case Study, Jason A. Plemmons Mr.

Public Health Theses

Introduction: According to the CDC (2008), tobacco-related deaths out number deaths from alcohol use, motor vehicle injuries, suicides, murders, human immunodeficiency virus (HIV), and illegal drug use. One out of every five deaths in the United States can be attributed to tobacco, culminating in a staggering 443,000 deaths in the US every year. Smoking is also the leading preventable cause of death in America (CDC, 2008).

In 2006, the Surgeon General’s Report speaks to not only the detrimental effects of smoking, but also the harmful effects second hand smoke can have on an individual’s health.

Furthermore, the Centers for Disease …

Tobacco Smoke And Asthma Among Adults At The National And State Levels: Do Smoke-Free Laws And Regulations Affect Smoking Rate Among Those With Asthma?, Mariam Ibrahim

Public Health Theses

ABSTRACT

Background: Asthma is a chronic lung disease that inflames and narrows the airways. This results in recurrent episodes of coughing, wheezing, shortness of breath, and chest tightness. Although the causes of asthma are poorly understood, genetic and environmental factors have been implicated in the development and exacerbation of the disease. Among environmental risk factors, cigarette smoke is a well-known risk factor to trigger asthma symptoms. Exposure to secondhand smoke irritates the airways and may trigger an attack in adults with asthma. Smoke-free laws and regulations in the United States differ by state. The enforcement of smoke-free legislation has …

Trends In Bicycling Attitudes, Knowledge And Behavior At An Urban University, Marian Maddox

Public Health Theses

BACKGROUND: Active transportation, such as using a bicycle to get one from one place to another, has definite benefits over driving or some other form of travel that requires less exertion; the most obvious of these is that it helps a person meet the daily recommendations for physical activity. College campuses tend to have higher rates of bicycle-commuters than non-campus environments, although Georgia State University faces unique barriers to bicycling due to its downtown location. In 2009, a cross-sectional study was conducted to assess bicycling attitudes, knowledge, and behaviors. In the two years that followed, a faculty-student collaborative known as …

Evaluation Of Existing Components Of The Ten Steps Of The Baby Friendly Hospital Initiative In Unaccredited Hospitals In The City Of Atlanta, Kaci Megan Galyon

Public Health Theses

Background: Breastfeeding is a tremendously important public health topic. Breastfeeding is associated with a myriad of health benefits on nearly all levels within the social ecological model (infants, mothers, families, workplaces, communities and societies). Scientific evidence supports that breastfeeding is associated with decreased obesity and other very costly health conditions that occur across the lifespan. The World Health Organization published 10 guidelines that comprise the Baby Friendly Hospital Initiative [BFHI] standards—which identify birthing facility-level elements that are associated with enhanced breastfeeding adoption rates.

Methods: The purpose of this study was to determine the extent to which birthing facilities in Atlanta …

A County-Level Analysis Of The Relationship Between Voter Behavior As A Proxy For Partisan Ideology, Income, And The Effects On Health Morbidity And Mortality Measures, Sarah M. Trimmer

Public Health Theses

Introduction: Domestic research studies focused on the interrelationships between political ideology characteristics inherent in policy decisions and the contributions these political determinants exert over health indicators and outcomes are limited. Given the paucity of research that focuses on political and policy support of health at the county-level, this study sets out to utilize the University of Wisconsin Population Health Institute’s (UWPHI) annual County Health Rankings data and examine them within the context of county-based majority political partisanship and economic measures. Methods: This exploratory ecological study examined differences between independent variables: partisan voting behavior (trichotomized as conservative, moderate, and liberal) and …

An Examination Of The Risk Factors Associated With Asthma Prevalence Among A Sample Of Displaced Public Housing Residents In Atlanta, Ga., Matt C. Jackson

Public Health Theses

Background: Asthma is a chronic illness that affects people of all age groups. Approximately 12% and 9% of children and adults, respectively, have asthma in Georgia. Asthma affects groups of people differently, with African Americans being twice as likely to be hospitalized for asthma. Hospitalizations related to asthma cost Georgians over $100 million dollars. The symptoms of coughing and wheezing can have a detrimental effect on the productivity of the asthmatic as well as lead to exorbitant medical costs for the asthmatic. This study examines the associations between known risk factors and asthma prevalence in a displaced housing population in …