Medicine and Health Sciences Commons^™

Safe, Supportive Neighborhoods: Are They Associated With Childhood Oral Health?, Elizabeth L. Crouch, Joni Nelson, Radhika Ranganathan, Melinda A. Merrell, Amy Martin

Faculty Publications

Objective

There has been limited examination of how community-level supports may influence oral health metrics among children. The purpose of our study is to examine the association between two types of community-level positive childhood experiences and oral healthcare and oral health outcomes among children ages 6 to 17 years of age.

Methods

This study uses a cross-sectional data set from the 2018–2019 National Survey of Children's Health. Two oral health metrics were used: preventive dental care, measured as one or more preventive dental visits in the past 12 months, and tooth decay, measured as tooth decay or cavities in the …

Examining The Association Between Rurality And Positive Childhood Experiences Among A National Sample, Elizabeth L. Crouch Ph.D., Janice C. Probst Ph.D., Sylvia Shi, Alexander C. Mclain Ph.D., Jan M. Eberth Ph.D., Monique J. Brown Ph.D., Melinda A. Merrell, Kevin J. Bennett

Faculty Publications

Purpose

The present study examines the association between rurality and positive childhood experiences (PCEs) among children and adolescents across all 50 states and the District of Columbia. Recent work has quantified the prevalence of PCEs at the national level, but these studies have been based on public use data files, which lack rurality information for 19 states.

Methods

Data for this cross-sectional analysis were drawn from 2016 to 2018 National Survey of Children's Health (NSCH), using the full data set with restricted geographic data (n = 63,000). Descriptive statistics and bivariate analyses were used to calculate proportions and unadjusted associations. …

Correlates Of Zero-Dose Vaccination Status Among Children Aged 12-59 Months In Sub-Saharan Africa: A Multilevel Analysis Of Individual And Contextual Factors, Chamberline Ozigbu, Bankole Olatosi, Zhenlong Li, James W. Hardin, Nicole L. Hair

Faculty Publications

Despite ongoing efforts to improve childhood vaccination coverage, including in hard-to-reach and hard-to-vaccinate communities, many children in sub-Saharan Africa (SSA) remain unvaccinated. Considering recent goals set by the Immunization Agenda 2030 (IA2030), including reducing the number of zero-dose children by half, research that goes beyond coverage to identify populations and groups at greater risk of being unvaccinated is urgently needed. This is a pooled cross-sectional study of individual- and country-level data obtained from Demographic and Health Surveys Program and two open data repositories. The sample includes 43,131 children aged 12–59 months sampled between 2010 and 2020 in 33 SSA countries. …

The Problem Of The Color Line: Spatial Access To Hospital Services For Minoritized Racial And Ethnic Groups, Jan M. Eberth, Pelvin Hung, Gabriel A. Benavidez, Janice Probst, Whitney E. Zahnd, Mary-Katherine Mcnatt, Ebony Toussaint, Melinda A. Merrell, Elizabeth L. Crouch

Faculty Publications

Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being …

Temporal Geospatial Analysis Of Covid-19 Pre-Infection Determinants Of Risk In South Carolina, Tianchu Lyu, Nicole L. Hair, Nicholas Yell, Zhenlong Li, Shan Qiao, Chen Liang, Xiaoming Li

Faculty Publications

Disparities and their geospatial patterns exist in morbidity and mortality of COVID-19 patients. When it comes to the infection rate, there is a dearth of research with respect to the disparity structure, its geospatial characteristics, and the pre-infection determinants of risk (PIDRs). This work aimed to assess the temporal–geospatial associations between PIDRs and COVID-19 infection at the county level in South Carolina. We used the spatial error model (SEM), spatial lag model (SLM), and conditional autoregressive model (CAR) as global models and the geographically weighted regression model (GWR) as a local model. The data were retrieved from multiple sources including …

Spatial-Temporal Relationship Between Population Mobility And Covid-19 Outbreaks In South Carolina: Time Series Forecasting Analysis, Chengbo Zeng, Jiajia Zhang Ph.D., Zhenlong Li Ph.D., Xiaowen Sun, Bankole Olatosi Ph.D., Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Background: Population mobility is closely associated with COVID-19 transmission, and it could be used as a proximal indicator to predict future outbreaks, which could inform proactive nonpharmaceutical interventions for disease control. South Carolina is one of the US states that reopened early, following which it experienced a sharp increase in COVID-19 cases.

Objective: The aims of this study are to examine the spatial-temporal relationship between population mobility and COVID-19 outbreaks and use population mobility data to predict daily new cases at both the state and county level in South Carolina.

Methods: This longitudinal study used disease surveillance …

The Intersection Of Rural Residence And Minority Race/Ethnicity In Cancer Disparities In The United States, Whitney E. Zhand, Cathryn Murphy, Marie Knoll, Gabriel A. Benavidez, Kelsey R. Day, Radhika Ranganathan, Parthenia Luke, Anja Zgodic, Kewei Shi, Melinda A. Merrell, Elizabeth L. Crouch, Heather M. Brandt, Jan M. Eberth

Faculty Publications

One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There …

Parental Concerns And Uptake Of Childhood Vaccines In Rural Tanzania – A Mixed Methods Study, Lavanya Vasudevan, Joy Noel Baumgartner, Sara Moses, Esther Ngadaya, Sayoki Godfrey Mfinanga, Jan Ostermann

Faculty Publications

Background

Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania.

Methods

Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. …

Elementary Classroom Teachers’ Self-Reported Use Of Movement Integration Products And Perceived Facilitators And Barriers Related To Product Use, Roddrick Dugger, Aaron Rafferty, Ethan Hunt, Michael W. Beets, Collin Andrew Webster, Brian Chen, Jeffrey Michael Rehling, Robert Glenn Weaver

Faculty Publications

Movement integration (MI) products are designed to provide children with physical activity during general education classroom time. The purpose of this study was to examine elementary classroom teachers’ self-reported use of MI products and subsequent perceptions of the facilitators of and barriers to MI product use. This study utilized a mixed-methods design. Elementary classroom teachers (n = 40) at four schools each tested four of six common MI products in their classroom for one week. Teachers completed a daily diary, documenting duration and frequency of product use. Following each product test, focus groups were conducted with teachers to assess facilitators …

Why Acute Ischemic Stroke Patients In The United States Use Or Do Not Use Emergency Medical Services Transport? Findings Of An Inpatient Survey, Sudha Xirasagar

Faculty Publications

Background Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS.

Methods During 2016–2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, …

Exploratory Qualitative Study To Understand The Underlying Motivations And Strategies Of The Private For-Profit Healthcare Sector In Urban Bangladesh, Alayne Mary Adams, Rushdia Ahmed, Tanzir Ahmed Shuvo, Sifat Shahana Yusuf, Sadika Akhter, Iqbal Anwar

Faculty Publications

Objectives This paper explores the underlying motivations and strategies of formal small and medium-sized formal private for-profit sector hospitals and clinics in urban Bangladesh and their implications for quality and access.

Methods This exploratory qualitative study was conducted in Dhaka, Sylhet and Khulna City Corporations. Data collection methods included key informant interviews (20) with government and private sector leaders, in-depth interviews (30) with clinic owners, managers and providers and exit interviews (30) with healthcare clients.

Results Profit generation is a driving force behind entry into the private healthcare business and the provision of services. However, non-financial motivations are also emphasised …

Digital Information Technology Use And Patient Preferences For Internet-Based Health Education Modalities: Cross-Sectional Survey Study Of Middle-Aged And Older Adults With Chronic Health Conditions, Nancy P. Gordon, Elizabeth L. Crouch

Faculty Publications

Background: Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education.

Objective: The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic …

High Medicaid Nursing Homes: Organizational And Market Factors Associated With Financial Performance, Robert Weech-Maldonado, Justin Lord, Rohit Pradhan, Ganisher Davlyatov, Neeraj Dayama, Shivani Gupta, Larry Hearld

Faculty Publications

High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services’ (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities …

Nursing Home Quality And Financial Performance: Is There A Business Case For Quality?, Robert Weech-Maldonado, Rohit Pradhan, Neeraj Dayama, Justin Lord, Shivani Gupta

Faculty Publications

This study examines the relationship between nursing home quality and financial performance to assess whether there is a business case for quality. Secondary data sources included the Online Survey Certification and Reporting (OSCAR), Certification and Survey Provider Enhanced Reporting (CASPER), Medicare Cost Reports, Minimum Data Set (MDS 2.0), Area Resource File (ARF), and LTCFocus for all free-standing, nongovernment nursing homes for 2000 to 2014. Data were analyzed using panel data linear regression with facility and year fixed effects. The dependent variable, financial performance, consisted of the operating margin. The independent variables comprised nursing home quality measures that capture the three …

Digital Information Technology Use And Patient Preferences For Internet-Based Health Education Modalities: Cross-Sectional Survey Study Of Middle-Aged And Older Adults With Chronic Health Conditions, Nancy P. Gordon, Elizabeth L. Crouch

Faculty Publications

Background: Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education.

Objective:The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic …

Prevalence And Factors Influencing Use Of Internet And Electronic Health Resources By Middle-Aged And Older Adults In A Us Health Plan Population: Cross-Sectional Survey Study, Elizabeth L. Crouch, Nancy P. Gordon

Faculty Publications

Background: Health care organizations are increasingly using electronic health (eHealth) platforms to provide and exchange health information and advice (HIA). There is limited information about how factors beyond internet access affect use of eHealth resources by middle-aged and older adults.

Objective: We aimed to estimate prevalence of use of the internet, health plan patient portal, and Web-based HIA among middle-aged and older adults; investigate whether similar sociodemographic-related disparities in eHealth resource use are found among middle-aged and older adults; and examine how sociodemographic and internet access factors drive disparities in eHealth resource use among adults who use the internet.

Methods: …

Socioeconomic Determinants Of Broadband Non-Adoption Among Consumer Households In South Carolina, Usa, Lori Dickes, Elizabeth L. Crouch, Thomas Walker

Faculty Publications

he policy environment around broadband technology in the United States is shifting again and there are concerns about the impact these proposed changes will have on the future of rural bro- adband deployment and access. Similar to the Obama administration’s discussion of net neutrality, reclas- sifying high-speed internet is again receiving growing media and policy attention at the federal and state level in the United States. Globally, it is argued that affordable high-speed internet access is imperative to rural and regional economic development success. The global digital divide and challenges of non-adoption impact both developing and developed nations. While many …

Evaluating Loss To Follow-Up In Newborn Hearing Screening In A Southern State, Elizabeth L. Crouch, Janice Probst, Kevin J. Bennett, Tara Carroll

Faculty Publications

Objective: The aim of this study was to examine loss to follow-up (LTFU) for diagnostic or early intervention (EI) services for South Carolina infants screened or diagnosed with hearing loss, and the risk factors associated with LTFU.

Design: A cross sectional analysis of data from South Carolina was used to examine LTFU for the use of audiologic evaluation services after initial newborn hearing screening and receipt of EI services after confirmation of hearing loss.

Results: Three percent (3.1%) of newborns screened in the state of South Carolina did not pass their hearing screening in 2013. Nearly half (49.1%) of those …

The Economic Impact Of Changing Water Levels: A Regional Economic Analysis Of Lake Thurmond, Rob Carey, Lori A. Dickes, Elizabeth L. Crouch

Faculty Publications

This article examines the economic impact of declining lake levels on the local economy in six counties near the publically managed Thurmond Reservoir, located along the border of Georgia and South Carolina. A regression analysis of the relationship between lake level elevations and lake front real estate transactions is used in conjunction with an input-output model to estimate the median monthly economic impact of a one-foot increase in lake level in terms of employment, output, disposable income, and net local government revenue on the six counties bordering the lake. Thurmond Lake elevations have a statistically significant impact on regional economic …

The Impact Of Changing Lake Levels On Property Values: A Hedonic Model Of Lake Thurmond, Lori Dickes, Elizabeth L. Crouch

Faculty Publications

This study uses hedonic pricing models to examine the relationship between lake levels and property values for properties adjacent to Lake Thurmond. Lake Thurmond is located along the Savannah River Basin, bordering Georgia and South Carolina. Of the 1,030 properties from 2000-2009 for which data was reliable and available, 388 were lake front homes. The model of the effect of lake level on sales prices also includes home characteristics, home condition variables, lake attributes, and macroeconomic control variables. Results reveal a statistically significant change in sales price when the lake is closer to full pool. Results confirm that declining Lake …

The Impact Of Changing Lake Levels On Property Values: A Hedonic Model Of Lake Thurmond, Lori Dickes, Elizabeth L. Crouch

Faculty Publications

This study uses hedonic pricing models to examine the relationship between lake levels and property values for properties adjacent to Lake Thurmond. Lake Thurmond is located along the Savannah River Basin, bordering Georgia and South Carolina. Of the 1,030 properties from 2000-2009 for which data was reliable and available, 388 were lake front homes. The model of the effect of lake level on sales prices also includes home characteristics, home condition variables, lake attributes, and macroeconomic control variables. Results reveal a statistically significant change in sales price when the lake is closer to full pool. Results confirm that declining Lake …

The Changing Role Of Physicians In Disaster Management And Hospital Incident Command, F. Matthew Mihelic, M. David Stockton, Stephen A. Cole, Gregory H. Blake

Faculty Publications

Recent changes in governmental policy toward disaster medicine and hospital incident command foreshadow a significant change in the role that physicians will play in disaster preparedness and response. The distinct discipline of Disaster Medicine has received authoritative recognition and promotion in the recent Homeland Security Presidential Directive 21, and recently established guidelines for incident command within hospitals have included a new position designated as “Medical/Technical Specialist(s)” that will assist the Incident Commander in disaster-related decision-making. This is a multidisciplinary position, and its functions can be filled by one or more individuals. As physician training and competency in Disaster Medicine increases, …