Medicine and Health Sciences Commons^™

Large-Scale Social And Behavior Change Communication Interventions Have Sustained Impacts On Infant And Young Child Feeding Knowledge And Practices: Results Of A 2-Year Follow-Up Study In Bangladesh, Sunny S. Kim, Phuong Hong Nguyen, Lan Mai Tran, Tina Sanghvi, Zeba Mahmud, Mohammad Raisul Haque, Kaosar Afsana, Edward A. Frongillo Jr., Marie T. Ruel, Purnima Menon

Faculty Publications

Background: Sustained improvements in infant and young child feeding (IYCF) require continued implementation of effective interventions. From 2010-2014, Alive & Thrive (A&T) provided intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM) in Bangladesh, demonstrating impact on IYCF practices. Since 2014, implementation has been continued and scaled up by national partners with support from other donors and with modifications such as added focus on maternal nutrition and reduced program intensity. Objective: We assessed changes in intervention exposure and IYCF knowledge and practices in the intensive (IPC + CM + MM) compared with nonintensive areas (standard nutrition counseling + …

Integrating Oral Health Into Social Marketing Campaigns: Program Development And Description For San Francisco Children’S Oral Health Strategic Plan, Carsen Bentley

Pacific Journal of Health

Integrating oral health into an existing San Francisco Department of Public Health (SFDPH) social marketing campaign was a specific goal of the San Francisco Children’s Oral Health Strategic Plan 2014-2017 with the purpose to more fully integrate oral health promotion into the City’s overall health promotion efforts. In the winter of 2015, utilizing a collaborative approach, oral health was successfully integrated in the Open Truth campaign, promoting decreased consumption of sugar sweetened beverages in order to improve health outcomes, including decreasing tooth decay.

The Early Steps Project: Occupational Therapy In A Pediatric Primary Care Setting, Anne H. Zachry, J. Flick, P. Richey

Faculty Presentations

The purpose of this study is expand on the Early STEPs project goal of identifying early developmental delays in infants and young children in a health disparate population and to collect preliminary data to lay the groundwork for a future NIH grant proposal. Individuals with less education have poor health and shorter life expectancies than well-educated individuals, and research reveals that poverty is directly related to limited education. An innovative approach is needed to overcome barriers, improve health literacy, and educate parents on effective parenting strategies for this population. Technology may be the part of the solution to this issue. …

Determining The Adoption And Implementation Of Nutrition Policies At Food Pantries Across The United States, Meagan Helmick

Theses & Dissertations

Food insecurity occurs when there is a lack of access to enough food to live an active, healthy life. Current efforts to address food insecurity include developing and implementing policies, programs, and practices at the federal, state, and local levels. Specifically, local efforts target decreasing food insecurity through emergency food networks including food banks and food pantries. Over the last several years, many food banks and food pantries have worked to improve the nutritional quality of the foods they offer. However, food pantries are smaller and less formal organizations than food banks. Thus, they have limited resources to develop and …

Creating A More Collaborative Tomorrow: Development Of A Patient Engagement Curriculum For A School Of Nursing And Health Professions, Alicia Digiammarino

Master's Projects and Capstones

Background: Healthcare has been moving steadily toward a patient-centered paradigm that seeks to involve patients more in their own care. Teaching communication skills to future health professionals can increase such patient participation. Despite the shift to patient-centered care, there is almost no training in patient engagement techniques provided to students at the University of San Francisco School of Nursing and Health Professions. Purpose: This project aimed to design and develop a sustainable patient engagement curriculum that meets the unique needs of faculty and students at the University. Methods: Interviews were conducted with eight faculty members to understand …

Study Protocol Of "Our Choice": A Randomized Controlled Trial Of The Integration Of Safer Conception Counseling To Transform Hiv Family Planning Services In Uganda., Kathy Goggin, Emily A. Hurley, Jolly Beyeza-Kashesya, Violet Gwokyalya, Sarah Finocchario-Kessler, Josephine Birungi, Deborah Mindry, Rhoda K Wanyenze, Glenn J Wagner

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: About 40% of HIV-positive women in sub-Saharan Africa become pregnant post-diagnosis. Despite about half of their pregnancies being planned, safer conception methods (SCM) are underutilized among serodiscordant couples, partially due to the fact that safer conception counseling (SCC) has not been integrated into routine HIV family planning (FP) services.

METHODS: Our Choice is a comprehensive FP intervention that promotes unbiased childbearing consultations to ensure clients receive SCC or contraception services to achieve their desired reproductive goals. The intervention is theoretically grounded and has demonstrated preliminarily feasibility and acceptance through pilot testing. This three-arm cluster randomized controlled trial compares two …

Attitudes Toward Evidence-Based Practice, Occupational Stress And Work-Related Social Support Among Health Care Providers In China: A Sem Analysis, Shan Qiao Ph.D., Xiaoming Li Ph.D., Yuejiao Zhou, Zhiyong Shen, Bonita Stanton

Faculty Publications

Individuals’ attitudes toward evidence-based practices (EBP) are critical in adopting, implementing and maintaining the EBP in clinical settings. Multiple empirical studies have examined how work context may shape perceptions and attitudes towards EBP. The current study aims to further explore how both work and family contexts, as assessed by three psychosocial indicators (i.e., occupational stress, work-related social support from coworkers, and work-related social support from family), may affect attitudes toward EBP among health care providers in HIV clinics in China. We analyzed cross-sectional survey data from 357 health care providers recruited from 40 HIV clinics across 16 cities/counties in Guangxi …

Prompts To Increase Physical Activity At Points-Of-Choice Between Stairs And Escalators: What About Escalator Climbers?, John Belletierre, Ben Nguyen, Sandy Liles, Vincent Berardi, Marc A. Adams, Paddy Dempsey, Yael Benporat, Jacqueline Kerr, Andrea Z. Lacroix, Melbourne Hovell

Psychology Faculty Articles and Research

Since 1980, many studies have evaluated whether stair-use prompts increased physical activity by quantifying changes in stair use. To more completely evaluate changes in physical activity, this study addressed the often-overlooked assessment of climbing up escalators by evaluating the degree to which stair-use sign prompts increased active ascent—defined as stair use or escalator climbing. Over 5 months, at an airport stairs/escalator point of choice, we video-recorded passersby (N = 13,544) who ascended either stairs or escalators, on 10 days with signs and 10 days without signs. Ascenders using the stairs, standing on the escalator, and climbing the escalator were …

Alternative Financial Services And Health Status In U.S. Metropolitan Statistical Areas, Courtney Hundley, Richard W. Wilson 8520196, John Chenault

Journal of Health Disparities Research and Practice

Abstract

Alternative financial services (AFS) such as, payday lenders, pawn brokers, tax refund loans, and check cashers are more prevalent in minority and lower income neighborhoods. These are neighborhoods also found to have disparities in health, compared to more affluent neighborhoods and communities. The focus of this paper is to determine if any relationship exists between use of AFS and health disparities.

Using data from a survey performed by the Federal Deposit Insurance Corporation (FDIC), we compared four banking variables to several measures of health for 85 metropolitan statistical areas (MSA) across the nation. The four banking variables all related …

Engagement Of Husbands In A Maternal Nutrition Program Substantially Contributed To Greater Intake Of Micronutrient Supplements And Dietary Diversity During Pregnancy: Results Of A Cluster-Randomized Program Evaluation In Bangladesh, Phuong Hong Nguyen, Edward A. Frongillo Jr., Tina Sanghvi, Gargi Wable, Zeba Mahmud, Lan Mai Tran, Bachera Aktar, Kaosar Afsana, Silvia Alayon, Marie T. Ruel, Purnima Menon

Faculty Publications

Background:

Although husbands may provide support during pregnancy, limited evidence exists on how to promote husbands' engagement and what impact it has. Alive & Thrive integrated nutrition-focused interventions, targeting both wives and husbands, through an existing Maternal, Neonatal, and Child Health (MNCH) platform in Bangladesh.

Objectives:

We evaluated 1) the impact of a nutrition-focused MNCH program, compared with the standard MNCH program, on husbands' behavioral determinants (i.e., awareness, knowledge, self-efficacy) and support to wives to adopt optimal nutrition practices and 2) how much of the previously documented impact on women's supplement intake and dietary diversity was explained by husbands' behavioral …

A Characterization Of The Medical-Legal Partnership (Mlp) Of Nebraska Medicine, Jordan Pieper

Capstone Experience: Master of Public Health

This research study was completed at Legal Aid of Nebraska’s Health, Education, and Law Project through the partnership it has formed working with Nebraska Medicine and Iowa Legal Aid. Traditionally, health and disease have always been viewed exclusively as "healthcare" issues. But with healthcare consistently growing towards holistic approaches to help patients, we now know there are deeper, structural conditions of society that can act as strong driving forces of a person's poor daily living conditions that can negatively impact health. The importance of a Medical-Legal Partnership is that it considers a patient's social determinants of health (SDHs). The goal …

Rape Prevention And Education: Finding What Works, Mina White, Francisco Michel, Sabrina Boyce, Ruvani Fonseka, Ricardo Vera-Monroy, Jay Silverman

Faculty Research, Scholarly, and Creative Activity

No abstract provided.

Improving Health And Well-Being: Connecting Research And Practice. The 24th Annual Conference Of The Health Care Systems Research Network, Karen L. Margolis, Nico Pronk, Jane E. Duncan, Sarah M. Greene

Journal of Patient-Centered Research and Reviews

The 24th annual conference of the Health Care Systems Research Network (HCSRN, formerly the HMO Research Network), held April 11–13, 2018, in Minneapolis, Minnesota, attracted 357 attendees. The HCSRN is a consortium of 18 community-based research organizations embedded in or affiliated with large health care delivery systems. Its annual research conference, held since 1994, is a unique venue that brings diverse stakeholders (eg, research teams, clinicians, patients, funders) together to explore a range of health research topics and scientific findings, with a unifying goal of connecting applied research to real-world care delivery for the betterment of individual and community health. …

Using Clinical Decision Support Within The Electronic Health Record To Reduce Incorrect Prescribing For Acute Sinusitis, Regina Ginzburg, Justin J. Conway, Eve Waltermaurer, Wendy Song, Samantha P. Jellinek-Cohen

Journal of Patient-Centered Research and Reviews

Purpose: Acute sinusitis has viral etiology in more than 90% of cases, but antibiotics are prescribed for more than 80% of adults in the United States. While applications of computer-assisted guidelines have been found effective in reducing inaccurate prescribing for acute respiratory infections, there is a paucity of research focused specifically on the utilization of electronic best practice alerts (BPA) in improving treatment for acute sinusitis.

Methods: This observational cohort study examined prescribing behavior for sinusitis at a single Federally Qualified Health Center 1 year prior and during the first year of implementation of a BPA in the electronic health …

Smokers' Neurological Responses To Novel And Repeated Health Warning Labels (Hwls) From Cigarette Packages, Johann F. Fridriksson, Chris Rorden, Roger D. Newman-Norlund, Brett Froeliger, Jim Thrasher

Faculty Publications

Graphic health warning labels (HWLs) depicting bodily injury due to smoking are effective for producing changes in affect, cognition and smoking behavior in adult smokers. However, little is known about the effects of repeated presentation of graphic HWL’s on the aforementioned processes. The goal of this study was to examine neural and behavioral responses to graphic HWL’s and evaluate whether the repeated presentation of graphic HWL’s leads to repetition suppression (RS). Smokers (N = 16) performed an event-related HWL cue task while blood oxygen level dependent (BOLD) signal was collected during a functional magnetic resonance imaging (fMRI) experimental session. Consistent …

Implementing The Cdcs Core Elements Of Outpatient Antibiotic Stewardship Program Into The Urgent Care, Deanna Powelson

Dissertations

Purpose: The inappropriate use of antibiotics has led to the development of antimicrobial

resistance which is a severe threat to the public and an increasing global problem. The

Centers for Disease Control and Prevention (CDC) estimates at least two million illnesses

and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States (CDC,

2014). The purpose of this quality improvement (QI) project was to evaluate the

effectiveness of an antibiotic stewardship program (ASP) on urgent care providers'

prescribing on viral respiratory tract infections (RTIs) including the common cold,

pharyngitis, and bronchitis.

Methods: This QI project implemented the CDCs Core …

Validity Of The Food Insecurity Experience Scale For Use In Sub-Saharan Africa And Characteristics Of Food-Insecure Individuals, Edwina A. Wambogo, Hala Ghattas Ph.D., Kenneth L. Leonard, Nadine R. Sahyoun

Faculty Publications

Background

The Food Insecurity Experience Scale (FIES) is a UN FAO-Voices of the Hungry project (FAO-VoH) metric of food insecurity (FI). The FAO-VoH tested the psychometric properties of FIES with the use of global 2014 Gallup World Poll (GWP) data. However, similarities in its psychometric structure in sub-Saharan Africa (SSA) to allow aggregation of SSA results were untested.

Objectives

We aimed to 1) assess the validity of FIES for use in SSA, 2) determine the prevalence of FI by country, age group, and gender, and 3) examine the sociodemographic and economic characteristics of individuals with FI.

Methods

The Rasch modeling …

What's So Bad About Hooking Up? : Factors Predictive Of More Positive Perceptions Following A Hookup, Jade A. M. Spaulding

Theses and Dissertations

The purpose of the study was to examine factors predictive of a more positive perceptions following a hookup. The participants included 188 students from Illinois State University. Participants completed a demographics questionnaire, the Hookup Scale, the Rosenberg Self-Esteem Scale, the Sexual Self-Esteem Inventory, religiosity questions, attitudes toward hooking up questionnaire, emotional reactions to hooking up questionnaire, and the Social Academic, Romantic, and Sexual Hooking Up Reactions Scale. The current study found that participants who reported high global self-esteem, high sexual self-esteem, and positive attitudes toward hooking up reported less regret, more positive reactions, and fewer negative reactions following a hookup.

Statewide Dissemination And Implementation Of Physical Activity Standards In Afterschool Programs: Two-Year Results, Michael W. Beets, R. Glenn Weaver, Keith Brazendale, Gabrielle Turner-Mcgrievy, Ruth P. Saunders, Justin P. Moore, Collin Webster, Mahmud Khan, Aaron Beighle

Kinesiology and Health Promotion Faculty Publications

Background: In 2015, YMCA afterschool programs (ASPs) across South Carolina, USA pledged to achieve the YMCA physical activity standard calling for all children to accumulate 30 min of moderate-to-vigorous physical activity (MVPA) while attending their ASPs. This study presents the final two-year outcomes from the dissemination and implementation efforts associated with achieving this MVPA standard.

Methods: Twenty ASPs were sampled from all South Carolina YMCA-operated ASPs (N = 97) and visited at baseline (2015) and first (2016) and second year (2017) follow-up. All ASPs were provided training to increase MVPA during the program by extending the scheduled time for …

Effects Of Bingocize® On Quality Of Life, Fall Risk, And Health Knowledge In Community-Dwelling Older Adults, Alyssa Kathryn Dispennette

Masters Theses & Specialist Projects

Quality of life (QOL) is an important aspects of overall well-being in older adults. QOL is associated with functional, physical, and psychological health; all of which can be improved with increased physical activity. A high fall risk is associated with low physical function and QOL. One in four older adults experiences a fall each year, making it necessary to focus public health interventions towards decreasing fall risk and improving QOL in older adults. Bingocize® is a health promotion program designed to promote health, health knowledge, physical activity, and social engagement among older adults. The purpose of this study was to …

Infant And Young Child Feeding In Emergencies: Organisational Policies And Activities During The Refugee Crisis In Lebanon, Linda Shaker-Berbari, Hala Ghattas Ph.D., Andrew G. Symon, Annie S. Anderson

Faculty Publications

Appropriate infant and young child feeding (IYCF) is key to reducing mortality amongst children aged under 2. Facilitating adherence to recommended IYCF practices during emergencies includes having relevant policies to support breastfeeding and complementary feeding as well as regulating the distribution of breast milk substitutes. In the current crisis, more than 1.2 million Syrian refugees are in Lebanon and it is timely to examine organisational IYCF policies and programmes. One hundred and thirty-five non-governmental organisations providing humanitarian aid in Lebanon were invited to participate in an online survey about organisational policies and programmatic activities on IYCF. Responses were obtained from …

Prostate Cancer Information Available In Health-Care Provider Offices: An Analysis Of Content, Readability, And Cultural Sensitivity, Seul Ki Choi, Jessica S. Seel, Brooks Yelton Ma, Lmsw, Susan E. Steck Phd, Mph, Rd, Douglas P. Mccormick, Johnny Payne, Anthony Minter, Elizabeth K. Deutchki, James Hébert Scd, Daniela B. Friedman Ph.D.

Faculty Publications

Prostate cancer (PrCA) is the most common cancer affecting men in the United States, and African American men have the highest incidence among men in the United States. Little is known about the PrCA-related educational materials being provided to patients in health-care settings. Content, readability, and cultural sensitivity of materials available in providers’ practices in South Carolina were examined. A total of 44 educational materials about PrCA and associated sexual dysfunction was collected from 16 general and specialty practices. The content of the materials was coded, and cultural sensitivity was assessed using the Cultural Sensitivity Assessment Tool. Flesch Reading Ease, …

Alternative Financial Services As A Social Determinant Of Health In U.S. Metropolitan Statistical Areas, Courtney Hundley, Richard W. Wilson, John Chenault

Faculty and Staff Scholarship

Alternative financial services (AFS) such as payday lenders, pawn brokers, tax refund loans, and check cashers are more prevalent in minority and lower income neighborhoods. These are neighborhoods also found to have disparities in health, compared to more affluent neighborhoods and communities. The focus of this paper is to determine if any relationship exists between use of AFS and health disparities. Using data from a survey performed by the Federal Deposit Insurance Corporation (FDIC), we compared four banking variables to several measures of health for 85 metropolitan statistical areas (MSA) across the nation. The four banking variables all related to …

Hubungan Pola Konsumsi Makanan Berisiko Dengan Obesitas Sentral Pada Wanita Usia 25-65 Tahun Di Bogor Tahun 2011-2012, Fara Irdini Azkia, Tri Yunis Miko Wahyono

Jurnal Epidemiologi Kesehatan Indonesia

Perubahan pola makan diketahui merupakan salah satu upaya untuk mengendalikan obesitas dan penyakit kronis lain. Tujuan penelitian ini adalah untuk mengetahui hubungan pola konsumsi makanan berisiko dengan obesitas sentral pada wanita usia 25-65 tahun. Penelitian ini menggunakan data baseline Studi Kohort PTM tahun 2011-2012 di Bogor, dengan desain studicross sectional. Sampel penelitian sebanyak 2531 orang. Hasil penelitian menunjukkan 54% responden mengalami obesitas sentral dengan rata-rata lingkar perut sebesar 80,9+ 11,6 cm. Tidak terdapat perbedaan risiko antara responden yang sering dan jarang mengonsumsi makanan berisiko untuk menjadi obesitas sentral setelah dikontrol variabel usia dan status pernikahan (PR 1,038 : 95% CI …

Faktor Risiko Terjadinya Kejadian Luar Biasa (Klb) Hepatitis A Di Kabupaten Tangerang Tahun 2016, Nenden Hikmah Laila, Renti Mahkota, Elvieda Sariwati, Dwi Agus Setiabudi

Jurnal Epidemiologi Kesehatan Indonesia

Hepatitis A adalah penyakit hati akibat virus hepatitis A yang dapat menyebabkan kesakitan ringan sampai berat. Di Indonesia Hepatitis A sering muncul dalam Kejadian Luar Biasa (KLB). Tahun 2014 tercatat 3 Provinsi dan 4 Kabupaten terjadi KLB dengan jumlah penderita 282. Penyelidikan epidemiologi ini bertujuan untuk mengetahui gambaran KLB dan mengidentifikasi faktor risiko KLB Hepatitis A di Kabupaten Tangerang tahun 2016. Desain studi yang digunakan dalam penelitian ini adalah desain kasus kontrol. Penyelidikan dilaksanakan pada bulan Maret 2016 di Kabupaten Tengerang. Besar sampel yaitu 44 kasus dan kontrol sebanyak 95. Data yang dikumpulkan dalam penyelidikan ini berupa data primer dan …

Evaluasi Metode Genexpert Mtb/Rif Dengan Sampel Raw Sputum Untuk Mendeteksi Tuberkulosis Paru, Tri Nugraha Susilawati, Leli Saptawati, Kusmadewi Eka Damayanti, Riska Larasati

Jurnal Epidemiologi Kesehatan Indonesia

Tuberkulosis (TB) merupakan penyakit menular yang masih menjadi masalah utama di Indonesia dan dunia. Tantangan utama dalam mendiagnosis TB secara konvensional yaitu rendahnya sensitivitas deteksi pada pemeriksaan mikroskopis dan lamanya waktu yang diperlukan untuk kultur. Penelitian ini bertujuan untuk mengevaluasi metode GeneXpert MTB/RIF untuk mendeteksiMycobacterium tuberculosis dengan sampel dahak langsung di RSUD Dr. Moewardi (RSDM), Surakarta. Analisis observasional dengan pendekatan kohort retrospektif menggunakan data sekunder hasil pemeriksaan GeneXpert MTB/RIF pada sampel dahak langsung di Laboratorium Mikrobiologi Klinik RSDM pada tahun 2012 2015. Sampel didapatkan dari pasien yang memenuhi kriteria suspek multidrug-resistant tuberculosis (MDR-TB) dan sampel tersebut telah dikultur di Balai …

Faktor Lingkungan Rumah Dan Kejadian Demam Berdarah Dengue Di Kota Palopo 2016, Marwanty Marwanty, Krisnawati Bantas

Jurnal Epidemiologi Kesehatan Indonesia

Latar belakang. Kota Palopo merupakan salah satu daerah endemis demam berdarah Dengue di Provinsi Sulawesi Selatan. Lingkungan rumah memiliki peran penting dalam penularan penyakit demam berdarah Dengue sebagai media interaksi antara nyamuk Aedes Aegypti dan manusia. Tujuan. Untuk mengetahui hubungan faktor lingkungan rumah dengan kejadian demam berdarah Dengue.Metode. Penelitian ini merupakan studi analitik dengan rancangan studi kasus kontrol. Total sampel penelitian sebanyak 236 sampel dengan perbandingan kasus dan kontrol 1:1. Analisis data mencakup analisis bivariat dan multivariat. Analisis multivariat dilakukan dengan uji regresi logistik ganda. Hasil. Hasil analisis multivariat menunjukkan bahwa interaksi antara faktor lingkungan rumah dengan pendidikan rendah meningkatkan …

Coverage And Determinants Of Second-Dose Measles Vaccination Among Under-Five Children In Aceh Jaya District, Aceh Province, Indonesia, Rizka Maulida, Lhuri Dwianti Rahmartani, Lila K. Hairani, Tri Yunis Miko Wahyono

Jurnal Epidemiologi Kesehatan Indonesia

Indonesia is aiming for measles elimination status by 2020. However, high number of measles cases are still prevalent and there are still coverage differences among provinces. Measles immunization coverage also varies among surveys and routine coverage report. With the addition of second dose measles vaccination (MCV2), measles infections in the country is expected to decrease. However, MCV2 coverage has been low after 2 years of implementation. Aceh Province was chosen for this study because its low coverage. This study aimed to measure the coverage and investigate the determinants of MCV2 in Aceh Jaya, Aceh Province. Dataset from “Assessment of the …

Disclosure Of Homosexual Behaviors To Healthcare Providers And Uptake Of Hiv Testing For Men Who Have Sex With Men: A Systematic Review., Shan Qiao Ph.D., Guangyu Zhou, Xiaoming Li

Faculty Publications

To promote HIV-testing and offer optimal care for men who have sex with men (MSM), health-care providers (HCPs) must first be aware of their patients’ sexual behaviors. Otherwise, HCPs may overlook MSM’s risks for HIV infection and their special health-care needs. For MSM, reporting their same-sex behaviors to HCPs (disclosure to HCPs) may promote their linkage to HIV prevention and treatment cascade and improve their health outcomes. No literature review has been conducted to examine the relationship between disclosure to HCPs and uptake of HIV-testing among MSM. The current study reviewed and synthesized findings from 29 empirical studies published in …

[2018 Winner] Filipino Americans: A Health Profile Addressing Health Disparities And The Effects Of U.S. Assimilation And Discrimination, Marisol Cruz

Ethnic Studies Research Paper Award

Filipino Americans have a rich history in migrating to the U.S as well as assimilating into American culture. They have a distinct immigrant experience because of their colonial past. This paper states Filipino American U.S demographics, health statistics, and traditional health beliefs and practices to understand Filipino American culture and beliefs. Lastly, there is an emphasis in the leading health disparity among them, heart disease, and the effects of racism and discrimination and how that impacts a Filipino Americans overall physical and mental health.