Medicine and Health Sciences Commons^™

Three Dimensional Nutrition: Exploring Nourishment Of Spirit, Mind, And Body During A 28-Day Daniel Fast At Southern Adventist University, Caitlin S. Hobbs

Senior Research Projects

A person who is living well can be said to be “making lifestyle choices with God’s help to support optimum physical, mental, emotional, and spiritual health and experiencing His gift of abundant life” (Tryon, 2009). All of these “dimensions” of health are interrelated, and in order for a person to truly flourish, each area must be nourished. Dietary choices can have an especially interesting impact on these dimensions. Eating healthfully is not always viewed as a joyous endeavor, but when viewed from a multi-dimensional perspective, it can become a more rewarding and intriguing pursuit.

One way to promote a nutritional …

Chhs December 2013 E-Newsletter, Dr. John Bonaguro, Dean, Vashon S. Wells, Editor, College Of Health And Human Services, Western Kentucky University

College of Health & Human Services Publications

No abstract provided.

A Profile Of Community Health Center Patients: Implications For Policy, Peter Shin, Carmen Alvarez, Jessica Sharac, Sara J. Rosenbaum, Amanda Van Vleet, Julia Paradise, Rachel Garfield

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers are a key source of comprehensive primary care in medically underserved communities across the country, and their role is expected to grow as health coverage expands under the Affordable Care Act (ACA). To sharpen understanding of the health center patient population, this brief compares it to the overall low-income population, using data from the Health Center Patient Survey and the National Health Interview Survey,respectively. The pre-ACA profile of health center patients that emerges sets the stage for measuring change following implementation of the reform law and can inform health center policy, planning, and assessment moving forward.

Factors Influencing The Decision And Ability To Seek Health Services Among Hiv/Aids Patients In Tanzania, Savitri Grover

Masters Theses & Specialist Projects

Understanding the barriers to treatment for individuals with HIV/AIDS in developing countries could have a major impact on their ability to seek healthcare services. The purpose of this study is to quantitatively analyze the effect of daily activities and structural factors, which act as barriers to seeking health services for individuals living with HIV/AIDS in Tanzania.

The study is based on the hypothesis that (1) Individuals living with HIV/AIDS who face both personal and structural barriers have poor health compared to those not facing the barriers. (2) Individuals living with HIV/AIDS demonstrate different decisions and abilities to seek health services …

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

How Medicaid Expansions And Future Community Health Center Funding Will Shape Capacity To Meet The Nation's Primary Care Needs, Leighton C. Ku, Julia Zur, Emily Jones, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

A new report by Drs. L. Ku, J. Zur, E. Jones, P. Shin and S. Rosenbaum examines the impact of federal and state policy decisions on community health centers and their ability to continue providing primary care to the nation's poorest residents. The report estimates that under a worst-case scenario the nation's health centers would be forced to contract, leaving an estimated 1 million low-income people without access to health care services by 2020.

Local Tobacco Control: Application Of The Essential Public Health Services Model In A County Health Department’S Efforts To Put It Out Rockland, Lisa D. Lieberman, Una Diffley, Sandy King, Shelley Chanler, Maryanne Ferrera, Oscar Alleyne, Joan Facelle

Department of Public Health Scholarship and Creative Works

In 2000, Rockland County, a small suburban county north of New York City, dedicated $1 million of its Master Settlement Agreement funds to a comprehensive tobacco control program, Put It Out Rockland. Developed and implemented by the county health department, this program used an essential public health services model and an ongoing financial investment, within the context of strong statewide tobacco control efforts, to lower adult smoking rates to 9.7% and to reduce both smoking among youths and exposure to secondhand smoke over the ensuing decade. By combining state funds and local dollars for a total of $6.75 cost per …

A Case For Refining The Who Global Strategy On Food Safety: Perspectives From India., Subbarao M Gavaravarapu, Katherine C Smith, Rajiv N Rimal

Prevention and Community Health Faculty Publications

No abstract provided.

Willow: Reaching Hiv-Positive African-American Women Through A Computer-Delivered Intervention, Charles H. Klein

Anthropology Faculty Publications and Presentations

This study evaluates the efficacy of Multimedia WiLLOW in enhancing HIV-protective sexual behaviors and psychosocial outcomes among HIV-positive African American women, including condom use for vaginal and anal sex, and psychosocial mediators associated with risk reduction practices. Using a community-based randomized controlled design, 168 participants completed a baseline and follow-up assessment as well as an exit satisfaction survey. Intervention participants reported significantly higher proportions of condom protected sex acts in the past 30 days (p=.002), with both HIV-negative (p=.040) and HIV-positive (p=.003) partners. They were also more likely to report 100% condom use (OR = .10; p=.030); a lower adjusted …

Chhs November 2013 E-Newsletter, Vashon S. Wells, Editor, Dr. John Bonaguro, Dean, College Of Health & Human Services, Western Kentucky University

College of Health & Human Services Publications

No abstract provided.

Seeking Value In Medicare: Performance Measurement For Clinical Professionals, Lisa Sprague

National Health Policy Forum

The Medicare program, despite its reputation of being a bill payer with little regard to the worth of the services it buys, has begun to put in place a range of programs aimed at assessing quality and value, with more to come. Attention to resource use and cost is nascent. The issues are complex, and it is no surprise that there is a level of contention between providers and regulators, even though both profess commitment to improved quality. This paper summarizes the quality and value programs that apply to physicians and other clinical professionals, as well as programs designed to …

Short- And Long-Term Associations Between Widowhood And Mortality In The United States: Longitudinal Analyses, J. Robin Moon, M. Maria Glamour, Anusha M. Vable, Sze Yan Liu, S.V. Subramanian

Department of Public Health Scholarship and Creative Works

Background

Past research shows that spousal death results in elevated mortality risk for the surviving spouse. However, most prior studies have inadequately controlled for socioeconomic status (SES), and it is unclear whether this ‘widowhood effect’ persists over time.

Methods

Health and Retirement Study participants aged 50+ years and married in 1998 (n = 12 316) were followed through 2008 for widowhood status and mortality (2912 deaths). Discrete-time survival analysis was used to compare mortality for the widowed versus the married.

Results

Odds of mortality during the first 3 months post-widowhood were significantly higher than in the continuously married (odds ratio …

Health Workforce Needs: Projections Complicated By Practice And Technology Changes, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts posit whether sufficient health care providers will be able to meet that demand. Some argue there are too few providers already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how physician practices are changing in response to market forces such as payment changes, provider distributions, and technology innovations. This issue brief reviews what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these …

Frontiers Of The New Social Marketing, R. Craig Lefebvre

GW Health Communication and Marketing Symposium Series

No abstract provided.

The Commission On Long-Term Care: Background Behind The Mission, Carol O'Shaughnessy

National Health Policy Forum

The American Taxpayer Relief Act of 2012 (ATRA, P.L. 112-240) created a Commission on Long-Term Care charged with developing a plan for financing of long-term services and supports (LTSS) and issuing a report in September 2013. Significant research and advocacy have been devoted to LTSS financing issues and perceived inadequacies of the delivery system over the past several decades, but the most recent comprehensive review of financing options was in 1990 by the Pepper Commission. This publication presents brief background behind the mission of the Commission, including a time line of selected federal and national activities on LTSS financing and …

Assessing The Potential Impact Of The Affordable Care Act On Uninsured Community Health Center Patients: A Nationwide And State-By-State Analysis, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In this brief, we estimate the number of uninsured community health center (CHC) patients who would gain coverage under the Affordable Care Act using data from the 2009 HRSA Survey of CHC patients and 2011 Uniform Data System. We find that were all states to implement the Affordable Care Act Medicaid expansion, an estimated 5 million uninsured health center patients – or two-thirds of all uninsured patients served by CHCs nationally – would be eligible for coverage. However, over one million uninsured patients – 72% of whom live in southern states – who would have been eligible for coverage will …

Structural Approaches To Health Promotion: What Do We Need To Know About Policy And Environmental Change?, Lisa D. Lieberman, Shelley D. Golden, Jo Anne L. Earp

Department of Public Health Scholarship and Creative Works

Although the public health literature has increasingly called on practitioners to implement changes to social, environmental, and political structures as a means of improving population health, recent research suggests that articles evaluating organization, community, or policy changes are more limited than those focused on programs with individuals or their social networks. Even when these approaches appear promising, we do not fully understand whether they will benefit all population groups or can be successful in the absence of accompanying individually oriented programs. The role of this broad category of approaches, including both policy and environmental changes, in decreasing health disparities is …

Prevention Of Type 2 Diabetes In Urban American Indian/Alaskan Native Communities: The Life In Balance Pilot Study, Daniel C. Benyshek, Michelle Chino, Carolee Dodge-Francis, Toricellas O. Begay, Hongbin Jin, Celeste Giordano

Environmental & Occupational Health Faculty Publications

Objective: The Life in BALANCE (LIB) study is a pilot translational study modeling the Diabetes Prevention Program (DPP) intensive lifestyle coaching intervention among an underserved, high-risk population: American Indians/Alaska Natives (AI/ANs) living in a large urban setting (Las Vegas, Nevada). Research Design and Methods: A total of 22 overweight/obese AI/ANs (age, 39.6 ± 10.4 years; BMI, 34.1 ± 6.3 kg/m2) at increased risk for developing type 2 diabetes (HbA1c > 5.4 (36 mmol/mol) < 6.4 percent (46 mmol/mol) participated in the program between April and December, 2011. Study participants completed a 16 week intensive lifestyle coaching intervention. In addition to obtaining qualitative data regarding opportunities and challenges of applying the lifestyle intervention for AI/AN participants in an urban setting, clinical data, including BMI, waist circumference, blood pres- sure, fasting blood glucose, and blood lipids (HDL, LDL and Triglycerides), were collected. Results: Only 12 of the 22 participants remained in the LIB program at the final post-program follow-up. Participants demonstrated significant decreased waist circumference and elevated HDL cholesterol. Triglycerides manifested the highest percentage change without statistical significance. No significant change was ob- served in blood pressure or fasting blood glucose. Conclusions: LIB participants’ improvements in BMI, waist circumference, HDL cholesterol and triglycerides suggests type 2 diabetes prevention programs aimed at urban AI/ANs show significant potential for reducing the risk of developing type 2 diabetes among this underserved and high risk community. Qualitative data suggest the main challenge for type 2 diabetes prevention specific to this population is a need for improved community outreach strategies.

Los Determinantes De La Diferencia En La Tasa De Fecundidad Adolescente Entre Comunidades Pobres Y Ricas En Buenos Aires, Emily Turner

Independent Study Project (ISP) Collection

The city of Buenos Aires has some of the lowest rates of teenage fertility in Argentina (Gogna, Binstock, Fernández, Ibarlucía, & Zamberlin, 2008). However, this aggregated number obscures the huge variance within the city. In the most current available data (2010/2012) from the government of the city of Buenos Aires (GCBA) broken down by comunas (areas) highest fertility rate for 15-19 year olds was 81.6 births (per 1000) versus the lowest fertility rate which was only 6.2 (D. d. e. d. GCBA). This discrepancy is huge and reflects the incredible economic disparity in Buenos Aires. The comunas with the three …

Weza Motrin Pichikeche Meu: El Entendimiento Cultural De La Obesidad Infantil En El Pueblo Mapuche, Katherine Shaffer

Independent Study Project (ISP) Collection

Research Question: How do the Mapuche people interpret childhood obesity, and how do they use this interpretation to treat and prevent this disease?

Objective: To describe the Mapuche concept of childhood obesity used by families and community leaders in Makewe, Chile, and how this concept is used to treat and prevent this disease.

Background: Childhood obesity is a growing problem throughout much of the world, including Chile, with grave effects on physical and mental health. There are a plethora of causes of this disease, from individuals with an imbalance in calorie expenditure, to national and international policies in economy and …

Opinions Of Individuals In The Greater Durban Area Concerning Government Healthcare, Alexander Braun

Independent Study Project (ISP) Collection

One important determinant of health in South Africa is how government entities, from the local level to the national level, use their health budgets. A complex system of organizations involving many government employees at the various levels are involved in the process of turning a budget allocation of Rand into healthcare services and goods that make their way to the South African people. What do individuals in the greater Durban area think about that process as it exists currently, and what do they think of the services that are eventually delivered to them? This is an important question, especially in …

A Comparison Of Malnutrition Causes And Treatments: A Case Of Mwanamugimu Nutrition Unit, Mulago National Referral Hospital, Kampala District And Nakifuma Government Health Unit, Mukono District, Berkley Singer

Independent Study Project (ISP) Collection

In beginning of the investigation process, the researcher set out to study malnutrition in Uganda. She wanted to study an urban region in comparison to a rural region and so based her research out of both Kampala and the Mukono region. The researcher set out to learn more about the causes of the condition and why children become malnourished. She also was interested in the differences that exist between the two different locations and why they exist. Finally, the researcher was eager to learn what malnutrition meant to each community and how health care professionals go about treating the condition …

The Association Between Insurance Status And Cervical Cancer Screening In Community Health Centers: Exploring The Potential Of Electronic Health Records For Population-Level Surveillance, 2008-2010, Stuart Cowburn, Matthew J. Carlson, Jodi A. Lapidus, Jennifer E. Devoe

Sociology Faculty Publications and Presentations

Introduction: Cervical cancer incidence and mortality rates in the United States have decreased 67% over the past 3 decades, a reduction mainly attributed to widespread use of the Papanicolaou (Pap) test for cervical cancer screening. In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. The objective of our study was to assess the association between cervical cancer screening and insurance status in Oregon and California community health centers …

Schistosomiasis (Bilharzia) In Madagascar: A Case Study Of A Neglected Tropical Disease, Sarah Grace Sawyer

Independent Study Project (ISP) Collection

Over 50% of Madagascar’s population is infected with intestinal or urinary schistosomiasis (Rollinson et al., 2012). The disease slowly debilitates infected persons, who are frequently children, resulting in lower productivity and reduced learning in school-age children. The disease involves a vicious cycle perpetuated by a number of environmental, psychological, and social factors. A multifaceted approach, involving mass treatment, biological control, environmental control, education, and disease surveillance, can lead to schistosomiasis control and elimination in Madagascar. This would yield many socio-economic benefits such as increased productivity, increased school attendance rates, and generally better welfare. Schistosomiasis is the most burdensome and deadly …

The Pertinence Of Maternal Education On Child Immunization In Rural Uttarakhand: More Than Just Increased Rates, Sarah Banerji

Independent Study Project (ISP) Collection

Child immunization rates in India continue to remain low, despite the 1985 implementation of a Universal Immunization Program that provides free basic immunizations to all children. There are numerous logistical factors that contribute to the low rates of immunization, but rates are made further worse by a lack of parental awareness and education about immunization, especially in village communities. This study examines the maternal understanding of immunization in rural Uttarakhand, both in villages in which an NGO has been working to improve maternal immunization education and in villages with no NGO involvement. It finds a positive correlation between increased immunization …

Social Ecological Constraints To Park Use In Communities With Proximate Park Access, J. Aaron Hipp, Deepti Adlakha, Ravikumar Chockalingam

Brown School Faculty Publications

Evidence correlates physical activity, psychological restoration, and social health to proximity to parks and sites of recreation. The purpose of this study was to identify perceived constraints to park use in low-income communities facing significant health disparities, but with proximate access to underutilized parks. The authors used a series of focus groups with families, teens, and older adults in neighborhoods with similar demographic distribution and parks over 125 acres in size. Constraints to park use varied across age groups as well as across social ecological levels, with perceived constraints to individuals, user groups, communities, and society. Policies and interventions aimed …

Physical Activity For Rural, Low-Income Children., Amber Todd, Jason Rice, Kristi King

Faculty Scholarship

No abstract provided.

I Don't Want To Save Second Base, Chelsea E. Broe

SURGE

Tomorrow kicks off Breast Cancer Awareness Month, and I have one request: This October, let’s not save second base.

I know, I know, you probably think this month is a good thing. If not for all of those T-shirts demanding every female-bodied person to feel their boobies, or the bracelets simply proclaiming “I love boobies,” people with breasts might forget that they even have them, or at the very least might start to think that their breasts are their own business. But the female body seems to be an object owned by the public, so we must always be reminded …

Multi-Criteria Decision Analysis As An Innovative Approach To Managing Zoonoses: Results From A Study On Lyme Disease In Canada, Cécile Aenishaenslin, Valérie Hongoh, Hassane D. Cissé, Anne Gatewood Hoen

Dartmouth Scholarship

ackground: Zoonoses are a growing international threat interacting at the human-animal-environment interface and call for transdisciplinary and multi-sectoral approaches in order to achieve effective disease management. The recent emergence of Lyme disease in Quebec, Canada is a good example of a complex health issue for which the public health sector must find protective interventions. Traditional preventive and control interventions can have important environmental, social and economic impacts and as a result, decision-making requires a systems approach capable of integrating these multiple aspects of interventions. This paper presents the results from a study of a multi-criteria decision analysis (MCDA) approach for …