Medicine and Health Sciences Commons^™

Impact Of Medicaid Redetermination On Underserved Populations In Region 7 States: A Review, Brianna Parr

Capstone Experience

When the COVID-19 Public Health Emergency ended in May of 2023, Medicaid began the process of redetermination across the states and returned to its original eligibility rules. Because of this, the healthcare status of many Americans was affected, resulting in the loss of healthcare coverage for millions of people. Of those who have lost coverage, children make up almost half of the total. This paper assesses the negative effects of Medicaid redetermination on children and other underserved populations in communities across the four states in Region 7 (Nebraska, Iowa, Missouri, and Kansas) and identifies programs that these states can implement …

An Ot Needs Assessment For Children And Families Residing In Shelters, Jessie Siono, Susan Macdermott

Spring 2024 Virtual OTD Capstone Symposium

This study created a needs assessment is to determine the unique occupational deficits of children and their families in California experiencing homelessness within a shelter setting via recording their lived experiences. A local family shelter was analyzed via observation and interviews with staff and residents of the shelter. The results were compiled into a facility assessment to identify supports and barriers to occupation. Results were also utilized to complete an occupational needs assessment for families and children living in homeless shelters. The study determined the occupational needs and occurrences of occupational deficits that were experienced by residents of the family …

Recruitment And Reach In A School-Based Pediatric Obesity Intervention Trial In Rural Areas., Bethany Forseth, Brittany Lancaster, Megan Olalde, Christie A. Befort, Rebecca E. Swinburne Romine, Meredith Dreyer, Kelsey Dean, Eve-Lynn Nelson, Ann M. Davis

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: The purpose of this study is to evaluate two recruitment strategies on schools and participant participation rates and representativeness (reach) within a pediatric obesity treatment trial tailored for families who live in rural areas.

METHODS: Recruitment of schools was evaluated based on their progress toward enrolling participants. Recruitment and reach of participants were evaluated using (1) participation rates and (2) representativeness of demographics and weight status of participants compared to eligible participants (who did not consent and enroll) and all students (regardless of eligibility). School recruitment, as well as participant recruitment and reach, were evaluated across recruitment methods comparing …

Parent And Child Anxiety Evaluated During An Early Period Of The Covid-19 Pandemic: A Mixed-Methods Study, Karla M. Abela, Darlene Acorda, Stanley Cron, Geri Lobiondo-Wood

Journal of Patient-Centered Research and Reviews

Purpose: The objective of this study was to explore parent and child anxiety during the pandemic. Unlike previous pandemics, measures implemented to prevent the transmission of the SARS-CoV-2 virus have been much more limiting.

Methods: An explanatory convergent mixed-methods design was used to describe anxiety of children 9–17 years of age and their parents during August–October 2020. Adult and child versions of State-Trait Anxiety Inventory (STAI) were used to examine levels as measured on STAI’s state-anxiety subscale. Web-based interviews with a subset of patients were conducted qualitatively to analyze anxiety-related themes.

Results: A total of 188 parents …

Maternal Resources For Care Are Associated With Child Growth And Early Childhood Development In Bangladesh And Vietnam, Sulochana Basnet, Edward A. Frongillo Jr., Phuong Hong Nguyen, Spencer Moore, Mandana Arabi

Faculty Publications

BACKGROUND:

Suboptimal child growth and development are significant problems in low- and middle-income countries. Maternal resources for care may help to improve growth and development. This study examined the association of maternal resources for care on child length, motor development and language development of children 12-23.9 months old.

METHODS:

We used baseline data from the Alive & Thrive household surveys collected in Bangladesh (n = 803) and Vietnam (n = 635). Resources for care were represented by maternal education, knowledge, height, well-nourishment, mental well-being, decision-making, employment, support in chores and perceived support. The regression analyses were adjusted for household wealth …

Factor Structure And Equivalence Of Maternal Resources For Care In Bangladesh, Vietnam, And Ethiopia, Sulochana Basnet, Edward A. Frongillo Jr., Phuong Hong Nguyen, Spencer Moore, Mandana Arabi

Faculty Publications

Objectives: Resources for care among women are crucial for children's growth and development. The objectives of this cross-sectional study were to determine if: (1) the factor structure of measures of maternal resources for care was comparable across countries and consistent with the theoretical constructs and (2) the measures showed equivalence across contexts.

Methods: The study included 4400, 4029 and 2746 women from Bangladesh, Vietnam, and Ethiopia, respectively. The measures of resources for care were maternal education, knowledge, height, body mass index, mental well-being, financial autonomy, decision-making, employment, support in chores, and perceived support.

Results: The factor analysis demonstrated that a …

A Cross-Sectional Study On Bullying And Psychological Disturbances Among Malaysian School Children, Muhammad Lokman Md Isa, Nurfatin Aina Mocktar, Wisam Nabeel Ibrahim, Mohd Said Nurumal, Muhammad Kamil Che Hasan

Makara Journal of Health Research

Background: Bullying is a common violence in school and has become a major public health and global concern. Bullying influences mental health and is identified as a leading factor of depression. Therefore, this study aimed to identify bullying prevalence and its association toward psychological disturbances (stress, anxiety, and depression).

Methods: This cross-sectional study was conducted in three secondary schools in Kuantan. After obtaining consent from parents/guardians, participants were asked to answer a self-administered questionnaire, including School Climate Bullying Survey, Depression Anxiety Stress Questionnaire-21, Patient Depression Questionnaire, and Generalized Anxiety Disorder. Demographic data were self-reported. Data were analyzed using …

Mothers’ Nutritional Knowledge, Self-Efficacy, And Practice Of Meal Preparation For School-Age Children In Yangon, Myanmar, Wut Yee Phyo, Ohn Khin Khin, Min Htike Aung

Makara Journal of Health Research

Background: Childhood malnutrition is a global public health concern. For Myanmar, mothers play a prominent role in improving the nutritional status of children as they prepare meals for children.

Methods: This community-based cross-sectional analytical study was conducted on 367 mother-child pairs (6–10 years). Significantly, systematic random sampling and structured questionnaires were utilized in this study.

Results: The mean age of mothers was 35.73 ± 6.9 years, and a majority had fair nutritional knowledge (52.3%), good self-efficacy (79.8%), and good practice of meal preparation (59.4%). The prevalence of childhood malnutrition was categorized as stunting (18.2%), underweight (18.8%), wasting …

Moving Beyond Giving Free Food: Specific Targeting And Tailoring In Response To Child Food Insecurity, Maryah Stella Fram, Edward A. Frongillo Jr.

Faculty Publications

No abstract provided.

National Nutrition Strategies That Focus On Maternal, Infant, And Young Child Nutrition In Southeast Asia Do Not Consistently Align With Regional And International Recommendations, Tuan T. Nguyen, Ashley Darnell, Amy Weissman, Jennifer Cashin, Mellissa Withers, Roger Mathisen, Karin Lapping, Timothy D. Mastro, Edward A. Frongillo Jr.

Faculty Publications

We examined the consistency of national nutrition strategies and action plans (NNS) focusing on maternal, infant, and young child nutrition in Southeast Asia with regional and international recommendations. Between July and December 2017, we identified and extracted information on context, objectives, interventions, indicators, strategies, and coordination mechanisms from the most recent NNS in nine Southeast Asian countries. All NNS described context, objectives, and the following interventions: antenatal care, micronutrient supplementation during pregnancy, breastfeeding promotion, improved complementary feeding, nutrition in emergencies, and food fortification or dietary diversity. Micronutrient supplementation for young children was included in eight NNS; breastfeeding promotion during pregnancy …

Early Breastfeeding Practices Contribute To Exclusive Breastfeeding In Bangladesh, Vietnam And Ethiopia, Phuong Hong Nguyen, Sunny S. Kim, Lan Mai Tran, Purnima Menon, Edward A. Frongillo Jr.

Faculty Publications

Limited evidence exists on the complex relationship among interventions, early initiation of breastfeeding (EIBF), prelacteal feeding and exclusive breastfeeding (EBF). We examined whether early breastfeeding practices are associated with EBF and how much improving EIBF and non-prelacteal feeding contributes to increased prevalence of EBF. Survey data were collected in 2010 and 2014 as part of impact evaluations of Alive & Thrive (A&T) interventions to improve infant and young child feeding (IYCF) practices in Bangladesh, Vietnam and Ethiopia. Multivariable logistic regression analyses were used to examine effects of interventions and early breastfeeding practices on EBF. Structural equation modelling quantified the direct …

Effect Of The Sims Program On Oral Hygiene Levels Of 5–6-Year-Old Children In The Kampar District, Malaysia: A Cluster-Randomized Controlled Trial, Nurul Hayati Anwar, Nor Azlida Mohd Nor, Zamros Yuzadi Mohd Yusof

Makara Journal of Health Research

Background: This study evaluated the effect of the “Senyuman Indah Milik Semua” program (SIMSP) versus the existing preschool oral healthcare program (POHP) on children’s oral health and parents’ oral health literacy (OHL) in Kampar district, Malaysia.

Methods: This was a cluster-randomized, matched pair, examiner-blind, controlled trial. Using computer-generated random tables, 14 preschools were allocated to the SIMSP intervention over 6 months and another 14 were allocated to the POHP, which was concealed at the cluster level. Healthy 5–6-year-old children and parents who understood the Malay language were recruited. The SIMSP was comprised of preschool visits by dental …

Can Children Catch Up From The Consequences Of Undernourishment? Evidence From Child Linear Growth, Developmental Epigenetics, And Brain And Neurocognitive Development, Jef L. Leroy, Edward A. Frongillo Jr., Pragya Dewan, Maureen M. Black, Robert A. Waterland

Faculty Publications

Recovery from nutritionally induced height deficits continues to garner attention. The current literature on catch-up growth, however, has 2 important limitations: wide-ranging definitions of catch-up growth are used, and it remains unclear whether children can recover from the broader consequences of undernutrition. We addressed these shortcomings by reviewing the literature on the criteria for catch-up in linear growth and on the potential to recover from undernutrition early in life in 3 domains: linear growth, developmental epigenetics, and child brain and neurocognitive development. Four criteria must be met to demonstrate catch-up growth in height: after a period in which a growth-inhibiting …

Association Of Multisetting Community Programs And Policies With Child Body Mass Index: The Healthy Communities Study, Vicki L. Collie-Akers, Stephen B. Fawcett, Jerry A. Schultz, Kandace K. Fleming, Rebecca E. Swinburne Romine, Lorrene D. Ritchie, Edward A. Frongillo Jr., S Sonia Arteaga

Faculty Publications

INTRODUCTION:

Expert opinion suggests that efforts to address childhood obesity should seek to transform the environments in which children operate. The objective of this study was to describe the extent to which multisetting programs and policies interact with community and child predictors and are associated with child body mass index (BMI) in the 130 US communities participating in the Healthy Communities Study.

METHODS:

For 2 years beginning in fall 2013, we collected data through key informant interviews on community programs and policies related to healthy weight among children that occurred in the 10 years before the interview. We characterized community …

Obesity Is Associated With Depression In Malaysian Schoolchildren: A Cross-Sectional Study, Mohd Said Nurumal, Rohulizzat Zainal Abidin, Wisam Nabeel Ibrahim, Muhammad Lokman Md Isa, Muhammad Kamil Che Hasan

Makara Journal of Health Research

Background: Overweight and obesity, which may lead to depression, have become prevalent among children worldwide. Hence, this study aimed to measure obesity and depression among schoolchildren in Kuantan.

Methods: This cross-sectional study was conducted in three different primary schools in Kuantan by purposive sampling. With consent from their parents/guardians, participants were given a self-administered questionnaire. Demographics and anthropometric measurement data were self-reported on the basis of the school records. Furthermore, body mass index was calculated. Data were analyzed using SPSS version 20.0, and chi-square and correlation tests were conducted for the variables.

Results: Among the 300 schoolchildren …

Association Between Breastfeeding And Child Stunting In Mexico, Ana Paola Campos, Mireya Vilar-Compte, Summer Sherburne Hawkins

Department of Public Health Scholarship and Creative Works

Background: Globally, the prevalence of child stunting has been decreasing over the past decades. How-ever, in low-and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting. Objective: To examine the association between breastfeeding (defined as never breastfed, any breast-feeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under –2 standard deviations of the World Health Organization child growth standards’ median) in Mexico. Methods: Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6–35 months with information on previously identified risk and protective factors for stunting. We conducted fixed-and mixed-effects logistic regression models sequentially controlling for each level of factors. Findings: Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breast-feeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models. Conclusions: According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.

Dimensions Of Stress In Parents Of Children With Autistic Spectrum Disorder, Amirah Hazwani Binti Bakri, Noor Aishah Binti Rosli, Zarinah Binti Mohd Kasirun, Mohd Hairul Nizam Bin Md Nasir, Fazidah Binti Othman, Tengku Sarina Aini Binti Tengku Kasim

Makara Journal of Health Research

Background: Parents of children with Autistic Spectrum Disorder (ASD) are at an increased risk for stress and other mental health problems. While treatment is mainly focused on the child, somehow parents’ stress is exacerbated. Accordingly, the purpose of this study was to identify the sources of stress in the parents of children with ASD. Methods: The 52 parents of children with ASD who participated in the study completed the child domain (CD) and parent domain (PD) subscales of the Parenting Stress Index Fourth Edition (PSI-4). Subsequently, the scores of the PSI-4 subscales were analyzed and compared. Results: …

Parenting Styles Are Associated With Overall Child Dietary Quality Within Low-Income And Food-Insecure Households, Michael P. Burke, Sonya J. Jones, Edward A. Frongillo Jr., Christine E. Blake, Maryah S. Fram

Faculty Publications

Objective: To examine the association between parenting styles and overall child dietary quality within households that are low-income and food-insecure.

Design: Child dietary intake was measured via a 24 h dietary recall. Dietary quality was assessed using the Healthy Eating Index-2005 (HEI-2005). Parenting styles were measured and scored using the Parenting Styles and Dimensions Questionnaire. Linear regressions were used to test main and interaction associations between HEI-2005 scores and parenting styles.

Setting: Non-probability sample of low-income and food-insecure households in South Carolina, USA.

Participants: Parent–child dyads (n 171). Parents were ≥18 years old and children were …

Perspective: Challenges In Use Of Adolescent Anthropometry For Understanding The Burden Of Malnutrition, Alison Tumilowicz, Ty Beal, Lynnette M. Neufeld, Edward A. Frongillo Jr.

Faculty Publications

Improving nutritional status during adolescence is an opportunity to improve the lives of this generation and the next. Estimating the burden of malnutrition at a population level is fundamental to targeting interventions and measuring progress over time, and for adolescents, we usually depend on survey data and the 2007 WHO Growth Reference to do so. There is substantial risk of misguided conclusions regarding adolescent prevalence estimates, however, when underlying methodological limitations of the indicators and reference are not adequately considered. We use national prevalence estimates among girls and young women 10-22 y of age from the 2014 State of Food …

Virus-Specific Memory T Cells Populate Tumors And Can Be Repurposed For Tumor Immunotherapy, Pamela C. Rosato, Sathi Wijeyesinghe, J Michael Stolley, Christine E. Nelson, Rachel Davis, Luke S. Manlove, Christopher A. Pennell, Bruce R. Blazar, Clark C. Chen, Melissa A. Geller, Vaiva Vezys, David Masopust

Faculty Publications

The immunosuppressive tumor microenvironment limits the success of current immunotherapies. The host retains memory T cells specific for previous infections throughout the entire body that are capable of executing potent and immediate immunostimulatory functions. Here we show that virus-specific memory T cells extend their surveillance to mouse and human tumors. Reactivating these antiviral T cells can arrest growth of checkpoint blockade-resistant and poorly immunogenic tumors in mice after injecting adjuvant-free non-replicating viral peptides into tumors. Peptide mimics a viral reinfection event to memory CD8+ T cells, triggering antigen presentation and cytotoxic pathways within the tumor, activating dendritic cells and natural …

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 …

Cohort Profile: The Maternal And Infant Nutrition Interventions In Matlab (Minimat) Cohort In Bangladesh, Shams El Arifeen, Eva-Charlotte Ekström, Edward A. Frongillo Jr., Jena Hamadani, Ashraful I. Khan, Ruchira T. Naved, Anisur Rahman, Rubhana Raqib, Kathleen M. Rasmussen, Katarina Ekholm Selling, Yukiko Wagatsuma, Lars Åke Persson

Faculty Publications

No abstract provided.

Sun Prevention Fun (Spf): A Multicomponent Sun Prevention Program For Children In Kindergarten And First Grade, Sarah Gouker

Evidence-Based Practice Project Reports

Skin cancer is an important topic in the United States due to the recent increase in cost and mortality. The purpose of this evidence-based practice (EBP) project was to determine if the early implementation of a multicomponent sun prevention program positively impacted kindergarten and first grade students’ knowledge and behavioral intentions to practice safe sun techniques after a one week period. Kotter’s Model of Change and the ACE Star model were utilized to guide this EBP project. An exhaustive review of the literature yielded 12 articles which were used to develop best practices for education on sun safety. The quality …

Health Insurance Enrollment Of Children And Young Adults In Wayne County, Michigan: A Qualitative Evaluation, Kristin Kan, Richard Lichtenstein, Michelle Famulare, Alison Jensen, Theresa Kowalski-Dobson, Joslyn Pettway, Erminia Ramirez, Madiha Tariq, Minal Patel

Journal of Health Disparities Research and Practice

Since the Affordable Care Act went into effect, community outreach to increase health insurance enrollment of young adults and children in low-income families of color has been a priority in Wayne County, Michigan. Our objective was to inform community efforts for improved outreach, we explored perceptions around the importance of health insurance and barriers to enrollment for children and young adults through a qualitative research study. We conducted a focus group with enrollment assisters and nine focus groups with Arab American, Latino/Hispanic, and African American community members. Several themes emerged about community members’ perceptions and experiences: they believe that children …

Can Integrated Interventions Create The Conditions That Support Caregiving For Better Child Growth?, Purnima Menon, Edward A. Frongillo Jr.

Faculty Publications

No abstract provided.

Assessing Asthma-Specific Health-Related Quality Of Life In Children With An Ecological Systems Approach, Jamyia Clark

Walden Dissertations and Doctoral Studies

Despite initiatives and management efforts to minimize exacerbation and adverse outcomes, asthma remains a leading cause of childhood chronic disease in the United States. Environmental, personal, and social factors have been associated with an increase of asthma morbidity. However, little is known about how they cumulatively affect children's quality of life. This study applied a multifactorial conceptual model grounded by the ecological systems theory framework to ascertain which environmental, personal, and social factors were cumulatively associated with adverse health-related quality of life (HRQoL) in children with asthma ages 5-17 years. A national, cross-sectional survey, the Behavioral Risk Factor Surveillance System …

Exposure To Large-Scale Social And Behavior Change Communication Interventions Is Associated With Improvements In Infant And Young Child Feeding Practices In Ethiopia, Sunny S. Kim, Rahul Rawat, Edina M. Mwangi, Roman Tesfaye, Yewelsew Abebe, Jean Baker, Edward A. Frongillo Jr., Marie T. Ruel, Purnima Menon

Faculty Publications

Optimal breastfeeding (BF) practices in Ethiopia are far below the government’s targets, and complementary feeding practices are poor. The Alive & Thrive initiative aimed to improve infant and young child feeding (IYCF) practices through large-scale implementation of social and behavior change communication interventions in four regions of Ethiopia. The study assessed the effects of the interventions on IYCF practices and anthropometry over time in two regions–Southern Nations, Nationalities and Peoples Region and Tigray. A pre- and post-intervention adequacy evaluation design was used; repeated cross-sectional surveys of households with children aged 0–23.9 mo (n = 1481 and n = 1494) and …

Supply- And Demand-Side Factors Influencing Utilization Of Infant And Young Child Feeding Counselling Services In Viet Nam, Phuong H. Nguyen, Sunny S. Kim, Tuan T. Nguyen, Lan M. Tran, Nemat Hajeebhoy, Edward A. Frongillo Jr., Marie T. Ruel, Rahul Rawat, Purnima Menon

Faculty Publications

Adequate utilization of services is critical to maximize the impact of counselling on infant and young child feeding (IYCF), but little is known about factors affecting utilization. Our study examined supply- and demand-side factors associated with the utilization of IYCF counselling services in Viet Nam. We used survey data from mothers with children <2y >(n = 1,008) and health staff (n = 60) from the evaluation of a program that embedded IYCF counseling into the existing government health system. The frequency of never users, one-time users, repeat users, and achievers of the recommended minimum number of visits at health facilities were …

Effects Of Multimodal Fever Education On Parents Of Febrile Children, Teresa S. Parkhouse

Evidence-Based Practice Project Reports

Insufficient knowledge regarding the physiology and appropriate management of fever in children often contributes to an increased parental anxiety, inappropriate antipyretic use, and overutilization of medical resources (Chang, Liu, & Huang, 2013; Crocetti, Moghbeli, & Serwint, 2001; Schmitt, 1980). Parental concerns regarding childhood fever can lead to an overuse of health care resources as febrile illness in children accounts for approximately 20% of emergency department visits, 30% of office visits, and over 50% of after-hour phone calls to private physicians (Zomorrodi & Attia, 2008). Research shows that multidimensional educational interventions are most effective in improving parental management of fever (Young …

Determinants Of Usage Of Age-Appropriate Child Safety Seats In Connecticut, Giuseppina Mendillo Violano

Walden Dissertations and Doctoral Studies

In the United States, motor vehicle crashes are one of the leading causes of unintentional injury death and disability for children ages 1'15 years. Despite local, state, and federal legislative and educational efforts, children continue to be restrained improperly and thus face harm. Identifying behaviors and barriers that place child occupants at risk is crucial for implementing focused, injury-prevention programs and policies. The purpose of this study was to evaluate the effectiveness of Connecticut's child passenger safety law that was strengthened in 2005. This study involved a multifactorial approach to predicting child seat use, guided by Roger's diffusion of innovations …