Community Health Commons^™

Healthcare Access Challenges Among Asian Americans, Phyo Theingi

University Honors Theses

Asian Americans are the fastest growing racial ethnic group in the U.S. According to the 2023 U.S. Census Bureau population estimate, Asian Americans account for 25.2 million (or 7.4%) of the nation's population. Asian Americans are not a monolith and represent a diversity of rich histories, cultures, languages and ethnicities. According to research conducted by the Pew Research Center, most Asian Americans face discrimination of some kind, including being treated as a foreigner in the U.S and being stereotyped as a model minority. They also experience health care access barriers. Research found that Asian Americans face barriers related to language …

Just-In-Time Adaptive Intervention To Improve Hiv Prevention And Substance Use In Youth Experiencing Homelessness (My-Ride): Protocol Fora Randomized Controlled Trial, Diane Santa Maria, Nikhil Padhye, Michael Businelle, Natasha Slesnick, Stefani Ricondo, Marguerita Lightfoot

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Youth who are experiencing homelessness face a higher risk of HIV infection compared to their housed peers, and suicide and overdose remain the leading causes of death among homeless youth. Just-in-Time Adaptive Interventions (JITAIs) are gaining momentum for HIV prevention and substance use research. Yet, most interventions for homeless youth have not addressed modifiable real-time factors. Objective: This paper describes the development and implementation of a randomized attention-controlled trial to assess the efficacy of motivating youth to reduce infections, disconnections, and emotional dysregulation (MY-RIDE), a JITAI to improve HIV prevention and substance use in homeless youth. Methods: This study …

Engaging Antiracist And Decolonial Praxis To Advance Equity In Oregon Public Health Surveillance Practices, Ryan J. Petteway, Daniel López-Cevallos, Mira Mohsini, Andres Lopez, Roberta S. Hunte, Tim Holbert, Kusuma Madamala

OHSU-PSU School of Public Health Faculty Publications and Presentations

Public health surveillance and data systems in the US remain an unnamed facet of structural racism. What gets measured, which data get collected and analyzed, and how and by whom are not matters of happenstance. Rather, surveillance and data systems are productions and reproductions of political priority, epistemic privilege, and racialized state power. This has consequences for how communities of color are represented or misrepresented, viewed, and valued and for what is prioritized and viewed as legitimate cause for action. Surveillance and data systems accordingly must be understood as both an instrument of structural racism and an opportunity to dismantle …

Salvation And Sweet Rolls: An Examination Of Mormon Diet Books, Rachel Noorda

English Faculty Publications and Presentations

Religious diet books highlight the overlap between religious and diet cultures. This article examines the intersection of Mormonism, diet culture, and fatphobia through an analysis of Mormon diet books published between 1990 and 2015. The study explores how Mormon diet books leverage the Word of Wisdom (the LDS health code) to promote weight loss and reinforce religious obedience. By framing dietary compliance as a spiritual mandate, these texts link physical health and body size to moral and spiritual worthiness. This conflation of body and spirit, rooted in Mormon theology, amplifies fatphobia by promoting thinness as a sign of obedience and …

Motivation To Collaborate: A Qualitative Exploration Of The Perspectives Of Service Providers On An Alternative First Response Program, Desiree' J. Duboise

Dissertations and Theses

Alternative first response programs have existed in the United States for decades, and the formation of these programs has increased across the country in light of public calls for non-police responses to emergency. Portland Street Response (PSR) is an alternative first response program located in Portland, Oregon. The program assists individuals experiencing mental health crises by providing unarmed response in non-violent situations that ordinarily would be responded to by armed police officers. In order for such programs to thrive, collaboration with other organizations is crucial. Service-providing organizations are uniquely prepared to collaborate with a program such as PSR due to …

Reconceptualizing The Interaction Between Adhd Symptoms And Environmental Context, Oliver G. Mcfadden

University Honors Theses

Difficult questions regarding etiology, prevalence, and individual treatment allude to the heterogenous and complex neurocognitive profile ADHD. Current understandings do not point to there being any yet-undiscovered, succinct set of features for the condition that will answer these questions. ADHD in fact has a heterogeneous etiology and neurocognitive profile, suffers from both overdiagnosis and underdiagnosis, and a variety of styles of treatment are conceivable to address this. Sociocultural factors have crucially guided the direction of ADHD pathology and medicalization and are woven into institutional environments. These extant problems have eluded ADHD research, and the debate over the construction and validity …

Community Paramedicine In Central Oregon: A Promising Model To Reduce Non-Urgent Emergency Department Utilization Among Medically Complexmedicaid Beneficiaries, Jessica Currier, Neal Wallace, Keshia Bigler, Maggie O’Connor, Paige E. Farris, Jackilen Shannon

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community-based health care settings. Outreach through community paramedicine to patients with a history of high hospital emergency department (ED) use and chronic health conditions has been found to reduce ED use. This study examined the effect of community paramedicine implemented in 2 rural counties in reducing nonemergent ED use among a sample of Medicaid beneficiaries with complex medical conditions and a history of high ED utilization.

Methods

A cluster randomized trial approach with a stepped wedge design was …

Experiences Of People With Serious Mental Illness Seeking Services At Community Mental Health Centers During The Covid-19 Pandemic, Emily Leickly

Dissertations and Theses

Community mental health centers (CMHCs) have been underfunded and overburdened since Reagan-era disinvestment and the United States' move toward neoliberalism. Rates of mental illness have been rising consistently, particularly in Oregon, as CMHCs face continuing financial pressures and staff retention issues. This was before the COVID-19 pandemic. Today, we are still trying to understand the ongoing pandemic's impact on people with serious mental illnesses (SMI). Most of the studies in this area thus far are quantitative, and first-hand accounts of the pandemic from people with SMI are largely absent. Additionally, research in this area fails to draw on critical alternative …

The Impact Of The Covid-19 Pandemic On Mental Health And Stressors Among Asian American And Pacific Islanders, Ava Lu Kupperman

University Honors Theses

The Asian American and Pacific Islander (AAPI) community, along with the rest of the population globally, has been facing disruptions emerging from the COVID-19 pandemic in all parts of life. However, with the significant rise in racism, the AAPI community has had to confront a set of new challenges in their lives. Utilizing studies and literature written over the course of the pandemic, the purpose of this literature review is to examine the impacts observed on mental health outcomes among AAPIs as a result of the COVID-19 pandemic. This paper aims to collect and present information surrounding the impact on …

Engaging Public Health Critical Race Praxis In Local Social Determinants Of Health Research: The Youth Health Equity And Action Research Training Program In Portland, Or—Yheartpdx, Ryan J. Petteway, Lourdes Gonzalez

OHSU-PSU School of Public Health Faculty Publications and Presentations

The social determinants of health (SDH) have long been considered a core mechanism through which racial health inequities are (re)produced and incubated in the U.S. Moreover, scholars have expressly—and appropriately—named structural racism as a precursor to inequities associated with SDH. However, while research on racial health inequities—SDH-related or otherwise—continues to grow, communities of color remain grossly underrepresented as public health researchers and practitioners. Additionally, although SDH are experienced in a very local sense, much research and practice fails to more deeply and thoroughly engage and center local community knowledges. Thus, much work around SDH and racial health inequities presents, ironically, …

The Passive Approach: How Academically Motivated Students Approach Their Mental Health., Megan E. Mccoy

Anthós

The research utilizes qualitative interviews and focus groups to understand how academically motivated students approach their mental health. Mental health is defined as “emotional, psychological, and social well-being,” by the Center for Disease Control and Prevention and is becoming a more significant concern in collegiate student populations. At Portland State University, the effects of mental health concerns on students are nearly double that of students around the U.S (Community Commons, n.d.). Academically motivated students are a group who seemingly strive for success and likely experience high levels of stress daily. The study found that students often take a passive approach …

2022 Community Needs Assessment Of Klamath County Residential Services And Housing Needs, Karen Cellarius, Aliza Tuttle, Jennifer Blakeslee

Regional Research Institute for Human Services

The PSU Regional Research Institute for Human Services (RRI) was asked by Klamath Basin Behavioral Health (KBBH) and the Oregon Health Authority (OHA) to conduct a community-wide needs assessment focusing on residential services and housing needs for populations that (1) Have behavioral health needs, and (2) Identify with a community experiencing inequities in access to health care resources.

The assessment was conducted in collaboration with KBBH and other community partners. Data sources included key informant interviews, written surveys of individuals impacted by mental health challenges and/or housing needs, and focus groups with representatives from underserved communities in Klamath County, Oregon. …

Reflecting On Resilience: Insight Into Resiliency Development And Utilization In Oregon's Older Adults From 2020 To 2022, Riley A. Wilton

University Honors Theses

The events of the last 2 years have complicated the lives of older adults throughout the world. For many, their survival can be traced back to one key trait: resilience. In the state of Oregon, the years 2020-2022 came with a host of issues that expanded past the COVID-19 pandemic. These events provide context for the world our storytellers discuss.

Using a snowball recruitment strategy through the efforts of community organizations and senior centers, 4 storytellers sat down to describe their resilience in different ways. They were asked to reflect on their own life experiences, how it influenced their resilience, …

The Effects Of Running On Arithmetic Problem Solving, Kayia C. Snyder, Nicholas Smith

OHSU-PSU School of Public Health Annual Conference

In this work, we propose to examine the effects of physical activity on academic performance as physical activity is shown to improve mood, energy levels, confidence, and memory retention. We propose to recruit a sample of 200 psychology students from Portland State University. Each student will be asked to take an arithmetic problem-solving test then asked to study the material for three weeks. Of the 200 students, 100 will be randomly assigned to a physical activity condition, in which they will be asked to run 30 minutes prior to studying, then all students will be asked to take a timed …

Antipsychotic Medication Administration In Oregon Assisted Living/Residential Care Settings: Analyzing An Action Situation, Sarah Dys

Dissertations and Theses

Antipsychotic medication use (APU) in assisted living and residential care (AL/RC) settings is an under-studied and controversial health policy issue. APU in older adults with dementia is associated with an increased risk of falls, hospitalizations, and early mortality. I operationalize the Institutional Analysis and Development Framework using a situational analysis approach, an extension of grounded theory methods, to explore the APU in Oregon AL/RC settings. Regulatory deficiency citations, Oregon AL/RC population data, and semi-structured interviews suggest that staff role clarity, organizational characteristics, and perceived agency influence decision-making around APU. AL/RC providers and caregivers are forced to simultaneously balance and prioritize …

Facilitators And Barriers To Healthy Eating Among American Indian And Alaska Native Adults With Type 2 Diabetes: Stakeholder Perspectives, Sarah Stotz, Nertila Bregaj, Kelly Gonzales, Luciana E. Hebert, Kelly R. Moore

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: American Indian and Alaska Native (AI/AN) adults have a higher prevalence of type 2 diabetes (T2D) and related complications than non-AI/AN adults. As healthy eating is a cornerstone of diabetes self-management, nutrition education plays an important role in diabetes self-management education.

Objective: To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D in order to inform the cultural adaptation of an existing diabetes nutrition education curriculum.

Methods: Individual interviews were conducted with 9 national content experts in diabetes nutrition education (e.g. registered dietitians, diabetes educators, experts on AI/AN food insecurity) and 10 community-based …

Examination Of Orthodontic Expenditures And Trends In The United States From 1996 To 2016: Disparities Across Demographics And Insurance Payers, Man Hung, Sharon Su, Eric S. Hon, Edgar Tilly, Alex Macdonald, Evelyn Lauren, Glen Roberson, Martin S. Lipsky

Institute on Aging Publications

Background: Orthodontics prevent and treat facial, dental, and occlusal anomalies. Untreated orthodontic problems can lead to significant dental public health issues, making it important to understand expenditures for orthodontic treatment. This study examined orthodontic expenditures and trends in the United States over 2 decades. Methods: This study used data collected by the Medical Expenditure Panel Survey to examine orthodontic expenditures in the United States from 1996 to 2016. Descriptive statistics for orthodontic expenditures were computed and graphed across various groups. Trends in orthodontic expenditures were adjusted to the 2016 United States dollar to account for inflation and deflation over time. …

Quarantine Ethics: From Past To Covid-19, Chrystal Barnes

OHSU-PSU School of Public Health Annual Conference

Quarantines have been a preventative measure for reducing communicable disease spread for centuries. The method of implementation can vary widely and to some extent requires some level of judgement from enforcing powers, often state police power. As such, historically, some quarantines have been unfairly enforced based on discriminatory practices. COVID-19 has brought about the most widespread and extended quarantine in U.S. history, which makes evaluating the ethics all the more critical. In addition, it is well established that COVID-19 impacts have disproportionately caused harm to populations, such as those who are of a low socioeconomic status and people of color. …

Understanding Individual And Family Experiences Associated With Dup: Lessons From The Early Assessment And Support Alliance (Easa) Program In Oregon, Usa, Ryan P. Melton, Shannon Blajeski, Diana Glasser

Regional Research Institute for Human Services

Research shows that a longer duration of untreated psychosis (DUP) is associated with worse psychiatric outcomes, with average length of DUP of 73 weeks in the U.S. The aim was to examine the DUP period for first episode psychosis in Oregon, with a focus on the processes between the first positive symptoms and first treatment. To investigate DUP, researchers used methods consistent with grounded theory to collect data from 9 participants and their families about the process between onset of psychotic symptoms and entrance into treatment. Results suggest that recognition of symptoms was the primary driver of help-seeking in this …

‘Presumptively Initiating Vaccines And Optimizing Talk With Motivational Interviewing’ (Pivot With Mi) Trial: A Protocol For A Luster Randomised Controlled Trial Of A Clinician Vaccine Communication Intervention, Douglas J. Opel, Jeffrey D. Robinson, Heather Spielvogle, Christine Spina, Kathleen Garrett, Amanda F. Dempsey, Cathryn Perreira, Miriam Dickinson, Chuan Zhou, Barbara Pahud, Multiple Additional Authors

Communication Faculty Publications and Presentations

Introduction A key contributor to under immunisation is parental refusal or delay of vaccines due to vaccine concerns. Many clinicians lack confidence in communicating with vaccine-hesitant parents (VHP) and perceive that their discussions will do little to change parents’ minds. Improving clinician communication with VHPs is critical to increasing childhood vaccine uptake.

Methods and analysis We describe the protocol for a cluster randomised controlled trial to test the impact of a novel, multifaceted clinician vaccine communication strategy on child immunisation status. The trial will be conducted in 24 primary care practices in two US states (Washington and Colorado). The strategy …

There’S More To The Story: Both Individual And Collective Policy Narratives Can Increase Support For Community-Level Action, Chris Skurka, Jeff Niederdeppe, Liana Winett

OHSU-PSU School of Public Health Faculty Publications and Presentations

Narratives can convey the need or community-level action to address social problems. Yet narratives often tell stories about specific individuals rather than the broader collectives these problems affect. Some theorists argue that individualizing collective problems inhibits audiences from recognizing upstream causes and solutions. This study tested how narrative individualization (whether a story focuses on an individual case or a larger collective) might produce trade-offs when mobilizing support for community-level policies to address childhood obesity. We also investigated whether narratives using language congruent with political partisans’ morals (equity or loyalty) might minimize polarized responses to such narratives. A large, Web-based experiment …

Gut Carriage Of Antimicrobial Resistance Genes In Women Exposed To Small-Scale Poultry Farms In Rural Uganda: A Feasibility Study, Ana A. Weil, Meti D. Debela, Daniel M. Muyanja, Bernard Kakuhikire, Charles Baguma, David Bangsberg, Alexander C. Tsai, Peggy S. Lai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Antibiotic use for livestock is presumed to be a contributor to the acquisition of antimicrobial resistance (AMR) genes in humans, yet studies do not capture AMR data before and after livestock introduction.

Methods: We performed a feasibility study by recruiting a subset of women in a delayed-start randomized controlled trial of small-scale chicken farming to examine the prevalence of clinically-relevant AMR genes. Stool samples were obtained at baseline and one year post-randomization from five intervention women who received chickens at the start of the study, six control women who did not receive chickens until the end of the study, …

Strong Men, Strong Communities: Design Of A Randomized Controlled Trial Of A Diabetes Prevention Intervention For American Indian And Alaska Native Men, Ka‘Imi Sinclair, Cara Carty, Kelly L. Gonzales, Cassandra Nikolaus, Lucas Gillespie, Dedra Buchwald

OHSU-PSU School of Public Health Faculty Publications and Presentations

Type 2 diabetes is a serious global epidemic that disproportionately affects disadvantaged populations. American Indians and Alaska Natives (AIs/ANs) have the highest rates of diabetes in the nation with a prevalence of 14.7% in 2018, more than twice that of non-Hispanic Whites. AI/AN men have the highest prevalence of diagnosed type 2 diabetes (14.5%) compared to non-Hispanic Black (11.4%), non-Hispanic Asian (10.0%), and non-Hispanic White (8.6%) men. Several landmark clinical trials have shown that lifestyle interventions can effectively prevent or delay the onset of diabetes among those at risk, including in AIs/ANs. Despite positive outcomes for AIs/ANs in these studies, …

Annual Wellness Visits And Influenza Vaccinations Among Older Adults In The Us, Terese Sara Hoj Jørgensen, Heather G. Allore, Miriam R. Elman, Corey L. Nagel, Mengran Zhang, Sheila Markwardt, Ana R. Quiñones

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives

Investigate whether combinations of sociodemographic factors, chronic conditions, and other health indicators pose barriers for older adults to access Annual Wellness Visits (AWVs) and influenza vaccinations.

Methods

Data on 4999 individuals aged ≥65 years from the 2012 wave of the Health and Retirement Study linked with Medicare claims were analyzed. Conditional Inference Tree (CIT) and Random Forest (CIRF) analyses identified the most important predictors of AWVs and influenza vaccinations. Multivariable logistic regression (MLR) was used to quantify the associations.

Results

Two-year uptake was 22.8% for AWVs and 65.9% for influenza vaccinations. For AWVs, geographical region and wealth emerged as …

The Politics Of Caregiving: Taking Stock Of State-Level Policies To Support Family Caregivers, Walter D. Dawson, Lauren Bangerter, Micheal Splaine

Institute on Aging Publications

The U.S. population is aging rapidly. The changing demographics offer several benefits and opportunities at local, national, and global levels (Kluge, Zagheni, Loichinger, & Vogt, 2014). Yet, living to an advanced age remains a significant risk factor for the need of care and support during one’s lifetime. Half of all adults 65 years of age and older will reach a point where they require a high level of support due to either physical or cognitive challenges (Tumlinson, Juring, & Alkema, 2016). At the same time, the number of older adults living with chronic disease (e.g., diabetes, …

Impactful Care: Addressing Social Determinants Of Health Across Health Systems, Nicole Lisa Friedman

Dissertations and Theses

There is emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity, inadequate or unstable housing, and lack of access to transportation may increase the risk of developing chronic conditions, reduce an individual's ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. In response, work on social needs is happening across large health systems in the United States, but the pace of progress is slow and accountability is diffuse.

The goal of this applied research project is …

Using “Remote” Training And Coaching To Increase Providers’ Skills For Working Effectively With Older Youth And Young Adults With Serious Mental Health Conditions, Janet S. Walker, Caitlin Baird

School of Social Work Faculty Publications and Presentations

Since about the turn of the century, a growing awareness of the poor outcomes resulting from “as usual” community mental health care has led to increasing efforts to implement programs and interventions with empirical evidence of effectiveness. However, these efforts have encountered numerous barriers, in particular the high cost of implementation, which has severely limited uptake and sustainment of empiricallysupported programs and interventions. Typically, the largest contributor to cost is the training and coaching required to ensure provider competence and fidelity to the intervention or program model. This paper describes a social innovation that aims to provide high-quality training and …

“Little Tablets Of Gold”: An Examination Of The Psychological And Social Dimensions Of Prep Among Lgbtq Communities, Christina J. Sun, Kirsten M. Anderson, Kim Toevs, Dayna Morrison, Caitlin Wells, Christina Nicolaidis

OHSU-PSU School of Public Health Faculty Publications and Presentations

There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users’ experiences were shaped by multiple forms of stigma. Participants …

Exploring The Extent Of The Hikikomori Phenomenon On Twitter: Mixed Methods Study Of Western Language Tweets, Pereira-Sanchez, Miguel Angel Alvarez-Mon, Angel Asunsolo Del Barco, Melchor Alvarez-Mon, Alan R. Teo

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Hikikomori is a severe form of social withdrawal, originally described in Japan but recently reported in other countries. Debate exists as to what extent hikikomori is viewed as a problem outside of the Japanese context. Objective: We aimed to explore perceptions about hikikomori outside Japan by analyzing Western language content from the popular social media platform, Twitter. Methods: We conducted a mixed methods analysis of all publicly available tweets using the hashtag #hikikomori between February 1 and August 16, 2018, in 5 Western languages (Catalan, English, French, Italian, and Spanish). Tweets were first classified as to whether they described …

Impacts Of An Opioid Overdose Prevention Intervention Delivered Subsequent To Acute Care, Caleb J. Banta-Green, Phillip O. Coffin, Joseph O. Merrill, Jeanne M. Sears, Chris Dunn, Norbert D. Yanez, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background Opioid overdose is a major and increasing cause of injury and death. There is an urgent need for interventions to reduce overdose events among high-risk persons.

Methods Adults at elevated risk for opioid overdose involving heroin or pharmaceutical opioids who had been cared for in an emergency department (ED) were randomised to overdose education combined with a brief behavioural intervention and take-home naloxone or usual care. Outcomes included: (1) time to first opioid overdose-related event resulting in medical attention or death using competing risks survival analysis; and (2) ED visit and hospitalisation rates, using negative binomial regression and adjusting …