Public Health Commons^™

Geographic Variation In The Structure Of Kentucky’S Population Health Systems: An Urban, Rural, And Appalachian Comparison, Rachel Hogg-Graham, Angela Carman, Glen P. Mays, Pierre Martin Dominique Zephyr

Journal of Appalachian Health

Introduction: Research examining geographic variation in the structure of population health systems is continuing to emerge, and most of the evidence that currently exists divides systems by urban and rural designation. Very little is understood about how being rural and Appalachian impacts population health system structure and strength.

Purpose: This study examines geographic differences in key characteristics of population health systems in urban, rural non-Appalachian, and rural Appalachian regions of Kentucky.

Methods: Data from a 2018 statewide survey of community networks was used to examine population health system characteristics. Descriptive statistics were generated to examine variation across geographic regions in …

Appalachian Regional Commission Recovery Ecosystem Background And Overview, Kostas Skordas, Andrew Howard

Journal of Appalachian Health

The Appalachian Regional Commission (ARC) has long addressed issues of substance abuse through funded community-based interventions, research, and sponsored conferences. Recently, the opioid crisis created a new urgency for cross-sector collaboration among various partners and funders dealing with this issue. This commentary provides an overview of recent efforts by the ARC to convene stakeholders to focus on assisting individuals with substance abuse disorder to access recovery services while pursuing education and training necessary to reenter the workforce and gain employment. Two papers have been prepared to describe this year-long effort. One paper focuses on the participatory methods used to gather …

Perspective On Substance-Abuse Recovery Ecosystem From The Appalachian Regional Commission Federal Co-Chair, Tim Thomas

Journal of Appalachian Health

The Appalachian Regional Commission (ARC) is a local, state, and federal partnership focused on economic development in the communities of the Appalachian Region. ARC Federal Co-Chairman Tim Thomas provides his perspective on how an economic development entity, such as ARC, can support efforts to address the Region’s drug crisis in a way that both saves lives and strengthens economic opportunity in communities throughout Appalachia.

Fiscal Challenges And Anticipated Changes To Kentucky's Population Health System, Jeffrey Howard

Journal of Appalachian Health

The hallmark of public health is population-level intervention. However, current public health funding in Kentucky is largely programmatic or disease-based. As a result, public health leaders are not able to appropriately utilize present resources to pursue population health endeavors. However, a recent transformation of the public health system has emphasized multisector partnerships and efficient funding mechanisms that may increase resources to pursue population-level health interventions based on community health assessments.

Lessons From A Five-Year Research Programme On Fgm/C And Their Relevance For Policy And Programmes In Kenya, Dennis Matanda, Agnes K. Meroka-Mutua, Samuel Kimani

Reproductive Health

The Sustainable Development Goals target the elimination of all forms of harmful practices, including female genital mutilation/cutting (FGM/C) by 2030. Kenya has made progress in addressing the elimination of FGM/C through ratification of global instruments and enactment of the Prohibition of FGM Act in 2011 and other supportive laws. The Act created the foundation for the establishment of the Anti-FGM Board, which provides policy leadership and coordination of anti-FGM/C programs in Kenya. More recently, the President of Kenya issued a decree for accelerated elimination of FGM/C by 2022. This synthesis report highlights how evidence generated over the last five years …

Effects Of Covid-19 On Nutrition In Bihar, Unicef, Population Council Institute

Poverty, Gender, and Youth

An extended nationwide lockdown and stoppage of economic activities resulting from COVID-19 caused substantial loss of income for many families in Bihar, India. One of the significant implications is a food shortage in households and a reduction in food intake. This nutrition shock may hit females harder than males due to the deep-rooted gendered culture prevalent in India. This study's key objectives are to understand the extent of food shortage in households, any changes in food intake, and coverage of government nutrition schemes. Half of the households in Bihar reported food shortages in the past month, causing most to reduce …

Self-Help Groups: A Potential Pivot Of Bihar's Response To Covid-19, Unicef, Population Council Institute

Poverty, Gender, and Youth

More than 10 million women in Bihar, India, are members of women’s self-help groups (SHGs), run by the Bihar Rural Livelihoods Promotion Society, Government of Bihar. The SHGs play a crucial role in the community by providing livelihood support and income-generating activities to their members. The key objectives of this study are to document SHG leaders’ engagement in community awareness and infection-prevention activities and the extent of support they give to their members through different funds and loans for livelihoods and income generation during the COVID-19 pandemic. About half of the SHG leaders were engaged in COVID-19–related community-awareness and prevention …

Covid-19 Times: Study Protocol For Rapid Assessment Of The Situation Of Women And Children In Bihar, Unicef, Population Council Institute

Poverty, Gender, and Youth

India reported its first COVID-19 case on January 30, 2020, and numbers began to rise in late March 2020. The containment measures implemented by the national and state governments, particularly the nationwide lockdown, have helped keep the COVID-19 pandemic at a relatively low level in India. Bihar, being one of the poorest states in India, is at particularly high risk of adverse health and economic effects of COVID-19 and the lockdown. The Population Council Institute, in partnership with UNICEF Bihar, is conducting a rapid longitudinal study that aims to inform the design and development of locally relevant suitable response mechanisms …

Returning Home: Effects Of Covid-19 On Migrant Households In Bihar, Unicef, Population Council Institute

Poverty, Gender, and Youth

Many migrants from metropolitan cities in India began to return to their native homes with the rise in COVID-19 cases in the cities and the extension of the lockdown. With relaxation of travel restrictions, Bihar started receiving migrants who were returning home. The government made arrangements for them to be quarantined before they traveled to their villages and homes. The key objectives of this study are to understand the extent of return migration, the impact of lockdown on migrant household livelihoods, and the opportunities for household economic revival through social protection schemes. Among migrant households, about half may experience return …

Effects Of Covid-19 On Livelihood, Employment, And Financial Resources, Unicef, Population Council Institute

Poverty, Gender, and Youth

COVID-19 and steps to break the chain of viral transmission led to certain economic challenges that triggered loss in livelihoods and income and constraints on financial resources in Bihar, India. Often, these effects were disproportionately experienced among the most marginalized. The key objective of this study is to assess the loss of income, livelihoods, and jobs among households in Bihar to help with program planning and implementation. Data were gathered May 13–22, 2020, from the existing study cohort of households under the UDAYA study. Interviews were conducted with a total of 794 participant households. About four-fifths of respondents said their …

Are More People Adopting Covid-19 Prevention Measures?, Unicef, Population Council Institute

Poverty, Gender, and Youth

Drawing on data from two rounds of COVID-19 knowledge, attitudes, and practices (KAP) telephone surveys conducted in Bihar, India, this research brief sheds light on the socioeconomic differentials and changes over time in the adoption of COVID-19 preventive measures. Though the adoption of preventive measures has increased, around two-fifths of males and one-quarter of females reported that they were currently practicing all four standard preventive measures. The better educated, wealthier, and those belonging to privileged castes were more likely than others to practice these measures, as were those who perceived moderate or high risk of COVID-19 in their neighborhood. Social …

Awareness Of And Receiving Social Protection Measures During Covid-19 Lockdown In Bihar, India, Unicef, Population Council Institute

Poverty, Gender, and Youth

Economic hardships caused by the nationwide lockdown to prevent the spread of COVID-19 have been reported across India. Social protection measures have been announced by the state and central governments to ease these hardships. The key objectives of this research brief are to examine the awareness and the social protection measures received during the COVID-19 lockdown in Bihar, and the socioeconomic differentials in receiving these measures. The majority of respondents (64%) reported a family member losing their job/income-earning opportunity and lacking resources to survive for long. Awareness of social protection schemes was high (88%). Among households, 68% reported having ration …

Demand For And Access To Family Planning Services Among Young Married Women During Covid-19 Crisis, Unicef, Population Council Institute

Poverty, Gender, and Youth

In Bihar, India, as a result of the COVID-19 lockdown and men returning home in large numbers and spending more time at home in high stress conditions, the need for contraceptive services could get greater. March to May are considered the “lean season” when demand is typically low for family planning (FP) programs in states like Bihar. However, higher demand caused by the lockdown and lack of access to health facilities has created a gap between demand and uptake. This could have negative consequences such as high numbers of unintended pregnancies, unsafe abortions, and maternal mortality. Current use of modern …

Disparities In Vulnerability To Severe Complications From Covid-19 In The United States, Emily E. Wiemers, Scott Abrahams, Marwa Alfakhri, V. Joseph Holtz, Robert F. Schoeni, Judith A. Seltzer

Population Health Research Brief Series

Preexisting health conditions increase vulnerability to severe complications from COVID-19. Among middle-aged and older Americans, vulnerability to severe COVID-19 complications based on preexisting conditions is 2-3 times greater for those with low versus high income. Vulnerability is about 40% higher for middle-aged and older adults with a high school degree or less than adults with a four-year college degree. In every age group, Blacks are more vulnerable than Whites, but Hispanics are at lower risk based on fewer preexisting health conditions.

Important Lessons On Fgm/C Abandonment From Four Research Studies In Egypt, Nada Wahba, Nahla G. Abdel-Tawab, Abeer Salem

Reproductive Health

Female genital mutilation/cutting (FGM/C) continues to be a widespread practice in Egypt. According to the 2014 Egypt Demographic and Health Survey, the prevalence of FGM/C was 92 percent among ever-married women aged 15–49. However, Egypt continues to witness a drastic surge in the medicalization of FGM/C, with 74 percent of women aged 19 years and younger circumcised by medical practitioners, compared to 55 percent in 1995. This policy brief provides key results and recommendations of four studies conducted by the Population Council/ Egypt under the Evidence to End FGM/C project, in coordination with Egypt’s National Population Council. The four studies …

Commentary: Using Law More Effectively Towards Abandonment Of Fgm/C In Kenya, Agnes K. Meroka-Mutua

Reproductive Health

Female genital mutilation/cutting (FGM/C) is considered a harmful cultural practice and a form of violence against women. Kenya has an FGM/C prevalence rate of 21 percent, but levels vary by ethnic group. Kenya has adopted a robust legal framework for the prohibition of FGM/C, including passage of the Prohibition of FGM Act in 2011, a detailed law that criminalizes carrying out FGM/C and associated offenses. Kenya relies on the human rights–based approach and criminalization in its legal framework for the prohibition of this practice. Despite extensive legal provisions, Kenya has prosecuted fewer than 100 cases, raising concerns with the law’s …

High Covid-19 Mortality Risk In Pennsylvania’S Rural Counties, Raeven Faye Chandler, Shannon M. Monnat, Yue Sun

Population Health Research Brief Series

COVID-19 cases in Pennsylvania have been concentrated in eastern urban counties this far. However, the 14-day incident rate has recently begun increasing in several rural counties that have high prevalence of several chronic health conditions that increase risk of severe complications and death from COVID-19.

New York’S Recovery Drove National Covid-19 Case Reduction, Sarah Hamersma

Population Health Research Brief Series

National COVID-19 trends mask large differences in trends across U.S. states. Reductions in March & April were due almost entirely to declines in New York. The failure of other states to enact strong physical distancing protocols and/or reopening too early has led to our current national surge in cases.

Attitudes, Behaviours, And The Well-Being Of Older Singaporeans In The Time Of Covid-19: Perspectives From The Singapore Life Panel, Paulin T. Straughan, William Tov, Seonghoon Kim, Terence Cheng, Stephen Hoskins, Micah Tan

ROSA Research Briefs

COVID-19 has affected all Singaporeans, regardless of age and socioeconomic status (SES). Many measures have been implemented by the government to control the spread of this disease, including restrictions on social gatherings, restrictions on overseas travel, and making it compulsory to wear a mask. Measures have also included a partial lockdown – known as the ‘circuit breaker’ – which began in April 2020. This forced Singaporeans to quickly adapt to a new normal with some doing better than others. This research brief provides an overview of how COVID-19 and its related measures have affected seniors in Singapore using data from …

Conocimientos, Actitudes Y Prácticas Relacionadas A La Pandemia Del Covid-19 En Comunidades Indígenas De Yucatán Y Chiapas, Isabel Vieitez Martínez, Silvana Larrea, Fabiola Romero, Ludivine Cicolella

Poverty, Gender, and Youth

La Organización Mundial de la Salud ha recientemente indicado su preocupación sobre el mayor impacto que está teniendo y tendrá la pandemia por Covid-19 en la población indígena de América Latina. Aún cuando los resultados del presente estudio no sean representativos de toda la población indígena que vive en los municipios de Chiapas y Yucatán donde se realizó la encuesta, consideramos que los datos pueden identificar dimensiones que necesitan estudiarse a mayor detalle. También pueden guiar algunas de las acciones de las organizaciones locales que trabajan en estas comunidades, señalando áreas de oportunidad con respecto a conocimientos, actitudes y prácticas, …

Measuring The Impact Of Covid-19 On Older Adults In Massachusetts, Ceara Somerville, Jan Mutchler, Caitlin Coyle

Center for Social and Demographic Research on Aging Publications

The spread of COVID-19 across the United States has affected every facet of life since early 2020. According to the Centers for Disease Control and Prevention (CDC), there are currently over 4 million cases across the nation and over 146,000 deaths from the virus. Massachusetts has been one of the states hit hardest, with over 100,000 confirmed cases and more than 8,000 deaths to date. The Commonwealth currently trails only New York and New Jersey in number of deaths. While cases surge around the country, Massachusetts has seen some leveling out of positive cases since the beginning of July. Though …

Knowledge Of Breast Cancer And Screening Methods Among Rural Women In Southwest Nigeria, Rowland Edet, Oluwayimika Ekundina

Department of Sociology: Faculty Publications

The objective of this study was to assess the awareness of rural women on breast cancer and its screening methods in Southwest Nigeria. Descriptive cross-sectional survey design with the aid of a semi-structured questionnaire was used to generate data among 422 rural women in selected communities in Egbeda local government area of Ibadan. The qualitative data was generated through in-depth interviews among rural women and key informant interviews among health workers in the communities. The study revealed that only 63.7% were aware of breast cancer screening methods compared to 31.6% who were not aware. The commonly known screening method among …

Black Midwifery In The United States: Past, Present, And Future, Alicia Suarez

Sociology & Anthropology Faculty publications

While sociologists have long explored health and illness, much of it has been androcentric and White-centered. Scholars began to focus more on women’s health including pregnancy and birth in the 1970s yet have historically largely ignored Black women’s birth experiences. Midwifery in the United States was once the standard practice for prenatal care and birth. However, the vast majority of births have been medicalized and now occur in hospital settings. In this review, I will highlight the role of race in the historical shifts in the provision of care to Black pregnant and birthing women, the marginalization of Black midwives …

Within-Person Variability Of Internal And External Sexual Consent, Malachi Willis

Graduate Theses and Dissertations

Background: Sexual consent is often conceptualized as an internal willingness to engage in sexual activity, which can be communicated externally to a sexual partner. Preliminary evidence indicates that people’s sexual consent varies from day to day. Study designs that assess sexual consent at multiple time points (e.g., experience sampling methodology [ESM]) are needed to better understand the within-person variability of sexual consent; however, extant validated measures of sexual consent are not appropriate for ESM studies, which require shorter assessments due to the increased burden this methodology has on participants. As such, the goal of this dissertation was to develop valid …

Urban-Rural Gaps In The Prevalence Of Hypertension, Obesity And Diabetes In Malaysia, Thangiah Govindamal

Student Works (2020-2029)

Rapid economic growth has driven urbanization in developed and developing economies. However, it also created several problems, such as a deterioration in health conditions worldwide and widening of urban-rural and income inequality. A major consequence of urbanization include the rising prevalence of non-communicable diseases, cardiovascular disease (CVD) and its risk factors, such as hypertension, obesity and diabetes. The rapid nutrient and physical activity transition due to urbanization and the peculiar form of economic transformation has impacted the CVD risk factors. Rising urban-rural differences in health profiles and CVD risk factors in both locations over years in Malaysia prompted this research …

Hpv Vaccination In Females: The Role Of Primary Health Care And Primary Health Care Providers, Brooke Bouza

Graduate Theses and Dissertations

Two reasons for subpar coverage of the Human papillomavirus (HPV) vaccine are missed clinical opportunities and nonacceptance of the vaccine upon recommendation from a medical provider. The purpose of study one was to examine factors associated with access and adherence to physician’s recommendations in association with HPV vaccine uptake. Data were obtained from National Health Interview Survey (2017). Variables theoretically related to clinical opportunities and adherence to physician’s recommendations were examined in association with HPV vaccine uptake. Univariate logistic regressions were run to determine the associations between the aforementioned variables and uptake of the HPV vaccine. Multinomial logistic regressions were …

Toxic Stress Among Black And African American Oregonians, Roberta Hunte, Margaret J.F. Braun

School of Social Work Faculty Publications and Presentations

Toxic stress is a reaction to ongoing adversity such as abuse, neglect, poverty, racism, discrimination, and exposure to violence; it is powerful enough to change brain chemistry and architecture. Toxic stress and associated changes to the brain can lead to poor health outcomes later in life. Adverse childhood experiences (ACEs), racism*, and discrimination can trigger toxic stress and have long term consequences for the health of many people, particularly those in the Black and African American community.

The current project examined toxic stress and its impact on the health of Black and African American Oregonians. We looked at two indicators …

Building Assets For Humanitarian Settings, Women's Refugee Commission, Population Council

Poverty, Gender, and Youth

This document is the Women’s Refugee Commission and the Population Council’s adaptation of the Building Assets Toolkit and its core activity, the Asset Exercise, for use in humanitarian contexts. An asset-building exercise is a thoughtful way to build intentional program content for girls to determine what assets they need in order to survive and thrive. This is particularly important for programs intended to reach the poorest girls in the poorest communities based on sound evidence on the reality of their lives. The Council’s Building Assets Toolkit is rooted in this exercise, helping practitioners, policymakers, and advocates build tailored, meaningful, …

Female Genital Mutilation/Cutting: A Review Of Laws And Policies In Kenya And Nigeria, Samuel Kimani, Otibho Obianwu

Reproductive Health

Female genital mutilation/cutting (FGM/C) is a cultural practice that has health and human rights impacts on girls and women. The health sector has responsibility for prevention and response to provision of care services to women/girls with FGM/C-related complications. The mandate for the health sector response to FGM/C is anchored in nationwide or sector-specific legal/policy instruments. Kenya and Nigeria have ratified global legal/policy instruments and adopted WHO guidelines/tools for the prevention and management of FGM/C. The extent to which existing legal/policy documents in these two countries address prevention and response to management of FGM/C has been unclear. A desk review was …

Appendices—Female Genital Mutilation/Cutting: A Review Of Laws And Policies In Kenya And Nigeria, Samuel Kimani, Otibho Obianwu

Reproductive Health

This document contains Appendices to “Female Genital Mutilation/Cutting: A Review of Laws and Policies in Kenya and Nigeria.” Appendix 1 contains two tables: “Components of Kenyan Laws Related to FGM/C Prevention and Management,” and “Components of Nigerian Laws Related to FGM/C Prevention and Management.” Appendix 2 contains seven tables: “Components Relevant to Health Sector Response to Prevention and Management of FGM/C in Kenyan Policies,” “Components Relevant to Health Sector Response to Prevention and Management of FGM/C in Nigerian Policies,” “Components Relevant to Health Sector Response to Prevention and Management of FGM/C in the Kenyan Plans of Action,” “Components Relevant to …