Public Health Commons^™

Healthy Motivations For Moms-To-Be (Healthy Mom2b) Study: A Mobile Health Intervention Targeting Gestational Weight Gain Among U.S. Women, Alicia Anne Dahl

Theses and Dissertations

INTRODUCTION: Almost one-half of all pregnant women in the U.S. exceed the Institute of Medicine’s (IOM) gestational weight gain (GWG) guidelines. Healthy GWG is critical for reducing adverse health outcomes associated with excessive GWG for the mother and infant. Electronic health (e-health) interventions delivered through mobile apps and websites hold potential as readily available resources for targeting health behaviors and monitoring GWG during pregnancy. The development of the Healthy Motivations for Moms-To-Be (HM2B) intervention was informed by health behavior theories, a systematic review of existing in-person and technology mediated interventions (Aim 1 of this dissertation), and results of an online …

Food Insecurity And Hypertension Prevalence, Awareness, Treatment And Control, Alexandra N. Luttrell

Theses and Dissertations

Objective: To examine the association between food insecurity and the prevalence of pre-hypertension and hypertension among U.S. adults. Additionally, this project will examine the association between food insecurity and the awareness, treatment and control (ATC) of hypertension.

Design: A cross-sectional study using data from the National Health and Nutritional Examination Survey (NHANES) 2011-2012 and 2013-2014 waves was deployed to examine the association between food insecurity and the prevalence and ATC of hypertension. Food security was measured by the cumulative number of affirmative responses to the 10-item U.S. Household Food Security Survey Module (HFSSM) questionnaire which were graded into four categories; …

How Do Health System Employees With Established Musculoskeletal Complaints Decide On Their Treatment Pathway? A Qualitative Approach, Noor Alshareef

Theses and Dissertations

Purpose: Non-pharmacologic treatment such as physical therapy (PT) are advocated for musculoskeletal pain for decreasing opioid use. Early access to PT has been shown to decrease costs and improve outcomes through direct access via self-referral. Although self-referral to PT is permitted in the majority of U.S states, health insurance coverage has been identified as a barrier preventing some patients with musculoskeletal complaints from using it. There are few studies examining patient factors related to early access to physical therapy via self-referral. The purpose of this study was to identify the factors outside of insurance that influence the choice to access …

Interpersonal Communication About Cigarette Warning Labels Among U.S. Smokers: Differences Between Latinos And Whites, Victoria Catherine Lambert

Theses and Dissertations

Pictorial health warning labels (HWLs) on cigarette packs are used worldwide to curb cigarette smoking, the leading preventable cause of death in the United States While individual-level mediators of HWLs’ effects on cessation have been thoroughly studied, interpersonal communication about HWLs has received less attention in HWL research. However, results from one study demonstrated the importance of interpersonal communication, finding that conversations about HWLs predicted quit attempts in Australia, Canada, and Mexico. That study also found that smokers in Mexico, where most smokers are Latino, reported more conversations than smokers in Australia and Canada, where most smokers are non-Latino White. …

The Impact Of The Medicaid Coverage Expansion And The Removal Of Cost-Sharing Under The Affordable Care Act On Mammography And Pap Tests, Abeer Alharbi

Theses and Dissertations

Background: The Affordable Care Act (ACA) aimed at making health care affordable and accessible including the use of preventive care services. To achieve these aims, the ACA expanded Medicaid coverage to population with income below 138% of FPL and removed cost-sharing when using preventive care services recommended by the USPSTF. This study tried to assess the impact of these provisions on the rate of mammography and Pap tests among women. Methods: Data was obtained from the Medical Expenditure Panel Survey - Household Component MEPS-HC. A difference-indifference design was used to determine the effect of Medicaid eligibility expansion on the outcomes …

Investigating Drug-Related Violence In Indian Country: The Lumbee Tribe Of North Carolina, Asa Alena Revels

Theses and Dissertations

Drug-related violence (DRV) impacts the over-all wellbeing of communities, with disparate health outcomes observable in many poor, minority communities. The purpose of this study was to better understand the multi-level social and environmental factors influencing elevated rates and prevention of DRV within the Lumbee, a southeastern American Indian Tribe. This was accomplished via in-depth, one-on-one interviews with 37 Lumbee Tribal Members and Key Leaders. The findings align with existing research, revealing the influence of such factors as poor socioeconomic conditions, coping strategies, broken family structures, and the influence of federal policy. Of interest was the substantial influence of the local …

Patient Characteristics, Discharge Disposition, And Hospital Factors Associated With All Cause 30-Day Hospital Readmission For Total Joint Arthroplasty In 2014, Hamad Yahya Alzamanan

Theses and Dissertations

Objective: Recent improvements in hospital care have come from a growing knowledge of factors that contribute to readmission. The objective of this work is to identify and describe the national readmission rate after Total Joint Arthroplasty, and to evaluate selected hospitals’ and patients’ factors for their association with the all-cause 30-day readmission rate after TJA in the United States in 2014. Method: Retrospective analysis of 938,504 TJA acute care hospital discharge records was performed, using a nationally representative database that is dedicated to the study of hospital readmissions, and accounts for 51% of total US hospitalizations. Logistic regression models were …

Chronic Conditions Profiles And Cardiometabolic Risk Factor Control Among A Diverse Sample Of Older Adults With Type 2 Diabetes Mellitus, Tsion Kidanie

Theses and Dissertations

Background: Multiple chronic condition is common in older adults with diabetes. Several prior studies have shown that having multiple chronic condition impact cardiometabolic risk factor controls (i.e., blood pressure, High-density lipoprotein (HDL) cholesterol level, and high glycated hemoglobin (HbA1c). However, it is not clear whether these results extend to a multiethnic sample of older adults.

Objectives: 1). Examine the association between Comorbidity profile and ABCs goals achievement. 2). Examine whether the association between comorbidity profile and ABCs goals achievement is moderated by race/ethnicity.

Methods: A sample of 3532 participants from Health and Retirement Study (HRS) years 2010 and 2012 and …

Food Acquisition And Shopping Patterns And Associations With Body Mass Index, Xiaonan Ma

Theses and Dissertations

Background: Obesity is a big public health concern in the US. Previous studies examined its association with food shopping practices measured by distance to the food store, shopping frequency, and type of store selected. However, not much is known about the actual food acquisition and shopping habits integrating multi-dimensional aspects. The purpose of this study was to identify distinct food acquisition and shopping patterns in populations primarily residing in food deserts in South Carolina (SC) and a general population in the US and characterize these patterns with respect to socioeconomic status (SES), nutritional knowledge, and perceptions and store selection …

Association Of Insurance And Provider Type With Patients’ Perceived Cost And Ease Of Access To Healthcare Services Among Medicare Beneficiaries Diagnosed With Diabetes, Metria Harris

Theses and Dissertations

Medicare beneficiaries diagnosed with diabetes are likely to have health complications or episodes associated with diabetes, resulting in higher health care utilization and costs. Andersen’s Health Care Utilization Behavior Model (HCBM) includes predisposing, enabling, and need factors, but it excludes perception. Ajzen’s Theory of Planned Behavior (TPB) shows that perception influences health service use. This study was performed using a real-world model integrating Andersen’s HCBM and Ajzen’s TPB to determine whether there was an association between insurance type (Medicare Part D versus non-Part D) and perceived ease of access or cost among Medicare beneficiaries with diabetes. The second objective was …

The Impact Of False Positive Mammography Results On Breast Cancer Screening Intention Among Black Women, Deeonna E. Farr

Theses and Dissertations

Extensive research indicates that false-positive mammograms (FPM) have been associated with negative psychosocial and cancer-related beliefs, but only a handful of studies examine Black women’s reactions to this experience. Additionally, these studies do not investigate how organizational and provider-level factors in concert with individual patient characteristics shape Black women’s experiences and reactions to FPM results. The purpose of this study was to determine the impact of organizational, provider, and individual-level factors on the processes and outcomes associated with FPM results in Black women. This study had two specific aims:

1) To describe, using a mixed methods approach, the organizational and …

Racism, Black College Students’ Mental Health, And The Efficacy Of Diversity And Inclusion Initiatives: A Case Study., Kaleea R. Lewis

Theses and Dissertations

Black college students who attend predominantly White institutions of higher education (PWIs) regularly encounter subtle and explicit forms of racism on campus. These daily experiences of prejudice and discriminatory behaviors can have an adverse impact on their mental health. This study examines the intersections of racism and mental health, particularly within an environment where racism is socially unacceptable. More specifically, this study uses qualitative methods to explore how Black college students who attend a predominately White institution of higher education (PWI) make meaning of their experiences with racial discrimination and its impact on their mental health, as well as their …

Association Of Objective Measures Of Sleep And Inflammation Markers On Police Officers: A Cross-Sectional Analysis, Megan R. Buss

Theses and Dissertations

Police officers are a unique occupational group due to the fact that they have more health problems than many other occupations. These health problems could be a result of elevated inflammation markers caused by poor sleep. Sleep influences circadian rhythms, which thereby influences the function of the immune system. The immune system is responsible for the body’s inflammatory response using pro-inflammatory cytokines such as IL-6, CRP, Fibrinogen, and TNF-a. These cytokines can become elevated if disruption of the sleep cycle occurs. Elevated levels of inflammatory markers are associated with increased risk of cardiovascular disease. Police officers also work shifts and …