Public Health Commons^™

Untangling The Relationship Between Antiretroviral Therapy Use And Incident Pregnancy: A Marginal Structural Model Analysis Using Data From 47,313 Hiv-Positive Women In East Africa, Batya Elul, Kara K. Wools-Kaloustian, Yingfeng Wu, Beverly S. Musick, Harriet Nuwagaba-Biribonwoha, Denis Nash, Samuel Ayaya, Elizabeth Bukusi, Pius Okong, Juliana Otieno, Deo Wabwire, Andrew Kambugu, Constantin T. Yiannoutsos

Publications and Research

Background: Scale-up of triple-drug antiretroviral therapy (ART) in Africa has transformed the context of childbearing for HIV-positive women and may impact pregnancy incidence in HIV programs.

Methods: Using observational data from 47,313 HIV-positive women enrolled at 26 HIV clinics in Kenya and Uganda between 2001 and 2009, we calculated the crude cumulative incidence of pregnancy for the pre-ART and on-ART periods. The causal effect of ART use on incident pregnancy was assessed using inverse probability weighted marginal structural models, and the relationship was further explored in multivariable Cox models.

Results: Crude cumulative pregnancy incidence at 1 year after enrollment/ART initiation …

Burden Of Disease Resulting From Lead Exposure At Toxic Waste Sites In Argentina, Mexico And Uruguay, Jack Caravanos, Jonathan Carrelli, Russell Dowling, Brian Pavilonis, Bret Ericson, Richard Fuller

Publications and Research

Background: Though lead contaminated waste sites have been widely researched in many high-income countries, their prevalence and associated health outcomes have not been well documented in low- and middle-income countries.

Methods: Using the well-established health metric disability-adjusted life year (DALY) and an exposure assessment method developed by Chatham-Stephens et al., we estimated the burden of disease resulting from exposure to lead at toxic waste sites in three Latin American countries in 2012: Argentina, Mexico and Uruguay. Toxic waste sites identified through Pure Earth’s Toxic Sites Identification Program (TSIP) were screened for lead in both biological and environmental sample media. Estimates …

Developing A Video-Based Ehealth Intervention For Hiv-Positive Gay, Bisexual, And Other Men Who Have Sex With Men: Study Protocol For A Randomized Controlled Trial, Sabina Hirshfield, Martin J. Downing Jr., Jeffrey T. Parsons, Christina Grov, Rachel J. Gordon, Steven T. Houang, Roberta Scheinmann, Patrick S. Sullivan, Irene S. Yoon, Ian Anderson, Mary Ann Chiasson

Publications and Research

Background: Gay, bisexual, and other men who have sex with men (GBMSM) accounted for 67% of new US human immunodeficiency virus (HIV) infections in 2012; however, less than 40% of HIV-positive GBMSM are virally suppressed. Preventing transmission from virally unsuppressed men who have condomless anal sex (CAS) with serodiscordant partners is a public health imperative. New HIV infections in GBMSM are attributed in part to online access to sex partners; therefore, low-cost eHealth interventions are a unique opportunity to reach men where they meet partners.

Objective: To describe the protocol of a randomized controlled trial evaluating whether video-based messaging delivered …

Assessing The Health Impact Of Transnational Corporations: Its Importance And A Framework, Frances E. Baum, David M. Sanders, Matt Fisher, Julia Anaf, Nicholas Freudenberg, Sharon Friel, Ronald Labontée, Leslie London, Carlos Monteiro, Alex Scott-Samuel, Amit Sen

Publications and Research

Background: The adverse health and equity impacts of transnational corporations’ (TNCs) practices have become central public health concerns as TNCs increasingly dominate global trade and investment and shape national economies. Despite this, methodologies have been lacking with which to study the health equity impacts of individual corporations and thus to inform actions to mitigate or reverse negative and increase positive impacts.

Methods: This paper reports on a framework designed to conduct corporate health impact assessment (CHIA), developed at a meeting held at the Rockefeller Foundation Bellagio Center in May 2015.

Results: On the basis of the deliberations …

An Analysis Of Weight Loss Articles And Advertisements In Mainstream Women’S Health And Fitness Magazines, Danna Ethan, Corey H. Basch, Grace Clarke Hillyer, Alyssa Berdnik, Mary Huynh

Publications and Research

Background: Magazines are a commonly used source for health and fitness information. Little is known about the nature and extent of weight loss strategies and products presented in mainstream women’s health and fitness magazines.

Methods: This preliminary cross-sectional study evaluated the prevalence of articles and advertisements featuring weight loss content and products in mainstream US-based health and fitness magazines, as well as assessed weight loss themes presented. Thirty-one US health and fitness-focused magazine issues were coded. Prevalence of, product type, and themes related to weight loss in articles and advertisements were assessed.

Results: Among the 31 issues of the five …

Tobacco Cessation And The Household Budget: A Longitudinal Analysis Of Consumption And Heterogeneity In The United States, Erin R. Rogers

Dissertations, Theses, and Capstone Projects

Objectives:

This dissertation was designed to: (1) estimate the relationships between recent, long-term, and relapsed tobacco cessation and dollars spent on non-tobacco goods among households in the U.S., (2) estimate the relationships between recent, long-term, and relapsed tobacco cessation and the budget shares allocated to non-tobacco goods among households in the U.S., and (3) to identify and characterize unobserved heterogeneity in the relationship between tobacco cessation and dollars spent on alcohol and food.

Methods:

Using 2006-2012 Consumer Expenditure Survey (CES) data, a cohort of 6,739 tobacco-consuming households was created and followed for four quarters. Households were categorized during the fourth …

Development Of A Patient-Centered Health Literacy Toolkit For Audiology And Hearing Loss (The 'Hh Lit Kit'), Jennifer L. Gilligan

Dissertations, Theses, and Capstone Projects

The Patient-Centered Health Literacy Toolkit for Audiology & Hearing Loss (‘HH Lit Kit’) represents four years of inquiry into health literacy and Patient-Centered Care (PCC) in audiology. While awareness of health literacy continues to gain momentum in medicine and public health, there is a paucity of information on PCC and health literacy in audiology.

Low health literacy is linked to poorer health and poorer quality of life. Patients with hearing loss are at high risk for low health literacy. This presents a major concern because hearing loss affects the way information is processed, retained, and applied. Gaps have been identified …

Ethnicity Matters: Implications For Understanding And Acting Upon Disparities In Health Affecting Black Men In The United States, Helen V. S. Cole

Dissertations, Theses, and Capstone Projects

Compared to non-Hispanic whites, non-Hispanic blacks have higher rates of mortality from heart disease, cancer, cardiovascular disease, and HIV/AIDS. Black men have a life expectancy approximately 4.7 years than the life expectancy of non-Hispanic white men, due in part to higher prevalence of chronic disease among black men. Many factors are hypothesized to contribute to disparities in health between races, including differences in socioeconomic status; culturally-linked behaviors such as diet, substance use, and physical activity; access to quality healthcare and other resources; and experiences of racism, both institutional and interpersonal. However, in public health research, race is usually treated as …

The Relationship Between Food Insecurity And Weight In The United States, 2011 – 2014, Sebastián Villamizar-Santamaría

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report examines the relation between weight and food insecurity in the United States between 2011 and 2014.

Methods: The data used in this report come from the Integrated Health Interview Services (IHIS) and its food security index. Weight is assessed by body mass index, and the population is divided into four weight groups based on body mass index ranges.

Results: First, food insecurity rates declined among the general population of Latinos between 2011 and 2014, however, food insecurity rates rose dramatically among underweight Latinos over that time period. Second, food insecurity rates were greatest among the obese and …

Prevalence Of Chronic Health Conditions Among Latinos In The United States Between 1999 And 2011, Amanda Mía Marín-Chollom

Center for Latin American, Caribbean, and Latino Studies

Introduction: This study examines the prevalence of five major chronic health conditions – heart disease, stroke, cancer, arthritis, and diabetes – among adults 18 years of age and older in the United States between 1999 and 2011.

Methods: The data used in this report come from the Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics, Health Data Interactive tables. Patterns were examined by age structure among the four largest race/ethnic groups in the U.S., and among the two largest Latino subgroups in the U.S. (Mexicans and Puerto Ricans)

Results: Latinos had higher rates of diabetes than …

The Expert Advice: Dental Patient Compliance Hinges On Effective Communication Strategies, Diana V. Macri

Publications and Research

Most dental hygienists would agree that motivating patients to adopt good oral health behaviors-often referred to as compliance-is the most challenging aspect of practice. This critical component of patient care is not unique to dentistry and dental hygiene. In 2010, the costs of health care in the United States exceeded $2.7 trillion with "between $100 and $300 billion of avoidable health-care costs [attributable] to nonadherence in the US annually."1 Nonadherence (a term used in the medical literature, which is synonymous with noncompliance) is associated with progression of disease and, subsequently, poor health outcomes resulting in an additional burden of billions …

Sociodemographic And Geospatial Correlates Of Stillbirths And Neonatal Mortality In Indonesia (1993–2007), Alka Dev

Dissertations, Theses, and Capstone Projects

Little research has focused on the determinants of stillbirth and neonatal mortality in Indonesia despite the fact that the country has one of the highest rates of stillbirths in the world and one of the highest rates of neonatal mortality in Asia. Several areas have not been explored due to data limitations, such as shared risk factors and measurement challenges, which can inform health policy and interventions and guide future research. This dissertation addresses this gap by comparing measurement challenges for stillbirth and neonatal mortality and identifying risk factors for both using Indonesian reproductive health survey data. Differences in estimates …

Severity And Clustering Of Menopausal Symptoms Among Obese And Nonobese Postmenopausal Women In India, E. S. Sharanya Shre, Kate Trout, Sonia Pant Singh, Awnish Kumar Singh, Surapaneni Krishna Mohan, Ashish Joshi

Publications and Research

Background: The symptoms of menopause have a negative impact on quality of life, especially in women transitioning to menopause and earlier transitions. This study was conducted with the objective of assessing the effect of obesity on the severity of menopausal symptoms and the clustering of symptoms in postmenopausal women in India.

Methodology: The Menopausal Rating Scale (MRS) was used to assess the severity of menopausal symptoms of postmenopausal women of Chennai, visiting Saveetha Medical College, Chennai, India. This cross‑sectional study was conducted from August to November 2013 in Chennai, India. Sociodemographic characteristics, anthropometric measurements, blood pressure level, menopausal history, personal …

Variation In Restaurant Sanitary Scores In New York City, Kyle Gregory

Theses and Dissertations

The purpose of this study was to determine whether restaurants that are homogenous in nature would exhibit substantially different hygiene scores based on the underlying consumer learning behaviors present in the neighborhoods in which the restaurants are located.

Factors Associated With Initiation Of Antiretroviral Therapy In The Advanced Stages Of Hiv Infection In Six Ethiopian Hiv Clinics, 2012 To 2013, Denis Nash, Olga Tymejczyk, Tsigereda Gadisa, Sarah Gorrell Kulkarni, Susie Hoffman, Muluneh Yigzaw, Batya Elul, Robert H. Remien, Maria Lahuerta, Shalo Daba, Wafaa El Sadr, Zenebe Melaku

Publications and Research

Introduction: Most HIV-positive persons in sub-Saharan Africa initiate antiretroviral therapy (ART) with advanced infection (late ART initiation). Intervening on the drivers of late ART initiation is a critical step towards achieving the full potential of HIV treatment scale-up. This study aimed to identify modifiable factors associated with late ART initiation in Ethiopia.

Methods: From 2012 to 2013, Ethiopian adults (n=1180) were interviewed within two weeks of ART initiation. Interview data were merged with HIV care histories to assess correlates of late ART initiation (CD4+ count <150 cells/mL or World Health Organization Stage IV).

Results: The median CD4 count at enrolment in HIV care was 263 cells/mL (interquartile range …

Associations Of Birth Order With Early Adolescent Growth, Pubertal Onset, Blood Pressure And Size: Evidence From Hong Kong’S “Children Of 1997” Birth Cohort, Man Ki Kwok, Gabriel M. Leung, C. Mary Schooling

Publications and Research

Background: Birth order has been proposed as a cardiovascular risk factor, because the lower birth weight and greater infant weight gain typical of firstborns could programme metabolism detrimentally.

Methods: We examined the associations of birth order (firstborn or laterborn) with birth weight-for-gestational age, length/height and body mass index (BMI) z-scores during infancy, childhood, and puberty using generalized estimating equations, with age at pubertal onset using interval- censored regression and with age-, sex- and height-standardized blood pressure, height and BMI z-scores at 13 years using linear regression in a population-representative Chinese birth cohort: “Children of 1997” (n = 8,327).

Results: Compared …

Tobacco, Alcohol, And Processed Food Industries – Why Do Public Health Practitioners View Them So Differently?, Katherine Smith, Lori Dorfman, Nicholas Freudenberg, Benjamin Hawkins, Shona Hilton, Oliver Razum, Heide Weishaar

Publications and Research

No abstract provided.

Inquiry Into The Implementation Of Bush’S Executive Order 13211 And The Impact On Environmental And Public Health Regulation, Elizabeth Ann Glass Geltman, Gunwant Gill, Miriam Jovanovic

Publications and Research

Executive Order 13211, promulgated in 2001, requires the federal government to consider the impact of federal action on energy independence as part of the George W. Bush’s National Energy Policy. This law review examines whether EO 13211 was used to curtail environmental protection and natural resource conservation. The article begins with a review of the procedure required of federal agencies under EO 13211 and its associated documents. The paper then examines case law and published federal rulemaking proceedings and examines how federal agencies apply tests to evaluate the potential energy effect. The study concludes that EO 13211 strikes a reasonable …

Reducing The Role Of The Food, Tobacco, And Alcohol Industries In Noncommunicable Disease Risk In South Africa, Peter Delobelle, David Sanders, Thandi Puoane, Nicholas Freudenberg

Publications and Research

Noncommunicable diseases (NCDs) impose a growing burden on the health, economy, and development of South Africa. According to the World Health Organization, four risk factors, tobacco use, alcohol consumption, unhealthy diets, and physical inactivity, account for a significant proportion of major NCDs. We analyze the role of tobacco, alcohol, and food corporations in promoting NCD risk and unhealthy lifestyles in South Africa and in exacerbating inequities in NCD distribution among populations. Through their business practices such as product design, marketing, retail distribution, and pricing and their business practices such as lobbying, public relations, philanthropy, and sponsored research, national and transnational …

The Good Food Jobs Nexus: A Strategy For Promoting Health, Employment, And Economic Development, Nicholas Freudenberg, Michele Silver, Lesley Hirsch, Nevin Cohen

Publications and Research

In the aftermath of the Great Recession, cities have looked to the rapidly growing food sector as a promising source of new employment, and yet most of the sector’s growth has come from low-wage, dead-end food jobs. A strategy to simultaneously increase food employment, improve conditions for food workers, and enhance access to healthy and affordable food to improve public health requires pursuing a “good food jobs” approach that supports policies and programs that advance all three goals. To inform such a strategy, this article analyzes policies and programs to create good food jobs in New York City and discusses …

Craigslist As A Source For Illicit Drugs: A Case Report And Review Of The Literature, Babak Tofighi, Alisha Desai, Christian Grov, Joshua D. Lee

Publications and Research

Introduction: Online drug markets and social media are facilitating the spread of information and sale of illicit substances. Online sites, such as Craigslist and Bluelight, underscore an emerging shift in contemporary drug consumerism.

Case Descriptions: We report on two cases. Case 1 is a 42-year-old male with a history of heroin-use disorder, presented for an initial visit to an office-based buprenorphine program, and reported having acquired heroin from Craigslist. Despite several harrowing experiences, Craigslist remained Patient 1’s primary method of purchasing heroin during a 14-month period. Craigslist ads also redirected the patient to the web site Bluelight, which …

Understanding Differences In Hiv/Hcv Prevalence According To Differentiated Risk Behaviors In A Sample Of Pwid In Rural Puerto Rico, Roberto Abadie, Melissa Welch-Lazoritz, Camila Gelpi-Acosta, Juan Carlos Reyes, Kirk Dombrowski

Publications and Research

Background: Blood contained in needles and injection equipment has been identified as a vector for HIV and HCV transmission among people who inject drugs (PWID). Yet, there is often a wide discrepancy in prevalence for both viruses. While microbiological differences between viruses influence prevalence, other variables associated with the way drugs are acquired and used, also play a role.

Methods: Respondent-driven sampling (RDS) methods recruited a sample of 315 current intravenous drug users in rural Puerto Rico. Information about type and frequency of use, HIV and HVC risk behaviors (sharing needles, cookers, cotton, and water), sexual behaviors, and alcohol use …

Parasitic Diseases Of The Central Nervous System: Lessons For Clinicians And Policy Makers, Arturo Carpio, Matthew L. Romo, R.M.E. Parkhouse, Brooke Short, Tarun Dua

Publications and Research

Parasitic diseases of the central nervous system are associated with high mortality and morbidity, especially in resource-limited settings. The burden of these diseases is amplified as survivors are often left with neurologic sequelae affecting mobility, sensory organs, and cognitive functions, as well as seizures/epilepsy. These diseases inflict suffering by causing lifelong disabilities, reducing economic productivity, and causing social stigma. The complexity of parasitic life cycles and geographic specificities, as well as overlapping clinical manifestations in the host reflecting the diverse pathogenesis of parasites, can present diagnostic challenges. We herein provide an overview of these parasitic diseases and summarize clinical aspects, …

Age And Employee Green Behaviors: A Meta-Analysis, Brenton M. Wiernik, Stephan Dilchert, Deniz S. Ones

Publications and Research

Recent economic and societal developments have led to an increasing emphasis on organizational environmental performance. At the same time, demographic trends are resulting in increasingly aging labor forces in many industrialized nations. Commonly held stereotypes suggest that older workers are less likely to be environmentally responsible than younger workers. To evaluate the degree to which such age differences are present, we meta-analyzed 132 independent correlations and 336 d-values based on 4676 professional workers from 22 samples in 11 countries. Contrary to popular stereotypes, age showed small positive relationships with pro-environmental behaviors, suggesting that older adults engaged in these workplace …

Chiropractors’ Perception Of Occupational Stress And Its Influencing Factors: A Qualitative Study Using Responses To Open-Ended Questions, Shawn Williams

Publications and Research

Background: Job stress and emotional exhaustion have been shown to have a negative impact on the helping professional. The development and causal relations of job stress and emotional exhaustion are rather unclear in the chiropractic profession. The objective of this study is to understand the main sources of occupational stress and emotional exhaustion among doctors of chiropractic.

Methods: Analysis of the written responses to web-based open-ended questionnaire was performed using an interpretive research methodology. Additionally, cross tabulation and Chi square statistical tests were conducted to match and couple the demographic data with the categorical themes.

Results: Fourteen professional stress categories …

Sexual Behavior Varies Between Same-Race And Different-Race Partnerships: A Daily Diary Study Of Highly Sexually Active Black, Latino, And White Gay And Bisexual Men, Christian Grov, Demetria Cain, H. Jonathan Rendina, Ana Ventuneac, Jeffrey T. Parsons

Publications and Research

Background. Gay and bisexual men (GBM) are at elevated risk for gonorrhea and chlamydia trachomatis (GC/CT). Rectal GC/CT symptoms may be less obvious than urethral, increasing opportunities for undiagnosed rectal GC/CT.

Method. A U.S. national sample of 1,071 GBM completed urethral and rectal GC/CT testing and an online survey.

Results. In total, 6.2% were GC/CT positive (5.3% rectal, 1.7% urethral). We calculated adjusted (for education, race, age, relationship status, having health insurance, and income) odds ratios for factors associated with rectal and urethral GC/CT diagnoses. Age was inversely associated with urethral and rectal GC/CT. Compared to White men, Latinos had …

Hypersexual, Sexually Compulsive, Or Just Highly Sexually Active? Investigating Three Distinct Groups Of Gay And Bisexual Men And Their Profiles Of Hiv-Related Sexual Risk, Jeffrey T. Parsons, H. Jonathan Rendina, Ana Ventuneac, Raymond L. Moody, Christian Grov

Publications and Research

Emerging research supports the notion that sexual compulsivity (SC) and hypersexual disorder (HD) among gay and bisexual men (GBM) might be conceptualized as comprising three groups—Neither SC nor HD; SC only, and Both SC and HD—that capture distinct levels of severity across the SC/HD continuum. We examined data from 370 highly sexually active GBM to assess how the three groups compare across a range of risk factors for HIV infection. Comparisons focused on psychosexual measures—temptation for condomless anal sex (CAS), self-efficacy for avoiding CAS, sexual excitation and inhibition—as well as reports of actual sexual behavior. Nearly half (48.9%) of this …

Multilevel Analysis Of Individual, Neighborhood, And Health Care Facility Characteristics Associated With Achievement And Maintenance Of Hiv Viral Suppression Among Persons Newly Diagnosed With Hiv In New York City, Ellen W. Wiewel

Dissertations, Theses, and Capstone Projects

Objective

To investigate the effect of individual, health care facility, and neighborhood characteristics on achievement and maintenance of HIV viral suppression, among New York City residents aged 13 years and older diagnosed with HIV between 2006 and 2012.

Methods

I used individual-level data from the New York City HIV surveillance registry and Case Surveillance-Based Sampling, facility-level data from the surveillance registry, and neighborhood-level data from the U.S. Census and American Community Survey. The outcomes of interest were first viral suppression after diagnosis (Aims 1 and 3; ≤400 copies/mL) and virologic failure after first suppression among persons who achieved suppression (Aim …

The Impact Of Foster Care On Depression: An Examination Of Placement Type And Mental Health Service Utilization Among Children And Adolescents, Kisha Cummings

Dissertations, Theses, and Capstone Projects

Background: Children and adolescents in foster care with a history of complex trauma such as neglect, emotional, physical, and sexual abuse have a greater odds of being clinically diagnosed with depression in adulthood compared to children and adolescents without such a history. The current study examines the prevalence of depression in a national sample of children and adolescents aged 7 to 17 years. This study asks whether a) foster care is associated with a greater prevalence of depression among children and adolescents in foster care compared to children and adolescents not in foster care; b) there is an association between …

Healthy Beginnings: Exploring The Impact Of Parental Stress And Relationship Quality On Birth Outcomes, Anna A. Divney

Dissertations, Theses, and Capstone Projects

This dissertation consists of three studies exploring the effects of maternal and paternal experiences of stress and perceptions of relationship quality on length of gestation and birth weight. The first study assessed the association of parental relationship quality with the baby’s length of gestation and birth weight among 2,072 families in the Fragile Families and Child Wellbeing study. Romantic relationships can be a substantial source of social support as well as stress, and have been shown to influence many health outcomes. Beyond crude relationship characteristics, however, few studies have assessed the association of other dimensions of relationship quality, such as …