Public Health Commons^™

Fortunate People In A Fortunate Land: Dwelling And Residential Alienation In Santa Monica's Rent-Controlled Housing, Lauren E.M. Everett

Dissertations and Theses

The importance of safe and stable housing for individual and community wellbeing is widely acknowledged. However, for the one third of Americans who rent their homes, housing-related stress and precarity (residential alienation) may undermine stability and a sense of home. Rent control is perhaps the most well-known tenant protection policy in the United States, but it remains highly controversial and its efficacy has been debated for decades. This research is the first academic inquiry to examine the policy through the experience of residents of rent-controlled housing. In academic discourse dominated by quantitative inquiry from the discipline of economics, this study …

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 …

The Longitudinal Effects Of A Family And Sleep Supportive Intervention On Service Member Anger And Resilience, Shalene Joyce Allen

Dissertations and Theses

The vast majority of workplace intervention research on employee anger and resilience primarily focuses on individual-level strategies for mitigating employee anger and resilience outcomes in the workplace, with no studies having examined these outcomes with tangible occupational health interventions utilizing organizational-level techniques. Thus, the current study extends the literature on how to provide improvements in employee anger and resilience using higher system and organizational change mechanisms by providing evidence-based support for the effectiveness of a Total Worker Health® intervention, referred to as the Family and Sleep Supportive Intervention Training (FaSST). This approach employs both health protection and health promotion strategies …

Affecting Absenteeism Through School-Based Health Services Delivery: A Configurational Comparative Methods Study Of Oregon's Public Secondary Schools, Kelly Elizabeth Coates

Dissertations and Theses

A student's ability to attend school regularly can be profoundly affected by poor health-related behaviors, illnesses, and chronic diseases that are left unaddressed and unattended. The delivery of health services in the school environment is uniquely positioned to interrupt the effects these health barriers to learning (HBLs) can have on subsequent diminished educational and health outcomes. The literature widely acknowledges the intersectionality between health and education, but no comprehensive overview exists of how different structures and processes within a school work (or do not work) together to lead to higher or lower student absenteeism. This research sought to fill that …

The Digital Divide And Health: Examining Digital Access As A Social Determinant Of Health, Elizabeth Melissa Withers

Dissertations and Theses

This dissertation is comprised of three papers that consider ways in which one's level of digital access may impact self-rated health. Data are from multiple years of three separate nationally representative cross-sectional surveys: National Health Interview Survey, General Social Survey, and Health Information National Trends Survey to address the primary overarching research question: Is there an association between digital access and health? The examination of the relationship between digital access and health is situated within a social determinants of health perspective and draws on van Dijk's (2005) causal and sequential model of digital access. Education, income, race and ethnicity, work …

Identifying The Cost Of Preventable Chronic Disease In Prison: Can Illness Prevention Of Adults In Custody Save Money?, Molly Bineham

Dissertations and Theses

This study investigates the cost of preventable health problems and ailments when compared to other costs of incarceration. The purpose of this study is to examine the impact of imprisonment on the costliest chronic illness. The health of adults in custody related to the general population and the overall fiscal cost of the deadliest chronic illness among incarcerated adults is discussed. Linear regression is used to analyze the occurrence of heart disease and diabetes among adults in custody while controlling for other factors. The results of this analysis provide insight that chronic diseases like heart disease and diabetes should be …

Get Your Model Out There: Advancing Methods For Developing And Using Causal-Loop Diagrams, Erin Suzanne Kenzie

Dissertations and Theses

As simple visual diagrams of key dynamics in complex systems, causal-loop diagrams could meet known needs in settings such as theory-based program evaluation and qualitative research. Methods for developing and using causal-loop diagrams, however, are underdeveloped. This dissertation comprises three articles that advance these methods. The first paper describes a systematic review of evaluation studies utilizing causal-loop diagramming to illustrate program theory. The second paper pilots an improved method for systematically generating causal-loop diagrams from qualitative data. The third paper presents a protocol for an interview-based approach to mapping mental models. Together, this research contributes to recognizing the modeler as …

Decolonizing Healthcare: A Black Feminist Analysis Of Sisters Informing Sisters On Topics Of Aids (Sista), Joy Mutare Fashu Kanu

Dissertations and Theses

This mixed methods project combines the conceptual insights offered by institutional ethnography, the deductive and inductive attributes of content analysis, semi structured interviews, and quantitative data analysis to study Sisters Informing Sisters on Topics of AIDS (SISTA), a social skills training program designed for sexually active, heterosexual African American women. This progressive program serves as a site to examine the complex relationship the U.S. state has had, and continues to have, with marginalized populations, particularly African Americans. The program reveals how the state, through the public health service, partners with scholars, researchers, and community-based organizations to produce, reproduce and perpetuate …

Aligning Food Environments With Institutional Values: A Mixed Methods Study Of Oregon Health Care Organizations, Elizaveta Walker

Dissertations and Theses

A major driver of the obesity epidemic is obesogenic food environments, characterized by nutrient-poor and energy-dense foods that saturate the collective physical, economic and sociocultural conditions that influence nutritional status. Food environments in organizations such as hospitals and public health agencies warrant special consideration given their health-focused mission. Improving food environments within health care settings has been highlighted by the Centers for Disease Control and Prevention (CDC) as one of seven key strategies to prevent obesity. However, most of the refereed literature examining healthy food environment policies (HFEPs) within hospitals focuses on the inpatient dietary environment, leaving a paucity of …

Smoking Behaviors In Patients Offered Lung Cancer Screening, Sara Elizabeth Golden

Dissertations and Theses

In the United States, smoking causes preventable diseases, including lung cancer, which is the leading cause of cancer deaths. Improving smoking cessation rates is important to decrease lung cancer deaths. Health care visits with a discussion about lung cancer screening (LCS) may help in increasing prevalence of smoking cessation. Importantly, insurers now require clinicians to have a shared decision-making discussion with patients that includes discussion of smoking abstinence before they can receive an LCS scan (i.e., a low-dose computed tomography scan). This discussion may represent a unique opportunity to encourage smoking cessation since it may prompt positive smoking behavior change. …

The Role Of Strategic Governance In Reducing Infant Mortality Under Crisis Conditions, Lynn Christine Finley

Dissertations and Theses

The infant mortality rate (IMR) in some developing countries has decreased faster than the global average even though these countries lack strong economic growth, good governance, and democracy (often acknowledged precursors to improved health outcomes). What accounts for the improvement of the IMR in the absence of these traditional pathways to health gains? Some scholars suggest that the concept of "strategic governance" might help direct attention to intermediary factors that reduce neonatal deaths in countries that experience crisis conditions. The main objective of this dissertation is to investigate the set of governance practices that have reduced IMR in two such …

Factors Affecting Clinical Research Enrollment Among Individuals With Alzheimer's Disease And Related Dementias, Nicole Grace Bouranis

Dissertations and Theses

The need to increase ADRD research participation has become more pressing as the prevalence of ADRD increases. Nearly 70,000 Oregonians and 7 million people in the United States live with ADRD, and this number is expected to increase by 200% by 2050 without identification of an intervention to halt its increase. Developing mechanisms for effective care and treatment depends on implementing research with numerous participants. Historically, ADRD research programs have had difficulty recruiting and enrolling individuals into studies for a variety of reasons. Given low recruitment rates, the interest in researching and evaluating effective strategies to recruit specifically for ADRD …

Organizational Risk In Multi-Sector Health Partnerships: A Case Study Of Oregon's Accountable Health Communities, Shauna Jean Nicole Petchel

Dissertations and Theses

The literature on collective action has documented that the perception of organizational risk -- both the uncertainty of potential outcomes and the meaning attached to them -- is an important factor in whether and how organizations engage in cross-sector collaborations. Yet there are few examples to date that document how health and social service leaders perceive organizational risks in cross-sector health partnerships focused on social determinants of health, or how their perceptions influence organizational commitment and willingness to engage in these partnerships over time.

This research aimed to fill this gap through a mixed methods case study of health and …

Life Satisfaction In Division Iaa And Division Iii Football Players, Krista Haunani Francisco

Dissertations and Theses

Level of life satisfaction is not something of which many sit down and take appraisal. However, levels of life satisfaction, especially low levels of life satisfaction, can have a direct effect on health. Low levels of life satisfaction cause an increase in self-reported stress. Inversely, high levels of stress cause a decrease in life satisfaction. This decrease in life satisfaction is associated with poor mental and physical health outcomes. A majority of student-athlete healthcare is centered around the physical aspects of health, with mental health just recently becoming a concern. It was apparent through the research for this study that …

Migrant Health Policies In The European Union: A Comparative Policy Analysis, Jessica Joanne Currier

Dissertations and Theses

There is an undeniable relationship between migration and health. Despite the fact that the concept of health as a fundamental human right has been enshrined in numerous international and supranational policy instruments, health disparities between migrants and host nation populations persist. Inequities in health are perpetuated by several factors that include, but are not limited to, immigration status, lack of knowledge of health system access points, appropriateness of health care services, language barriers, and unique health profiles of migrants. The literature firmly positions migrants as a vulnerable population due to their collective risk of poor health outcomes in multiple areas. …

Hospital-Based Services For Opioid Use Disorder: A Study Of Supply-Side Attributes, Kelsey Caroline Priest

Dissertations and Theses

The United States (U.S.) is in the midst of an opioid overdose epidemic. In the U.S., overdose deaths related to opioid exposure are the leading cause of accidental death, yet life-saving treatments, such as methadone or buprenorphine (opioid agonist therapy [OAT]), are underused. OAT underused is due, in part, to complex regulatory and health services delivery environments. Public health officials and policymakers have focused on expanding OAT access in the community (e.g. office-based buprenorphine treatment, and opioid treatment programs); however, an often-overlooked component of the treatment pathway is the acute care delivery setting, in particular hospitals.

Opioid use disorder (OUD)-related …

Racial Disparities In A State Based Workers' Compensation System, Caroline Kristine Smith

Dissertations and Theses

Racial, ethnic, and linguistic minority workers suffer higher rates of work-related injuries and illnesses in the United States compared to their White counterparts. Explanations for these higher rates include potential socioeconomic causes (education, income, and wealth) and occupational segregation into more dangerous occupations. What is less studied are the post-injury sequelae for minority workers, which is their experiences in the workers' compensation system, as well as their health and return to paid employment. What is known comes primarily from qualitative literature, which includes themes of racial discrimination (from employers, health care providers, and workers' compensation employees), a lack of information …

Age-Based Differences In The Usefulness Of Resources: A Multi-Study Investigation Of Work And Well-Being Outcomes, Lale Muazzez Yaldiz

Dissertations and Theses

The labor force is aging globally. It is projected that the number of older workers will increase in the workforce in the near future. At the same time, it is estimated that workplaces will grow more age-diverse, where younger and older workers will work side-by-side more often than they used to. These demographic shifts in the workforce necessitate a further understanding of the differences between the values, needs and motivation, and work outcomes of employees of different ages. To this end, few studies to date have investigated whether job-related resources are differentially useful for the work and non-work outcomes of …

Quantifying Spatial Potential Access Equity In An Agent Based Simulation Model Of Buprenorphine Treatment Policy In The United States, Alexandra Elizabeth Nielsen

Dissertations and Theses

Opioid dependence and opioid related deaths are a public health problem which the United States Centers of Disease Control have declared an epidemic. While opioid agonist therapy for opioid addiction has been accepted as the most effective treatment for opioid dependence among academics, and office based buprenorphine treatment has been available in the Unites States for over 10 years, OB buprenorphine faces many barriers to widespread adoption. Empirical data on the geographic distribution of physicians able to prescribe buprenorphine and the prescribing patterns of those physicians show considerable unevenness in access and utilization of treatment services.

Federal-level policies have recently …

Enhancing Value-Based Healthcare With Reconstructability Analysis: Predicting Risk For Hip And Knee Replacements, Cecily Corrine Froemke

Dissertations and Theses

Legislative reforms aimed at slowing growth of US healthcare costs are focused on achieving greater value, defined specifically as health outcomes achieved per dollar spent. To increase value while payments are diminishing and tied to individual outcomes, healthcare must improve at predicting risks and outcomes.

One way to improve predictions is through better modeling methods. Current models are predominantly based on logistic regression (LR). This project applied Reconstructability Analysis (RA) to data on hip and knee replacement surgery, and considered whether RA could create useful models of outcomes, and whether these models could produce predictions complimentary to or even stronger …

Socioeconomic Determinants Of Health Disparities By Race And Ethnicity: The Mediating Role Of Social, Psychological And Behavioral Factors, Amanuel Zimam Melekin

Dissertations and Theses

Socioeconomic status (SES) is inversely related to health status. Disparities in health status among races and ethnic groups are partly attributable to differences in SES, but the indirect pathways by which SES may influence health status are not widely studied.

Using the Health and Retirement Study (HRS) data, this dissertation examined the pathways by which SES, via social, psychological, and behavioral factors predicted physical impairment and overnight hospitalization, and asked whether these indirect relationships differed by race/ethnicity. The HRS is a nationally representative multistage area probability sample administered biennially to respondents over the age of 51 and their spouses. Data …

Foundational Knowledge And Other Predictors Of Commitment To Trauma-Informed Care, Stephanie Anne Sundborg

Dissertations and Theses

Trauma-informed care (TIC) is an approach to service delivery based on the understanding of the prevalence of psychological trauma among service users, knowledge about the impact trauma has on engagement to services, and recognition that service settings can be re-traumatizing. For more than a decade, momentum has been building on this topic. Practitioners are pursuing the knowledge and skills needed to implement trauma-informed service delivery, while organizations are building infrastructure and processes aimed at supporting this approach. Disciplines across many human service sectors are eager to incorporate TIC into policy and practice. Despite this enthusiasm, implementation efforts are slow. Acquiring …

The Effects Of Frequency Of Social Interaction, Social Cohesion, Age, And The Built Environment On Walking, Gretchen Allison Luhr

Dissertations and Theses

The purpose of this dissertation was to explore, through a social ecological framework, the multifaceted effects of the neighborhood environment by investigating how dimensions of both the built environment and the neighborhood social context may interact to influence walking. Aesthetics, land use mix, crime, and pedestrian infrastructure were considered with respect to built environment walkability, and the neighborhood social context was conceptualized using measures of both social cohesion and social interaction with neighbors. This research used data from an Environmental Protection Agency (EPA)-funded study of 748 adults (18 years of age and older) residing in the Lents neighborhood in Portland, …

Immediate And Short-Term Effects Of Kinesio® Taping On Lower Trunk Range Of Motion In Division I Athletes, Hoshito Mizutani

Dissertations and Theses

Low back pain (LBP) is a common health problem that contributes to the high cost of health care. Improvement in trunk range of motion has been considered to be an important factor in ameliorating the symptoms of LBP. Kinesio® taping is a prominent therapeutic modality commonly used in the variety of populations for treating musculoskeletal conditions. However, previous research on the efficacy of Kinesio® taping for LBP is limited. The purpose of this study was to investigate the immediate and short-term effects of Kinesio® taping with the muscle inhibition technique on active trunk flexion range of motion. Twenty-five subjects with …

Exploring The Impact Of An Ld Diagnosis On The Self-Determination Of Women In Poverty, Cynthia Jakes Stadel

Dissertations and Theses

This collective case study explored the impact of a later-in-life learning disability (LD) diagnosis on women in poverty. The study focused on the perspectives of four women who were not identified with LD as children but accessed assessment services as adults receiving Oregon's Temporary Assistance for Needy Families (TANF). All four reported painful awareness of learning differences as youths; as adults they voluntarily engaged in a "labeling event," furthering a process toward personal transformation and enhanced well-being initiated by their own awareness and curiosity. The women described critical social and emotional support systems and relationships that helped them integrate understanding …

Thinking About Work At Home: Implications For Safety At Work, Frankie Guros

Dissertations and Theses

Safety at work is of the utmost importance to employees and the organizations they work for, and as such, it is a central issue for occupational health psychology. Although dramatic decreases in the number of worker injuries and fatalities have been observed over the last several decades, safety remains a principal concern for organizations. This is especially true in occupations in which employees face serious threats to their personal safety, such as correctional officers (COs). While a number of studies have identified workplace factors that contribute to worker safety, few have attempted to draw a link between employee nonwork experiences …

Non-Steroidal Anti-Inflammatory Drug Use In Collegiate Athletes, Brian Robert Davis

Dissertations and Theses

Non-steroidal anti-inflammatory drugs (NSAID) are a class of medications used in the treatment of pain, inflammation, and illness. These medications are common, affordable, and easy to access. For these reasons, NSAIDs are commonly used by athletes of all backgrounds for treating injuries and as ergogenic aids. However, despite these behaviors, NSAIDs have well-documented side effects and the efficacious nature of these medications has been brought into question. Despite this, many athletes continue to use these medications frequently and indiscriminately. It is not known why athletes use these medications in light of their questionable effectiveness and cited adverse effects. Therefore, this …

Trauma-Informed Research And Planning: Understanding Government And Urban Native Community Partnerships To Addressing Substance-Exposed Pregnancies In Portland, Or, Amanda Mercier

Dissertations and Theses

In 2011, representatives from the Multnomah County Health Departments and several Native-serving organizations came together to address substance-exposed pregnancies among urban Native Americans in Portland, Oregon. From these partnerships, the Future Generations Collaborative was formed representing a significant shift toward community-led maternal child health research and planning. Additionally, the Future Generations Collaborative adopted a historical trauma-informed community based participatory research and planning process. This is particularly significant considering government agencies' role in colonization within Native communities. The purpose of this case study is to explore partnerships between government agencies and the Portland Native community within the Future Generations Collaborative. Given …

Participation, Information, Values, And Community Interests Within Health Impact Assessments, Nicole Iroz-Elardo

Dissertations and Theses

Health impact assessment (HIA) has emerged in the U.S. as one promising process to increase social and environmental justice through addressing health equity issues within planning. HIA practice is guided by values such as democracy and equity and grounded in broad social determinants of health. The most readily applied definition of democracy is problematic because it implies an element of direct, participatory engagement with the public. This is at odds with HIA practice that largely relies on stakeholder engagement strategies.

This dissertation critically examines the engagement strategies of three transportation planning HIA cases to more fully understand how the HIA …

Factors Influencing Youth Self-Perceptions Of Overweight And Obesity, Caitlin Helen Sommers

Dissertations and Theses

This study sought to examine whether participation in physical activity affects the ability to correctly classify body size, based on body mass index classifications. Secondarily, this study determined whether adolescents who incorrectly classified their body size overestimated or underestimated their size. Self-report data from the Youth Risk Behavior Surveillance Survey collected by the Centers for Disease Control and Prevention were analyzed. Logistic regression was performed to examine relationships between self-perception of body size and physical activity, television viewing time, computer/video game use, physical education class time, and extracurricular sports activities. Significance was set to p<0.05. Physical activity was the only statistically significant independent variable (p=0.058, OR = 1.060). Although physical activity was shown to be statistically significant, it did not appear to meaningfully increase the ability of youth to correctly classify body size. Secondary analysis showed that adolescents who incorrectly classified their body size were more likely to underestimate their body size. Females more frequently underestimated their body size (females=673; males=384).