Public Health Commons^™

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, …

Cost Effectiveness Of Potential Art Adherence Monitoring Interventions In Sub-Saharan Africa, Andrew N. Phillips, Valentina Cambiano, Fumiyo Nakagawa, Loveleen Bansi-Matharu, Papa Salif Sow, Peter Ehrenkranz, Deborah Ford, Owen Mugurungi, Tsitsi Apollo, Joseph Murungu, David R. Bangsberg, Paul Revill

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background -Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost.

Methods - An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance …

Real Talk: Developing A Computer-Delivered Sexual Health Program For Black Men Who Have Sex With Men, Charles H. Klein, Carmela Lomonaco

Anthropology Faculty Publications and Presentations

HIV disproportionately affects Black men who have sex with men (MSM), yet there are few evidence-based programs that respond to the diverse realities of Black MSM communities. This article examines the development of Real Talk, a new harm reduction-based, sexual health intervention for Black MSM. We first analyze the key themes from our formative research: (1) stigma, discrimination, and intersectionalities in the lives of Black MSM, (2) the importance of safe spaces and community provided by health promotion programs, and (3) moving beyond condoms in sexual health messaging. We then describe our agile design product development process and present an …

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 …

Civic Engagement Among Orphans And Non-Orphans In Five Low- And Middle-Income Countries, Christine L. Gray, Brian W. Pence, Lynne C. Messer, Jan Ostermann, Rachel A. Whetten, Nathan M. Thielman, Karen O'Donnell, Kathryn Whetten

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in resource-poor settings. Understanding whether and how OSC are engaged in civic activities is important for community and world leaders who need to provide care for OSC and ensure their involvement in sustainable development.

Methods: The Positive Outcomes for Orphans study (POFO) is a multi-country, longitudinal cohort study of OSC randomly sampled from institution-based care and from family-based care, and …

A Livelihood Intervention To Improve Economic And Psychosocial Well-Being In Rural Uganda: Longitudinal Pilot Study, Bernard Kakuhikire, Diego Suquillo, Elly Atuhumuza, Rumbidzai Mushavi, Jessica M. Perkins, Atheendar S. Venkataramani, Sheri D. Weiser, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

HIV and poverty are inextricably intertwined in sub-Saharan Africa. Economic and livelihood intervention strategies have been suggested to help mitigate the adverse economic effects of HIV, but few intervention studies have focused specifically on HIV positive persons. We conducted three pilot studies to assess a livelihood intervention consisting of an initial orientation and loan package of chickens and associated implements to create poultry microenterprises. We enrolled 15 HIV-positive and 22 HIV-negative participants and followed them for up to 18 months. Over the course of follow-up, participants achieved high chicken survival and loan repayment rates. Median monthly income increased, and severe …

A Framework To Address Challenges In Communicating The Developmental Origins Of Health And Disease, Liana Winett, Lawrence Wallack, Dawn M. Richardson, Janne Boone-Heinonen, Lynne C. Messer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Findings from the field of Developmental Origins of Health and Disease (DOHaD) suggest that some of the most pressing public health problems facing communities today may begin much earlier than previously understood. In particular, this body of work provides evidence that social, physical, chemical, environmental, and behavioral influences in early life play a significant role in establishing vulnerabilities for chronic disease later in life. Further, because this work points to the importance of adverse environmental exposures that cluster in population groups, it suggests that existing opportunities to intervene at a population level may need to refocus their efforts “upstream” to …

Process Evaluation And Assessment Of Use Of A Large Scale Water Filter And Cookstove Program In Rwanda, Christina K. Barstow, Corey Nagel, Thomas Clasen, Evan A. Thomas

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: In an effort to reduce the disease burden in rural Rwanda, decrease poverty associated with expenditures for fuel, and minimize the environmental impact on forests and greenhouse gases from inefficient combustion of biomass, the Rwanda Ministry of Health (MOH) partnered with DelAgua Health (DelAgua), a private social enterprise, to distribute and promote the use of improved cookstoves and advanced water filters to the poorest quarter of households (Ubudehe 1 and 2) nationally, beginning in Western Province under a program branded Tubeho Neza (“Live Well”). The project is privately financed and earns revenue from carbon credits under the United Nations …

Is Housing Making People Sick?: An Overview Of Seven Studies That Raise Questions To Consider As We Incorporate Health Into Planning And Build New Housing To Address Shortages And Energy Efficiency, Merilee D. Karr

Metroscape

The article discusses the unintended consequences of some of the strategies for housing energy efficiency: they can lead to indoor air pollution that is making people sick. As we pursue ways to reduce the cost of housing, we must pursue innovation in building materials and techniques that might reduce the negative health consequences of sealing our homes from the elements.

Elimination Of Taenia Solium Transmission In Northern Peru, Hector H. Garcia, Armando E. Gonzalez, Victor C.W. Tsang, Seth E. O'Neal, Fernando Llanos‑Zavalaga, Guillermo Gonzalvez, Jaime Romero, Silvia Rodriguez, Luz M. Moyano, Viterbo Ayvar, Andre Diaz, Allen Hightower, Philip S. Craig, Marshall W. Lightowlers, Charles G. Gauci, Elli Leontsini, Robert H. Gilman

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Taeniasis and cysticercosis are major causes of seizures and epilepsy. Infection by the causative parasite Taenia solium requires transmission between humans and pigs. The disease is considered to be eradicable, but data on attempts at regional elimination are lacking. We conducted a three-phase control program in Tumbes, Peru, to determine whether regional elimination would be feasible.

Methods: We systematically tested and compared elimination strategies to show the feasibility of interrupting the transmission of T. solium infection in a region of highly endemic disease in Peru. In phase 1, we assessed the effectiveness and feasibility of six intervention …

Food-Related Practices And Beliefs Of Rural Us Elementary And Middle School Teachers, Nancy Findholt, Betty T. Izumi, Jackilen Shannon, Thuan Nguyen

Community Health Faculty Publications and Presentations

INTRODUCTION:

Childhood obesity disproportionately affects rural populations; therefore, promoting healthy eating among rural children is essential. Teachers are important role models for children and can influence children's eating behaviors through their own behaviors and beliefs about food. This study examined the food-related practices and beliefs of rural elementary and middle school teachers.

METHODS:

Data were used from the SNACZ study, a school- and community-based trial conducted in rural Oregon. Kindergarten through eighth-grade teachers (n=87), teaching students usually aged 5-14 years, from eight rural school districts completed a baseline survey in November 2012 concerning their classroom food practices, eating behaviors at …

North Douglas County Community Needs Health Assessment (Phase 1), Callie H. Lambarth, Diane Reid, Beth L. Green

Early Childhood

Beginning in February 2016, the North Douglas County (NDC) communities of Drain, Elkton, and Yoncalla, Oregon engaged in a Community Health Needs Assessment (CHNA) planning process, focusing on children ages birth-to-8 and their families. The purpose of this process was to explore, understand, and integrate linkages between early learning and young child and family health; identify health-related resources currently available and accessible to NDC families; and prioritize health areas of interest to be explored during the CHNA.

The North Douglas County CHNA builds on community partnerships already established in the region through initiatives that aim to coordinate and align early …

Re-Inventing Adherence: Toward A Patient-Centered Model Of Care For Drug-Resistant Tuberculosis And Hiv, Max R. O'Donnell, A. Daftary, M. Frick, Y. Hirsch-Moverman, K. R. Amico, M. Senthilingam, A. Wolf, J. Z. Metcalfe, P. Isaakidis, J. L. Davis, J. R. Zelnick, J.C.M. Brust, N. Naidu, M. Garretson, David Bangsberg, N. Padayatchi, G. Friedland

OHSU-PSU School of Public Health Faculty Publications and Presentations

BACKGROUND—Despite renewed focus on molecular tuberculosis (TB) diagnostics and new antimycobacterial agents, treatment outcomes for patients co-infected with drug-resistant TB and human immunodeficiency virus (HIV) remain dismal, in part due to lack of focus on medication adherence as part of a patient-centered continuum of care.

OBJECTIVE—To review current barriers to drug-resistant TB-HIV treatment and propose an alternative model to conventional approaches to treatment support.

DISCUSSION—Current national TB control programs rely heavily on directly observed therapy (DOT) as the centerpiece of treatment delivery and adherence support. Medication adherence and care for drug-resistant TB-HIV could be improved by fully implementing team-based patient-centered …

Racial And Ethnic Disparities In Desire For Reversal Of Sterilization Among U.S. Women, Ginny Garcia-Alexander, Kelly Gonzales, Elizabeth Carol Hauck

Sociology Faculty Publications and Presentations

Purpose: Female sterilization rates and subsequent desire for reversal of the procedure are substantially higher in minorities, low-income women, and those who use public insurance. Despite the disproportionate distribution of these outcomes, few studies in this area have considered the extent to which such disparities are attributable to a restricted set of contraceptive options among medically underserved populations, which may in turn explain higher rates of desire for reversal. Methods: We use the most recent wave of NSFG data (2011-2013) to estimate odds ratios for race/ethnicity on the likelihood of desire for reversal of sterilization, while controlling for an array …

Dietary Fat Intake And Reproductive Hormone Concentrations And Ovulation In Regularly Menstruating Women, Sunni L. Mumford, Jorge E. Chavarro, Cuilin Zhang, Neil J. Perkins, Lindsey A. Sjaarda, Anna Z. Pollack, Karen C. Schliep, Kara A. Michels, Shvetha M. Zarek, Torie C. Plowden, Rose G. Radin, Lynne C. Messer, Robyn A. Frankel, Jean Wactawski-Wende

Community Health Faculty Publications and Presentations

Background: Emerging evidence suggests potential links between some dietary fatty acids and improved fertility, because specific fatty acids may affect prostaglandin synthesis and steroidogenesis.

Objective: The objective of this exploratory study was to evaluate associations between total and specific types of dietary fat intake and 1) hormone concentrations and 2) the risk of sporadic anovulation in a cohort of 259 regularly menstruating women in the BioCycle Study.

Design: Endogenous reproductive hormones were measured up to 8 times/cycle for up to 2 cycles, with visits scheduled with the use of fertility monitors. Dietary intake was assessed with up to …

Micrometeorological Simulations To Predict The Impacts Of Heat Mitigation Strategies On Pedestrian Thermal Comfort In A Los Angeles Neighborhood, Mohammad Taleghani, David J. Sailor, George A. Ban-Weiss

Mechanical and Materials Engineering Faculty Publications and Presentations

The urban heat island impacts the thermal comfort of pedestrians in cities. In this paper, the effects of four heat mitigation strategies on micrometeorology and the thermal comfort of pedestrians were simulated for a neighborhood in eastern Los Angeles County. The strategies investigated include solar reflective ‘cool roofs’, vegetative ‘green roofs’, solar reflective ‘cool pavements’, and increased streetlevel trees. Aseries of micrometeorological simulations for an extreme heat day were carried out assuming widespread adoption of each mitigation strategy. Comparing each simulation to the control simulation assuming current land cover for the neighborhood showed that additional street-trees and cool pavements reduced …

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 …

Reasons For Missing Antiretroviral Therapy: Results From A Multi-Country Study In Tanzania, Uganda, And Zambia, Olivier Koole, Julie A. Denison, Joris Menten, Sharon Tsui, Fred Wabwire-Mangen, Gideon Kwesigabo, Modest Mulenga, Andrew F. Auld, Simon G. Agolory, Ya Diul Mukadi, Eric Van Praag, Kwasi Torpey, Seymour Williams, Jonathan Kaplan, Aaron Zee, David Bangsberg, Robert Colebunders

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives To identify the reasons patients miss taking their antiretroviral therapy (ART) and the proportion who miss their ART because of symptoms; and to explore the association between symptoms and incomplete adherence.

Methods Secondary analysis of data collected during a cross-sectional study that examined ART adherence among adults from 18 purposefully selected sites in Tanzania, Uganda, and Zambia. We interviewed 250 systematically selected patients per facility (≥18 years) on reasons for missing ART and symptoms they had experienced (using the HIV Symptom Index). We abstracted clinical data from the patients’ medical, pharmacy, and laboratory records. Incomplete adherence was defined as …

Pain And Psychiatric Comorbidities Among Two Groups Of Iraq- And Afghanistan-Era Veterans, Kristin M. Phillips, Michael E. Clark, Ronald J. Gironda, Suzanne Mcgarity, Ronald W. Kerns, Christine A. Elnitsky, Elena M. Andresen, Rose C. Collins

OHSU-PSU School of Public Health Faculty Publications and Presentations

This study aimed to (1) identify the prevalence and severity of pain and psychiatric comorbidities among personnel who had been deployed during Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) and (2) assess whether the Department of Veterans Affairs (VA) Polytrauma System of Care and an OIF/OEF/OND registry reflect real differences among patients. Participants (N = 359) were recruited from two VA hospitals. They completed a clinical interview, structured diagnostic interview, and self-report measures. Results indicated pain was the most common complaint, with 87% experiencing pain during the prior week and 56% reporting moderate or …

Associations Between Performance On An Abbreviated Cogstate Battery, Other Measures Of Cognitive Function, And Biomarkers In People At Risk For Alzheimer's Disease, Annie M. Racine, Lindsay R. Clark, Sara C. Berman, Rebecca L. Koscik, Kimberly D. Mueller, Derek Norton, Christopher R. Nicholas, Kaj Blennow, Henrik Zetterberg, Bruno M. Jedynak, Murat Bilgel, Cynthia M. Carlsson, Bradley T. Christian, Sanjay Asthana, Sterling C. Johnson

Mathematics and Statistics Faculty Publications and Presentations

It is not known whether computerized cognitive assessments, like the CogState battery, are sensitive to preclinical cognitive changes or pathology in people at risk for Alzheimer's disease(AD). In 469 late middle-aged participants from the Wisconsin Registry for Alzheimer's Prevention(mean age 63.8±7 years at testing; 67% female; 39% APOE4+), we examined relationships between a CogState abbreviated battery(CAB) of seven tests and demographic characteristics, traditional paper-based neuropsychological tests as well as a composite cognitive impairment index, cognitive impairment status(determined by consensus review), and biomarkers for amyloid and tau(CSF phosphorylated-tau/Aβ42 and global PET-PiB burden) and neural injury(CSF neurofilament light protein). CSF and PET-PiB …

Assessing The Everyday Discrimination Scale Among American Indians And Alaska Natives, Kelly Gonzales, Carolyn Noonan, R. Turner Goins, William G. Henderson, Janette Beals, Spero M. Manson, Kelly J. Action, Yvette Roubideaux

OHSU-PSU School of Public Health Faculty Publications and Presentations

The Everyday Discrimination Scale (EDS) has been used widely as a measure of subjective experiences of discrimination. The usefulness of this measure for assessments of perceived experiences of discrimination by American Indian and Alaska Native (AI/AN) peoples has not been explored. Data derived from the Special Diabetes Program for Indians—Healthy Heart Demonstration Project (SDPI-HH), a large-scale initiative to reduce cardiovascular risk among AI/ANs with Type 2 diabetes. Participants (N = 3,039) completed a self-report survey that included the EDS and measures of convergent and divergent validity. Missing data were estimated by multiple imputation techniques. Reliability estimates for the EDS were …