Public Health Commons^™

How Urban Land Use Contributes To Inequitable Health Outcomes: An Interdisciplinary Review & Analysis, Bliss Storm Croton

University Honors Theses

Using existing literature as a basis for initial review, this paper seeks to explore the relationship between urban land use and socioeconomic status as both pertain to the prevalence of psychological health diagnoses among neighborhood residents. The purpose of this analysis is to investigate the combined literature from multiple areas of research in order to gain a more holistic, up-to-date scope of knowledge regarding how discriminatory neighborhood land use may result in poorer psychological health outcomes for urban populations. By utilizing an interdisciplinary approach, some of the locally relevant, long-term impacts of uneven development and environmental injustice are examined based …

Contraceptive Use Following Unintended Pregnancy Among Ugandan Women Living With Hiv, Jana Jarolimova, Jerome Kabakyenga, Kara Bennett, Winnie R. Muyindike, Annet Kembabazi, Jeffrey N. Martin, Peter W. Hunt, Yap Boum, Jessica E. Haberer, David Bangsberg, Angela Kaida, Lynn T. Matthews

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Preventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda.

Study design: This was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011–2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or …

Towards A People’S Social Epidemiology: Envisioning A More Inclusive And Equitable Future For Social Epi Research And Practice In The 21st Century, Ryan J. Petteway, Mahasin Mujahid, Rachel Morello-Frosch, Amani Allen

OHSU-PSU School of Public Health Faculty Publications and Presentations

Social epidemiology has made critical contributions to understanding population health. However, translation of social epidemiology science into action remains a challenge, raising concerns about the impacts of the field beyond academia. With so much focus on issues related to social position, discrimination, racism, power, and privilege, there has been surprisingly little deliberation about the extent and value of social inclusion and equity within the field itself. Indeed, the challenge of translation/action might be more readily met through re-envisioning the role of the people within the research/practice enterprise—reimagining what “social” could, or even should, mean for the future of the field. …

World Health Organization Cardiovascular Disease Risk Charts: Revised Models To Estimate Risk In 21 Global Regions, Stephen Kaptoge, Lisa Pennells, Dirk De Bacquer, Marie Therese Cooney, Maryam Kavousi, Gretchen Stevens, Leanne Margaret Riley, Stefan Savin, Taskeen Khan, Servet Altay, Carlos J. Crespo, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions.

Methods: In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history …

Air Pollution, Neighborhood Deprivation, And Autism Spectrum Disorder In The Study To Explore Early Development, Laura A. Mcguinn, Gayle C. Windham, Lynne C. Messer, Di Qian, Joel Schwartz, Lisa A. Croen, Eric J. Moody, Ana G. Rappold, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: To examine whether neighborhood deprivation modifies the association between early life air pollution exposure and autism spectrum disorder (ASD), we used resources from a multisite case–control study, the Study to Explore Early Development.

Methods: Cases were 674 children with confirmed ASD born in 2003–2006; controls were 855 randomly sampled children born during the same time period and residents of the same geographic areas as cases. Air pollution was assessed by roadway proximity and particulate matter

Results: Neighborhood deprivation modified (P_{for interaction} = 0.08) the association between PM2.5 exposure during the first year of life …

Correlates Of Same-Sex Behavior Disclosure To Health Care Providers Among Black Msm In The United States: Implications For Hiv Prevention, Christina J. Sun, Karin Tobin, Pilgrim Spikes, Carl Latkin

OHSU-PSU School of Public Health Faculty Publications and Presentations

Disclosure of same-sex behavior to health care providers (HCPs) by men who have sex with men (MSM) has been argued to be an important aspect of HIV prevention. However, Black MSM are less likely to disclose compared to white MSM. This analysis of data collected in the United States from 2006–2009 identified individual and social network characteristics of Black MSM (n = 226) that are associated with disclosure that may be leveraged to increase disclosure. Over two-thirds (68.1%) of the sample had ever disclosed to HCPs. Part-time employment (AOR = 0.32, 95% CI = 0.11–0.95), bisexual identity (AOR = …

Clinical Practice Variation Among Adult Infectious Disease Physicians In The Management Of Staphylococcus Aureus Bacteremia, Catherine Liu, Luke Strnad, Susan E. Beekmann, Philip M. Polgreen, Henry F. Chambers

OHSU-PSU School of Public Health Faculty Publications and Presentations

Infectious disease management of Staphylococcus aureus bacteremia (SAB) was surveyed through the Emerging Infections Network. While there were areas of consensus, we found substantial practice variation in diagnostic evaluation and management of adult patients with SAB. These findings highlight opportunities for further research and guidance to define best practices.

Divergent Trends In Life Expectancy Across The Rural-Urban Gradient And Association With Specific Racial Proportions In The Contiguous Usa 2000-2005, Yun Jian, Lucas Neas, Lynne C. Messer, Christine L. Gray, Jyotsna S. Jagai, Kristen M. Rappazzo, Danelle T. Lobdell

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives: To estimate county-level adult life expectancy for Whites, Black/African Americans (Black), American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (Asian) populations and assess the difference across racial groups in the relationship among life expectancy, rurality and specific race proportion.

Methods: We used individual-level death data to estimate county-level life expectancy at age 25 (e25) for Whites, Black, AIAN and Asian in the contiguous USA for 2000–2005. Race–sex-stratified models were used to examine the associations among e25, rurality and specific race proportion, adjusted for socioeconomic variables.

Results: Lower e25 was found in the central USA for AIANs and …

Racial/Ethnic Differences In Multimorbidity Development And Chronic Disease Accumulation For Middle-Aged Adults, Ana R. Quiñones, Anda Botoseneanu, Sheila Markwardt, Corey L. Nagel, Jason T. Newsom, David A. Dorr, Heather G. Allore

Psychology Faculty Publications and Presentations

Multimorbidity–having two or more coexisting chronic conditions–is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.

We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly- available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic …

Medicaid Patients' Use Of Dental Benefits, Merit Roshdy

University Honors Theses

Oregon Health Plan patients experienced reduction to their dental coverage in 2003. This study explores Medicaid patients’ use of those dental services that are still offered to them and the effect of their use on self-assessment of their oral health. A phone survey was conducted in 2017 and collected a sample of 293 Medicaid patients in Oregon. Only two thirds of participants reported that they have a regular dentist. Participants were more likely to rate their overall health as Excellent/Good when also rating their gum health as Excellent/Good. Low English Proficiency (LEP) patients were NOT less likely to visit their …

Prescription Opioid Use Patterns, Use Disorder Diagnoses, And Addiction Treatment Receipt After The 2014 Medicaid Expansion In Oregon, Rachel Springer, Miguel Marino, Steffani R. Bailey, Heather Angier, Jean O'Malley, Megan Hoopes, Stephan Lindner, Jennifer E. Devoe, Nathalie Huguet

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background/Aims: Evidence suggests Medicaid beneficiaries in the USA are prescribed opioids more frequently than are people who are privately‐insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid‐use‐disorder (OUD), along with time from OUD diagnosis to medication‐assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014, or returned to Medicaid coverage after expansion.

Design: Cross‐sectional study using inverse‐propensity weights to adjust for …

It's Not Easy - Impacts Of Suicide Prevention Research On Study Staff, Jason I. Chen, Ginnifer L. Mastarone, Lauren M. Denneson

Communication Faculty Publications and Presentations

Suicide prevention researchers who work with individuals at high risk of suicide or are exposed to details of suicide attempts and deaths may experience negative impacts on their own well-being. This is not unlike the experiences of mental health providers, where repeated exposure to clients' difficult experiences gas long been identified as an occupational risk (Molnar et al., 2017). however, there have been few studies evaluating how exposure to details of suicide-related behavior impacts researcher well-being. This gap in the literature is worrisome, as researcher' mental health and well-being might be negatively impacted by repeated exposure to graphic details of …

Does Ownership Make A Difference In Primary Care Practice?, Stephan Lindner, Leif I. Solberg, William L. Miller, Bijal A. Balasubramanian, Miguel Marino, K. John Mcconnell, Samuel T. Edwards, Kurt C. Stange, Rachel J. Springer, Deborah J. Cohen

OHSU-PSU School of Public Health Faculty Publications and Presentations

Purpose: We assessed differences in structural characteristics, quality improvement processes, and cardiovascular preventive care by ownership type among 989 small to medium primary care practices.

Methods: This cross-sectional analysis used electronic health record and survey data collected between September 2015 and April 2017 as part of an evaluation of the EvidenceNOW: Advancing Heart Health in Primary Care Initiative by the Agency for Health Care Research and Quality. We compared physician-owned practices, health system or medical group practices, and Federally Qualified Health Centers (FQHC) by using 15 survey-based practice characteristic measures, 9 survey-based quality improvement process measures, and 4 …

Dohad And The Latina Paradox, Chelsea Peterson, Kellie Pertl, Lulu Gonzalez, Molly Sax

OHSU-PSU School of Public Health Annual Conference

The Latina Paradox is the observation that Latina mothers in the United States have better than expected birth outcomes despite lower socioeconomic status and higher prevalence of risk factors. The Latina Paradox is particularly prominent among women born in Mexico that immigrate to the U.S. prior to having children. Mexican-born women who give birth in the U. S. experience fewer incidences of low birth weight than White women born in the U. S. Various factors are responsible for the Latina Paradox, including social and cultural support in maternity, traditional diet, and immigration of healthier than average women to the U.S. …

Quantifying The Invisible: A Literature Review And History Of Research On The Health Effects Of Wildfire Smoke, Lily A. Cook Ma

OHSU-PSU School of Public Health Annual Conference

The objective of this scoping review is to provide an overview of issues affecting the results of studies on the health effects of non-occupational wildfire exposure. Although it is well established that wildfire smoke is harmful to people with chronic respiratory conditions, research on other health impacts have often found inconsistent results or small effect sizes. These results are often misinterpreted to mean that wildfire smoke has a negligible effect on non-respiratory outcomes such as cardiovascular health or mortality. However, what these results actually reflect is the complexity of determining public exposure to wildfire smoke, as well as variations in …

A Data Collection Program For Reducing Ipv In Lgbtq+ Communities, Alexandra Michel, Nicholas Cheke, Lourdes Gonzalez, Rachel Greim

OHSU-PSU School of Public Health Annual Conference

Sexual and gender minority populations are not currently being accurately tracked or counted in most domestic violence (DV) and intimate partner violence (IPV) surveillance programs in Oregon. However, research indicates that LGBTQ+ populations experience IPV at rates comparable or even higher than heterosexual populations. Additionally, distrust of law enforcement and services designed around heterosexual experiences of IPV further reduce the ability of LGBTQ+ populations, particularly transgender women, to access IPV services. We propose that through the use of a PRECEED-PROCEED model, a program could be developed to more accurately collect sexual orientation and gender identity data by IPV service providers …

Validity Of An Atopic Dermatitis Outcome Measure For Real-World Clinical Practice, Christina Topham, Dylan Haynes, Molly Brazil, Eric Simpson

OHSU-PSU School of Public Health Annual Conference

Introduction: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in the United States. AD is associated with reduced quality of life and substantial financial costs, making it burdensome at an individual and population level. Disease severity outcome measures are validated tools to assess severity and therapeutic response. Recent consensus statements have identified gold-standard outcome measures for AD in clinical trials, but further work is needed evaluating outcome measures feasible for clinical practice.

Objective: To investigate the validity and feasibility of the product of investigator global assessment and body surface area (IGA x BSA) as an outcome measure …

Take Control: A Proposed Mental Health Treatment Program To Be Implemented In Youth Correctional Facilities Around Oregon Based On The Evidence-Based Target Program, Zoey S. Rochefort

OHSU-PSU School of Public Health Annual Conference

70% of youth in state and local juvenile justice systems exhibit symptoms of one or more mental health disorders and are not receiving adequate treatment. Currently, in Oregon, there is no mental health-screening requirement for youth admitted into detention centers or correctional facilities. Though this doesn’t mean kids never get diagnosed, it does mean there is a large delay in time before treatment begins where they could be receiving care. The Take Control program is working to mitigate wasted time and improve mental health treatment for youth inmates through a seven-step treatment program that provides youth with steps and strategies …

Study Of Physical Literacy And Physical Fitness In School Children, Natalie T. Pexton

OHSU-PSU School of Public Health Annual Conference

Background: Currently there is no standard physical education (P.E.) assessment for tracking students’ progress across the state. As a result, there is little data on the physical literacy and physical fitness of school children which are essential to lifelong physical activity.

Physical Literacy is the confidence, knowledge, and ability to execute fundamental movement skills like hopping, throwing, and kicking.

Cardiorespiratory fitness is a measure of the stamina and capacity to perform aerobic exercise.

Objective: To test the “PlayFun” physical literacy and “Pacer” cardiorespiratory fitness tests with Portland Public School students.

Methods:

Setting: Two Portland Public School district elementary …

Preventing Infectious Hematopoietic Necrosis In Salmonid Fish Along The Columbia River Basin, Whitney L. Wright

OHSU-PSU School of Public Health Annual Conference

Infectious hematopoietic necrosis virus (IHNV) is a member of the Rhabdoviridae family and causes infectious hematopoietic necrosis (IHN) disease in many salmonid species during the juvenile or “fry” stage of life. IHNV is endemic to Western North America and occurs in the Columbia River Basin, where Steelhead and Chinook salmon are the most abundant IHNV-vulnerable species. IHNV can cause an epidemic in wild or farmed stocks, killing 90-95 percent of the fish it infects. Transmission is currently understood to occur by direct exposure through the gills, and the virus is shed typically from asymptomatic or clinically ill carrier adults at …

Theorizing Indigenous Student Resistance, Radical Resurgence, And Reclaiming Spiritual Teachings About Tma’Áakni (Respect), Michelle M. Jacob, Kelly L. Gonzales, Chris Finley, Stephany Runninghawk Johnson

OHSU-PSU School of Public Health Faculty Publications and Presentations

Indigenous dispossession and environmental devastation are intertwined outcomes of settler colonialism’s cycle of violence. However, indigenous people continue to draw from cultural and spiritual teachings to resist such forms of violence, and engage in what Leanne Simpson calls “radical resurgence.” Our paper analyzes the Yakama elders’ teachings about Tma’áakni (Respect), to examine principles and forms of indigenous resistance and resurgence, demonstrated by indigenous students in support of the NoDAPL(No Dakota Access PipeLine) movement. Elders’ teachings, which are rooted in spiritual traditions held by indigenous peoples since time immemorial, are useful for understanding and articulating the importance of the contemporary indigenous …

Overcoming Barriers To Adopting And Implementing Pharmacotherapy: The Medication Research Partnership, Raina Croff, Kim Hoffman, Kelly Alanis-Hirsch, Jay Ford, Dennis Mccarty, Laura Schmidt

OHSU-PSU School of Public Health Faculty Publications and Presentations

Pharmacotherapy includes a growing number of clinically effective medications for substance use disorder, yet there are significant barriers to its adoption and implementation in routine clinical practice. The Medication Research Partnership (MRP) was a successful effort to promote adoption of pharmacotherapy for opioid and alcohol use disorders in nine substance abuse treatment centers and a commercial health plan. This qualitative analysis of interviews (n = 39) conducted with change leaders at baseline and at the end/beginning of 6-month change cycles explains how treatment centers overcame obstacles to the adoption, implementation, and sustainability of pharmacotherapy. Results show that barriers to …

Growing Healthy Together: Protocol For A Randomized Clinical Trial Using Parent Mentors For Early Childhood Obesity Intervention In A Latino Community, Byron A. Foster, Kelsey Weinstein, Jackilen Shannon

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Latino children in the US experience high rates of obesity, increasing their risk of subsequent diabetes. There are few clinical trials among low-income, Latino families to test interventions that account for and address their unique situation.

Methods/design: This trial, conducted in a Head Start (early childhood education) setting, randomly assigns children 2–5 years of age who have obesity by CDC (Centers for Disease Control and Prevention) guidelines (at least 95th percentile body mass index) and their parents to one of three conditions: (1) control, (2) parent mentor with an experimental curriculum, or (3) parent mentor with a …

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 …

Employment Opportunities And Experiences Among Recent Master’S-Level Global Health Graduates, William Cherniak, Elahe Nizami, Quentin Eichbaum, Jessica Evert, Ashti Doobay-Persaud, Sharon Rudy, Ginny Defrank, Tom Hall, Adam Hoverman

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives: To examine the job search, employment experiences, and job availability of recent global health-focused master’s level graduates. Methods: An online survey was conducted from October to December 2016 based out of Washington, DC. The study sample includes students graduating with master’s degrees in global health, public health with a global health concentration or global medicine from eight U.S. universities. Results: Out of 256 potential respondents, 152 (59%) completed the survey, with 102/152 (67%) employed. Of unemployed graduates, 38% were currently in another educational training program. Out of 91 employed respondents, 62 (68%) reported they had limitations or gaps in …

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 …

Role Of The Hospital In The 21st Century Opioid Overdose Epidemic: The Addiction Medicine Consult Service, Kelsey C. Priest, Dennis Mccarty

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: The aim of the study was to explore and describe the structure and design elements of addiction medicine consult (AMC) services within selected US hospitals. Methods: As part of a larger mixed methods study, 10 qualitative semi-structured telephone interviews were completed with board-certified addiction medicine physicians affiliated with the Addiction Medicine Foundation's Addiction Medicine Fellowship Programs at 9 US hospitals. Interviews were transcribed, coded, and analyzed using a directed content analysis. Results: Interviews completed with established AMC services in 9 hospitals probed AMC structure and design commonalities and differences across 4 domains: (1) availability and coverage, (2) team composition, …

Equalization Of Four Cardiovascular Risk Algorithms After Systematic Recalibration: Individual-Participant Meta-Analysis Of 86 Prospective Studies, Lisa Pennells, Stephen Kaptoge, Angela Wood, Mike Sweeting, Xinghui Zhao, Carlos J. Crespo, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after ‘recalibration’, a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.

Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination …

Quality Of Life And Stigma Among People Living With Hiv/Aids In Iran, Mohammad Ebrahimi Kalan, Jian Han, Ziyad Ben Taleb, Kristopher P. Fennie, Mohammad Asghari Jafarabadi, Maryam Dastoorpoor, Nima Hajhashemi, Mitra Naseh, Shahnaz Rimaz

School of Social Work Faculty Publications and Presentations

Background: Stigma against HIV profoundly affects the quality of life (QOL) of people living with HIV/AIDS (PLWHA). We aimed to assess the factors associated with QOL in PLWHA in Iran, specifically HIV-related stigma, sociodemographic and clinical characteristics.

Methods: Two hundred PLWHA participated in this cross-sectional study. Data were collected using sociodemographic, stigma, and WHO-QOL-BREF questionnaires. Correlations, ANOVAs, and Student’s t-distribution tests were performed as bivariate analyses. We employed stepwise multiple linear regression analysis to explore the main factors associated with QOL domains.

Results: Six domains of QOL were negatively correlated with three domains of stigma (p < 0.001 for all). Stepwise multiple linear regression revealed that, after adjusting for con-founders, lack of healthcare insurance, having no basic knowledge of HIV/AIDs prior to diagnosis, low monthly income of participants and family, and stigma (blaming and distancing, discrimination, and fear) were associated with low mean score of different domains of QOL.

Conclusion …

Adapting An Elementary School Nutrition Context Assessment For High School Settings And Students, Deborah H. John, Beret Halverson, Tia H. Ho

Urban Studies and Planning Faculty Publications and Presentations

The school nutrition context is comprised of supportive environmental features, programs, policies, and social relationships that shape students’ healthy dietary choices and patterns. When engaging students as change agents, advocates, and partners in making healthy nutrition choices easier, environmental assessment tools developed for adults may be too complex or inappropriately tailored for youth. Adolescents need practical, user-tailored tools that reliably measure the food and beverage environments they encounter in school to inform youth-led changes to the school nutrition context. To meet this need, an evidence-based school environmental assessment was adapted for use in high schools by students as evaluators. Cooperative …