Public Health Commons^™

Brief Report: The Impact Of Disease Stage On Early Gaps In Art In The "Treatment For All" Era - A Multisite Cohort Study., Ingrid T. Katz, Nicholas Musinguzi, Kathleen Bell, Anna Cross, Mwebesa Bosco Bwana, Gideon Amanyire, Stephen Asiimwe, Catherine Orrell, David R. Bangsberg, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Adoption of "Treat All" policies has increased ART initiation in sub-Saharan Africa; however, unexplained early losses continue to occur. More information is needed to understand why treatment discontinuation continues at this vulnerable stage in care.

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. …

Provider Perspectives On Persistent Urinary Incontinence Following Obstetric Fistula Repair In Ethiopia, Laura E. Jacobson, Melaku Abriha Marye, Elena Phoutrides, Rahel Nardos

OHSU-PSU School of Public Health Faculty Publications and Presentations

Each year an estimated 50,000 to 100,000 women worldwide are affected by obstetric fistula. This devastating but preventable maternal morbidity leaves women incontinent, stigmatized, isolated, and often with a still birth. While fistula rates in Ethiopia have declined in recent years, estimates range from 7 to 40 percent of women suffer from persistent urinary incontinence after successful closure of their fistula. Few studies have focused on the unique experiences and challenges that providers face treating fistula patients, particularly those who experience persistent urinary incontinence. The goal of this research is to characterize the fistula provider's accounts of how to manage, …

Assisting Students And Families During The Covid-19 Crisis: Diversity & Equity In Action Through A Educator-Family-Community Health Worker Intersection, Eric J. López, Oscar J. Muñoz, Eva Menchaca-López

Northwest Journal of Teacher Education

The current COVID-19 crisis has exposed new and existing issues related to access and equity for our students and families. The following article discusses a model for interconnecting educators, families, and community health workers (CHW) that can integrate diversity and equity for practitioners and educator preparation programs. Integrating CHWs provides a unique opportunity to utilize their cultural responsive skills and knowledge. Implications for practitioners and educator preparation programs are discussed.

What You Should Know About Racism-20: A Fact Sheet In The Time Of Covid-19, Ryan J. Petteway

OHSU-PSU School of Public Health Faculty Publications and Presentations

Satire has a history within public health and medical scholarship. However, research and academic works related to COVID-19, health inequities, and structural racism to date have not engaged/explored satire as a critical mode of reflection, analysis, and commentary. Drawing from social epidemiology literature related to structural racism, and rooted in critical race theory and critical theory related to narrative power, this paper—in the form of a "RACISM-20" fact sheet/health promotion flyer—uses satire and humor as critical commentary on mainstream public health discourse of/responses to COVID-19, transposing structural racism and COVID-19 to accentuate how individualist, apolitical, and “colorblind” downstream frames of …

Exploratory Study Of Obesogenic Commercial School Food Environments In The Portland Metropolitan Area, Sruthi Eapen

University Honors Theses

Objective

The purpose of this exploratory research was to study commercial food environments around high schools in the Portland metropolitan area to explore the question: How do the economic, geographic, and racial demographics of public high schools in the Portland metropolitan area affect the prevalence and make-up of obesogenic commercial food environments surrounding these schools?

Methods

Commercial food environments within a 1 km radius of 35 public high schools in the Portland metropolitan area were surveyed. The “healthiness” of the environment was calculated by establishing a “Food Environment Score.” This score was correlated with economic, geographic, and racial demographics obtained …

Community-Derived Recommendations For Healthcare Systems And Medical Students To Support People Who Are Houseless In Portland, Oregon: A Mixed-Methods Study, Caroline King, Cameron Fisher, Jacob Johnson, Arum Chun, David Bangsberg, Paula C. Carder

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: People who are houseless (also referred to as homeless) perceive high stigma in healthcare settings, and face disproportionate disparities in morbidity and mortality versus people who are housed. Medical students and the training institutions they are a part of play important roles in advocating for the needs of this community. The objective of this study was to understand perceptions of how medical students and institutions can meet needs of the self-identified needs of the houseless community.

Methods: Between February and May 2018, medical students conducted mixed-methods surveys with semi-structured qualitative interview guides at two community-based organizations that …

Adherence To Hiv Antiretroviral Therapy Among Pregnant And Postpartum Women During The Option B+ Era: 12-Month Cohort Study In Urban South Africa And Rural Uganda, Lynn T. Matthews, Catherine Orrell, Mwebesa B. Bwana, Alexander C. Tsai, Christina A. Psaros, Stephen Asiimwe, Gideon Amanyire, Nicholas Musinguzi, Kathleen Bell, David Bangsberg, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: We conducted a cohort study to understand patterns of anti-retroviral therapy (ART) adherence during pregnancy, postpartum and non-pregnancy follow-up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. Methods: We collected survey data, continuously monitored ART adherence (Wisepill), HIV-RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow-up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non-pregnancy-related (neither pregnant nor postpartum). Fractional regression …

Impact And Mortality Of Covid-19 On People Living With Dementia: Cross-Country Report, Aida Suárez-González, Gill Livingston, Lee Fay Low, Suzanne Cahill, Niamh Hennelly, Walter D. Dawson, Wendy Weidner, Martina Bocchetta, Cleusa P. Ferri, Jordi A. Matias-Guiu, Multiple Additional Authors

Institute on Aging Publications

This report brings together international evidence on the impact of the COVID-19 pandemic on people living with dementia and an overview of international policy and practice measures to mitigate the impact of COVID-19 among people living with dementia.

Key Findings

• We have collected data on impact and mortality of COVID-19 in people living with dementia in 9 countries: The United Kingdom (UK), Spain, Ireland, Italy, Australia, the United States (US), India, Kenya and Brazil.
• The share of people whose deaths were linked to COVID-19 in care homes who had dementia ranges from 29% to 75% across those countries. Within countries, …

How Does The Effect Of Hurricane Katrina Influence Healthcare Infrastructure And Resilience?, Sean Y. Wei

University Honors Theses

In August 2005, Hurricane Katrina brought upon the city of New Orleans, LA one of the costliest natural disasters in U.S. history. This paper looks at how hospitals were prepared before Katrina, responded to, and grappled with the aftermath of this natural disaster. In the aftermath of Katrina, careful investigation of the healthcare system along with its hospitals, physicians, patients, and residents allow us to take innovative measures and provide guidance to create recommendations to better monitor and care for individuals in the future. Frameworks of resilience theories, studies, and recommendations display how and why disaster planning is essential. The …

Understanding Transmission And Control Of The Pork Tapeworm With Cystiagent: A Spatially Explicit Agent‑Based Model, Ian W. Pray, Wayne Wakeland, William Pan, William E. Lambert, Hector H. Garcia, Armando E. Gonzalez, Seth E. O'Neal, Cysticercosis Working Group Peru

Systems Science Faculty Publications and Presentations

Background: The pork tapeworm, Taenia solium, is a serious public health problem in rural low-resource areas of Latin America, Africa and Asia, where the associated conditions of nuerocysticercosis (NCC) and porcine cysticercosis cause substantial health and economic harms. An accurate and validated transmission model for T. solium would serve as an important new tool for control and elimination, as it would allow for comparison of available intervention strategies, and prioritization of the most effective strategies for control and elimination efforts.

Methods: We developed a spatially-explicit agent-based model (ABM) for T. solium (“CystiAgent”) that differs from prior T. solium models by …

Differential Effects Of Buprenorphine/Naloxone Vs. Methadone On Quality Of Life Over Time: A Subset Of The Bravo Study (Buprenorphine To Improve Hiv Care Engagement And Outcomes: A Randomized Trial), Ali Mirzazadeh Javaheri

University Honors Theses

Health-related Quality of Life (QoL) is generally poorer in individuals with opioid use disorder (OUD) in comparison with those suffering from other chronic diseases. Little is known about the difference each buprenorphine/naloxone (BUP/NX) or methadone maintenance therapy (MMT) may make in the QoL for the HIV-infected people with OUD who are new to HIV care. The objective of this study is to evaluate the difference in the impact that BUP/NX and MMT treatment delivery models make on the QoL of the HIV-infected participants with OUD in Vietnam.

This study was a subset of the BRAVO study, buprenorphine to improve HIV …

Toxic Stress Among Black And African American Oregonians, Roberta Hunte, Margaret J.F. Braun

School of Social Work Faculty Publications and Presentations

Toxic stress is a reaction to ongoing adversity such as abuse, neglect, poverty, racism, discrimination, and exposure to violence; it is powerful enough to change brain chemistry and architecture. Toxic stress and associated changes to the brain can lead to poor health outcomes later in life. Adverse childhood experiences (ACEs), racism*, and discrimination can trigger toxic stress and have long term consequences for the health of many people, particularly those in the Black and African American community.

The current project examined toxic stress and its impact on the health of Black and African American Oregonians. We looked at two indicators …

Differential Vpu-Mediated Cd4 And Tetherin Downregulation Functions Among Major Hiv-1 Group M Subtypes, Gisele Umviligihozo, Kyle D. Cobarrubias, Sandali Chandrarathna, Steven W. Jin, Nicole Reddy, Helen Byakwaga, Conrad Muzoora, Mwebesa B. Bwana, Guinevere Q. Lee, Peter W. Hunt, David Bangsberg, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Downregulation of BST-2/tetherin and CD4 by HIV-1 viral protein U (Vpu) promotes viral egress and allows infected cells to evade host immunity. Little is known however about the natural variability in these Vpu functions among the genetically diverse viral subtypes that contribute to the HIV-1 pandemic. We collected Vpu isolates from 332 treatment-naive individuals living with chronic HIV-1 infection in Uganda, Rwanda, South Africa, and Canada. Together, these Vpu isolates represent four major HIV-1 group M subtypes (A [n = 63], B [n = 84], C [n = 94], and D [n = 59]) plus intersubtype …

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 …

Health And Dental Care Expenditures In The United States From 1996 To 2016, Man Hung, Martin S. Lipsky, Ryan Moffat, Evelyn Lauren, Eric S. Hon, Jungweon Park, Gagandeep Gill, Julie Xu, Lourdes Peralta, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: As total health and dental care expenditures in the United States continue to rise, healthcare disparities for low to middle-income Americans creates an imperative to analyze existing expenditures. This study examined health and dental care expenditures in the United States from 1996 to 2016 and explored trends in spending across various population subgroups.

Methods: Using data collected by the Medical Expenditure Panel Survey, this study examined health and dental care expenditures in the United States from 1996 to 2016. Trends in spending were displayed graphically and spending across subgroups examined. All expenditures were adjusted for inflation or …

Do Household Asset Wealth Measurements Depend On Who Is Surveyed? Asset Reporting Concordance Within Multi-Adult Households In Rural Uganda., Meghan L. Smith, Bernard Kakuhikire, Charles Baguma, Justin D. Rasmussen, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: In resource-limited settings, the Filmer & Pritchett asset index is frequently used to measure household economic status. Little is known about how its validity is affected by differential reporting or recall within households.

Methods: As part of a whole-population survey in a rural region of southwestern Uganda, we elicited household asset information from married dyads (404 men and 404 matched women) residing within the same households. We assessed the extent to which the asset index yielded differing measures of relative household wealth, depending on whether the husband’s or wife’s survey data were used in its calculation. To …

Iron-Deficiency Anaemia (Ida): Socio-Cultural Misconceptions Intersect The Health Of Vulnerable Populations In Developing Countries, Samantha G. Alarcon Basurto

University Honors Theses

Iron is a mineral that the human body uses to make hemoglobin, a protein that red blood cells need to carry oxygen from the lungs to all parts of the body. The lack of adequate iron in the blood is known as iron deficiency, which if experienced in greater proportions, can lead to anaemia. Iron-deficiency anaemia is generally understood as a nutritional deficiency that can be treated by diets of food rich in iron content or the ingestion of iron supplements; yet lack of information, restricted access to bioavailable iron-rich foods, minimal awareness of anaemia’s detrimental effects on children’s cognitive …

Sudden Cardiac Death In Young Adults With Long-Chain 3-Hydroxyacyl Coa Dehydrogenase Deficiency (Lchadd), Ajesh Saini

University Honors Theses

Long-chain 3-Hydroxyacyl CoA Dehydrogenase Deficiency (LCHADD) is an autosomal recessive defect in fatty acid oxidation that presents with hypoketotic hypoglycemia and/or hypertrophic cardiomyopathy in infancy, and recurrent rhabdomyolysis in adolescence, however, sudden cardiac death has not been a previously reported complication of LCHADD. We have conducted a case review study comparing young adult LCHADD patients who have experienced sudden cardiac arrest events (n=5) to similar patients who have not (n=5) for the purpose of evaluating associated cardiac risk factors. We reviewed medical records from ECG tests, hospitalization reports, acylcarnitine, and complete metabolic panels, clinic notes, and autopsy reports. Retrospective chart …

Emergence In The Strengths And Love Of My People To Counter Invisibility For Liberation In The White Academy, Emily D. Carrillo-Casares

University Honors Theses

Through a literature review and personal reflection, my thesis will focus on the strengths and love of my people to counter invisibility for liberation in the white academy. More importantly, my aim in this paper is to illustrate the strengths, courage, and will-power I came across to dismantle the concealed barriers in a system that misperceived my values. I will speak from the first person to express my feelings and experiences. When I use the words, my people, I mean people who identify themselves as Hispanic/Latino or non-white. The goal of this paper is to explicate how I remained strong …

A Public Health Recommendation Countering The Online Anti-Vaccination Movement, Grace M. Neumann

University Honors Theses

The anti-vaccination movement had posed a threat to the health of communities, since the inception of the smallpox inoculation practice. As the anti-vaxx movement continues to grow in strength and reach, public health officials must be prepared to combat the flow of misinformation, with sound scientific data in a way that connects with individuals from all communities. Online platforms such as blogs and social media, allow newfound access to vaccine opinions and information, posing an even greater risk of vaccine misinformation being spread to the public. Different communities hold different reasons for vaccine hesitancy and avoidance. An effective public health …

Frequency Of Limited English Proficient (Lep) Patient Visits And Language Resources: An Assessment Of Rural Oregon's Health Centers And Working With Lep Communities, Gabriel I. Lehrburger

University Honors Theses

Persons with limited English proficiency (LEP) can face barriers when seeking health care. Rural communities often have reduced access to some health resources. However, little is known about how rural communities meet the language needs of their LEP populations. A cross-sectional survey and interview were designed and sent to managerial staff in rural health centers around the state of Oregon. During the months of January – March 2020, survey and interview data were collected to assess the relationship between frequency of LEP patient visits and available language resources in rural Oregon. The study also investigated staff perceptions when working with …

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 …

Pregnancy Outcomes And Documentation Status Among Latina Women: A Systematic Review, Dawn M. Richardson, Sarah B. Andrea, Amber Ziring, Cassandra Robinson, Lynne Messer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Purpose: The impression that Latinas experience paradoxically good pregnancy outcomes in the United States persists, despite evidence showing that these outcomes are not enjoyed by all Latina subgroups. We conducted this systematic literature review to examine the relationship between documentation status and pregnancy outcomes among Latinas.

Methods: This review synthesizes empirical evidence on this relationship; examines how these studies define and operationalize documentation status; and makes recommendations of how a more comprehensive methodological approach can guide public health research on the impact of documentation status on Latina immigrants to the United States. We searched the literature within PubMed, …

Meta-Analysis Of Tobacco Control Policies For Reducing Tobacco Consumption, Arya Kevin Naghdi

University Honors Theses

The harmful effects of tobacco consumption and smoking have been well documented, and the literature is conclusive on their negative effects. However, there is still a great deal of discussion to be had on which policies and strategies can be employed to decrease smoking rates. Tobacco control policies used in the past included tobacco taxes, smoke free zones, anti-smoking media, sale to minors bans, and advertising restrictions on tobacco companies. Yet, it is still unclear which policies are most effective and least effective when it comes to reducing smoking rates. A meta-analysis of 11 articles analyzing the effects of each …

Safe Consumption Facilities As Harm Reduction, Christina Jäderholm, Dana Crossby, Rachel Greim, Chelsea Peterson, Dawn Richardson

OHSU-PSU School of Public Health Annual Conference

Overview/Issue

Substance use disorder (SUD) is one of the largest public health challenges in Oregon, with approximately 1-in-10 Oregonians living with SUD and some experiencing overdose annually. Safe Consumption Facilities (SCF) have been shown to facilitate entry into treatment programs and prevent fatal overdoses and needle sharing, but have not yet been implemented.

Challenges

SCFs have succeeded in Canada and Europe; yet several barriers exist to implementation in the U.S. The most common challenges include: low public support and a lack of understanding regarding SUD and harm reduction strategies; limited funding and research in the United States; and the complexities …

Defining Stress Among Oregon Corrections Professionals, Jessica T. Ballin

OHSU-PSU School of Public Health Annual Conference

Corrections professionals experience some of the highest levels of chronic stress compared to other occupations. This leads to poor mental and physical health, increased mortality, negative job performance, and increased economic costs, such as work-related injuries, sick leave, worker’s compensation claims and disability. Improving health and safety among this occupation requires identifying the factors contributing to stress and the associated economic impact. We assessed corrections professionals (n=296) working at six different Oregon Department of Corrections facilities near the Portland-area of varying security levels. Participants completed a cross-sectional survey, including demographics, work history and validated stress and occupational constructs. The outcome …

Water 4.0, Arthur Preston

OHSU-PSU School of Public Health Annual Conference

A review of local drinking water quality/technologies, and strategies to improve water quality using emerging next generation technology.