Public Health Commons^™

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 …

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 …

Family Caregiver Satisfaction With Inpatient Rehabilitation Care, Kristine T. Hanson, Kathleen F. Carlson, Greta Friedemann-Sanchez, Laura A. Meis, Courtney H. Van Houtven, Agnes C. Jensen, Sean M. Phelan, Joan M. Griffin

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction:

Informal family caregivers play an increasingly important role in healthcare. Despite their role in ongoing management and coordination of care, caregiver satisfaction with the healthcare services care recipients receive has been understudied. We sought to assess what influences caregiver satisfaction with inpatient care provided to their care recipient among caregivers of veterans with traumatic brain injury (TBI) and polytrauma.

Methods:

Data from the Family and Caregiver Experience Survey, a national survey of caregivers of veterans with TBI and polytrauma, was used to explore factors associated with caregiver satisfaction with the care his/her care recipient received while an inpatient at …

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 …

Workplace Incivility And Employee Sleep: The Role Of Rumination And Recovery Experiences, Caitlin A. Demsky, Charlotte Fritz, Leslie B. Hammer, Anne E. Black

Psychology Faculty Publications and Presentations

This study examines the role of negative work rumination and recovery experiences in explaining the association between workplace incivility and employee insomnia symptoms. Drawing on the perseverative cognition model of stress and the effort–recovery model, we hypothesize a moderated mediation model in which workplace incivility is associated with insomnia symptoms via negative work rumination. This indirect effect is proposed to be conditional on employees’ reported level of recovery experiences (i.e., psychological detachment from work and relaxation during nonwork time). In examining this model, we further establish a link between workplace incivility and sleep and identify one pathway to explain this …

Technology Management Maturity Assessment Model: An Exploratory Multi-Criteria Approach For Healthcare Organizations, Amir Shaygan, Tugrul Daim

Engineering and Technology Management Faculty Publications and Presentations

Maturity Models are organizational management tools that have been developed and used for decades as organizations' way of responding to the constant pressure of trying to achieve and maintain competitive advantage through concurrent innovation, quality improvement, and cost reduction. The decision makers in the healthcare industry have been no exception in reaping the benefits of determining the merits and weaknesses of strategies through systematic quality improvement provided by maturity models. Although there are many healthcare maturity models in literature, there is a lack of models that provides managers and decision makers with a systematic, multi-criteria, and quantifiable maturity model. This …

Patient Empowerment Via Mobile Personal Health Records And Mobile Health Applications: A Review Of The Current Use, Abdulaziz S. Alhomod, Saeed Alzahrani

Engineering and Technology Management Faculty Publications and Presentations

Consumer empowerment has gained a significant attention in the medical field recently, and despite the ambiguity of its definitions, elements and measurement tools, it is apparent that mobile and other communication technology can play a major role in keeping patients informed, involved and empowered. This paper aims to explore methods by which mobile applications contribute to consumer empowerment and allowed enhanced patient control over their health.

Social Norms, Misperceptions, And Mosquito Net Use: A Population‑Based, Cross‑Sectional Study In Rural Uganda, Jessica M. Perkins, Paul J. Krezanoski, Sae Takada, Bernard Kakuhikire, Vincent Batwala, Alexander Tsai, Nicholas A. Christakis, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Mosquito net use is an essential part of malaria prevention. Although previous research has shown that many people sleep under a mosquito net in endemic areas, it is unknown whether people underestimate how common it is to sleep under a net every night. Furthermore, perceived social norms about whether most others sleep under a mosquito net every night may contribute to personally sleeping under a net, given decades of research showing that people often mimic others’ behaviours.

Methods: Population-based data were collected from 1669 adults across eight villages in one rural parish in southwestern Uganda. Individuals’ perception about whether …

Equity In Starting Salaries: A Tangible Effort To Achieve Gender Equity In Medicine, Esther Choo, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Letter to the Editor.

In 2017, for the first time, more women than men enrolled in medical school, marking a pivotal moment for setting and achieving reasonable goals for gender equity in medicine.

Inequity in compensation is a key target: The gender pay gap begins upon first hire, is not explained by part-time work or choice of specialty, and compounds over time. In a 2016 Wall Street Journal analysis, female physicians earned only 64.5% of what male physicians earned, the largest disparity amongst the 446 occupations examined. In its 2018 compensation report, Doximity reported an average physician gender gap of …

Cardiovascular Risk Factors Associated With Venous Thromboembolism, John Gregson, Stephen Kaptoge, Thomas Bolton, Lisa Pennells, Peter Willeit, Carlos J. Crespo, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Importance It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE).

Objective To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism.

Design, Setting, and Participants This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731 728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421 537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February …

Geospatial-Temporal, Demographic, And Programmatic Adoption Characteristics Of A Large-Scale Water Filter And Improved Cookstove Intervention In Western Province, Rwanda, Katie Fankhauser, Corey L. Nagel, Christina Barstow, Miles Kirby, Evan A. Thomas

OHSU-PSU School of Public Health Faculty Publications and Presentations

Lowering the global disease burden of preventable disease has been addressed in part by the distribution of health products and behavior change campaigns in low-income countries. Realizing a health impact requires adoption by participants, and the topic of program uptake and sustained adoption has been studied extensively, although an ecological context is largely missing from existing work. This study characterizes self-reported and observed adoption of improved cookstoves and point-of-use water filters among nearly 80,000 households in Rwanda using demographic and programmatic variables from implementer surveys and integration of geospatial and temporal data based on differentiated recipient location. The odds of …

Shared Medical Appointments And Patient-Centered Experience: A Mixed-Methods Systematic Review, Kim H. Wadsworth, Trevor G. Archibald, Allison E. Payne, Anita K. Cleary, Byron L. Haney, Adam S. Hoverman

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Shared medical appointments (SMAs), or group visits, are a healthcare delivery method with the potential to improve chronic disease management and preventive care. In this review, we sought to better understand opportunities, barriers, and limitations to SMAs based on patient experience in the primary care context.

Methods: An experienced biomedical librarian conducted literature searches of PubMed, Cochrane Library, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and SSRN for peer-reviewed publications published 1997 or after. We searched grey literature, nonempirical reports, social science publications, and citations from published systematic reviews. The search yielded 1359 papers, including qualitative, quantitative, …

Internet Addiction, Smartphone Addiction, And Hikikomori Trait In Japanese Young Adult: Social Isolation And Social Network, Masaru Tateno, Alan R. Teo, Wataru Ukai, Junichiro Kanazawa, Ryoko Katsuki, Hiroaki Kubo, Takahiro A. Kato

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: As the number of internet users increases, problems related to internet overuse are becoming more and more serious. Adolescents and youth may be particularly attracted to and preoccupied with various online activities. In this study, we investigated the relationship of internet addiction, smartphone addiction, and the risk of hikikomori, severe social withdrawal, in Japanese young adult.

Methods: The subjects were 478 college/university students in Japan. They were requested to complete the study questionnaire, which consisted of questions about demographics, internet use, the Internet Addiction Test (IAT), the Smartphone Addiction Scale (SAS)–Short Version (SV), the 25-item Hikikomori Questionnaire …

Exploring The Extent Of The Hikikomori Phenomenon On Twitter: Mixed Methods Study Of Western Language Tweets, Pereira-Sanchez, Miguel Angel Alvarez-Mon, Angel Asunsolo Del Barco, Melchor Alvarez-Mon, Alan R. Teo

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Hikikomori is a severe form of social withdrawal, originally described in Japan but recently reported in other countries. Debate exists as to what extent hikikomori is viewed as a problem outside of the Japanese context. Objective: We aimed to explore perceptions about hikikomori outside Japan by analyzing Western language content from the popular social media platform, Twitter. Methods: We conducted a mixed methods analysis of all publicly available tweets using the hashtag #hikikomori between February 1 and August 16, 2018, in 5 Western languages (Catalan, English, French, Italian, and Spanish). Tweets were first classified as to whether they described …

Use Of Single Irbs For Multi-Site Studies: A Case Report And Commentary From A National Drug Abuse Treatment Clinical Trials Network Study, Ceilidh Nichols, Lynn E. Kunkel, Robin Baker, Eve Jelstrom, Megan Addis, Kim Hoffman, Dennis Mccarty, P. Todd Korthuis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Recent NIH policy stipulates that multi-site studies must use a single or IRB (Institutional Review Board) in order to streamline the review process while maintaining standards for human subjects protection. The Western States Node of the Clinical Trials Network (CTN) used a single IRB for protocol CTN-0067, a clinical trial testing the use of an opioid antagonist (extended-release naltrexone) versus opioid agonists (buprenorphine or methadone) for opioid use disorders among individuals living with HIV. This case study discusses the processes and challenges associated with use of a single IRB. These lessons are also informed by other single IRB experiences within …

Making The Business Case For An Addiction Medicine Consult Service: A Qualitative Analysis, Kelsey C. Priest, Dennis Mccarty

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

As the drug poisoning crisis worsens in North America and opioid use disorder (OUD)-related hospital admissions increase, policymakers and hospital administrators are beginning to recognize the important role of hospitals in the OUD care continuum. This study explores and describes how U.S. addiction medicine physicians created and presented business propositions to hospital administrators to support the development of addiction medicine consult (AMC) services.

Methods

Fifteen qualitative interviews were completed with board-certified or board-eligible addiction medicine physicians from 14 U.S. hospitals. The interviews occurred as part of a broader mixed methods study exploring hospital service delivery for patients admitted with …

Alternative Payment Models And Hospital Engagement In Health Information Exchange, Sunny C. Lin, John M. Hollingsworth, Julia Adler-Milstein

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives:

To assess whether hospital participation in alternative payment models (APMs) is associated with greater engagement in health information exchange (HIE) along 4 dimensions: volume of patients for whom information is exchanged, diversity of information types, breadth of partner types, and depth of technical approach.

Study Design:

Pooled, cross-sectional analysis of data on US hospitals from 2014–2015.

Methods:

APM participation came from Leavitt Partners data, Medicare public use files, and the American Hospital Association (AHA) Annual Survey. We used Medicare data to measure HIE volume for 798 hospitals attesting to stage 2 Meaningful Use and the AHA Information Technology Supplement …

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 …

Wet Markets And Avian Influenza: Public Policy Decisions In Hong Kong, Shawn Smallman

International & Global Studies Faculty Publications and Presentations

After the emergence of H5N1 avian influenza in 1997 Hong Kong implemented a sophisticated system to regulate live poultry markets. While this system is well implemented and thorough, it also has limitations. The rise of H7N9 avian influenza (which is typically acquired through contact with poultry, including in live markets) makes this an appropriate time to revisit the ethical and practical issues related to this trade. Based on data from field observations of live markets in Hong Kong, and interviews with experts in the field, this paper recommends that the government of Hong Kong create a committee to examine the …

Analyzing Policies Through A Dohad Lens: What Can We Learn?, Julia M. Goodman, Janne Boone-Heinonen, Dawn M. Richardson, Sarah B. Andrea, Lynne C. Messer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Social, health, and environmental policies are critical tools for providing the conditions needed for healthy populations. However, current policy analyses fall short of capturing their full potential impacts across the life course and from generation to generation. We argue that the field of Developmental Origins of Health and Disease (DOHaD), a conceptual and research framework positing that early life experiences significantly affect health trajectories across the lifespan and into future generations, provides an important lens through which to analyze social policies. To illustrate this point, we synthesized evidence related to policies from three domains—family leave, nutrition, and housing—to examine the …

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 …

Perceptions Of Needs, Assets, And Priorities Among Black Men Who Have Sex With Men With Hiv: Community-Driven Actions And Impacts Of A Participatory Photovoice Process, Christina J. Sun, Jennifer L. Nall, Scott D. Rhodes

OHSU-PSU School of Public Health Faculty Publications and Presentations

Black men who have sex with men (MSM) with HIV experience significant health inequities and poorer health outcomes compared with other persons with HIV. The primary aims of this study were to describe the needs, assets, and priorities of Black MSM with HIV who live in the Southern United States and identify actions to improve their health using photovoice. Photovoice, a participatory, collaborative research methodology that combines documentary photography with group discussion, was conducted with six Black MSM with HIV. From the photographs and discussions, primary themes of discrimination and rejection, lack of mental health services, coping strategies to reduce …

Associations Between Environmental Quality And Adult Asthma Prevalence In Medical Claims Data, Christine L. Gray, Danelle T. Lobdell, Kristen M. Rappazzo, Yun Jian, Jyotsna S. Jagai, Lynne Messer Phd, Mph, Achal P. Patel, Stephanie A. Deflorio-Barker, Christopher Lyttle, Julian Solway, Andrey Rzhetsky

OHSU-PSU School of Public Health Faculty Publications and Presentations

As of 2014, approximately 7.4% of U.S. adults had current asthma. The etiology of asthma is complex, involving genetics, behavior, and environmental factors. To explore the association between cumulative environmental quality and asthma prevalence in U.S. adults, we linked the U.S. Environmental Protection Agency's Environmental Quality Index (EQI) to the MarketScan® Commercial Claims and Encounters Database. The EQI is a summary measure of five environmental domains (air, water, land, built, sociodemographic). We defined asthma as having at least 2 claims during the study period, 2003–2013. We used a Bayesian approach with non-informative priors, implementing mixed-effects regression modeling with a Poisson …

Associations Between Environmental Quality And Infant Mortality In The United States, 2000–2005, Achal P. Patel, Jyotsna S. Jagai, Lynne C. Messer, Christine L. Gray, Kristen M. Rappazzo

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: The United States (U.S.) suffers from high infant mortality (IM) rates and there are significant racial/ethnic differences in these rates. Prior studies on the environment and infant mortality are generally limited to singular exposures. We utilize the Environmental Quality Index (EQI), a measure of cumulative environmental exposure (across air, water, land, sociodemographic, and land domains) for U.S. counties from 2000 to 2005, to investigate associations between ambient environment and IM across maternal race/ethnicity.

Methods: We linked 2000–2005 infant data from the U.S. Centers for Disease Control and Prevention to the EQI (n = 22,702,529; 144,741 deaths). We utilized multi-level …

Lifetime Economic Burden Of Intimate Partner Violence Among U.S. Adults, Cora Peterson, Megan C. Kearns, Wendy Likamwa Mcintosh, Lianne Fuino Estefen, Christina Nicolaidis, Kathryn E. Mccollister, Amy Gordon, Curtis Florence

School of Social Work Faculty Publications and Presentations

Introduction: This study estimated the U.S. lifetime per-victim cost and economic burden of intimate partner violence.

Methods: Data from previous studies were combined with 2012 U.S. National Intimate Partner and Sexual Violence Survey data in a mathematical model. Intimate partner violence was defined as contact sexual violence, physical violence, or stalking victimization with related impact (e.g., missed work days). Costs included attributable impaired health, lost productivity, and criminal justice costs from the societal perspective. Mean age at first victimization was assessed as 25 years. Future costs were discounted by 3%. The main outcome measures were the mean per-victim (female and …

The Association Between Physical Inactivity And Obesity Is Modified By Five Domains Of Environmental Quality In U.S. Adults: A Cross-Sectional Study, Christine L. Gray, Lynne C. Messer, Kristen M. Rappazzo, Jyotsna S. Jagai, Shannon C. Grabich, Danelle T. Lobdell

OHSU-PSU School of Public Health Faculty Publications and Presentations

Physical inactivity is a primary contributor to the obesity epidemic, but may be promoted or hindered by environmental factors. To examine how cumulative environmental quality may modify the inactivity-obesity relationship, we conducted a cross-sectional study by linking county-level Behavioral Risk Factor Surveillance System data with the Environmental Quality Index (EQI), a composite measure of five environmental domains (air, water, land, built, sociodemographic) across all U.S. counties. We estimated the county-level association (N = 3,137 counties) between 2009 age-adjusted leisure-time physical inactivity (LTPIA) and 2010 age-adjusted obesity from BRFSS across EQI tertiles using multi-level linear regression, with a random intercept for …