Public Health Commons^™

Laboratory Diagnosis Of Neurocysticercosis (Taenia Solium), Hector H. Garcia, Seth E. O'Neal, John Noh, Sukwan Handali

OHSU-PSU School of Public Health Faculty Publications and Presentations

Neurocysticercosis accounts for approximately 30% of all epilepsy cases in most developing countries. The immunodiagnosis of cysticercosis is complex and strongly influenced by the course of infection, the disease burden, the cyst location, and the immune response of the host. The main approach to immunodiagnosis should thus be to evaluate whether the serological results are consistent with the diagnosis suggested by imaging. Antibody detection is performed using lentil lectin-purified parasite antigens in an enzyme-linked immunoelectrotransfer blot format, while antigen detection uses a monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA). Promising new assay configurations have been developed for the detection of both …

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

Dissertations and Theses

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

Federal-level policies have recently …

An Indigenous Framework Of The Cycle Of Fetal Alcohol Spectrum Disorder Risk And Prevention Across The Generations: Historical Trauma, Harm And Healing, Kelly Gonzales, Michelle M. Jacob, Amanda Mercier, Heather Heater, Lindsay Nall Goes Behind, Jillene Joseph, Suzie Kuerschner

OHSU-PSU School of Public Health Faculty Publications and Presentations

No abstract provided.

Periodic Atlas Of The Metroscape: The Geography Of Health, Joshua Ollinger, Ashley Donald, Randy Morris

Metroscape

Our ability to lead a fulfilling life and pursue our goals is largely shaped by our health. Although we experience these conditions such as illness and disabilities at a very personal level, factors outside of our control are often what determines our health. Known as the Social Determinants of Health, where we are born, work, live, and spend our lives is considered equally if not more important to our health status than medical care and personal health behaviors. As a result, certain communities and populations disproportionately experience burdens. Identifying and increasing awareness of health disparities is an essential step toward …

Quantifying Bias In Measuring Insecticide-Treated Bednet Use: Meta-Analysis Of Self-Reported Vs Objectively Measured Adherence, Paul J. Krezanoski, David R. Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background Insecticide-treated bednets (ITNs) are recommended for use by 3.4 billion people at risk of malaria world-wide. Policy makers rely on measurements of ITN use to optimize malaria prevention efforts. Self-reports are the most common means of assessing ITN use, but self-reports may be biased in a way that reduces their reliability as a proxy for ITN adherence. This meta-analysis compared self-reported and two methods which are more objective measures of ITN use to explore whether self-reports overestimate actual ITN adherence.

Methods A comprehensive search of electronic databases and hand searching reference lists resulted in screening 2885 records and 202 …

Equity Arguments In News Reporting On School Nutrition Policy, Liana B. Winett, Lori Dorfman, Larissa Yoshino, Laura Nixon

OHSU-PSU School of Public Health Faculty Publications and Presentations

Purpose: In two related studies, we examined how equity-based arguments featured in news debate over federal school nutrition policy. Methods: We conducted content analyses of national and local print and broadcast news (September 1, 2014-December 31, 2015), examining arguments rooted in appeals about equity and/or disparities. Results: Equity and/or disparities appeals appeared in 24% television, 14% national print, and 5% local print stories. Socioeconomic inequities were mentioned most; racial/ethnic inequities appeared minimally. Conclusions: Neither equity nor disparity featured prominently in this news debate over policy created to address children's nutritional inequities. When included, arguments focused on overcoming inequities' effects rather …

Harnessing Social Media To Explore Youth Social Withdrawal In Three Major Cities In China: Cross-Sectional Web Survey, Lucia Lin Liu, Tim Mh Li, Alan R. Teo, Takahiro A. Kato, Paul W.C. Wong

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Socially withdrawn youth belong to an emerging subgroup of youth who are not in employment, education, or training and who have limited social interaction intention and opportunities. The use of the internet and social media is expected to be an alternative and feasible way to reach this group of young people because of their reclusive nature.

Objective: The aim of this study was to explore the possibility of using various social media platforms to investigate the existence of the phenomenon of youth social withdrawal in 3 major cities in China.

Methods: A cross-sectional open Web survey …

Food Insecurity, Social Networks And Symptoms Of Depression Among Men And Women In Rural Uganda: A Cross-Sectional, Population-Based Study, Jessica M. Perkins, Viola N. Nyakato, Bernard Kakuhikire, Alexander C. Tsai, Sv Subramanian, David Bangsberg, Nicholas A. Christakis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: To assess the association between food insecurity and depression symptom severity stratified by sex, and test for evidence of effect modification by social network characteristics.

Design: A population-based cross-sectional study. The nine-item Household Food Insecurity Access Scale captured food insecurity. Five name generator questions elicited network ties. A sixteen-item version of the Hopkins Symptom Checklist for Depression captured depression symptom severity. Linear regression was used to estimate the association between food insecurity and depression symptom severity while adjusting for potential confounders and to test for potential network moderators.

Setting: In-home survey interviews in south-western Uganda. Subjects: All adult residents …

Social Network Correlates Of Ipv Acceptance In Rural Honduras And Rural Uganda, Holly B. Shakya, Jessica M. Perkins, Margaret Traeger, Alexander C. Tsai, David Bangsberg, Bernard Kakuhikire, Nicholas A. Christakis

OHSU-PSU School of Public Health Faculty Publications and Presentations

We investigated the household-level social network correlates of acceptance of intimate partner violence (IPV) in rural, agrarian settings of Honduras and Uganda, two low-income countries with unequal access to resources based upon gender. We collected complete social network data in each location (Honduras in 2014 and Uganda in 2012), across a diverse range of relationships, and then created a measure of household cohesion by calculating the degree to which members of a household nominated each other as important social connections. Our measure of IPV acceptance was based on 4 questions from the Demographic Health Survey to assess the conditions under …

Help-Seeking On Facebook Versus More Traditional Sources Of Help: Cross-Sectional Survey Of Military Veterans, Alan R. Teo, Heather E. Marsh, Samuel B.L. Liebow, Jason I. Chen, Christopher W. Forsberg, Christina Nicolaidis, Somnath Saha, Steven K. Dobscha

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a source of help or how it compares to other sources of potential support for mental health problems.

Objective: This study aimed to evaluate the degree to which military veterans with depression use social media for help-seeking in comparison to other more traditional sources of help.

Methods: Cross-sectional self-report survey of 270 adult military veterans with probable major depression. Help-seeking intentions were measured with a modified General Help-Seeking …

Comparing Men Who Have Sex With Men And Transgender Women Who Use Grindr, Other Similar Social And Sexual Networking Apps, Or No Social And Sexual Networking Apps: Implications For Recruitment And Health Promotion, Christina J. Sun, Erin L. Sutfin, Laura H. Bachmann, Jason Stowers, Scott D. Rhodes

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: Researchers and public health professionals have increased their attention to GPS-based social and sexual networking applications (apps) tailored to gay, bisexual, and other men who have sex with men (MSM) and transgender women. These populations continue to be disproportionately affected by HIV in the United States; therefore, these apps, in particular Grindr, have become an important sampling venue for the recruitment of HIV-related research participants. As such, it is essential to identify differences among app users to avoid potential sampling bias. This paper seeks to identify differences in MSM and transgender women who use Grindr and those who …

Opposing Effects Of Impulsivity And Mindset On Sources Of Science Self- 5 Efficacy And Stem Interest In Adolescents, Lisa K. Marriott, Leigh A. Coppola, Suzanne H. Mitchell, Jana L. Bouwma-Gearhart, Zunqiu Chen, Dara Shifrer, Alicia Feryn, Jackilen S. Shannon

OHSU-PSU School of Public Health Faculty Publications and Presentations

Impulsivity has been linked to academic performance in the context of Attention Deficit Hyperactivity Disorder, though its influence on a wider spectrum of students remains largely unexplored, particularly in the context of STEM learning (i.e. science, technology, engineering, and math). STEM learning was hypothesized to be more challenging for impulsive students, since it requires the practice and repetition of tasks as well as concerted attention to task performance. Impulsivity was assessed in a cross-sectional sample of 2,476 students in grades 6-12. Results show impulsivity affects a larger population of students, not limited to students with learning disabilities. Impulsivity was associated …

Enriching Clinical Learning Environments Through Partnerships: Academic And Practice Partnerships To Strengthen Care For Older Adults In Residential And Assisted Living Settings, Juliana Cartwright, Diana L. White

Institute on Aging Publications

This report was prepared by Oregon Health & Science University (OHSU) School of Nursing and the Institute on Aging at Portland State University to describe an academic-community partnership using the Enriching Clinical Learning Environments through Partnerships (ECLEPs) model. This two-year project was conducted with 34 students in the RN-BSN program in eight assisted living (AL) communities and ElderPlace, a PACE program serving residents in assisted living and other residential settings. Quality improvement was the focus of the project. Features of the ECLEPs model include:

• An intentional partnership between academic and clinical organizations
• Relationship-based; shared decision making
• Long-term commitment between partners …

Chinese Herbal Medicine Therapy And The Risk Of Mortality For Chronic Hepatitis B Patients With Concurrent Liver Cirrhosis: A Nationwide Population-Based Cohort Study, Tzung-Yi Tsai, Tsung-Hsing Hung, Hanoch Livneh, I-Hsin Lin, Ming-Chi Lu, Chia-Chou Yeh

Counselor Education Faculty Publications and Presentations

Chronic hepatitis B (CHB) is increasingly recognized as a public health problem in Taiwan. After affected patients are diagnosed with contaminant liver cirrhosis (LC), adverse clinical outcomes, especially death, are common. This study aimed to investigate the effect of Chinese herbal medicine (CHM), an essential branch of Traditional Chinese medicine (TCM), on the mortality risk among CHB patients with contaminant LC. This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 1522 patients 20–70 years of age with newly diagnosed CHB with LC during 1998–2007. Among them, 508 (33.37%) had received CHM products after the onset …

Water Insecurity And Gendered Risk For Depression In Rural Uganda: A Hotspot Analysis, Christine E. Cooper-Vince, Hawk Arachy, Bernard Kakuhikire, Dagmar Vořechovská, Rumbidzai Mushavi, C. Baguma, Amy Q. Mcdonough, David R. Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background:

Water insecurity is linked to depression in low- and middle-income countries (LMICs), though it remains unclear how geospatial clustering of water insecurity in rural regions is associated with risk for depression.

Methods: We conducted a population-based survey of a rural parish in southwestern Uganda (N = 1603) to evaluate the joint geospatial clustering of water insecurity and risk for depression among men and women living in rural Uganda.

Results:

Geospatial clustering of self-reported water insecurity and depressive symptoms was found to be present among both men and women. Depression hotspots were more often observed near water insecurity hotspots among …

Concerning Trends In Allopathic Medical School Faculty Rank For Indigenous People: 2014–2016, Erik Brodt, Amanda Bruegl, Erin K. Thayer, M. Patrice Eiff, Kelly L. Gonzales, Carlos J. Crespo

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Trends in faculty rank according to racial and ethnic composition have not been reviewed in over a decade.

Objective: To study trends in faculty rank according to racial and ethnicity with a specific focus on Indigenous faculty, which has been understudied.

Methods: Data from the Association of American Medical Colleges’ Faculty Administrative Management Online User System was used to study trends in race/ethnicity faculty composition and rank between 2014 and 2016, which included information on 481,753 faculty members from 141 US allopathic medical schools.

Results: The majority of medical school faculty were White, 62.4% (n = 300,642). Asian …

Gender Differences In Sexual And Reproductive Health Protective And Risk Factors Of Batswana Adolescents: Implications For Parent And Adolescent Interventions, Christina J. Sun, Esther S. Seloilwe, Mabel Magowe, Kefalotse S. Dithole, Kim S. Miller, Janet S. St. Lawrence

OHSU-PSU School of Public Health Faculty Publications and Presentations

Adolescents in sub-Saharan Africa and in Botswana in particular continue to bear the brunt of the HIV epidemic. This analysis assessed gender differences among theory-based sexual and reproductive health protective and risk factors in a cross-sectional sample of 228 Batswana adolescents. Incongruence between preferred and actual sources of sexual information and several important gender differences in parent-adolescent relationships, psychosocial influences, and adolescent sexual behaviors were identified. Parents were the fourth most common source of information about sex; yet, over three-quarters of adolescents preferred to have parents teach them about sex. Boys reported more positive relationships with their parents and girls …

From Research-To-Practice: An Adaptation And Dissemination Of The Compass Program For Home Care Workers, Ryan Olson, Jennifer Hess, Kelsey N. Parker, Sharon V. Thompson, Anjali Rameshbabu, Kristy Luther Rhoten, Miguel Marino

OHSU-PSU School of Public Health Faculty Publications and Presentations

The COMmunity of Practice And Safety Support (COMPASS) program was developed to prevent injuries and advance the health and well-being of home care workers. The program integrates elements of peer-led social support groups with scripted team-based programs to help workers learn together, solve problems, set goals, make changes, and enrich their supportive professional network. After a successful pilot study and randomized controlled trial, COMPASS was adapted for the Oregon Home Care Commission’s training system for statewide dissemination. The adapted program included fewer total meetings (7 versus 13), an accelerated meeting schedule (every two weeks versus monthly), and a range of …

Hospital Variation In Costs – A Challenge To The Value Proposition, Aaron B. Caughey, Jonathan M. Snowden

OHSU-PSU School of Public Health Faculty Publications and Presentations

Mini Commentary on 2017-OG-19978R1: Hospital Variation in Cost of Childbirth and Contributing Factors: A Cross-Sectional Study. To view this article visit https://doi.org/10.1111/1471-0528.15007.

Treatment And Prevention Of Opioid Use Disorder: Challenges And Opportunities, Dennis Mccarty, Kelsey C. Priest, P. Todd Korthuis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Treatment for opioid use disorder in the United States evolved in response to changing federal policy and advances in science. Inpatient care began in 1935 with the US Public Health Service Hospitals in Lexington, Kentucky, and Fort Worth, Texas. Outpatient clinics emerged in the 1960s to provide aftercare. Research advances led to opioid agonist and opioid antagonist therapies. When patients complete opioid withdrawal, return to use is often rapid and frequently deadly. US and international authorities recommend opioid agonist therapy (i.e., methadone or buprenorphine). Opioid antagonist therapy (i.e., extended-release naltrexone) may also inhibit return to use. Prevention efforts emphasize public …

Patient-Provider Relationship And Perceived Provider Weight Bias Among American Indians And Alaska Natives, Kelly L. Gonzales, Ginny Garcia, Michelle M. Jacob, C. Muller, Lonnie A. Nelson, Spero M. Manson

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective The objective of this study was to examine patient–provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health.

Methods Among a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north-west region of the USA, ordinary least squares regression analysis was completed to examine associations.

Results Better working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated …

Treatment Guidelines And Early Loss From Care For People Living With Hiv In Cape Town, South Africa: A Retrospective Cohort Study, Ingrid T. Katz, Richard Kaplan, Garrett Fitzmaurice, Dominick Leone, David R. Bangsberg, Linda-Gail Bekker, Catherine Orrell

OHSU-PSU School of Public Health Faculty Publications and Presentations

South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl.

Comparison Of Respondent-Reported And Sensor-Recorded Latrine Utilization Measures In Rural Bangladesh: A Cross-Sectional Study, Maryann G. Delea, Corey L. Nagel, Evan A. Thomas, Amal K. Halder, Nuhu Amin, Abul K. Shoab, Matthew C. Freeman, Leanne Unicomb, Thomas F. Clasen

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Health improvements realized through sanitation are likely achieved through high levels of facilities utilization by all household members. However, measurements of sanitation often rely on either the presence of latrines, which does not guarantee use, or respondent-reported utilization of sanitation facilities, which is prone to response bias. Overstatement of sanitation metrics limits the accuracy of program outcome measures, and has implications for the interpretation of related health impact data.

Methods: We conducted a cross-sectional study of 213 households in 14 village water, sanitation and hygiene committee clusters throughout rural Bangladesh and used a combined data- and relationship-scale approach …

Teaching Undergraduate Students To Visualize And Communicate Public Health Data With Infographics, Justin D. Shanks, Betty Izumi, Christina J. Sun, Allea Martin, Carmen Byker Shanks

OHSU-PSU School of Public Health Faculty Publications and Presentations

The purpose of this study was to explore the degree to which an infographic assignment facilitated student learning around health science issues, as well as the ways in which the assignment was an effective teaching tool. The objectives of the assignment were to (1) understand the purposes of and potential uses for infographics, (2) cultivate creative visual communication skills, and (3) disseminate a complex health topic to diverse audiences. The infographic assignment was developed at Montana State University and piloted at Portland State University. Students were assigned to small groups of three or four to create an infographic focused on …

Preliminary Findings Of A Technology-Delivered Sexual Health Promotion Program For Black Men Who Have Sex With Men: Quasi-Experimental Outcome Study, Charles H. Klein, Tamara Kuhn, Danielle Huxley, Jamie Kennel, Elizabeth Withers, Carmela Lomonaco

Anthropology Faculty Publications and Presentations

Background: Human immunodeficiency virus (HIV) disproportionately affects black men who have sex with men (MSM), yet there are few evidence-based interventions specifically designed for black MSM communities. In response, the authors created Real Talk, a technology-delivered, sexual health program for black MSM.

Objective: The objective of our study was to determine whether Real Talk positively affected risk reduction intentions, disclosure practices, condom use, and overall risk reduction sexual practices.

Methods: The study used a quasi-experimental, 2-arm methodology. During the first session, participants completed a baseline assessment, used Real Talk (intervention condition) or reviewed 4 sexual health brochures (the standard of …

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

Dissertations and Theses

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

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

County-Level Cumulative Environmental Quality Associated With Cancer Incidence, Jyotsna S. Jagai, Lynne C. Messer, Kristen M. Rappazzo, Christine L. Gray, Shannon C. Grabich, Danelle T. Lobdell

Institute for Sustainable Solutions Publications and Presentations

BACKGROUND: Individual environmental exposures are associated with cancer development; however, environmental exposures occur simultaneously. The Environmental Quality Index (EQI) is a county-level measure of cumulative environmental exposures that occur in 5 domains.

METHODS: The EQI was linked to county-level annual age-adjusted cancer incidence rates from the Surveillance, Epidemiology, and End Results (SEER) Program state cancer profiles. All-site cancer and the top 3 site-specific cancers for male and female subjects were considered. Incident rate differences (IRDs; annual rate difference per 100,000 persons) and 95% confidence intervals (CIs) were estimated using fixed-slope, random intercept multilevel linear regression models. Associations were assessed with …

Household Water Insecurity, Missed Schooling, And The Mediating Role Of Caregiver Depression In Rural Uganda, Christine E. Cooper-Vince, Bernard Kakuhikire, Dagmar Vořechovská, Amy Q. Mcdonough, Jessica M. Perkins, Atheendar S. Venkataramani, Rumbidzai Mushavi, Charles Baguma, Scholastic Ashaba, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: School attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children’s water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations.

Method: We conducted a population-based, cross-sectional study of female household heads (N = 257) and …

Prevalence, Age Profile, And Associated Risk Factors For Hymenolepis Nana Infection In A Large Population-Based Study In Northern Peru, Percy M. Vilchez Barreto, Ricardo Gamboa, Saul Santivañez, Seth E. O'Neal, Claudio Muro, Andrés G. Lescano, Luz M. Moyano, Guillermo Gonzálvez, Hector H. García

OHSU-PSU School of Public Health Faculty Publications and Presentations

Hymenolepis nana, the dwarf tapeworm, is a common intestinal infection of children worldwide. We evaluated infection and risk factor data that were previously collected from 14,761 children aged 2-15 years during a large-scale program in northern Peru. We found that 1,124 of 14,761 children (7.61%) had H. nana infection, a likely underestimate given that only a single stool sample was examined by microscopy for diagnosis. The strongest association with infection was lack of adequate water (adjusted prevalence ratio [aPR] 2.22, 95% confidence interval [CI] 1.82-2.48) and sanitation infrastructure in the house (aPR 1.94, 95% CI 1.64-2.29). One quarter of …

Planning And Designing The Improving Addiction Care Team (Impact) For Hospitalized Adults With Substance Use Disorder, Honora Englander, Melissa B. Weimer, Rachel Solotaroff, Christina Nicolaidis, Benjamin Chan, Christine M. Velez, Alison Noice, Tim Hartnett, Ed Blackburn, Pen Barnes, P. Todd Korthuis

School of Social Work Faculty Publications and Presentations

People with substance use disorders (SUD) have high rates of hospitalization and readmission, long lengths of stay, and skyrocketing healthcare costs. Yet, models for improving care are extremely limited. We performed a needs assessment and then convened academic and community partners, including a hospital, community SUD organizations, and Medicaid accountable care organizations, to design a care model for medically complex hospitalized patients with SUD. Needs assessment showed that 58% to 67% of participants who reported active substance use said they were interested in cutting back or quitting. Many reported interest in medication for addiction treatment (MAT). Participants had high rates …