Public Health Commons^™

South Africans With Recent Pregnancy Rarely Know Partner’S Hiv Serostatus: Implications For Serodiscordant Couples Interventions, Lynn T. Matthews, Lizzie Moore, Tamaryn L. Crankshaw, Cecilia Milford, Fortunate N. Mosery, Ross Greener, Christina Psaros, Steven A, Safren, David Bangsberg, Jennifer A. Smit

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Implementation of safer conception strategies requires knowledge of partner HIV-serostatus. We recruited women and men in a high HIV-prevalence setting for a study to assess periconception risk behavior among individuals reporting HIV-serodiscordant partnerships. We report screening data from that study with the objective of estimating the proportion of individuals who are aware that they are in an HIV-serodiscordant relationship at the time of conception.

Methods: We screened women and men attending antenatal and antiretroviral clinics in Durban, South Africa for enrollment in a study of periconception risk behavior among individuals with serodiscordant partners. Screening questionnaires assessed for study eligibility …

The Transformative Power Of Narrative As A Behavioral Change Communication Tool To Reduce Health Disparities In Cervical Cancer Among Latinas: Global Implications, Lourdes Baezconde-Garbanati, Joyee S. Chatterjee, Lauren B. Frank, Sheila T. Murphy, Meghan B. Moran, Lisa N. Werth, Nan Zhao, Paula Amezola De Herrera, Don Mayer, Jeremy Kagan, Dave O'Brien

Communication Faculty Publications and Presentations

Cervical cancer is the third most common type of cancer in women globally. Latinas carry a disproportionate burden of this disease. In the United States, when compared with non-Hispanic Whites (NHW), Latinas endure much higher incidence rates (13.86 vs. 7.70 per 100,000) with mortality rates 1.5 times greater than for non-Hispanic white women . In order to address this disparity, a multidisciplinary team engaged in a transformative study to test if narrative, developed in culturally specific ways as a behavioral change communication tool, works better than non-narrative in increasing knowledge and changing attitudes and behaviors and, if so, why. This …

Trauma-Informed Research And Planning: Understanding Government And Urban Native Community Partnerships To Addressing Substance-Exposed Pregnancies In Portland, Or, Amanda Mercier

Dissertations and Theses

In 2011, representatives from the Multnomah County Health Departments and several Native-serving organizations came together to address substance-exposed pregnancies among urban Native Americans in Portland, Oregon. From these partnerships, the Future Generations Collaborative was formed representing a significant shift toward community-led maternal child health research and planning. Additionally, the Future Generations Collaborative adopted a historical trauma-informed community based participatory research and planning process. This is particularly significant considering government agencies' role in colonization within Native communities. The purpose of this case study is to explore partnerships between government agencies and the Portland Native community within the Future Generations Collaborative. Given …

Participation, Information, Values, And Community Interests Within Health Impact Assessments, Nicole Iroz-Elardo

Dissertations and Theses

Health impact assessment (HIA) has emerged in the U.S. as one promising process to increase social and environmental justice through addressing health equity issues within planning. HIA practice is guided by values such as democracy and equity and grounded in broad social determinants of health. The most readily applied definition of democracy is problematic because it implies an element of direct, participatory engagement with the public. This is at odds with HIA practice that largely relies on stakeholder engagement strategies.

This dissertation critically examines the engagement strategies of three transportation planning HIA cases to more fully understand how the HIA …

Congestive Heart Failure Self-Management Among Us Veterans: The Role Of Personal And Professional Advocates, Eleni Skaperdas, Anaïs Tuepker, Christina Nicolaidis, Jessica K. Robb, Devan Kansagara, David H. Hickam

School of Social Work Faculty Publications and Presentations

Objective: Understand patients’ experiences with primary care services for congestive heart failure (CHF) and explore the relationship between health services and self-management.

Methods: We conducted semi-structured interviews with thirty-nine patients with CHF receiving care at one Veterans Affairs Medical Center (VA). We analyzed data using thematic content analysis.

Results: Participants acknowledged the importance of ongoing engagement in the plan of care for CHF. They attributed success in this effort to be greatly influenced by personal advocates. The advocates included both members of the healthcare team with whom they had a continuity relationship and friends or family members who assisted on …

Exposure To Fine Particulate Matter During Pregnancy And Risk Of Preterm Birth Among Women In New Jersey, Ohio, And Pennsylvania, 2000–2005, Kristen M. Rappazzo, Julie L. Daniels, Lynne C. Messer, Charles Poole, Danelle T. Lobdell

Community Health Faculty Publications and Presentations

Background: Particulate matter < 2.5 micrometers in aerodynamic diameter (PM2.5) has been variably associated with preterm birth (PTB).

Objective: We classified preterm births into four categories (20–27, 28–31, 32–34, and 35–36 weeks completed gestation) and estimated risk differences (RD) for each category in association with a 1-µg/m3 increase in PM2.5 exposure during each week of gestation.

Methods: We assembled a cohort of singleton pregnancies that completed at least 20 weeks of gestation during 2000-2005 using live birth certificate data from three states (Pennsylvania, Ohio, and New Jersey) (n = 1,940,213; 8% PTB). We estimated mean PM2.5 exposures for each week of gestation from monitor-corrected Community Multi-Scale Air Quality modeling data. RDs were …

A Program Evaluation Of A Housing With Services Project For Low-Income Adults In Portland, Oregon, Jack A. Phillips, Paula C. Carder, Diana White

Student Research Symposium

Reducing hospital use and connecting individuals to local available services and supports are key features of the Affordable Care Act. Adult residents of public housing tend to experience worse health outcomes than other adults. Poor self-rated health and high rates of emergency department use and hospitalization among these residents have prompted efforts to improve health outcomes. Even among residents living independently, prior research indicates that health and social disparities can be effectively addressed through coordinated care and improved access to health and social services.

Cedar Sinai Park—a nonprofit residential care organization located in Portland, Oregon—will implement a demonstration project attempting …

The Effect Of Early Head Start On Child Welfare System Involvement: A First Look At Longitudinal Child Maltreatment Outcomes, Beth L. Green, Catherine Ayoub, Jessica Dym Bartlett, Adam Von Ende, Carrie Jeanne Furrer, Rachel Chazen-Cohen, Claire Vallotton, Joanne Klevens

Center for Improvement of Child and Family Services Publications

The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and …

Citizenship Documentation Requirement For Medical Eligibility: Effects On Oregon Children, Brigit A. Hatch, Jennifer E. Devoe, Jodi A. Lapidus, Matthew J. Carlson, Bill J. Wright

Sociology Faculty Publications and Presentations

BACKGROUND AND OBJECTIVES: The Deficit Reduction Act (DRA) of 2005 mandated Medicaid beneficiaries to document citizenship. Using a prospective cohort (n=104,375), we aimed to (1) determine characteristics of affected children, (2) describe effects on health insurance coverage and access to needed health care, and (3) model the causal relationship between this new policy, known determinants of health care access, and receipt of needed health care.

METHODS: We identified a stratified random sample of children shortly after the DRA was implemented and used state records and surveys to compare three groups: children denied Medicaid for inability to document citizenship, children denied …

Tobacco Use Among Adults Initiating Treatment For Hiv Infection In Rural Uganda, Gina R. Kruse, David Bangsberg, Judith A. Hahn, Jessica E. Haberer, Peter Hunt, Conrad Muzoora, John P. Bennett, Jeffrey N. Martin, Nancy A, Rigotti

OHSU-PSU School of Public Health Faculty Publications and Presentations

We conducted a longitudinal study of tobacco use among adults initiating antiretroviral therapy (ART) in Mbarara, Uganda where 11% of men and 3% of women use tobacco according to the 2011 Demographic and Health Survey. In a prospective cohort, self-reported tobacco use was assessed before starting ART and reassessed every 3–4 months. Plasma cotinine, a nicotine metabolite, was measured in a subset of adults pre-ART to verify self-report. Among 496 subjects, 50 (10%) reported current tobacco use (20% of men, 6% of women). Most (53%) adults with elevated cotinine levels (>15 ng/mL) reported no tobacco use. By 6 months …

U-54 Building Infrastructure Leading To Diversity (Build) National Institutes Of Health: Enhancing Cross-Disciplinary Infrastructure Training At Oregon, Carlos J. Crespo

Community Health Faculty Publications and Presentations

This presentation focuses on the NIH Building Infrastructure Leading to Diversity (BUILD) Initiative (U54) that was awarded to Portland State University.

The Dynamic Relationship Between Social Support And Hiv-Related Stigma In Rural Uganda, Sae Takada, Sheri D. Weiser, Elias Kumbakumba, Conrad Muzoora, Jeffrey N. Martin, Peter Hunt, Jessica E. Haberer, Annet Kawuma, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background—Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support.

Purpose—The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma.

Methods—We collected quarterly data from a cohort of 422 people living with HIV in Uganda, followed for a median of 2.1 years. We used multilevel regression to model the contemporaneous and 3-month-lagged associations between social support and both enacted and internalized stigma.

Results—Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged instrumental social support was negatively correlated with enacted stigma. Internalized stigma and …

Gently Clarifying The Application Of Horn’S Parallel Analysis To Principal Component Analysis Versus Factor Analysis, Alexis Dinno

Community Health Faculty Publications and Presentations

Horn’s parallel analysis (PA) is an empirical method used to decide how many components in a principal component analysis (PCA) or factors in a common factor analysis (CFA) drive the variance observed in a data set of n observations on p variables (Horn, 1965). This decision of how many components or factors to retain is critical in applications of PCA or CFA to reducing the dimensionality of data in analysis (as when compositing multiple scale items into a single score), and also in exploratory factor analysis where the different contributions of each factor to each observed variable help generate theory …

A Qualitative Study Of Rural Primary Care Clinician Views On Remote Monitoring Technologies, Melinda M. Davis, Jillian M. Currey, Sonya Howk, Molly R. Desordi, Linda Boise, Lyle J. Fagnan, Nancy Vuckovic

Community Health Faculty Publications and Presentations

Purpose: Remote monitoring technologies (RMTs) may improve the quality of care, reduce access barriers, and help control medical costs. Despite the role of primary care clinicians as potential key users of RMTs, few studies explore their views. This study explores rural primary care clinician interest and the resources necessary to incorporate RMTs into routine practice.

Methods: We conducted 15 in-depth interviews with rural primary care clinician members of the Oregon Rural Practice-based Research Network (ORPRN) from November 2011 to April 2012. Our multidisciplinary team used thematic analysis to identify emergent themes and a cross-case comparative analysis to explore variation by …

Comment On “The Effect Of Same-Sex Marriage Laws On Different-Sex Marriage: Evidence From The Netherlands”, Alexis Dinno

Community Health Faculty Publications and Presentations

In the recent Demography article titled “The Effect of Same-Sex Marriage Laws on Different-Sex Marriage: Evidence From the Netherlands,” Trandafir attempted to answer the question, Are rates of opposite sex marriage affected by legal recognition of same sex marriages? The results of his approach to statistical inference—looking for evidence of a difference in rates of opposite-sex marriage—provide an absence of evidence of such effects. However, the validity of his conclusion of no causal relationship between same-sex marriage laws and rates of opposite-sex marriage is threatened by the fact that Trandafir did not also look for equivalence in rates of opposite-sex …

Factors Influencing Youth Self-Perceptions Of Overweight And Obesity, Caitlin Helen Sommers

Dissertations and Theses

This study sought to examine whether participation in physical activity affects the ability to correctly classify body size, based on body mass index classifications. Secondarily, this study determined whether adolescents who incorrectly classified their body size overestimated or underestimated their size. Self-report data from the Youth Risk Behavior Surveillance Survey collected by the Centers for Disease Control and Prevention were analyzed. Logistic regression was performed to examine relationships between self-perception of body size and physical activity, television viewing time, computer/video game use, physical education class time, and extracurricular sports activities. Significance was set to p<0.05. Physical activity was the only statistically significant independent variable (p=0.058, OR = 1.060). Although physical activity was shown to be statistically significant, it did not appear to meaningfully increase the ability of youth to correctly classify body size. Secondary analysis showed that adolescents who incorrectly classified their body size were more likely to underestimate their body size. Females more frequently underestimated their body size (females=673; males=384).

Exploring The Effects Of Multi-Level Protective And Risk Factors On Child And Parenting Outcomes In Families Participating In Healthy Start/Healthy Families Oregon (Hs/Hfo), Peggy Nygren

Dissertations and Theses

While many studies focus on the links between multiple risk factors and negative outcomes such as child maltreatment, less is known about the influence of protective factors in the face of risks. The theoretical base of this study was a social ecological model of interactive influences including individual parent, family, and neighborhood level factors to predict outcomes. Protective Factor Index (PFI) and Risk Factor Index (RFI) predictors were developed to explore potential multi-level protective factor buffering effects on key child development and parenting outcomes. Participants were first time mothers enrolled in a randomized controlled study of the Healthy Start/ Healthy …

Work Stress Reactivity And Health Outcomes: A Study Of Nurses, Laurie Marie Jacobs

Dissertations and Theses

Negative events encountered in daily life influence individual well-being. Individuals vary in their reactivity to these events, the extent to which they are behaviorally, physiologically, and psychologically influenced by them (Almeida, 2005; Neupert, Almeida, & Charles, 2007). Reactivity to events in the form of changes in health behavior could represent either an attempt at coping (Cooper, Frone, Russell, & Mudar, 1995) or a stressor-related failure of self-control (Muraven & Baumeister, 2000). Such changes in behavior could have later effects on health.

Although a great deal of attention has been paid to both the immediate and long-term effects of stressors on …

Batterer Intervention Programs' Response To State Standards, Ashley Lynn Boal

Dissertations and Theses

The study of policy implementation has recently garnered research and federal attention highlighting the importance of implementation in achieving desired policy and program outcomes (Durlak & DuPre, 2008; Meyers, Durlak & Wandersman, 2012; National Institutes of Health, 2013). Psychology is one discipline that is well poised to guide the study of policy implementation as it can inform the creation, development, and outcomes associated with the introduction of a policy (Esses & Dovidio, 2011; Fischhoff, 1990). Given that batterer intervention programs (BIPs) have been developed to prevent future intimate partner violence (IPV) and improve victim safety, ensuring these programs have successfully …

Us Medical Specialty Global Health Training And The Global Burden Of Disease, Vanessa B. Kerry, Rochelle P. Walensky, Alexander C. Tsai, Regan W. Bergmark, Brian A. Bergmark, Chaturia Rouse, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Rapid growth in global health activity among US medical specialty education programs has lead to heterogeneity in types of activities and global health training models. The breadth and scope of this activity is not well chronicled.

Methods: Using a standardized search protocol, we examined the characteristics of US medical residency global health programs by number of programs, clinical specialty, nature of activity (elective, research, extended curriculum based field training), and geographic location across seven different clinical medical residency education specialties. We tabulated programmatic activity by clinical discipline, region and country. We calculated the Spearman's rank correlation coefficient to estimate …

Willow: Reaching Hiv-Positive African-American Women Through A Computer-Delivered Intervention, Charles H. Klein

Anthropology Faculty Publications and Presentations

This study evaluates the efficacy of Multimedia WiLLOW in enhancing HIV-protective sexual behaviors and psychosocial outcomes among HIV-positive African American women, including condom use for vaginal and anal sex, and psychosocial mediators associated with risk reduction practices. Using a community-based randomized controlled design, 168 participants completed a baseline and follow-up assessment as well as an exit satisfaction survey. Intervention participants reported significantly higher proportions of condom protected sex acts in the past 30 days (p=.002), with both HIV-negative (p=.040) and HIV-positive (p=.003) partners. They were also more likely to report 100% condom use (OR = .10; p=.030); a lower adjusted …

Factors Associated With Pruritic Papular Eruption Of Human Immunodeficiency Virus Infection In The Antiretroviral Therapy Era, S. L. Chua, E. H. Amerson, K. S. Leslie, T. H. Mccalmont, P. E. Leboit, J. N. Martin, David Bangsberg, T. A. Maurer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background—Pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and it is reported to improve with antiretroviral therapy (ART). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure.

Objectives—To determine factors associated with PPE in HIV-infected persons receiving ART.

Methods—A case–control study nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases had received ART for ≥ 15 months and had an itchy papular …

The Association Between Insurance Status And Cervical Cancer Screening In Community Health Centers: Exploring The Potential Of Electronic Health Records For Population-Level Surveillance, 2008-2010, Stuart Cowburn, Matthew J. Carlson, Jodi A. Lapidus, Jennifer E. Devoe

Sociology Faculty Publications and Presentations

Introduction: Cervical cancer incidence and mortality rates in the United States have decreased 67% over the past 3 decades, a reduction mainly attributed to widespread use of the Papanicolaou (Pap) test for cervical cancer screening. In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. The objective of our study was to assess the association between cervical cancer screening and insurance status in Oregon and California community health centers …

Patients’ Perception Of Patient–Provider Communication In Fertility Preservation Decision Making Among Young Women With Cancer, Aakrati Mathur, E. Roberto Orellana, Amy Frohnmayer, Pauline Jivanjee, Lillian Nail, Brandon Hayes-Lattin, Rebecca G. Block

School of Social Work Faculty Publications and Presentations

Fertility preservation (FP) for patients with cancer is an emerging field. With the advancement of technology, patients may face a complex decision-making process about whether to preserve fertility. The purpose of this article is to explore how young women with cancer perceive patient–provider communication in FP decision making. In this study, 25 women between the ages of 18 and 39 were interviewed retrospectively. They were interviewed one time to learn about their decision-making process related to FP. Results of this analysis indicate that patients seek support and involvement from providers throughout the process of decision making. They prefer providers to …

The Historical, Political, Social, And Individual Factors That Have Influenced The Development Of Aging And Disability Resource Centers And Options Counseling, Sheryl Dejoy Elliott

Dissertations and Theses

This thesis reports on the perspectives and experiences of policymakers, advocates, agency supervisors, and experts in the field of gerontology, about the development of Aging and Disability Resource Centers (ADRC) programs and Options Counseling (OC). By examining the foundations upon which ADRCs and OC are built, this study sought to inform future research about the effectiveness of existing practice, increase understanding of best practices, and clarify whether these emerging services are accomplishing original goals.

ADRCs and OC intend to address long-term care issues and healthcare needs by providing a single entry point to the social service system. ADRCs offer information, …

A Community-Based Wellness Program To Reduce Depression In African Americans: Results From A Pilot Intervention, Christina Nicolaidis, Corliss Mckeever, Sandra Meucci

School of Social Work Faculty Publications and Presentations

Background

African-Americans are less likely than non-Hispanic Whites to find antidepressants acceptable or seek care for depression.

Objective

To develop and pilot-test a culturally-tailored, community-based, psycho-educational wellness and exercise promotion program to reduce depressive symptoms in African-Americans.

Methods

Participants were African-Americans with moderate depressive symptoms, who were interested in exercise, but were not exercising regularly. They attended a 6-week psycho-educational group program during which they set personal activity goals and learned depression self-management skills. We conducted pre- and post-intervention surveys and post-intervention feedback sessions.

Results

21 African-Americans participated in the intervention. The program had excellent attendance and satisfaction. We found …

Same Sex Marriage And The Perceived Assault On Opposite Sex Marriage, Alexis Dinno, Chelsea Whitney

Community Health Faculty Publications and Presentations

Background: Marriage benefits both individuals and societies, and is a fundamental determinant of health. Until recently same sex couples have been excluded from legally recognized marriage in the United States. Recent debate around legalization of same sex marriage has highlighted for anti-same sex marriage advocates and policy makers a concern that allowing same sex couples to marry will lead to a decrease in opposite sex marriages. Our objective is to model state trends in opposite sex marriage rates by implementation of same sex marriages and other same sex unions.

Methods and Findings: Marriage data were obtained for all …

Biopiracy And Vaccines: Indonesia And The World Health Organization's New Pandemic Influenza Plan, Shawn Smallman

International & Global Studies Faculty Publications and Presentations

Viral samples of avian influenza are essential to preparing pre-pandemic vaccines. In 2007, the conflicting interests of the developed and developing nations led Indonesia to briefly stop sharing viral samples. The result was a struggle in which the two blocs argued for different paradigms for viral sample sharing. The first paradigm, articulated by the developed world, depicted the issue as one of health security, in which international law mandated the sharing of viral samples. The second paradigm, advanced by the developing world, depicted viral sample sharing as a form of biopiracy, which violated countries' sovereign control of their biological resources. …

Transport And Health: A Look At Three Latin American Cities, Janeth Mosquera Becerra, Rodrigo S. Reis, Lawrence D. Frank, Farah A. Ramirez-Marrero, Benjamin Welle, Eugenio Arriaga Cordero, Fabian Mendez Paz, Carlos J. Crespo, Veronica Dujon, Enrique Jacoby, Jennifer Dill, Lynn Weigand, Carlos M. Padin

Community Health Faculty Publications and Presentations

Transport is associated with environmental problems, economic losses, health and social inequalities. A number of European and US cities have implemented initiatives to promote multimodal modes of transport. In Latin America changes are occurring in public transport systems and a number of projects aimed at stimulating non-motorized modes of transport (walking and cycling) have already been implemented. Based on articles from peer-reviewed academic journals, this paper examines experiences in Bogota (Colombia), Curitiba (Brazil), and Santiago (Chile), and identifies how changes to the transport system contribute to encourage active transportation. Bus rapid transit, ciclovias, bike paths/lanes, and car use restriction are …

International And Domestic Student Health-Information Seeking And Satisfaction, Stacy Theodora Austin

Dissertations and Theses

This study examines two groups -international and domestic students at Portland State University (PSU) - in terms of their motivations to seek university-health services, and their satisfaction with university-health services. The Theory of Motivated Information Management (W. A. Afifi & Weiner, 2004) served as the foundation for this study to examine the preferences of students in terms of the ways they seek information about their health concerns. Differences in international and domestic students' anxiety, efficacy, and satisfaction with physicians were supported. International students reported more anxiety than domestic students. Domestic students reported being more efficacious than international students when talking …