Public Health Commons^™

Patient And Provider Comfort Discussing Substance Use, Moira Ray, Mary Catherine Beach, Christina Nicolaidis, Dongseok Choi, Somnath Saha, P. Todd Korthuis

School of Social Work Faculty Publications and Presentations

BACKGROUND AND OBJECTIVES: Substance use is a prevalent issue in primary care with wide-reaching implications, particularly for the care of HIV-infected patients. This analysis identified patient and provider characteristics associated with high comfort discussing substance use in HIV primary care clinics using multivariable logistic regression.

METHODS: A total of 413 patients and 44 providers completed surveys on their comfort discussing substance use. Additional independent variables from surveys included demographics, drug and alcohol use, self-efficacy, and activation for patients. Providerlevel data included demographics, training, practice descriptors, and stress levels.

RESULTS: The majority of patients (76%) and providers (73%) reported high comfort. …

Exploring Four Barriers Experienced By African Americans In Healthcare: Perceived Discrimination, Medical Mistrust, Race Discordance, And Poor Communication, Adolfo Gabriel Cuevas

Dissertations and Theses

For many health conditions, African Americans bear a disproportionate burden of disease, injury, death, and disability compared to European Americans. African Americans also use health services less frequently than do European Americans and this underuse of services contributes to health disparities in the United States. Studies have shown that some disparities are present not as a result of poor access to care, but, to a certain extent, as a result of the experiences patients have at their doctors' offices. It is, therefore, essential to understand African American patients' perspectives and experiences with healthcare providers. Past studies have shown that four …

The Institutional Context That Supports Team-Based Care For Older Adults, Anna Foucek Tresidder

Dissertations and Theses

The aging population in the U.S. is dramatically increasing; it is predicted that not only will individuals live longer but also that they will live with multiple chronic diseases that could require high levels of medical and social resources. While the aging population increases, the number of health care providers choosing to specialize in caring for the elderly is decreasing just as dramatically. Teams are believed to be a possible response to more efficiently use the providers available, take advantage of alternative provider types, and integrate a range of health and social services to meet patient needs more effectively. Interdisciplinary …

Proyecto Interconexiones: A Pilot Test Of A Community-Based Depression Care Program For Latina Violence Survivors, Christina Nicolaidis, Angie Mejia, Marlen Perez, Anabertha Alvarado, Rosemary Celaya-Alston, Yolanda Quintero, Raquel Aguillon

Chicano/Latino Studies Faculty Publications and Presentations

Background: Latina intimate partner violence (IPV) survivors often face great barriers to depression care. We sought to use a community-based participatory research (CBPR) approach to create and evaluate a community-based depression care program for Latina IPV survivors.

Methods: We created a multifaceted, culturally tailored intervention, based on principles of chronic illness management. A promotora provided case management services and led 12 weekly group sessions. Participants completed surveys at baseline and 6 months and participated in open-ended exit interviews.

Results: Ten Spanish-speaking Latina women participated in the intervention. The program had excellent attendance, with 100% of women attending …

Differences In Demographic, Behavioral, And Biological Variables Between Those With Valid And Invalid Accelerometry Data: Implications For Generalizability, Paul D. Loprinzi, Bradley J. Cardinal, Carlos J. Crespo, Gary R. Brodowicz, Ross E. Andersen, Ellen Smit

Community Health Faculty Publications and Presentations

Background: The exclusion of participants with invalid accelerometry data (IAD) may lead to biased results and/or lack of generalizability in large population studies. The purpose of this study was to investigate whether demographic, behavioral, and biological differences occur between those with IAD and valid accelerometry data (VAD) among adults using a representative sample of the civilian noninstitutionalized U.S. population. Methods: Ambulatory participants from NHANES (2003-2004) who were 20-85 years of age were included in the current study and wore an ActiGraph 7164 accelerometer for 7 days. A "valid person" was defined as those with 4 or more days of at …

The Hispanic Paradox And Older Adults’ Disabilities: Is There A Healthy Migrant Effect?, Esme Fuller Thomson, Amini Nuru-Jeter, Dawn M. Richardson, Ferrah Raza, Meredeth Minkler

Community Health Faculty Publications and Presentations

The “Hispanic Paradox” suggests that despite rates of poverty similar to African Americans, Hispanics have far better health and mortality outcomes, more comparable to non-Hispanic White Americans. Three prominent possible explanations for the Hispanic Paradox have emerged. The “Healthy Migrant Effect” suggests a health selection effect due to the demands of migration. The Hispanic lifestyle hypothesis focuses on Hispanics’ strong social ties and better health behaviors. The reverse migration argument suggests that the morbidity profile in the USA is affected when many Hispanic immigrants return to their native countries after developing a serious illness. We analyzed data from respondents aged …

Community-Based Approaches To Mental Health And Conflict Resolution In Post-Conflict Libya, Amanda Lubit

Anthropology Theses

Post-conflict Libya faces the challenges of establishing a national health system that is capable of addressing mental health needs for a population traumatized by decades of repression and a recent war. In order to recover, traumatized populations require feelings of safety, calm, empowerment, connectedness, and hope. To help achieve this outcome, programs must focus on medical and social aspects at both the individual and community level.

As part of an internship experience, I worked with Dr. Omar Reda, a Libyan psychiatrist at Oregon Health and Science University (OHSU) who helps communities, organizations and mental health professionals throughout Libya to address …

Perceived Experiences Of Discrimination In Health Care: A Barrier For Cancer Screening Among American Indian Women With Type 2 Diabetes, Kelly Gonzales, Anna K. Harding, William E. Lambert, Rongwei Fu, William G. Henderson

OHSU-PSU School of Public Health Faculty Publications and Presentations

Purpose - Breast and cervical cancer-mortality disparities are prominent among American Indian women. These disparities, in part, may result from patients perceived experiences of discrimination in health care. This report evaluates the impact of perceived discrimination on screening for breast and cervical cancer in a sample of 200 American Indian women with type 2 diabetes.

Methods - Data were collected from patient report and medical records. Prevalence of breast and cervical cancer screening were assessed. Unadjusted and adjusted logistic regression analyses were used to assess associations between perceived discrimination, cancer screening status, and patients' health care-seeking behaviors.

Findings - Substantial …

Lower Nutritional Status And Higher Food Insufficiency In Frail Older Us Adults, Ellen Smit, Kerri M. Winters-Stone, Paul D. Loprinzi, Alice M. Tang, Carlos J. Crespo

Community Health Faculty Publications and Presentations

Frailty is a state of decreased physical functioning and a significant complication of ageing. We examined frailty, energy and macronutrient intake, biomarkers of nutritional status and food insufficiency in US older adult (age ≥ 60 years) participants of the Third National Health and Nutrition Examination Survey (4731). Frailty was defined as meeting ≥ 2 and pre-frailty as meeting one of the following four-item criteria: (1) slow walking; (2) muscular weakness; (3) exhaustion and (4) low physical activity. Intake was assessed by 24 h dietary recall. Food insufficiency was self-reported as ‘sometimes’ or ‘often’ not having enough food to eat. Analyses …

Health Behaviour Changes After Diagnosis Of Chronic Illness Among Canadians Aged 50 Or Older, Jason T. Newsom, Nathalie Huguet, Pamela L. Ramage-Morin, Michael Joseph Mccarthy, Julie Bernier, Mark S. Kaplan, Bentson H. Mcfarland

Community Health Faculty Publications and Presentations

Changes in health behaviors (smoking, physical activity, alcohol consumption, and fruit and vegetable consumption) after diagnosis of chronic health conditions (heart disease, cancer, stroke, respiratory disease, and diabetes) were examined among Canadians aged 50 or older. Results from 12 years of longitudinal data from the Canadian National Population Health Survey indicated relatively modest changes in behavior. Although significant decreases in smoking were observed among all groups except those with respiratory disease, at least 75% of smokers did not quit. No significant changes emerged in the percentage meeting physical activity recommendations, except those with diabetes, or in excessive alcohol consumption, except …

Body Mass Index And The Risk Of Prostate Cancer, Daniel Lee Mcgee, Carlos J. Crespo

Community Health Faculty Publications and Presentations

Background: This article presents cohort studies that use data from the National Health Information Survey from 1986 to 1994 and compares the effectiveness of Cox proportional hazards models that assume a linear relationship between body mass index (BMI) and the risk of prostate cancer with models that assume a J-shaped relationship. Methods and results: Our study found that for black males over 40 years of age, neither a linear nor a J-shaped relationship yielded a statistically significant model. With white males over 40 years, assuming a linear relationship did not yield a statistically significant model (P = 0.582). When we …

Rethinking The “Pre” In Pre-Therapy Counseling: No Benefit Of Additional Visits Prior To Therapy On Adherence Or Viremia In Ugandans Initiating Arvs, Mark J. Siedner, Alexander J. Lankowski, Jessica E. Haberer, Annet Kembabazi, Nneka Emenyonu, Alexander C. Tsai, Conrad Muzoora, Elvin H. Geng, Jeffrey N. Martin, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Many guidelines recommend adherence counseling prior to initiating antiretrovirals (ARVs), however the additional benefit of pre-therapy counseling visits on early adherence is not known. We sought to assess for a benefit of adherence counseling visits prior to ARV initiation versus adherence counseling during the early treatment period.

Methods: We performed a secondary analysis of data from a prospective cohort of HIV-infected patients in Mbarara, Uganda. Adults were enrolled upon initiation of ARVs. Our primary exposure of interest was ARV adherence counseling prior to initiating therapy (versus concurrent with initiation of therapy). Our outcomes of interest were: 1) average adherence …

High Acceptability For Cell Phone Text Messages To Improve Communication Of Laboratory Results With Hiv-Infected Patients In Rural Uganda: A Cross-Sectional Survey Study, Mark J. Siedner, Jessica E. Haberer, Mwebesa B. Bwana, Norma C. Ware, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Patient-provider communication is a major challenge in resource-limited settings with large catchment areas. Though mobile phone usership increased 20-fold in Africa over the past decade, little is known about acceptability of, perceptions about disclosure and confidentiality, and preferences for cell phone communication of health information in the region.

Methods: We performed structured interviews of fifty patients at the Immune Suppression Syndrome clinic in Mbarara, Uganda to assess four domains of health-related communication: a) cell phone use practices and literacy, b) preferences for laboratory results communication, c) privacy and confidentiality, and d) acceptability of and preferences for text messaging to …

Mean Cd4 Cell Count Changes In Patients Failing A First-Line Antiretroviral Therapy In Resource-Limited Settings, Alexandra Calmy, Eric Balestre, Fabrice Bonnet, Andrew Boulle, Eduardo Sprinz, Robin Wood, Eric Delaporte, Eugène Messou, James Mcintyre, Kamal Marhoum El Filali, Mauro Schechter, N. Kumarasamy, David Bangsberg, Patrick Mcphail, Stefaan Van Der Borght, Carlos Zala, Matthias Egger, Rodolphe Thiébaut, François Dabis, Art-Linc Of Iedea Collaboration (Asia, South America, East, Southern And West Africa)

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART.

Method: Naïve patients on a first-line ART regimen with at least two measures of HIV-RNA available after ART initiation were included in the study. The relationships between mean CD4 cell count change and HIV-RNA at 6 and 12 months after ART initiation (M6 and M12) were assessed by linear mixed models adjusted for gender, age, …

Motivating Men Who Have Sex With Men To Get Tested For Hiv, Magaly M. Blas, Luis A. Menacho, Isaac E. Alva, E. Roberto Orellana

School of Social Work Faculty Publications and Presentations

Although men who have sex with men (MSM) have the highest HIV prevalence in Peru, they are underserved by traditional preventive programs. Interestingly, in Peru the Internet and cell-phones have emerged as a convenient tool to reach this population.

Safety And Adherence To Intermittent Pre-Exposure Prophylaxis (Prep) For Hiv-1 In African Men Who Have Sex With Men And Female Sex Workers, Gaudensia Mutua, Eduard J. Sanders, Peter Mwangi Mugo, Omu Anzala, Jessica E. Haberer, David R. Bangsberg, Burc Barin, James F. Rooney, David Mark, Paramesh Chetty, Patricia Fast, Frances H. Priddy

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Little is known about safety of and adherence to intermittent HIV PrEP regimens, which may be more feasible than daily dosing in some settings. We present safety and adherence data from the first trial of an intermittent PrEP regimen among Kenyan men who have sex with men (MSM) and female sex workers (FSW).

Methods/Principal Findings: MSM and FSW were randomized to daily oral FTC/TDF or placebo, or intermittent (Monday, Friday and within 2 hours after sex, not to exceed one dose per day) oral FTC/TDF or placebo in a 2:1:2:1 ratio; volunteers were followed monthly for 4 months. Adherence …

Social, Structural And Behavioral Determinants Of Overall Health Status In A Cohort Of Homeless And Unstably Housed Hiv-Infected Men, Elise D. Riley, Torsten B. Neilands, Kelly Moore, Jennifer Cohen, David Bangsberg, Diane Havler

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Previous studies indicate multiple influences on the overall health of HIV-infected persons; however, few assess and rank longitudinal changes in social and structural barriers that are disproportionately found in impoverished populations. We empirically ranked factors that longitudinally impact the overall health status of HIV-infected homeless and unstably housed men.

Methods and Findings: Between 2002 and 2008, a cohort of 288 HIV+ homeless and unstably housed men was recruited and followed over time. The population was 60% non-Caucasian and the median age was 41 years; 67% of study participants reported recent drug use and 20% reported recent homelessness. At baseline, …

Associations Between The Quality Of The Residential Built Environment And Pregnancy Outcomes Among Women In North Carolina, Marie Lynn Miranda, Lynne C. Messer, Gretchen L. Kroeger

Community Health Faculty Publications and Presentations

Background: The built environment, a key component of environmental health, may be an important contributor to health disparities, particularly for reproductive health outcomes.Objective: In this study we investigated the relationship between seven indices of residential built environment quality and adverse reproductive outcomes for the City of Durham, North Carolina (USA).

Methods: We surveyed approximately 17,000 residential tax parcels in central Durham, assessing > 50 individual variables on each. These data, collected using direct observation, were combined with tax assessor, public safety, and U.S. Census data to construct seven indices representing impor­tant domains of the residential built environment: housing damage, property disorder, …

Potential For False Positive Hiv Test Results With The Serial Rapid Hiv Testing Algorithm, Steven Baveewo, Moses R. Kamya, Harriet Mayanja-Kizza, Robin Fatch, David Bangsberg, Thomas J. Coates, Judith A. Hahn, Rhoda K. Wanyenze

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Rapid HIV tests provide same-day results and are widely used in HIV testing programs in areas with limited personnel and laboratory infrastructure. The Uganda Ministry of Health currently recommends the serial rapid testing algorithm with Determine, STAT-PAK, and Uni-Gold for diagnosis of HIV infection. Using this algorithm, individuals who test positive on Determine, negative to STAT-PAK and positive to Uni-Gold are reported as HIV positive. We conducted further testing on this subgroup of samples using qualitative DNA PCR to assess the potential for false positive tests in this situation.

Results: Of the 3388 individuals who were tested, 984 were …

A Novel Tool For Assessing And Summarizing The Built Environment, Gretchen L. Kroeger, Lynne C. Messer, Sharon E. Edwards, Marie Lynn Miranda

Community Health Faculty Publications and Presentations

Background: A growing corpus of research focuses on assessing the quality of the local built environment and also examining the relationship between the built environment and health outcomes and indicators in communities. However, there is a lack of research presenting a highly resolved, systematic, and comprehensive spatial approach to assessing the built environment over a large geographic extent. In this paper, we contribute to the built environment literature by describing a tool used to assess the residential built environment at the tax parcel-level, as well as a methodology for summarizing the data into meaningful indices for linkages with health data. …

Conceptualizing Neighborhood Space: Consistency And Variation Of Associations For Neighborhood Factors And Pregnancy Health Across Multiple Neighborhood Units, Lynne C. Messer, Lisa C. Vinikoor-Imler, Barbara A. Laraia

Community Health Faculty Publications and Presentations

The purpose of this research was to assess the consistency of associations between neighborhood characteristics and pregnancy-related behaviors and outcomes across four nested neighborhood boundaries using race-stratified fixed-slope random-intercept multilevel logistic models. High incivilities was associated with increased smoking, inadequate weight gain and pregnancy-induced hypertension (PIH), while walkability was associated with decreased smoking and PIH for white women across all neighborhood definitions. For African American women, high incivilities was associated with increased smoking and inadequate gestational weight gain, while more walkable neighborhoods appeared protective against smoking and inadequate weight gain in all but the smallest neighborhoods. Associations with neighborhood attributes …

Risk Factors For Homelessness Among Community Mental Health Patients With Severe Mental Illness, Rupert Talmage Van Wormer

Dissertations and Theses

The purpose of this study was to identify risk factors associated with homelessness, assess the relationship between housing status and consumption of costly publicly funded resources, to identify characteristics associated with service retention, and to evaluate whether length of treatment is associated with better outcomes. The target population was homeless and formerly homeless adults with SMI enrolled in community mental health services at the Downtown Emergency Service Center SAGE mental health program located in Seattle. The sample consisted of 380 SAGE patients who had continuous enrollment in 2005. These patients formed the cohort for the study. Agency records for these …

Oral Health Knowledge, Attitudes, And Behaviors: Investigation Of An Educational Intervention Strategy With At-Risk Females, Susan Romano Rustvold

Dissertations and Theses

A self-perpetuating cycle of poor health literacy and poor oral health knowledge and behavior affects approximately 90 million people in the United States, most especially those from low-income groups and other at-risk populations such as those with addiction. Poor oral health can result from lack of access to regular preventive dental appointments, lack of access to restorative care when dental diseases are treatable, and low oral health knowledge that leads to poor oral health self-care behaviors. In addition, patients' dental anxiety can impede care, because highly anxious people often avoid dental appointments. To address these issues, this inquiry examined oral …

Thirdhand Tobacco Smoke: Emerging Evidence And Arguments For A Multidisciplinary Research Agenda, Georg E. Matt, Penelope J. Quintana, Hugo Destaillats, Lara A. Gundel, Mohamad Sleiman, Brett C. Singer, Peyton Jacob, Jonathan P. Winickoff, Prue Talbot, Suzaynn Schick, Yinsheng Wang, Bo Hang, Manuela Martins-Green, James F. Pankow, Melbourne F. Hovell, Neal L. Benowitz, Virender K. Rehan, Jonathan M. Samet

Civil and Environmental Engineering Faculty Publications and Presentations

There is broad consensus regarding the health impact of tobacco use and secondhand smoke exposure, yet considerable ambiguity exists about the nature and consequences of thirdhand smoke (THS). We introduce definitions of THS and THS exposure and review recent findings about constituents, indoor sorption-desorption dynamics, and transformations of THS; distribution and persistence of THS in residential settings; implications for pathways of exposure; potential clinical significance and health effects; and behavioral and policy issues that affect and are affected by THS. Physical and chemical transformations of tobacco smoke pollutants take place over time scales ranging from seconds to months and include …

Developing Countries, Vaccine Access And Influenza Outbreaks: Ethics And Global Health Governance When Facing A Pandemic, Shawn Smallman

International & Global Studies Faculty Publications and Presentations

The threat posed by influenza pandemics raises serious ethical issues, as well as questions of global health governance. In order to create pre-pandemic vaccines, global health authorities need access to virus from regional outbreaks. But because the countries where these outbreaks occur are unlikely to benefit from the vaccine, they are sometimes reluctant to share this seed stock, and may try to make proprietary arrangements with pharmaceutical companies, as briefly occurred in Indonesia. Although these arrangements may increase developing countries' access to vaccine, they hamper the global cooperation necessary to prepare for influenza outbreaks. Developing countries, in contrast, point to …

A Study Of Riders' Noise Exposure On Bay Area Rapid Transit Trains, Alexis Dinno, Cynthia Powell, Margaret Mary King

Community Health Faculty Publications and Presentations

Excessive noise exposure may present a hazard to hearing, cardiovascular and psychosomatic health. Mass transit systems, such as the Bay Area Rapid Transit (BART) system, are potential sources of excessive noise. The purpose of this study was to characterize transit noise and riders' exposure to noise on the BART system using three dosimetry metrics. We made 268 dosimetry measurements on a convenience sample of 51 line segments. Dosimetry measures were modeled using linear and non-linear multiple regression as functions of average velocity, tunnel enclosure, flooring, and wet weather conditions, and presented visually on a map of the BART system. This …

Preliminary Efficacy Of A Computer-Delivered Hiv Prevention Intervention For African American Teenage Females, Charles H. Klein, Josefina J. Card

Anthropology Faculty Publications and Presentations

This study translated SiHLE (Sisters Informing, Healing, Living, and Empowering), a 12-hour Centers for Disease Control and Prevention evidence based group-level intervention for African American females 14-18 years of age, into a 2-hour computer-delivered individual-level intervention. A randomized controlled trial (n = 178) was conducted to examine the efficacy of the new Multimedia SiHLE intervention. Average condom-protected sex acts (proportion of vaginal sex acts with condoms, last 90 days) for sexually active participants receiving Multimedia SiHLE rose from M = 51% at baseline to M = 71% at 3-month follow-up (t = 2.06, p = .05); no statistically significant difference …

Community-Based Approaches To Reduce Toxins In Housing: Lessons Learned From Working With Diverse Communities, Erin Mcnally, Ian Blazina, Stephanie Farquhar

Community Health Faculty Publications and Presentations

This article will review lessons learned from a community-based participatory research project with Latino and Somali residents in Portland, Oregon. The aim of the Healthy Futures Collaborative (HFC) project was to reduce in-home environmental health hazards associated with childhood respiratory illness and asthma through a process that strengthened social support and civic engagement. Using a community-based approach, the HFC trained community residents as community scientists to ensure local leadership and participation. Results suggest an increase in Somali and Latino residents' knowledge of environmental stressors and changes in behavior that may improve indoor environmental quality. Especially when working with historically marginalized …

Interpretations Of Interpretations: Combining Community-Based Participatory Research And Interpretive Inquiry To Improve Health, Jessica Gregg, Lourdes Centurion, Julio Maldonado, Raquel Aguillon, Rosemary Carmela Celaya-Alston, Stephanie Farquhar

Community Health Faculty Publications and Presentations

Background: Latina immigrants from Mexico suffer significantly increased morbidity and mortality from cervical cancer when compared with non-Hispanic White women, largely owing to lack of screening and appropriate treatment. Objectives: To demonstrate that by combining the tools of community-based participatory research (CBPR) with the tools of interpretive inquiry, it is possible to address explicit community concerns surrounding a particular problem such as cervical cancer while also examining what other, perhaps less immediately visible, matters consume the time and attention of community members. Methods: We first briefly discuss and compare CBPR as an approach to research and interpretive inquiry as a …

Anticipated Effects Of The U.S. Mexico City Policy On The Attainability Of The Millennium Development Goals And Future Development Efforts In Sub-Saharan Africa, Katherine Clare Alexander

Anthós

In the low-income countries of sub-Saharan Africa, the performance of pyramidal reproductive health and family planning services with public outreach initiatives has not met the expectations or the needs of the communities they serve. Insufficient case management, limited management capacity and referral and communication failures are challenges faced on the delivery level, while on the policy level these health clinics face insufficient coordination among organizations and weak links between programs (Schneider, 2006). The Mexico City Policy, first introduced by President Reagan in 1984, only exacerbated these challenges for organizations that offer comprehensive contraception and family planning programs by denying any …