Public Health Commons^™

Urgent Care Program Influences On An Integrated Health Care System, Craig H. Carter

Dissertations and Theses

The Veterans Health Administration (VHA) is the most extensive integrated health care delivery system in the world with over 20,000 physicians, 1,600 facilities, and more than 400,000 employees, caring for nine million veterans. The health care provided covers traditional outpatient and hospital-based services such as primary care, surgery, critical care, mental health, orthopedics, pharmacy, radiology, and physical therapy. Most VHA facilities offer additional medical and surgical specialties such as audiology, speech pathology, dermatology, dental, geriatrics, urology, oncology, podiatry, prosthetics, and vision care. Some of the more extensive VHA facilities offer advanced health care services, such as organ transplants and plastic …

Construction And Mutagenesis Of Ssv1 Mutants In Extreme Viruses, Lou Ann F. O'Connor, Jono Abshier, Kenneth M. Stedman

Student Research Symposium

Archaeal viruses with unique structures such as spindle-shaped virions are found abundantly in extreme environments like geothermal hot springs around the world. Among all spindle-shaped viruses, the model Sulfolobus Spindle-shaped Virus 1 (SSV1) is best studied. Creating the lemon-shaped or spindle-shaped virion structure are two proteins, VP1 as the major capsid protein, and VP3 as the minor capsid protein. The primary structure of VP1 consists of a proteolytic cleavage site at position 66 that is believed to be necessary for virus evolution. Recent studies showed that genetic mutation of the amino acid, glutamate (E) at position 66 in VP1 which …

Considering The Historical And Systemic Context, To What Extent Are Cuban Women’S Healthcare And Reproductive Rights Affected By The Privacy And Social Influence Of Cuba Today?, Autumn Cowell

Student Research Symposium

This paper will examine how historical and systemic values continue to frame social influences thus impacting Cuban women’s healthcare and reproductive rights. If the impact of history and systems still affects social influences then Women’s Healthcare and Reproductive Rights may be compromised. This investigation will highlight the potential benefits and risks of historical and systemic values that have affected challenges or changes within Cuban culture. And how these social influences are found within the areas of prevention, intervention, and treatment. This paper hopes to outline how the Cuban government and society are sustaining the protection of Cuban women’s access to …

Cognitive And Economic Development, John Luke Gallup

OHSU-PSU School of Public Health Annual Conference

A burgeoning literature finds that early childhood risk factors have large causal effects on individuals' cognitive development, education and earnings, but has not assessed the impact on the economy as a whole.

Cognitive ability is the foundation of human capital and the capacity to learn. The risk factors for poor cognitive development are very high in many countries. Each risk factor also causes child mortality, making child survival a viable proxy for good cognitive development conditions. The cognitive development of current workers happened decades earlier when they were children, providing a predetermined correlate. Controlling for country characteristics, income levels and …

Knowledge Of Medicaid Expansion To Recent And Undocumented Immigrants Among Oregon Mexican-Origin Latinos: (Work In Progress), Nancy Ledezma, Grace Parra, Alejandra Nunez, Dr. Blair Darney

OHSU-PSU School of Public Health Annual Conference

Background

Recent and undocumented immigrants are explicitly excluded from federal Medicaid and state insurance exchanges. The first phase of Healthier Oregon was implemented in July 2022 and expanded Medicaid (OHP) benefits to undocumented immigrants ages 19-25 or 55 and older. The second phase was implemented in July 2023 and extended benefits to everyone regardless of age. We assessed understanding of Healthier Oregon among Mexican-origin Latinos. We hypothesize that many potentially eligible people may not know about the program, if they qualify, or how to apply.

Methods

This is a cross-sectional study in collaboration with the General Consulate of Mexico. Our …

Understanding Variation In Provider Referral Rates To Early Intervention For Children With Developmental Delays, Gabriella Tangkilisan, Zoe Kilmer, Michelle Owens, Benjamin Sanders, Katharine Zuckerman

OHSU-PSU School of Public Health Annual Conference

Background:

Early detection and treatment of developmental disabilities (DD), including Autism Spectrum Disorder (ASD), improves language, IQ, and adaptive outcomes. Guidelines recommend immediate referral to Early Intervention (public developmental therapy services) upon positive ASD/DD screening in infant/toddler well child checks. However, children screening positive for ASD/DD are not always referred for Early Intervention services. This project aimed to understand why pediatricians do and do not refer children with positive DD/ASD screens to early intervention.

Methods:

We conducted qualitative interviews with pediatricians who participated in a randomized trial investigating family navigation for children with autism risk. We determined pediatrician referral rates …

A Window Of Opportunity: Describing Participants Engaged In A Comprehensive Perinatal Care Model To Treat Substance Use Disorder During Pregnancy, Christina Jäderholm

OHSU-PSU School of Public Health Annual Conference

In 2019, 12% of pregnant persons were estimated to use psychoactive substances, the highest rate in US history. Substance use disorder (SUD) is a chronic, relapsing condition, and while pregnancy presents a unique opportunity for SUD intervention, research on pregnant and postpartum SUD patient experiences is vital for informing perinatal systems of care. The purpose of this presentation is to describe a sample from SUN, a comprehensive perinatal care program for pregnant persons with SUD in North Carolina.

Methods

We abstracted medical records (n=29), surveyed participants (n=29), and conducted two focus groups (n=7). Medical records provided participant demographics; medical, social, …

Exploring Decolonial And Indigenous Mental Health Framework And Practice To Address Complex Trauma Among Palestinian Youth Living Under Violence Of Settler-Colonialism, Vivian L. Duong, Corrin Murphy

OHSU-PSU School of Public Health Annual Conference

The growing settler colonial project of Israel forced indigenous Palestinians to flee from their homeland to further the Zionist movement of establishing a Jewish-majority state. The forced dispossession and displacement of Palestinians at this time was referred to as the Nakba, or catastrophe (Masalha, 2002). From 1947 and 1949, approximately 750,000 Palestinians from a population of 1.9 million were made refugees (Al Jazeera, 2017). Also referred to as the ethnic cleansing of Palestine, Zionists forcibly took over 78 percent of Palestine, destroyed about 530 villages and cities, and killed around 15,000 Palestinians including more than 70 massacres (Al Jazeera, 2017). …

Supporting Self-Managed Abortion Care In “Practice Not Premise”: Provider Perspectives, Roles, And Referral Pathways In India, Laura E. Jacobson Mph, Caila Brander, P. Balasubramanian, Sruthi Chandrasekaran, Blair Darney, Julia Goodman, Ruvani Jayaweera, Caitlin Gerdts

OHSU-PSU School of Public Health Annual Conference

Objective: Describe provider perspectives and roles in self-managed abortion (SMA) in India and identify referral pathways to facility- and self-managed abortion care.

Methods: We conducted a qualitative study of 33 semi-structured interviews with a range of providers (medical, community health, and pharmacy) in India. We conducted a thematic analysis and identified referral pathways including the type of provider, the abortion care modality (in-facility or SMA), and the reason.

Results: Referrals to facility-managed abortion care were common. Providers' perception of SMA safety coupled with­ liability concerns resulted in discouraging clients from seeking SMA. Nonetheless, participants acknowledged three areas where providers played …

Impact Of Two Shift Schedules On Post-Shift Blood Pressure In Firefighters, Ayeisha H. Haswarey

OHSU-PSU School of Public Health Annual Conference

Background: Firefighters have an increased risk of cardiometabolic disease compared to the general population. Blunted blood pressure (BP) dipping during nocturnal sleep is associated with increased cardiometabolic disease morbidity/mortality. Shift work can alter diurnal BP oscillation, but the extent of alteration by different schedules remains debated. No study to date has examined firefighting shift schedules, necessitating a longitudinal evaluation to begin to understand their implications for cardiometabolic health. Thus, this preliminary analysis compares how two common schedules (24/48 hours on/off vs. 1/3/2/3 days on/off) impact post-shift BP and dipping in 20 firefighters.

Methods: 20 participants (10% female; 25-54 years of …

Inequities In Chronic Stress Exposure At The Intersection Of Race, Gender, And Sexual Identity In A Nationally Representative Sample Of U.S. Adults, Jordan M. Lancaster, Efrain H. Chavez Martinez

OHSU-PSU School of Public Health Annual Conference

Background

Social inequity rooted in systemic oppression is robustly associated with mental and physical health; chronic stress is highlighted as a key mechanism. Limited research examining the association between sexual identity alone and C-reactive protein (CRP) – an upstream biological marker of chronic stress exposure – has yielded mixed results.

Purpose

To examine whether race/ethnicity, gender, and sexual identity interact to produce unequal levels of CRP.

Methods

Using cross-sectional data from the 2003-2010 waves of the National Health and Nutrition Examination Survey, we examined intersectional (self-reported race*gender*sexual identity) patterns in log-transformed CRP levels using a multivariable linear model among 10,885 …

The Use Of Extreme Risk Protection Orders Intended To Prevent Mass Violence In Oregon: A Descriptive Study, Rosol Mikail, Rebecca Valek, Shauna Rakshe, Rebecca Teichman, Susan Defrancesco, Kathleen Carlson

OHSU-PSU School of Public Health Annual Conference

Purpose: Firearm violence is a critical public health issue in the United States. Extreme Risk Protection Order (ERPO) laws are an intervention method that have been enacted in many states to prevent firearm violence including mass violence threats. This study examined the characteristics of ERPO petitions filed in Oregon for a 6-year period that involved mass violence threats.

Method: ERPO petitions included in court records obtained through the Oregon Judicial Case Information Network, from January 1, 2018, to December 31, 2023 were abstracted; a 20% random sample of records was double-coded to ensure interrater reliability. An epidemiologic analysis of cases …

Transgender And Non-Binary Health In Oregon Under A Single-Payer Health System, Amy (Mick) L. Mcveety (They/She)

OHSU-PSU School of Public Health Annual Conference

As the state with the highest percentage of population who identifies as LGBTQ+, Oregon has a duty to provide adequate health protections and services to its transgender and nonbinary (TGNB) residents, particularly given the disparities TGNB individuals face in housing, employment, education, and health. Following recommendations from the Oregon Joint Task Force on Universal Health Care, Oregon should implement a single-payer health care system, with particular attention to:

1. Protecting patient privacy in EHR and other systems, particularly for youth TGNB patients;
2. Expanding the covered gender-affirming services and removing barriers such as cost-sharing and prior authorization, and;
3. Recruiting TGNB providers and …

Gender Affirming Surgery And Pain In Adolescents: Teen And Parent Experiences, Corrin Murphy, Eleanor Battison, University Of Rhode Island, Anna Wilson Phd

OHSU-PSU School of Public Health Annual Conference

Background: Adolescents seeking gender affirming medical care face unique biopsychosocial challenges, including experiences of discrimination and stigma. Transgender and gender diverse (TGD) adolescents often undergo gender affirming surgery (GAS). While there is an increase in GAS for TGD adolescents in the U.S., little is known about the pain experiences in the post-surgical period among these youth. There have been no studies to our knowledge that examine the psychological functioning of parents and their ability to handle their child's distress, which may be affected by their child's post-GAS pain experiences. Parental responses to their children’s pain and distress may, in turn, …

The Cost Of Healthy Eating, Diana Prychyna, Miriam R. Elman, Joy Kim, Karen F. Miller, Deonni P. Stolldorf, Sean P. Collins, Bory Kea

OHSU-PSU School of Public Health Annual Conference

Abstract

Background

Each year in the United States, 15-20% of 1 million visits to the Emergency Department for Acute Heart Failure result in home discharge, with patients often experiencing adverse health outcomes within 30 days. The study, Get With the Guidelines in Emergency Department Patients With Heart Failure (GUIDED-HF), utilized ‘Self-Care Coaches’ who meet participants via telehealth calls to discuss self-care maintenance after discharge as a strategy to mitigate adverse health outcomes; and offer provisions of resources, including a cookbook by the American Association for Heart Failure Nurses (AAHFN).

During the calls, we observed gaps in self-care for retired older …

The Association Between Acculturation & C-Reactive Protein In U.S. Immigrants: A Cross-Sectional Study, Jessica Kilinski Bs, Rosol Mikail Bs, Kelly M. Reavis Phd, Mph, Deborah Karasek Phd, Mph

OHSU-PSU School of Public Health Annual Conference

Purpose: Immigrants undergo acculturation as they assimilate to a different culture, potentially leading to immense stress. Our objective was to examine the association between acculturation and C-reactive protein (CRP), a marker of stress-induced inflammation. We hypothesized that U.S. foreign-born adults 20 years and older with higher degrees of acculturation would have higher CRP levels compared to those with lower acculturation.

Method: We used 2017-2018 National Health and Nutrition Examination Survey (NHANES) data from 1526 participants to conduct a cross-sectional analysis. We measured acculturation as language spoken at home (categorized as low, moderate, and high) and examined its association with CRP …

Gaza's Healthcare System In Collapse: An Exploratory Analysis Of Healthcare Attacks In Occupied Palestinian Territories (Opts) And Israel Since October 2023, Vincenzo J. Cornacchione

OHSU-PSU School of Public Health Annual Conference

Decades of apartheid practices and oppression in Occupied Palestinian Territories (OPTs), marked by mass displacement, restricted access to essential services, and countless human rights violations, have culminated in today's systematic dismantling of Gaza’s healthcare infrastructure. To investigate the systematic obstruction of healthcare access in OPT, this exploratory analysis employs an open intelligence dataset containing event data on reported healthcare attack incidents in OPT and Israel since October 2023. Specifically, this analysis seeks to elucidate the nature and extent of healthcare attacks in OPT by answering student-defined research questions, based on a priori expectations around the data. The analysis confirms that …

Employer Voices: Insights On Bolstering Career Development For Graduate Students, Alexandria J. Ashraf Mph, Josh Hodsden Mba, Justin Howe Ba, Danielle Ross Ba, Dalton Wesemann Ba, Lisa K. Marriott Phd

OHSU-PSU School of Public Health Annual Conference

Title: Employer voices: Insights on Bolstering Career Development for Graduate Students

Alexandria J. Ashraf, MPH; Josh Hodsden, MBA, CPH; Justin Howe, BA; Danielle Ross, BA, CPH; Dalton Wesemann, BA; Lisa K. Marriott, PhD

Background: The development of the public health workforce has become increasingly vital as our world faces current and future challenges. The workforce has gained considerable insight into job skills that enhance responses to emergent needs. Building the foundation for a larger scale study on public health workforce needs, this project established processes for engaging with professionals who have hired recent public health graduates.

Methods: Open-ended questions assessed …

Strong Hearts Program: The Results Of A Novel Primary-Care Based Diagnostic And Referral Program For Chagas Disease In East Boston, Ma, Usa, Javier J. Huerta

OHSU-PSU School of Public Health Annual Conference

Purpose: Chagas disease (CD), a neglected parasitic infection, affects ~300,000 people in the US. Untreated, CD leads to irreversible cardiac morbidity and death in 20-30% of cases, yet

Methods: After provider and community sessions, 14,354 patients were screened at EBNHC from March 2017 - May 2023, following a prespecified protocol. Confirmed Chagas patients were referred to Boston Medical Center for further evaluation. Using chi-squared tests, we analyze diagnostic uptake and prevalence stratified by demographics. Additionally, we abstracted care continuum barriers from Chagas patients' records.

Results: Per quarter, a median of 572 patients were screened (IQR: 393 – 712). …

Impact Of Medical Formula Shortage On Patients With Inborn Errors Of Metabolism (Iem) And Their Dietitians, Haemin Lee

OHSU-PSU School of Public Health Annual Conference

Since Feb. of 2022, patients with inborn errors of metabolism (IEM) suffered medical formula shortages due to an abrupt shut down of a major formula company in the US. The goal of this project was to understand the nutritional and psychosocial impacts on patients with IEM and changes in patient-dietitian relations as a result of the unexpected formula shortage.

Two survey were set up and disseminated via REDCap to patients(18 years-old or older), parent/legal gurdian of patients in the US, from Dec.2023-Jan.2024. Of those 571 records, 139(60.4%) patient surveys and 166(48.7%) caregiver surveys were retained for analysis after dropping complete …

“Sense Of Belonging”: Partnering With Central Oregon's Communities To Promote Health And Social Inclusion, Christina Jäderholm

OHSU-PSU School of Public Health Annual Conference

Abstract:

Community-engaged research can increase local research capacity and create momentum for social change. From research planning to dissemination, partnering with organizations and engaging with community members requires dedicated work and time. Using the Belonging project in Central Oregon as an example, we outline the ‘nuts and bolts’ of a community-engaged research process and highlight how we validated our findings through co-interpretation sessions.

Project

The Belonging project is a collaboration between Oregon Health & Science University (OHSU), Oregon State University - Cascades, the Central Oregon Health Council, and the Central Oregon communities. The project began [early] 2022 and concluded Feb …

Self-Reported Follow-Up Care Needs Can Be Met In Both Facility And Self-Managed Abortion: Evidence From Low- And Middle-Income Countries, Laura E. Jacobson Mph

OHSU-PSU School of Public Health Annual Conference

Objective: To understand in-facility follow-up care-seeking behavior among both people who self-managed medication abortions (SMA) and those who obtained facility-managed care in six countries and to explore factors that contribute to meeting individual’s self-reported care needs that are core to person-centered care.

Study Design: We conducted a qualitative thematic analysis of 67 in-depth interviews conducted with facility or SMA seekers. We first classified individuals as having their care needs met or not, and whether they sought follow-up care. We then identified predisposing, enabling, or need factors that contributed to having care needs met or not.

Results: A total of n=67 …

Using Systems Thinking Tools To Inform The Implementation Of A Cysticercosis Control Program In Rural Peru, Lisset M. Dumet Poma Mba, Angela Spencer Phd, Ruth Atto Bsc, Vanessa Cruz Bsc, Percy Vilchez Mph, Seth O'Neal Md, Mph For The Cysticercosis Working Group In Peru

OHSU-PSU School of Public Health Annual Conference

Cysticercosis is an infectious disease responsible for 30-40% of acquired epilepsy in endemic areas such as rural Peru. Ring Treatment (RT) is a community-engaged cysticercosis control strategy, shown to be efficacious when delivered by research teams. We applied the Consolidated Framework for Implementation Research with additional constructs compatible with low-resource contexts in the formative evaluation to develop a protocol for implementing RT.

We included small, medium, and large municipal districts from northern Peru representing different rural primary health delivery settings. We collected 169 semi-structured and 341 network interviews. We applied Social-Network-Analysis to identify key players, roles, and collaborations to inform …

Trauma Informed Approaches To Researcher-Participant Relationships: Examples From A Housing And Health Study, Cristina Flores, Jade Garza, Judith R. Solomon, Marisa Westbrook

OHSU-PSU School of Public Health Annual Conference

In qualitative research, the aim of researcher-participant relationships is to allow for vulnerability and authenticity while maintaining professional boundaries. Trauma-informed care (TIC) in mental health services and social work considers the impact of violence and victimization in the lives of clients, while emphasizing trauma as causation (SAMHSA, 2014; Butler, 2011). Applying a trauma-informed approach to qualitative research processes may assist in building rapport with research participants, minimizing re-traumatization, appropriately interpreting results, and uncovering cultural significance. Research suggests that trauma-informed approaches avoid excluding underrepresented voices and allows researchers to engage through a social justice and health equity lens (Roche, 2020). For …

Gut Feelings: A Literature Review On The Gut-Brain Axis And Its Potential Influence On Mood, Grace Johnson

University Honors Theses

In recent decades, research on the gut-brain axis has evolved due to an increasing interest in the connection between gut health and mental health. The gut-brain axis presents a new frontier of health for both medical professionals and psychologists as there is expanding evidence illustrating the comorbidity of gut disorders and mood disorders. Due to the complex nature of studying the gut-brain axis and the myriad of influences on mood disorders such as depression, research has yet to find significant results definitively tying the two together. Nonetheless, the current body of literature on the topic provides a promising outlook on …

Risk Factors Of Dental Anxiety And Exploration Of Interventions, Katelin Hancock

University Honors Theses

Within this literature review, the root causes of dental anxiety, current intervention methods, and possible preventative interventions are discussed. Dental anxiety affects millions of individuals across diverse backgrounds and can be detrimental to oral health. This issue can arise from various sources, however, different socioeconomic and sociodemographic factors can contribute to an individual's risk of developing dental anxiety. Understanding what predisposes certain populations to become more likely to develop dental anxiety is imperative to holistically address the concern. Investigating the relationship between lack of access, oral health, and anxiety levels allows for an understanding of the root causes of anxiety. …

What Adolescents Say In Text Messages To Motivate Peer Networks To Access Health Care And Sexually Transmitted Infection Testing: Qualitative Thematic Analysis, Marguerita Lightfoot, Chadwick Campbell, Allysha C. Maragh-Bass, Joi Jackson-Morgan, Kelly Taylor

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background:While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths.

Objective:This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic.

Methods:We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance …

Exploring Attrition And Linguistic Shifts: The Impact Of Covid-19 And Anti-Asian Discrimination On The East And Southeast Asian Diaspora, Amy Wan-Ling Lin

University Honors Theses

This thesis investigates the complex interplay of language and identity among speakers of East Asian and Southeast Asian languages in the United States, within the context of the COVID-19 pandemic and the concurrent rise in anti-Asian hate. The study adopts a mixed-methods approach to delve into these complexities, guided by three research questions exploring changes in language use since the onset of the pandemic, changes in perspective on language identity since the onset of the pandemic, and the effect of geopolitical climate, specifically the rise in Asian hate, on language use and perspective on language identity. The qualitative methodology employed …

Screening Tools For Employment In Clinical Healthcare Delivery Systems: A Content Analysis, Mina Colon, Julia M. Goodman

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background The relationship between work and health is complex and bidirectional, where work can have both health-harming and health-enhancing effects. Though employment is recognized as a social determinant of health, and clinical healthcare delivery systems are increasingly using screening tools to ask patients about social needs, little research has explored the extent to which employment-related social risk is captured in these screening tools. This study aimed to identify and characterize employment- and work-related questions in social risk screening tools that have been implemented in clinical healthcare delivery systems.

Methods We conducted a qualitative content analysis of employment-related items in screening …

Impacts Of Sex Work Criminalization On Sex Workers In Oregon: A Pilot Study, Stephanie Wahab, Katie Shammel

School of Social Work Faculty Publications and Presentations

Executive Summary

Context for the Study
In July, 2023, Oregon legislators voted to fund research exploring the impacts of the criminalization of sex work in Oregon. Unfortunately, the Governor vetoed the budget item, stating that the private sector should fund this type of public health research and noting the need for additional public discussion about the issue. To date, there have been no attempts to study the impacts of prostitution laws on the people most impacted by them in Oregon. The research presented in this report seeks to address this gap.

This qualitative pilot study was designed to better understand …