Public Health Commons^™

Multilevel Analysis In Rural Cancer Control: A Conceptual Framework And Methodological Implications, Whitney Zahnd, Sara L. Mclafferty, Jan M. Eberth

Faculty Publications

Rural populations experience a myriad of cancer disparities ranging from lower screening rates to higher cancer mortality rates. These disparities are due in part to individual-level characteristics like age and insurance status, but the physical and social context of rural residence also plays a role. Our objective was two-fold: 1) to develop a multilevel conceptual framework describing how rural residence and relevant micro, macro, and supra-macro factors can be considered in evaluating disparities across the cancer control continuum and 2) to outline the unique considerations of multilevel statistical modeling in rural cancer research. We drew upon several formative frameworks that …

Humanitarian Engineering Design For Health Challenges: An Inter-Faculty Service Based Learning Model, Yara Najem, Imad H. Elhajj, Zaher Dawy, Aline Germani, Hala Ghattas Ph.D., Muhammad Zaman, Youseph Yazdi

Faculty Publications

The study introduces and evaluates a unique inter-faculty service learning course as a pedagogical model that enhances students’ learning and knowledge of health problems and associated engineering intervention design for populations affected by protracted crises.

Background: With an increase in humanitarian protracted crises around the world, due to conflict and natural disasters, we are in dire need to reinvent how we educate, train, and conduct research in these environments. Engineering and Health Sciences disciplines, individually and collectively, have been working to fill the gaps and address pressing public health issues. However, courses merging those disciplines and focusing on emerging humanitarian …

The Role Of Ict In Antiretroviral Therapy-Related Knowledge Seeking Among Older Chinese Living With Hiv, Yao Zhang, Xiaoming Li Ph.D., Shan Qiao Ph.D., Yuejiao Zhou, Zhiyong Shen

Faculty Publications

Antiretroviral therapy (ART) enables HIV patients to reduce disease progression. ART adherence is closely related to patients’ knowledge about the medical treatment. This study investigated the role of information and communication technologies (ICTs) in supporting ART-related knowledge seeking among older Chinese with HIV, using cross-sectional data collected from 2012 to 2013 in Guangxi, China. Of the 2987 HIV patients, 688 were 45 years or older and going through ART. We used an 11-item scale (α=0.69), which was developed based on existing literature, to assess ART-related knowledge to obtain a composite score (0-11). Less than 5% of the participants sought HIV-related …

The Empower Action Model: A Framework For Preventing Adverse Childhood Experiences By Promoting Health, Equity, And Well-Being Across The Life Span, Aditi Srivastav, Melissa Strompolis, Amy Moseley, Kelsay Shania Daniels

Faculty Publications

The empower action model addresses childhood adversity as a root cause of disease by building resilience across multiple levels of influence to promote health, equity, and well-being. The model builds on the current evidence around adverse childhood experiences and merges important frameworks within key areas of public health—the socio-ecological model, protective factors, race equity and inclusion, and the life course perspective. The socio-ecological model is used as the foundation for this model to highlight the multilevel approach needed for improvement in public health. Five key principles that build on the protective factors literature are developed to be applied at each …

Prospective Analysis Of Food Consumption And Nutritional Status And The Impact On The Dietary Inflammatory Index In Women With Breast Cancer During Chemotherapy, Isis Danyelle Dias Custódio, Fernanda De Paula Franco, Eduarda Da Costa Marinho, Taísa Sabrina Silva Pereira, Mariana Tavares Miranda Lima, Maria Del Carmen Bisi Molina, Nitin Shivappa, James R. Hébert, Carlos Eduardo Paiva, Yara Cristina De Paiva Maia

Faculty Publications

Considering the implications of adverse effects of chemotherapy (CT) and the potential impact of diet on patients’ recovery, this study aimed to prospectively evaluate the association between the consumption of food groups, patients’ Dietary Inflammatory Index (DII®) scores, and their nutritional status. Anthropometric and dietary assessments of 55 women with breast cancer (BC) were performed at three time points. T0 is the time point after the first CT cycle, T1 is the time point after the intermediate CT cycle, and T2 is the time point after the last CT cycle. We identified a significant increase in weight, body mass index, …

Inflammation And Acute Traffic-Related Air Pollution Exposures Among A Cohort Of Youth With Type 1 Diabetes, Robin C. Puett, Jeff D. Yanosky, Murray A. Mittleman, Jessica Montresor-Lopez, Ronny A. Bell, Tessa L. Crumee, Dana Dabeleae, Lawrence M. Dolan, Ralph B. D'Agostino Jr, Santica M. Marcovina, Catherine Pihokeri, Kristi Reynolds, Elaine Urbina, Angela D. Liese

Faculty Publications

Background: Evidence remains equivocal regarding the association of inflammation, a precursor to cardiovascular disease, and acute exposures to ambient air pollution from traffic-related particulate matter. Though youth with type 1 diabetes are at higher risk for cardiovascular disease, the relationship of inflammation and ambient air pollution exposures in this population has received little attention.

Objectives: Using five geographically diverse US sites from the racially- and ethnically-diverse SEARCH for Diabetes in Youth Cohort, we examined the relationship of acute exposures to PM2.5 mass, Atmospheric Dispersion Modeling System (ADMS)-Roads traffic-related PM concentrations near roadways, and elemental carbon (EC) with biomarkers of inflammation …

The Association Between Dietary Inflammatory Index (Dii) And Cancer Risk In Korea: A Prospective Cohort Study Within The Koges-Hexa Study, Injeong Ryu, Minji Kwon, Cheongmin Sohn, Nitin Shivappa, James R. Hébert, Woori Na, Mi Kyung Kim

Faculty Publications

Several epidemiological studies have shown that there are consistently positive associations between dietary inflammatory index (DII (R)) scores and cancer incidence in Western populations. However, few DII-cancer studies have been conducted in East Asian populations. In a large cohort representative of the general Korean population, we investigated whether the DII is associated with overall cancer risk. A total of 163,660 participants (56,781 males and 106,879 females) had evaluable data for analyses. This follow-up study was carried out over the course of 7.9 years. DII scores were calculated based on Semi-Quantitative Food-Frequency Questionnaire (SQ-FFQ) data for 106 food items. Cancers were …

Understanding And Use Of Food Labeling Systems Among Whites And Latinos In The United States And Among Mexicans: Results From The International Food Policy Study, 2017, Claudia Nieto, Alejandra Jauregui, Alejandra Contreras-Manzano, Edna Arillo-Santillan, Simon Barquera, Christine M. White, David Hammond, Jim Thrasher

Faculty Publications

Background Obesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world.

Methods Adults from online consumer panels in the US (Whites n = 2959; Latinos n = 667) and in Mexico (n = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline …

Individual- And Community- Level Associations With Healthcare Utilization Among A Health System, Emergency Department Population, Carlene A. Mayfield

Theses and Dissertations

AIM: The primary aim of this study was to examine individual-level and community- level characteristics associated with ambulatory or primary care utilization, emergency department (ED) utilization, and ED charges among a sample of ED patients.

DESIGN AND SAMPLE: Data for this cross-sectional study were obtained from three distinct sources: (i) electronic medical records (EMR); (ii) billing records; and (iii) the 2013-2017 American Community Survey (ACS). The individual-level EMR and billing sample included all adults residing in Mecklenburg County, North Carolina who visited an Atrium Health ED in 2017. The ACS sample included population and demographic estimates from Mecklenburg County’s 27 …

The Association Of Health Insurance And Prescription Drug Coverage On Cost-Related Non-Adherence And Hospitalization Across Age-Related Groups Of Individuals With Copd, Shamika Martin Walls

Theses and Dissertations

Background: COPD patients have poor adherence to prescribed treatment. Individuals with COPD have higher out-of-pocket treatment cost than individuals without COPD. The significant out of pocket COPD related treatment cost can lead to prescription drug non-adherence especially for individuals without health insurance or prescription drug coverage.

Significance: Since the implementation of Medicare Part D on January 1, 2006, there are no studies that have used national data to evaluate the association of health insurance and prescription drug coverage on cost related non-adherence and hospitalization among individuals 50-64 years old with COPD compared to individuals 65 years and older …

Addressing The Surgical Deficit: A Global Imperative For Plastic And Reconstructive Surgeons, Rachel W. Davis, Walter D. Johnson, Larry H. Hollier

Faculty Publications

Despite poor access to quality surgical and anesthesia care for the majority of the world's people, with greatest impact on low- and middle-income countries, surgery has only recently begun to gain acceptance as a necessary component of global health. As a leader in global surgical funding, the field of Plastic and Reconstructive Surgery is uniquely positioned to influence change in global policy and financial support. For improvements in surgical access and outcomes worldwide, investment in surgical systems, commitment to national surgery, obstetric, and anesthesia planning, and continued evaluation and improvement of care delivery should be pursued.

Associations Among Neighborhood Socioeconomic Deprivation, Physical Activity Facilities, And Physical Activity In Youth During The Transition From Childhood To Adolescence, Morgan N. Clennin, Min Lian, Natalie Colabianchi, Andrew Kaczynski, Marsha Dowda, Russell R. Pate

Faculty Publications

Background: This study aims to examine the longitudinal association of neighborhood socioeconomic deprivation (SED) with physical activity in youth during the transition from elementary to middle school, and to determine if access to physical activity facilities moderates this relationship. Methods: Data were obtained from the Transitions and Activity Changes in Kids (TRACK) study, which was a multilevel, longitudinal study designed to identify the factors that influence changes in physical activity as youth transition from elementary to middle school. The analytic sample for the current study included 660 youth with complete data in grades 5 (baseline) and 7 (follow-up). A repeated …

An Evidence Based Rationale For Making Tick - Borne Relapsing Fever A Nationally Notifiable Disease, Kyle M. Hatcher

Theses and Dissertations

Tick – borne relapsing fever (TBRF) is globally dispersed, and within the United States is found primarily in the mid – west, south - west, and north – west portions of the country. TBRF is a disease which causes patients to experience flu – like symptoms and is distinguished by multiple relapses of high fever which can cause individuals to be hospitalized multiple times over months. TBRF is caused by Borrelia spp. spirochetes and spread by Onthidoros spp. soft – shelled ticks. First diagnosed in the early 20th century, the disease has gone underdiagnosed and has attracted little attention for …

Dietary Advanced Glycation End-Products (Ages) And Breast Cancer Risk And Survival, Omonefe Opeyemi Omofuma

Theses and Dissertations

Introduction: Advanced glycation end-products (AGEs) are implicated in the pathogenesis of chronic diseases including cancer. AGEs are produced endogenously and are also consumed from foods. High amounts of AGEs are found in animal products and processed foods, and AGE formation is accelerated during cooking at high temperatures. Using data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), we assigned and quantified NƐ-carboxymethyl-lysine (CML)-AGE content in food and investigated the association between dietary AGE intake and breast cancer (BrCa) risk. We assessed whether the risk was modified by race/ethnicity, obesity status, fruit and vegetable intake, BrCa invasiveness …

The Relationship Between The Electronic Health Record Patient Portal And Shared Decision Making, Gloria Esoimeme

Theses and Dissertations

Shared decision making (SDM) is a collaborative decision-making style where the patient and the physician are involved in the clinical decision-making process. The goal of this dissertation project was to examine the relationship between the patient portal of an electronic health record (EHR) and SDM.

The SDM process has three main components: information sharing, deliberation and decision making. Patients participate in SDM at varying levels: some patients may prefer to share information and deliberate but leave the final decision making to the provider while others prefer to participate in all the three components of SDM. The patient portal of an …

The Association Of Reimbursement Methods With The Tendency Of Primary Care Physicians To Apply The American Diabetic Association’S Recommendations And Make Referrals To Specialists Among Ambulatory Care Patients In Us Outpatient Settings., Abdullah Alharbi

Theses and Dissertations

We report on a study of the comparison of two reimbursement methods, capitation (CAP) and fee for service (FFS), as well as mixed payment, with respect to the implementation of the ADA recommendations for Diabetes Type 2 (DM2) management and referral rates for specialist health care in the outpatient setting of the United States.

Our purpose in examining these specific topics is to determine whether there is any difference in the implementation of the ADA recommendations or the frequency of referral between visits paid under CAP vs under FFS because both quality and cost of healthcare is affected by these …

Longitudinal Trajectories Of Depressive Symptoms Among Youth And Young Adults With Type 1 Diabetes: Predictors And Health Outcomes, Melanie Whitmire Sutherland

Theses and Dissertations

Type 1 diabetes (T1D) is one of the most frequently diagnosed chronic illnesses among youth, and has many long-term complications, including retinopathy, neuropathy, and cardiovascular disease. The risk of these complications may be reduced through maintaining glycemic control and one potential risk factor for failure to achieve optimal glycemic control is elevated depressive symptoms among youth and young adults (YYA) with T1D. YYA with T1D are at increased risk of depression, which has been associated with adverse outcomes such as poor adherence to self-management and poor glycemic control. Although a robust body of research exists on the association between comorbid …

The Intergenerational Effects Of Adverse Childhood Experiences On Children’S Emergency Department Utilization And Depression And Anxiety In South Carolina, Eboni E. Haynes

Theses and Dissertations

Adult exposure to adverse childhood experiences (ACEs) is common in the U.S., with over half of adults reporting exposure to at least one ACE. Childhood trauma is associated with risk factors for premature death, disability, poor physical and mental health, and lower quality of life in adults. Traumatic experiences also influence parenting behaviors later in life, placing offspring at an increased risk of ACE exposure. Few studies have explored the intergenerational effects of ACEs on the health and well-being of offspring. This study sought to identify whether associations existed between caregiver ACE exposures and emergency department (ED) utilization for sick …

Did Medicaid Expansion Under The Affordable Care Act Reduce The Likelihood That People Report Employment Status Changes Due To Health, U.S., 2009-2017, Songyuan Deng

Theses and Dissertations

Medicaid expansion of Affordable Care Act (ACA) extended coverage to low-income working adults. While Medicaid expansion led to increased healthcare use and national healthcare expenditures, current studies do not examine the effects of Medicaid expansion on health status from the perspective of social roles, for example, changes in employment status. This study use data from the Current Population Survey to examine the association between Medicaid expansion and the probability to attribute part-time work or not-in-labor- force to health issues among people with family annual income no more than 138 of Federal Poverty Level, with a difference-in-differences study design. We found …

Clinically Integrated Networks: The ‘Magic Pill’ For Improving The Quality Of Health Care?, Kaitlyn Ann Crosby

Theses and Dissertations

The Patient Protection and Affordable Care Act (ACA) served as a paradigm shift to reimburse physicians based on health outcomes or quality of care patients receive in relation to and conscious of the cost to provide care, rather than the traditional fee-for- service (FFS) system. To implement value-based care under the ACA, value-based care models (VBCM), such as patient-centered medical homes (PCMH) and accountable care organizations (ACO), were formed with the ultimate goal to advance quality of care. Among commercially insured populations, clinically integrated networks (CIN) have emerged as another type of VBCM.

Since CINs are the newest type of …

Examining Women’S Perceptions Of Maternity Care In Public And Private Sectors Of National Guard Hospitals In Saudi Arabia: A Qualitative Study, Hanin M. Almahmoud

Theses and Dissertations

Every second, a baby is born. The process of birth is a complex one – biologically, medically, and emotionally. In particular, women in labor need both physical and emotional care. They need to be heard, to be comforted, and to be safe.

Women’s satisfaction can be used as a legitimate way to measure the quality of maternity care. Moreover, when health systems practice patient-centered care and listen to women’s concerns and what they want out of their care, it can lead to improvements in their satisfaction. Hospitals in Saudi Arabia are considered to be among the best and most technologically …

Women’S Socio-Economic Empowerment And Uptake Of Hiv Testing In Ethiopia, Dawit Alemu

Theses and Dissertations

Introduction: Sub-Sahran Africa constitute two-thirds of all people living with HIV in the world. HIV infection rate is high in the continent with women comprising 56% of new HIV infections among adults 15 and older. Women 15 to 24 are the most affected constituting 66 % of new infections occurring among this age group. The purpose of this study was to examine how gender power relations between men and women affect health seeking behavior, particularly HIV testing, among Ethiopian women age15 to 49.

Methods: The Ethiopian Demographic and Health Survey (EDHS) from 2016 served as the data source for …

Hiv Care Location: An Evaluation Of Single Versus Multi Facility Utilization Of Hiv/Aids Care Services And Patient Health Outcomes And Clinical Indicators In South Carolina, Melanie Gwynn

Theses and Dissertations

Background: On the HIV/AIDS care continuum, the “retention in care” metric does not distinguish between single-facility (SF) or multi-clinic utilization (MC), also described as HIV care location (or type). SF utilization is vital as it has been linked optimal clinical outcomes among People Living with HIV/AIDS (PLWH). Published research detailing the prevalence of HIV care type and its association with health outcomes/clinical indicators, has been studied only in limited urban settings. Additionally, coinfections such as sexually transmitted infections (STIs), have yet to be evaluated as potential predictive factors for HIV care type.

Methods: A cross-sectional design was used …

Health Insurance Program For The Poor, Out-Of-Pocket Costs, And Catastrophic Health Expenditures In India, Shyamkumar Sriram

Theses and Dissertations

Background

India is currently taking steps to provide Universal Health Coverage (UHC) as envisaged in its National Health Policy 2017. Financial protection is considered the backbone of UHC. In India, OOP expenses accounts for about 62.6% of total health expenditure - one of the highest in the world. Out of 1.324 billion people in India, around 12.4% of the population is below the poverty line. Lack of health insurance coverage and inadequate coverage are important reasons for high OOP health expenditures. High OOP health expenditures push many households into poverty. The objective of this research is to examine the effect …

A Policy Analysis Of South Carolina Drug Court Legislation: H. 3322 § 302: Drug Court Program Act (2019), Mae Chinnes

Senior Theses

The purpose of this thesis is to examine a piece of drug court legislation currently being considered by the South Carolina Legislature, H. 3322 § 302. An overview of drug criminalization in the United States, its impact, and drug courts are provided. This is followed by a review of the literature on the key programmatic components of drug court best practices, including: target population, incentives and sanctions, management team, and duration. An example analysis of Florida’s Thirteenth Judicial Circuit Drug Court Program policies proceeds the analysis of H. 3322. Parameters of successful drug court legislation and program outcomes are defined …

The Household Water Insecurity Experiences (Hwise) Scale: Development And Validation Of A Household Water Insecurity Measure For Low-Income And Middle-Income Countries, Sera L. Young, Godfred O. Boateng, Zeina Jamaluddine, Joshua D. Miller, Edward A. Frongillo, Torsten B. Neilands, Shaleans M. Collins, Amber Wutich, Wendy E. Jepson, Justin Stoler

Faculty Publications

Objective Progress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings.

Methods Cross-sectional surveys were implemented in 8127 households across 28 sites in 23 low-income and middle-income countries. Data collected included 34 items on water insecurity in the prior month; socio-demographics; water acquisition, use …

The Household Water Insecurity Experiences (Hwise) Scale: Development And Validation Of A Household Water Insecurity Measure For Low-Income And Middle-Income Countries, Sera L. Young, Godfred O. Boateng, Zeina Jamaluddine, Joshua D. Miller, Edward A. Frongillo Jr., Torsten B. Neilands, Shelean M. Collins, Amber Wutich, Wendy E. Jepson, Justin Stoler, On Behalf Of The Hwise Research Coordination Network

Faculty Publications

Objective

Progress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings.

Methods

Cross-sectional surveys were implemented in 8127 households across 28 sites in 23 low-income and middle-income countries. Data collected included 34 items on water insecurity in the prior month; sociodemographics; water acquisition, use …

Smoke-Free Policies And Smoking Cessation In The United States, 2003–2015, Andrea R. Titus, Lucie Kalousova, Rafael Meza, David T. Levy, Jim Thrasher, Michael R. Elliott, Paula M. Lantz, Nancy L. Fleischer

Faculty Publications

(1) Background: Smoking restrictions have been shown to be associated with reduced smoking, but there are a number of gaps in the literature surrounding the relationship between smoke-free policies and cessation, including the extent to which this association may be modified by sociodemographic characteristics. (2) Methods: We analyzed data from the Tobacco Use Supplement to the Current Population Survey, 2003–2015, to explore whether multiple measures of smoking restrictions were associated with cessation across population subgroups. We examined area-based measures of exposure to smoke-free laws, as well as self-reported exposure to workplace smoke-free policies. We used age-stratified, fixed effects logistic regression …

Would You Test For 5000 Shillings? Hiv Risk And Willingness To Accept Hiv Testing In Tanzania, Jan Ostermann, Derek S. Brown, Axel Mühlbacher, Bernard Njau, Nathan Thielman

Faculty Publications

Objectives: Despite substantial public health efforts to increase HIV testing, testing rates have plateaued in many countries and rates of repeat testing for those with ongoing risk are low. To inform policies aimed at increasing uptake of HIV testing, we identified characteristics associated with individuals’ willingness-to-accept (WTA) an HIV test in a general population sample and among two high-risk populations in Moshi, Tanzania.

Methods: In total, 721 individuals, including randomly selected community members (N = 402), female barworkers (N = 135), and male Kilimanjaro mountain porters (N = 184), were asked in a double-bounded contingent valuation format if they would …

Odds Of Acute Kidney Injury In Patients Receiving Dipeptidyl Peptidase 4 Inhibitors: A National Cohort Study Within The Department Of Veterans Affairs, Shawn Scott Sutton, Joseph Maggnoli, Tammy H. Cummings, James W. Hardin

Faculty Publications

Preclinical and clinical data of dipeptidyl peptidase 4 (DPP‐4) inhibitors have demonstrated discordant data regarding acute kidney injury (AKI). Therefore, we aimed to evaluate the association between DPP‐4 use and AKI. This cohort study utilized data from the Department of Veterans Affairs evaluating patients diagnosed with type 2 (T2) diabetes with a DPP‐4 inhibitor and compared with nondiabetic and diabetic patients. The primary end point is the development of AKI, and statistical analyses were performed to examine the association. DPP‐4 use is associated with a lower odds of AKI compared with diabetics (adjusted odds ratio (OR) = 0.39; 95% confidence …