Public Health Commons^™

Evaluation Of A Clinic-Based Peer Navigation Program (Pnp) For African Americans Living With Hiv In South Carolina, Kimberly Butler Willis

Theses and Dissertations

Peer navigation programs have been identified as a potential motivator in care engagement and retention for patients living with HIV, although the data is inconsistent. HIV management requires important disease management considerations and innovative approaches for patient care. Medication advancements and technology have drastically improved care for most patients living with this chronic disease; yet African Americans contract, live with, and die because of HIV-related complications at disproportionately higher rates compared to their White peers.The purpose of this exploratory mixed-methods outcome evaluation is to: (1) determine if peer navigation is a viable intervention to improve three key HIV care metrics: …

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 …

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 …

Disparities In Colorectal Cancer: Measuring Spatial Accessibility, Screening, And Surveillance Outcomes In South Carolina, Michele J. Josey

Theses and Dissertations

The purpose of this dissertation project is to add to the growing literature about the multi-faceted aspects of colorectal cancer (CRC) prevention and related disparities. We focused on the spatial distribution of facilities performing screening services to identify areas that underutilize colonoscopy screening. Next, we examined how the food and physical activity environment affects precursors of CRC by considering plausible pathways. Finally, we explored if access to health insurance reduced the racial disparity of receiving a timely surveillance colonoscopy after a CRC diagnosis.

We utilized the SC Ambulatory Surgery Discharge Database, an all-payer, population-based outpatient dataset with colonoscopy records from …

The Association Of Hospital Practices To Breastfeeding Behaviors In South Carolina: Analysis Of 2013-2015 Pregnancy Risk Assessment Monitoring System (Prams) Data, Larisa Donnette Bruner

Theses and Dissertations

Objective: The purpose of this study was to determine whether hospital practices are associated with breastfeeding initiation and breastfeeding duration for ≥10 weeks.

Methods: We analyzed the 2013-2015 South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) data. The population of interest was mothers who delivered a single live birth in the hospital. The infant was alive and living with the mother at the time of the survey. Chi-square and logistic regression were used to examine breastfeeding initiation and duration among all women who delivered in a hospital and those who stated that they initiated breastfeeding while in the …

Polyp Detection During Colonoscopy Among Uninsured Patients In South Carolina, Lauren Hill

Theses and Dissertations

Little information is known on what demographic, behavioral, and procedural factors influence the number of polyps found during a colonoscopy screening for colorectal cancer (CRC). The main objective of this study is to describe the polyp detection rate (PDR), number of polyps removed, and predictors of polyp count overall and for high-risk polyps among uninsured patients undergoing colonoscopy in the Colorectal Cancer Prevention Network (CCPN) program of South Carolina. We performed a secondary data analysis on CCPN data for colonoscopies performed between May 2014 and May 2017. We assessed the association of polyp count with the following variables: age, race, …

Trends In Gestational Weight Gain In South Carolina, 2004 - 2015, Marilyn Elizabeth Wende

Theses and Dissertations

Objective: Excessive and inadequate gestational weight gain (GWG) are associated with a myriad of adverse pregnancy outcomes. The objective of this study was to examine secular trends in GWG in South Carolina (SC) from 2004 to 2015. We hypothesized that there was a trend of higher GWG z scores (GWGZ) over this 11-year time period after adjusting for changes in population characteristics. We also hypothesize that a trend of higher mean GWGZ at higher percentiles is more apparent for African Americans, rural women, and women who are overweight or obese before pregnancy.

Data and Methods: Data came from SC …

The Influence Of Fine Particulate Matter On Inflammatory Bowel Disease In South Carolina: An Ecological Analysis, Joshua Eric Sellner

Theses and Dissertations

Background. The Inflammatory Bowel Diseases, including both Ulcerative Colitis and Crohn’s Disease, are lifelong disorders of the Gastrointestinal tract. In recent years, both conditions have become much more prevalent and recognized as major public health issues. Environmental factors have become the focus of recent research around the cause of these diseases. Although shown to have detrimental effects on diseases similar to that of the Inflammatory Bowel Diseases, fine particulate matter’s role in these diseases has not been adequately investigated.

Aim. The purpose of this study was to test the relation of fine particulate matter with hospitalizations attributable to …

Depression Among Pregnant Latinas In South Carolina, Andrew Fogner

Theses and Dissertations

The aim of the study was to determine the prevalence of depression among pregnant Latinas. To bring to light the importance of prenatal depression prevention, we assessed the effect of the quality of healthcare providers among South Carolina Latinas (n=171). Women answered a validated CES-D and were categorized as depressed (score >16). In multivariate analyses, good perception of quality of healthcare was more likely among women who were not depressed; adjusted odds ratio of 0.75, 95% confidence interval 0.37 – 1.55. The findings show the need for tailoring healthcare to Latinas with prenatal depression prevention. It is imperative to understand …

Physical Activity And Breast Cancer In South Carolina, Chisom Onyeuku

Theses and Dissertations

This study examined the relationship between breast cancer incidence and recreational physical activity. It was one of the first studies in the southeastern US to examine incident breast cancer and physical activity in an ethnically diverse cohort of women. In terms of physical activity, both lifetime and recent physical activity were analyzed. All physical activity data were from validated self-reported surveys. The study examined BMI, menopausal status and race as key confounders and effect modifiers. The study found evidence that for Black women, there was a positive relationship between the amount of lifetime physical activity and the odds of incident …

Smoking Cessation In Pregnancy And Gestational Weight Gain In South Carolinian Mothers, 2009-2011, Laquenta Latreese Weldon

Theses and Dissertations

Purpose: To determine if smoking cessation during pregnancy is associated with excessive gestational weight gain (GWG).

Methods: Data came from the 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing population-based survey of live births in South Carolina (n=2,603). Participant smoking status was classified as nonsmoker (did not smoke before or during pregnancy), persistent smoker (smoked before and throughout pregnancy), or quitter (smoked before but quit during pregnancy). Multinomial logistic regression model was estimated to examine the association between smoking status and meeting the 2009 Institute of Medicine guidelines, while linear regression model was used for the continuous outcomes such …

Statewide Scale-Up Of Group Prenatal Care In South Carolina, Kristin M. Van De Griend

Theses and Dissertations

Background: Poor birth outcomes and racial disparities in birth outcomes in South Carolina are widely recognized problems. To improve maternal and child health outcomes, especially among vulnerable groups, universal access to timely, appropriate, and effective care should remain a priority through increased availability and accessibility. An interagency collaborative in South Carolina expanded CenteringPregnancy (CP) from two to five medical practices throughout the state. CenteringPregnancy is associated with improved birth outcomes and reduced rates of racial disparities in preterm birth throughout the United States. Important questions in the literature remain about strategies and determinants of scaling up sexual and reproductive …

Examination Of The Association Of Receipt Of Opioid Therapy And Lung Cancer Patient Survival Rates Among South Carolina Medicaid Recipients, Jametta Sade Magwood

Theses and Dissertations

Introduction: Lung cancer is a high pain cancer that can require the attention of clinical specialists. Already vulnerable populations, like those that inhabit rural areas, when dealing with chronic diseases, like lung cancer, need and deserve adequate medical attention. However, rural communities often lack clinical specialists and are left without the needed care. It is necessary to investigate the current availability of treatment options (medications) available to cancer patients in rural communities. Gaining this knowledge can result in economic savings and improvement of the quality of life for rural populations.

Methods: Medicaid data from 1996-2010 was used to …

Food Security Status And Life Events Among Households With Children In The Midlands Of South Carolina, Erin Rebekah Drucker

Theses and Dissertations

Purpose: Food insecurity is a major public health problem in the United States (US) with 14.5% of US households having experienced some level of food insecurity in 2012. Among households with children, 20% experienced low food security in 2012, and in half of these households, both the children and adults were affected. Food insecurity among children can have lifelong negative health and mental effects. Life events are defined as self-­‐reported life changes, which create a strain on resources and an opportunity for food insecurity, Methods: The Midlands Family Study (MFS) was a cross-­‐ sectional study that surveyed households …

Elucidating Perceived And Actual Cancer Risk In Disadvantaged Neighborhoods Differentially Impacted By Environmental Hazards To Inform Future Public Health Interventions, Lashanta J. Rice

Theses and Dissertations

In the United States, racial and ethnic minorities, economically disadvantaged and medically underserved groups bear a disproportionate amount of the cancer burden. Myriad social and environmental factors attribute to these disparities including disparate exposures to environmental pollutants, which account for two percent of all cancer deaths nationally. There is empirical evidence demonstrating risk perceptions and cancer worry are shaped by race/ethnicity and social and environmental experiences. Cancer risk perceptions among Non-Whites, especially Blacks compared to Whites is lower for various reasons. Low perceived cancer risk may explain persistent cancer disparities, since protective health behaviors are higher among persons who perceive …

Food Environment And Birth Outcomes In South Carolina, Xiaoguang Ma

Theses and Dissertations

An increasing number of studies examined the association between neighborhood characteristics and birth outcomes. However, the results can be difficult to compare because of the variety of indicators used to characterize the neighborhood. As an important neighborhood characteristic, the food environment is associated with residents' nutrition status, diet quality, and related health outcomes. In addition, the food environment has been found to influence women's diet quality during pregnancy, which is a key factor in predicting birth outcomes. However to date, studies on food environment and birth outcomes are extremely limited.

This study examined the association between food environment (evaluated by …