Public Health Commons^™

Adult Nursing Students’ Perceptions Of Social Presence In Facilitator-Created Subject- Specific Videos In An Online Nursing Course, Jamie Anne Marcus

Theses and Dissertations

The literature established that online instruction consists of cognitive, teaching, and social presence. Studies on the element of social presence linked text-based delivery of instruction with learners’ feelings of isolation and disengagement. This research findings prompted this facilitator creation of five-to-seven-minute companion videos that aligned and complemented weekly text-based learning modules to ascertain students’ perceptions of these videos as a medium for channeling social presence.

Post-video viewing surveys yielded responses to pragmatic and emotional questions. Pragmatic questions were aimed at the visual impact of professor’s delivery of information. Emotional questions gauged the students’ feelings of connectivity with the facilitator. Triangulated …

Association Of Objective Measures Of Sleep And Inflammation Markers On Police Officers: A Cross-Sectional Analysis, Megan R. Buss

Theses and Dissertations

Police officers are a unique occupational group due to the fact that they have more health problems than many other occupations. These health problems could be a result of elevated inflammation markers caused by poor sleep. Sleep influences circadian rhythms, which thereby influences the function of the immune system. The immune system is responsible for the body’s inflammatory response using pro-inflammatory cytokines such as IL-6, CRP, Fibrinogen, and TNF-a. These cytokines can become elevated if disruption of the sleep cycle occurs. Elevated levels of inflammatory markers are associated with increased risk of cardiovascular disease. Police officers also work shifts and …

Understanding The Mechanisms Linking Gendered Intrahousehold Bargaining Power And Child Nutrition In Rural Nepal, Shibani Kulkarni

Theses and Dissertations

Child undernutrition is a serious issue in Nepal as 36% of children below five years of age are chronically undernourished. Reducing child undernutrition is an important priority to prevent adverse effects through the life course that perpetuate the cycle of undernutrition and poverty.

Women’s intra-household bargaining power is an important determinant of child nutrition. Intra-household bargaining power is an individual’s relative social and economic position within the household to access and control resources, and influence decision-making. In our research, we use women’s intra-household bargaining power as a resource for care, which enables women to be exposed to nutrition information, gain …

A Longitudinal Analysis Of Shiftwork And Self-Reported Depression In A Police Cohort, Meghan Holst

Theses and Dissertations

Background: Shiftwork is associated with many chronic diseases stemming from the disruption of circadian rhythms. Police officers have a high risk for many adverse conditions including depression. Abnormal bodily functions, such as increased stress and disturbed sleeping patterns, may play an important role in the development and severity of depression. This study was designed to assess the association between depressive symptoms and shiftwork in a police cohort from Buffalo, NY

Methods: This longitudinal analysis consists of 470 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Data were collected during visit 3 between 2004-2005 and visit …

Effect Modification By Stroke To The Relationship Between Tooth Loss And Cognitive Decline, Amanda Collins

Theses and Dissertations

Background: A decline in cognitive functioning is one of the greatest burdens that older adults face. Studies indicate that periodontal disease is positively associated with cognitive decline. The link between stroke and cognitive decline is well-established, and literature supports that tooth loss and stroke are associated as well, but the role that stroke plays in the relationship between tooth loss and decline in cognitive functioning is, as of yet, unclear. This study uses data from the REGARDS cohort to examine the effect of stroke on the relationship between periodontal disease and cognitive function.

Methods: The REGARDS cohort is comprised of …

Food Insecurity And Hypertension Prevalence, Awareness, Treatment And Control, Alexandra N. Luttrell

Theses and Dissertations

Objective: To examine the association between food insecurity and the prevalence of pre-hypertension and hypertension among U.S. adults. Additionally, this project will examine the association between food insecurity and the awareness, treatment and control (ATC) of hypertension.

Design: A cross-sectional study using data from the National Health and Nutritional Examination Survey (NHANES) 2011-2012 and 2013-2014 waves was deployed to examine the association between food insecurity and the prevalence and ATC of hypertension. Food security was measured by the cumulative number of affirmative responses to the 10-item U.S. Household Food Security Survey Module (HFSSM) questionnaire which were graded into four categories; …

Factors Affecting Patient Satisfaction With Healthcare System Of Turkey, Serdar Aydin

Theses and Dissertations

The World Health Organization (WHO) defines health system as comprising of all the organizations, resources, and institutions dedicated to improving health. Health systems have a responsibility not just to improve the health of the population they serve but to provide financial protection against the costs of illness and to respond to people’s expectation with dignity. Besides, healthcare satisfaction and consumer satisfaction have become the latest trend in measuring quality to have a competitive advantage or best practice in the healthcare industry. Over the past 30 years, consumer satisfaction has gained widespread recognition as a measure of quality in many services …

Hiv In The United States: A Spatial Examination Of Testing And Outcomes, Sazid Shameem Khan

Theses and Dissertations

The main objectives of this dissertation were to provide a complete depiction of the prevalence of HIV across the United States and to assess HIV testing trends among various subpopulations. Additionally, we focused on measuring spatial access to HIV testing resources across the U.S. South, where HIV is rapidly becoming more burdensome and resources have historically been allocated disproportionately. We sought to identify disparate populations and locations that require further focus moving forward to stem the HIV epidemic. We utilized a variety of data sources such as the Behavioral Risk Factor Surveillance System (BRFSS) which was used to assess national …

Examining Faith-Based Communities As Leverage Points For The Prevention Of Childhood And Adolescent Obesity, Caroline Glagola Dunn

Theses and Dissertations

Faith-based research and partnerships are becoming more popular as an approach to address the health of underserved populations including racial and ethnic minorities and rural populations. Despite growing interest in faith-health partnerships, little research is available assessing faith-based interventions as potential leverage points for the prevention of childhood and adolescent obesity and the promotion of healthy behaviors. This research aimed to examine the potential for such partnerships within the context of ongoing research partnerships in South Carolina. Specifically, the first study assessed current peer-reviewed literature to determine reporting of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM elements) in faith-based nutrition …

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, …

The Effect Of Neighborhood Characteristics And Acculturation On Vegetable Intake Among U.S. Hispanics, Anna Victoria Mesa

Theses and Dissertations

The growing prevalence of chronic disease among the U.S. Hispanic population has drawn increasing attention to modifiable behaviors such as diet in an effort to curb the burden of disease among this population. While factors affecting dietary intake among U.S. Hispanics have been largely studied, this study broadens the scope of existing analyses from examining the role of individual-level factors, including acculturation, to also include environmental factors such as neighborhood ethnic composition. Multilevel mixed modeling was employed to test the interaction of individual acculturation with neighborhood ethnic composition to predict vegetable intake among a sample of U.S. Hispanics. Individuals who …

Residential Mobility And Enrollment Churn In A Medicaid Population, John E. Stewart

Theses and Dissertations

Previous investigations show high rates of enrollment discontinuity, or churn, among Medicaid participants. Discontinuity of coverage can limit appropriate use of health care, increase emergency department utilization and in-patient hospitalization, negatively affect self-reported health, increase health care spending, and compound Medicaid administrative costs. Efforts to more fully understand and ultimately reduce enrollment churn thus are vital to Medicaid agencies and beneficiaries. Residential moves are life transitions, often marking other significant life events (e.g., changes in employment or family structure) that can alter eligibility for Medicaid benefits. Few studies have examined residential moves among Medicaid members, or considered residential mobility as …

The Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among Insured Elderly, Min Jee Lee

Theses and Dissertations

Background: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning on January 1, 2011. This study investigated the effect of the ACA’s removing of financial barriers on the receipt of colonoscopies among insured elderly, who are predominantly covered by Medicare. Moreover, this study examined how income-related disparities in colonoscopy use have changed over the past decade and attempted to quantify various contributions to income-related disparity in the use of colonoscopies among insured elderly. Methods: Five cycles (2008, 2010, 2012, 2014, and 2016) of the Behavioral Risk Factor Surveillance System (BRFSS) were utilized to …

Body Mass Index Trajectories And The Relationship Between Stressful Life Changes And Nutrition-Related Health Outcomes Among United States Army Soldiers, Julianna Marie Jayne

Theses and Dissertations

Body mass index (BMI) has risen among members of the military, though to a lesser degree than in civilian populations. BMI as an anthropometric tool has been essential for population surveillance and documenting the obesity epidemic and its health consequences. One use for BMI in population surveillance is to model the BMI trajectories of a population over time. Many studies are available on the BMI trajectories and determinants of BMI in civilians, but few studies of this nature in military populations exist. Establishing the shape and determinants of BMI trajectories among Soldiers is critical given the importance of weight management …

A Qualitative Exploration Of Experiences And Motivations For Diabetes Self-Management In African American Men Between The Ages Of 40-85 With Type 2 Diabetes, Anthony Q. Walker

Theses and Dissertations

Diabetes is a devastating disease that can affect an individual’s health and quality of life, but if managed properly, individuals with diabetes can have a good quality of life. Diabetes strikes African American men at a high rate. This study used a qualitative design to explore African American men between the ages of 40-85 with type 2 diabetes (T2DM) and their definition of diabetes and motivation, their experience of living with diabetes, their self-management behaviors, their motivations for managing diabetes, and what they and healthcare providers believe motivates them to self-manage diabetes and to attend diabetes self-management education (DSME) programs. …

Sleep, Shiftwork Adaptation, Autonomic Dysfunction, And Metabolic Syndrome, Torrance Torrance

Theses and Dissertations

Background: Sleep is considered a physiological necessity and its disruption is associated with a wide variety of adverse mental and physical health outcomes including increased incidence of obesity, cancer, hypertension, cardiovascular disease, type 2 diabetes mellitus, stroke, depression, post-traumatic stress disorder (PTSD), work-related and vehicle accidents, and aberration of the autonomic nervous system.

Methods: Three studies were conducted from three separate populations. The first study examined the latent trajectories of self-reported sleep quality in active duty Army soldiers over a 3-year period using data from the Global Assessment 2.0 survey and Repeated Measures Latent Class Analysis (RMCLA) procedures. Generalized Estimating …

Healthy Motivations For Moms-To-Be (Healthy Mom2b) Study: A Mobile Health Intervention Targeting Gestational Weight Gain Among U.S. Women, Alicia Anne Dahl

Theses and Dissertations

INTRODUCTION: Almost one-half of all pregnant women in the U.S. exceed the Institute of Medicine’s (IOM) gestational weight gain (GWG) guidelines. Healthy GWG is critical for reducing adverse health outcomes associated with excessive GWG for the mother and infant. Electronic health (e-health) interventions delivered through mobile apps and websites hold potential as readily available resources for targeting health behaviors and monitoring GWG during pregnancy. The development of the Healthy Motivations for Moms-To-Be (HM2B) intervention was informed by health behavior theories, a systematic review of existing in-person and technology mediated interventions (Aim 1 of this dissertation), and results of an online …

The Impact Of The Medicaid Coverage Expansion And The Removal Of Cost-Sharing Under The Affordable Care Act On Mammography And Pap Tests, Abeer Alharbi

Theses and Dissertations

Background: The Affordable Care Act (ACA) aimed at making health care affordable and accessible including the use of preventive care services. To achieve these aims, the ACA expanded Medicaid coverage to population with income below 138% of FPL and removed cost-sharing when using preventive care services recommended by the USPSTF. This study tried to assess the impact of these provisions on the rate of mammography and Pap tests among women. Methods: Data was obtained from the Medical Expenditure Panel Survey - Household Component MEPS-HC. A difference-indifference design was used to determine the effect of Medicaid eligibility expansion on the outcomes …

Investigating Drug-Related Violence In Indian Country: The Lumbee Tribe Of North Carolina, Asa Alena Revels

Theses and Dissertations

Drug-related violence (DRV) impacts the over-all wellbeing of communities, with disparate health outcomes observable in many poor, minority communities. The purpose of this study was to better understand the multi-level social and environmental factors influencing elevated rates and prevention of DRV within the Lumbee, a southeastern American Indian Tribe. This was accomplished via in-depth, one-on-one interviews with 37 Lumbee Tribal Members and Key Leaders. The findings align with existing research, revealing the influence of such factors as poor socioeconomic conditions, coping strategies, broken family structures, and the influence of federal policy. Of interest was the substantial influence of the local …

Patient Characteristics, Discharge Disposition, And Hospital Factors Associated With All Cause 30-Day Hospital Readmission For Total Joint Arthroplasty In 2014, Hamad Yahya Alzamanan

Theses and Dissertations

Objective: Recent improvements in hospital care have come from a growing knowledge of factors that contribute to readmission. The objective of this work is to identify and describe the national readmission rate after Total Joint Arthroplasty, and to evaluate selected hospitals’ and patients’ factors for their association with the all-cause 30-day readmission rate after TJA in the United States in 2014. Method: Retrospective analysis of 938,504 TJA acute care hospital discharge records was performed, using a nationally representative database that is dedicated to the study of hospital readmissions, and accounts for 51% of total US hospitalizations. Logistic regression models were …

Chronic Conditions Profiles And Cardiometabolic Risk Factor Control Among A Diverse Sample Of Older Adults With Type 2 Diabetes Mellitus, Tsion Kidanie

Theses and Dissertations

Background: Multiple chronic condition is common in older adults with diabetes. Several prior studies have shown that having multiple chronic condition impact cardiometabolic risk factor controls (i.e., blood pressure, High-density lipoprotein (HDL) cholesterol level, and high glycated hemoglobin (HbA1c). However, it is not clear whether these results extend to a multiethnic sample of older adults.

Objectives: 1). Examine the association between Comorbidity profile and ABCs goals achievement. 2). Examine whether the association between comorbidity profile and ABCs goals achievement is moderated by race/ethnicity.

Methods: A sample of 3532 participants from Health and Retirement Study (HRS) years 2010 and 2012 and …

Food Acquisition And Shopping Patterns And Associations With Body Mass Index, Xiaonan Ma

Theses and Dissertations

Background: Obesity is a big public health concern in the US. Previous studies examined its association with food shopping practices measured by distance to the food store, shopping frequency, and type of store selected. However, not much is known about the actual food acquisition and shopping habits integrating multi-dimensional aspects. The purpose of this study was to identify distinct food acquisition and shopping patterns in populations primarily residing in food deserts in South Carolina (SC) and a general population in the US and characterize these patterns with respect to socioeconomic status (SES), nutritional knowledge, and perceptions and store selection …

Association Of Insurance And Provider Type With Patients’ Perceived Cost And Ease Of Access To Healthcare Services Among Medicare Beneficiaries Diagnosed With Diabetes, Metria Harris

Theses and Dissertations

Medicare beneficiaries diagnosed with diabetes are likely to have health complications or episodes associated with diabetes, resulting in higher health care utilization and costs. Andersen’s Health Care Utilization Behavior Model (HCBM) includes predisposing, enabling, and need factors, but it excludes perception. Ajzen’s Theory of Planned Behavior (TPB) shows that perception influences health service use. This study was performed using a real-world model integrating Andersen’s HCBM and Ajzen’s TPB to determine whether there was an association between insurance type (Medicare Part D versus non-Part D) and perceived ease of access or cost among Medicare beneficiaries with diabetes. The second objective was …

The Impact Of False Positive Mammography Results On Breast Cancer Screening Intention Among Black Women, Deeonna E. Farr

Theses and Dissertations

Extensive research indicates that false-positive mammograms (FPM) have been associated with negative psychosocial and cancer-related beliefs, but only a handful of studies examine Black women’s reactions to this experience. Additionally, these studies do not investigate how organizational and provider-level factors in concert with individual patient characteristics shape Black women’s experiences and reactions to FPM results. The purpose of this study was to determine the impact of organizational, provider, and individual-level factors on the processes and outcomes associated with FPM results in Black women. This study had two specific aims:

1) To describe, using a mixed methods approach, the organizational and …

Three Essays On Maternal And Child Health, Mandar V. Bodas

Theses and Dissertations

This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the …

Prescription Drug Monitoring Programs And Opioid Poisoning: Evaluating The Impact Of Prescriber Use Mandates On Prescription Opioid Poisoning Emergency Department Visits, Sarah Almanie

Theses and Dissertations

Introduction: Prescription drug monitoring programs (PDMPs) are one strategy established to curb the prescription opioid abuse epidemic. Prescriber use mandates has emerged as a promising practice to increase PDMPs impact on prescription opioid abuse; however, evidence of its effectiveness has not yet been established. Kentucky was the first state to implement comprehensive prescriber use mandates in July 2012.

Objective: To assess the relationship between prescriber use mandates policy and emergency department (ED) visits related to prescription opioid poisoning among adults in Kentucky and

North Carolina. Secondary aim: to evaluate the economic impact of prescriber use mandates in Kentucky.

Methods: A …

Economic Burden Of Renal Cell Carcinoma (Rcc) And Treatment Patterns, Overall Survival And Healthcare Costs Among Older Metastatic Rcc Patients, Hrishikesh P. Kale

Theses and Dissertations

Background

Renal cell carcinoma (RCC) is the most common type of kidney cancer. Patients diagnosed with metastatic RCC (mRCC) have shorter overall survival compared to those diagnosed at earlier stages. Several targeted therapies, which cost from $7,000 - $16,000 per month have been approved since 2005 to treat mRCC. In addition, there is a growing interest in the use of cytoreductive nephrectomy (CN) with targeted therapies among mRCC patients. However, little is known regarding the economic burden of RCC and role of CN and prescribing patterns of targeted therapies among older mRCC patients.

Objectives

1) To assess the economic burden …

Family Planning And Hiv Interventions Among Women In Low-Income Settings, Steven P. Masiano

Theses and Dissertations

This dissertation examines the effectiveness of interventions related to family planning and the uptake of HIV-related preventive services among women in low-income settings. Women in low-income settings and living with HIV face many barriers to care, including limited access to services for family planning and HIV-related preventive care. At the same time, national, regional, and global efforts are looking for interventions to help control rapid population growth, create an HIV-free generation, and provide adequate preventive care for those living with HIV. This dissertation cuts across these issues and can help to inform debate and policies to address these issues.

This …

The Impact Of Mother–Father Relationship, Social Support And Neighborhood Context On Preterm Birth, Timothy O. Ihongbe

Theses and Dissertations

Background: Preterm birth is a major public health concern in the US. Previous studies have suggested that quality of the mother-father relationship, social support, and neighborhood violence may be associated with preterm birth; however, findings are equivocal.

Objectives: The main objectives of this dissertation were: 1) to determine the modifying effect of perceived residential environment on the association between quality of mother–father relationship and preterm birth in a sample of African-American women, 2) to examine whether the receipt of social support modifies the association between neighborhood violence exposure and preterm birth in a nationally representative sample of US women, and …

A Stakeholder Examination Of Gestational Weight Gain Guidelines, Melissa Kwitowski

Theses and Dissertations

Obesity is a significant health concern for women of childbearing age. More than 40% of women have a Body Mass Index (BMI) in the overweight or obese ranges at the time they conceive, posing significant health risks for both mother and child. Excessive weight gain during pregnancy is common and associated with numerous deleterious complications. The Institute of Medicine published gestational weight gain (GWG) guidelines based on prepregnancy BMI. However, more than 50% of women gain in excess of these recommendations. Further, many women report receiving minimal guidance from their healthcare providers regarding weight gain, nutrition, and physical activity during …