Public Health Commons^™

A Preventable Epidemic: Kotter’S Eight Step Change Model Applied To Type 2 Diabetes In Youth, Jo Marie Courtney

Florida Public Health Review

Type 2 diabetes affecting children is a global epidemic that can be addressed by applying leadership models traditionally applied to corporate business structures. Leadership models provide the guidelines to apply to a problem and create a vision of change. Approximately 346 million individuals currently suffer from diabetes worldwide. According to the World Health Organization (WHO), ofthose individuals with diabetes, 90% have type 2. Once a disease characterized by middle-aged, overweight adults, type 2 diabetes is now being diagnosed in children and adolescents. The severity oftype 2 diabetes is greater than the diagnosis portrays due to the many co-morbidities and risk …

Should Marijuana Be Decriminalized? [An Annotated Bibliography], Christina M. Costa

Undergraduate Research Award

No abstract provided.

Prescriptions For Excellence In Health Care Winter 2011 Dowload Full Pdf

Prescriptions for Excellence in Health Care Newsletter Supplement

No abstract provided.

A Monitoring And Evaluation Plan For The Core Competencies Of Skilled Birth Attendants In Nepal, Roberta Goldstein

Capstone Collection

The purpose of this capstone is to present a Monitoring and Evaluation (M&E) plan of the core competencies, for Skilled Birth Attendants (SBA) of Nepal. The World Health Organization has laid out 10 specific skills that assess a SBAs competency. Nepal presently lacks any formal process for monitoring quality assurance of its SBAs and therefore has no measurement of their effectiveness. This Capstone proposes a simple M&E plan to begin the process of quality measurement, using a recent follow-up study done by the Nepali government, other articles and the experiences of the author. The tools included in this Capstone are …

Dog Ownership During Pregnancy, Maternal Activity, And Obesity: A Cross-Sectional Study, Carri Westgarth, Jihong Liu, Jon Heron, Andrew R. Ness, Peter Bundred, Rosalind M. Gaskell, Alexander J. German, Sandra Mccune, Susan Dawson

Faculty Publications

The Avon Longitudinal Study of Parents and Children (ALSPAC) is an observational study of 14273 UK pregnant singleton mothers in 1990/1991. We examined outcomes of self report of strenuous activity (hours per week) at 18 and 32 weeks of gestation, hours spent in leisure-time physical activities and types, and pre-pregnancy body mass index (BMI); overweight status was defined as pre-pregnancy BMI$25 and obesity BMI$30. Pet ownership and activity data were reported for 11,466 mothers. Twenty-five percent of mothers owned at least one dog. There was a positive relationship between participation in activity at least once a week and dog ownership …

Public Health Spending, Preventable Outcomes, And Medical Cost Offsets: Questions For Health Reform, Glen P. Mays

Health Management and Policy Presentations

Uncertainty continues to surround the health and economic effects that can be expected from increased federal spending on public health and prevention strategies. Recent research provides some insight into the question of whether spending on public health strategies can offset the need for future spending on medical care.

Incentivized Hiv Testing--Is It Needed And Effective? Developing An Evaluation Tool, Dawn Spellman

Capstone Collection

The following is a case study of agencies in Seattle, WA who provide HIV testing followed by an evaluation tool for the agencies to determine the role of incentivizing HIV testing. Some agencies I interviewed provide incentives for the testing and others do not.

This Capstone will focus on six agencies currently providing HIV testing and provides a tool for agencies to use to attempt to answer the following question: In the face of reduced funding for HIV prevention and a mandate to continue to push for increasingly getting more Men who have Sex with Men (MSM) tested for HIV, …

Differences In Immunity Offered By The Influenza Vaccination Among Active Duty Us Air Force Personnel From 2007-2011, Billy D. Pruett

Master of Public Health Program Student Publications

OBJECTIVE: To investigate the potential difference in vaccine effectiveness among Active Duty Air Force (ADAF) personnel vaccinated against influenza from 2007-2011. Particularly, to determine if any difference in the protection offered is based on sex, vaccine type, or both.

METHODS: The proposed study incorporated a cross-sectional design using the Department of Defense’s (DoD) comprehensive databases. Laboratory-confirmed influenza and other Influenza-Like Illness (ILI) cases were identified for each of the four influenza seasons of interest, vaccination status and history was then verified, and 2x2 tables were constructed in order to calculate odds ratios.

RESULTS: No consistent difference in vaccine effectiveness in …

Families In Need Of Services (Fins) Commission, Institute For Public Health And Justice, Status Offenders

Policy & Position Papers

No abstract provided.

Does Place Of Residence Affect Risk Of Suicide? A Spatial Epidemiologic Investigation In Kentucky From 1999 To 2008, Daniel M. Saman, Sabrina Walsh, Anna Borówko, Agricola Odoi

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: Approximately 32,000 people take their own lives every year in the United States. In Kentucky, suicide mortality rates have been steadily increasing since 1999. Few studies in the United States have assessed spatial clustering of suicides. The purpose of this study was to identify high-risk clusters of suicide at the county level in Kentucky and assess the characteristics of those suicide cases within the clusters.

METHODS: A spatial epidemiological study was undertaken using suicide data for the period January 1, 1999 to December 31, 2008, obtained from the Kentucky Office of Vital Statistics. Descriptive analyses using Pearson's chi-square test …

College Of Public Health News, Georgia Southern University

College of Public Health: News & Publications

• Dr.P.H. Candidate Chosen for CDC Volunteer Program

The Geographic Value Of Patient-Carried Medical Records In Improving Healthcare In The Us, Lauren Edmundson

The Macalester Review

American medical records have typically been maintained in a single location. However, patient-carried medical records (PCMRs) present an opportunity to alter the space in which health records and information operate. While past research has evaluated PCMRs from a largely economic perspective, this research examines potential benefits of PCMRs through a geographic framework. In total, while further work is needed to perfect the PCMR system, they can ultimately serve as a tool to alleviate four specific complaints made by American patients: lack of communication between provider and patient, lack of communication between providers, medical error, and high costs.

Childhood Obesity And Restrictions Of Parental Liberty. A Response To "Paternalism, Obesity, And Tolerable Levels Of Risk", Kristin Voigt

Democracy & Education

This paper responds to Michael Merry’s recent contribution on childhood obesity. Merry’s analysis highlights the difficulties in finding an appropriate balance between children’s and parents’ interests in antiobesity interventions and emphasizes the importance of weight stigma and its effects on the obesity debate. He concludes by recommending both a greater focus on policies that address society's contribution to childhood obesity and a greater involvement of obese individuals in the policy debate. This response focuses on three points. First, a more explicit recognition of parents’ interests can support the case for the kinds of policies Merry has in mind. Second, while …

Effective Leadership To Alter School Food Environments And Improve Public Health, Philip R. Mcnab

Florida Public Health Review

Multiple studies show that many children and adolescents in the United States are overweight or at risk for overweight; moreover, the numbers are still rising. Contributing to the problem is the fact that schoolchildren, on average, are eating too much fast food and well below the recommended amounts offruits and vegetables. From a public health perspective, these are severe problems, as they have been associated with diseases such as heart stroke and heart disease. Not surprisingly, school food environments, which are often saturated with low-nutrient energy-dense foods, are not helping matters and need to be altered. Interventions involving nutrition education …

Epidemiology Of Hepatocellular Carcinoma In Florida – Part I: A Statewide Report, Angel E. Alsina, Aryan Beharry, Narrad Beharry, Nyingi Kemmer, Edson Franco, Haydy Rojas, Guy W. Neff

Florida Public Health Review

The increasing incidence ofhepatocellular carcinoma (HCC) has become a burgeoning public health problem. The effect has been most notable at liver transplant centers. Traditional reports of liver cancer include many non-HCC variants. This study aims at determining the incidence of HCC in the state of Florida, utilizing data from Florida Cancer Data Systems. This study pertains exclusively to HCC. Of 2,296,794 cancer cases, 4,447 HCC and variants were identified (68.7%). Incidence rates were as follows. The incidence of HCC in the state of Florida was 6.1 cases /100,000 population/year; Male: 9.6/100,000 population/year vs. Female: 2.7; Whites: 6.5/100,000 population/year vs. Blacks: …

Leadership To Address Sexual Education In Schools, Shannon Kelley

Florida Public Health Review

This paper will take the strategies ofleadership proposed by Bennis and Nanus (1985) in application to sexual education in schools. The severity and significance of the sexual health of youth will be shown, with an emphasis on contributing risk behaviors and ideologies. An overview ofthe current state ofteenage pregnancy and sexual disease incidence will be included. Next, the factors that contribute to the disparities of sexual health in youth will be addressed. These factors include: race, parental and peer support, participation in a sexual education program, and current policies on sexual education. A discussion about the relation ofthe factors to …

Addressing The Failure Of Abstinence-Only Sex Education Programs: An Emerging Leadership Perspective, Cedric Harville Ii

Florida Public Health Review

Over the past 15 years, abstinence-only sex education has been the sole method of education supported by the federal government as it relates to adolescent sexual health. Despite the exponential increase offunding provided for abstinence-only sex education, few tangible positive results have surfaced. At high rates, teens still take part in risky sexual behaviors, and are at high risks for teen pregnancy, sexually transmitted diseases, and HIV/AIDS. As a result, it is necessary to take an alternative approach that provides adolescents with a comprehensive view of sex education in order to effectively reduce these negative outcomes. A comprehensive education will …

Not Just A Mother’S Decision: A Multifactorial Exploration Of Low Breastfeeding Rates In African American Women, Mackenzie R. Tewell

Florida Public Health Review

The benefits of breastfeeding for both mother and newborns are well established. Yet, black women in the U.S. consistently have the lowest rates ofbreastfeeding initiation and duration. Utilizing the various levels ofthe Social Ecological Model, this paper explores the factors that are thought to be responsible for this disparity. Poverty, a lack of resources, and societal disapproval weigh heavily upon already strained intrapersonal relationships where social support is severely lacking. Familial influence proves pivotal in a mother’s decision ofwhether or not to breastfeed. The role ofWIC clinics are also examined as a source of intervention, though literature demonstrates women receive …

Influenza Vaccinations: A Leadership Approach, Christine Ann Meister

Florida Public Health Review

Each year thousands of individuals in the United States are diagnosed with cases of seasonal influenza (flu) and the recent pandemic strain ofH1N1 influenza. Complications ofthe flu can lead to serious health issues resulting in hospitalization and even death. Vaccination for seasonal flu and H1N1 can decrease the number ofcases ofthe flu, thus decreasing the number of complications resulting from infection. Unfortunately, a large percentage of the population chooses not to get vaccinated every year for the seasonal flu because they do not trust vaccine safety and effectiveness. To gain the public’s trust and increase the number ofinfluenza inoculations, the …

Environmental Drivers Of Ross River Virus In South-East Tasmania, Australia: Towards Strengthening Public Health Interventions, Angela Werner, Sarah Goater, Scott Carver, Greg Robertson, Philip Weinstein

Global Health Faculty Publications

In Australia, Ross River virus (RRV) is predominantly identified and managed through passive health surveillance. Here, the proactive use of environmental datasets to improve community-scale public health interventions in southeastern Tasmania is explored. Known environmental drivers (temperature, rainfall, tide) of the RRV vector Aedes camptorhynchus are analysed against cumulative case records for five adjacent local government areas (LGAs) from 1993 to 2009. Allowing for a 0- to 3-month lag period, temperature was the most significant driver of RRV cases at 1-month lag, contributing to a 23. 2% increase in cases above the long-term case average. The potential for RRV to …

Kentucky Worksite Wellness Tax Credit: A Health Impact Assessment, Cecilia M. Watkins, T. Lovely

Public Health Faculty Publications

The purpose of the assessment was to evaluate the potential effects of a worksite wellness tax credit on three main areas of concern for Kentucky: (!) nutrition, physical activity and obesity levels of children whose parents receive Worksite Wellness services, (2) jobs and (3) social cohesion.

Effect Of Nutrition Changes On Foods Selected By Students In A Middle School-Based Diabetes Prevention Intervention Program: The Healthy Experience, Connie Mobley, Diane D. Stadler, Myrlene A. Staten, Laure El Ghormli, Bonnie Gillis, Jill Hartstein, Anna Maria Siega-Riz, Amy Virus, Healthy Study Group

GW Biostatistics Center

No abstract provided.

Repeat Prenatal Corticosteroid Prior To Preterm Birth: A Systematic Review And Individual Participant Data Meta-Analysis For The Precise Study Group (Prenatal Repeat Corticosteroid International Ipd Study Group: Assessing The Effects Using The Best Level Of Evidence) - Study Protocol, Caroline A. Crowther, Fariba Aghajafari, Lisa M. Askie, Elizabeth V. Asztalos, Peter Brocklehurst, Elizabeth A. Thom, +22 Additional Authors

GW Biostatistics Center

Background

The aim of this individual participant data (IPD) meta-analysis is to assess whether the effects of repeat prenatal corticosteroid treatment given to women at risk of preterm birth to benefit their babies are modified in a clinically meaningful way by factors related to the women or the trial protocol.

Methods/Design

The Prenatal Repeat Corticosteroid International IPD Study Group: assessing the effects using the best level of Evidence (PRECISE) Group will conduct an IPD meta-analysis. The PRECISE International Collaborative Group was formed in 2010 and data collection commenced in 2011. Eleven trials with up to 5,000 women and 6,000 infants …

Association Of Hexachlorobenzene (Hcb), Dichlorodiphenyltrichloroethane (Ddt), And Dichlorodiphenyldichloroethylene (Dde) With In Vitro Fertilization (Ivf) Outcomes., Shruthi Mahalingaiah, Stacey A. Missmer, Arnab Maity, Paige L. Williams, John D. Meeker, Katharine Berry, Shelley Ehrlich,, Melissa J. Perry, Daniel W. Cramer, Russ Hauser

Environmental and Occupational Health Faculty Publications

Background: Hexachlorobenzene (HCB), dichlorodiphenyltrichloroethane (DDT), and dichlorodiphenyldichloroethylene (DDE) are persistent chlorinated pesticides with endocrine activity that may adversely affect the early stages of human reproduction.

Objective: Our goal was to determine the association of serum levels of HCB, DDT, and DDE with implantation failure, chemical pregnancy, and spontaneous abortion in women undergoing in vitro fertilization (IVF) from 1994 to 2003.

Methods: Levels of HCB and congeners of DDT and DDE were measured in serum collected during the follicular phase. Multivariable-adjusted statistical models accommodating multiple outcomes and multiple cycles per woman were used to estimate the relation between serum pesticide levels …

Multi-Person Sex Among A Sample Of Adolescent Female Urban Health Clinic Patients, Emily F. Rothman, Michele R. Decker, Elizabeth Miller, Elizabeth Reed, Anita Raj, Jay G. Silverman

Prevention and Community Health Faculty Publications

Adolescent sexual activity involving three or more people is an emerging public health concern. The goal of this exploratory, cross-sectional study was to describe the prevalence, correlates, and context of multiple-person sex among a sample of adolescent females seeking health care from an urban clinic. Because sex involving multiple people may either be consensual (i.e., “three-ways” or “group sex”) or forced (i.e., “gang rape”), we use the term “multi-person sex” (MPS) to encompass these experiences. Subjects were 328 females, ages 14–20 years old, who utilized a Boston-area community- or school-based health clinic between April and December of 2006, and completed …

The Impact Of A 3-Year After-School Obesity Prevention Program In Elementary School Children, Zenong Yin, Justin B. Moore, Maribeth H. Johnson, Marlo M. Vernon, Bernard Gutin

Faculty Publications

Background: Children tend to be sedentary during the after-school hours, and this has deleterious effects on their health. The objective of the present study was to determine the effects of a 3-year after-school physical activity (PA) program, without restriction of dietary energy intake, on percent body fat (%BF), cardiorespiratory fitness (CRF), and cardiometabolic markers in children.

Methods: A cluster randomization design was employed. A total of 574 3^rd grade children from 18 elementary schools in the south-eastern United States participated. The intervention consisted of 80 minutes of age-appropriate moderate-to-vigorous PA each school day. The main outcomes of interest were …

Cardiovascular Fitness Moderates The Relations Between Estimates Of Obesity And Physical Self-Perceptions In Rural Elementary School Students, Nathanael G. Mitchell, Justin B. Moore, Wendy S. Bibeau, Kathleen M. Rudasill

Faculty Publications

Background: Levels of physical activity decline throughout childhood. Children's physical self-perceptions have been found to relate to their physical activity. Understanding the relationships among physical self-perceptions, obesity, and physical activity could have important implications for interventions in children. Methods:The current study investigated the moderating effect of cardiovascular fitness (CVF, heart rate recovery from a 3-minute step test) on the relationship between obesity (BMI, waist circumference) and physical self-perceptions (athletic competence, physical appearance) in 104 fourth- and fifth-grade children from a small rural community. Results: Hierarchical regression analyses indicated that CVF moderated the relations between BMI and waist circumference on …

Utilization Of Ct Scans And Mris In An Insured Population With Migraine, Neil I. Goldfarb, Valerie Pracilio, Mph, Daisy Ng-Mak, Phd, Joe Couto, Pharmd, Mba, Cary Sennett, Md, Phd, Mary Hopkins, Rn, Jon Bumbaugh, Stephen Silberstein, Md

College of Population Health Lectures, Presentations, Workshops

Background:

• Neuroimaging is a diagnostic tool that may be used to rule out a serious condition when a patient presents with head pain. It is not typically warranted for patients who have a normal neurologic exam, and may be over utilized despite established practice parameters set by the American Academy of Neurology.

•A decision to use neuroimaging should consider the type of headache and presence of any clinical features that suggest a serious condition.

Over-utilization of neuroimaging has cost and safety implications.

The United States Headache Consortium, a panel of experts on migraine, set the guidelines for diagnosis and …

Association Between Triptanuse And Cardiac Contraindications In An Insured Migraine Population, Daisy Ng-Mak, Phd, Valerie P. Pracilio, Mph, Stephen Silberstein, Md, Joseph Couto, Pharmd, Mba, Cary Sennett, Md, Phd, Mary Hopkins, Rn, Jon Bumbaugh, Neil I. Goldfarb

College of Population Health Lectures, Presentations, Workshops

Background

Safety concerns exist when using triptansto treat patients with cardiac contraindications.

–Triptans cause vasoconstriction, a safety concern for migraineurswith cardiovascular (CV) disease or other cardiac risk factors.

–All triptans contain contraindications in their package inserts to avoid use in patients with cardiac conditions.

•Previous research indicates that clinicians are less likely to prescribe triptansin patients with CV disease or CV risk factors.

Limited research has examined the proportion of migraine patients with cardiovascular disease or those individuals who were concurrently treated with triptans.

Effect Of Different Doses Of Aerobic Exercise On Total White Blood Cell (Wbc) And Wbc Subfraction Number In Postmenopausal Women: Results From Drew, Neil M. Johannsen, Damon L. Swift, William D. Johnson, Vishwa D. Dixit, Conrad P. Earnest, Steven N. Blair, Timothy S. Church

Faculty Publications

Background: Elevated total white blood cell (WBC) count is associated with an increased risk of coronary heart disease and death. Aerobic exercise is associated with lower total WBC, neutrophil, and monocyte counts. However, no studies have evaluated the effect of the amount of aerobic exercise (dose) on total WBC and WBC subfraction counts.

Purpose: To examine the effects of 3 different doses of aerobic exercise on changes in total WBC and WBC subfraction counts and independent effects of changes in fitness, adiposity, makers of inflammation (IL-6, TNF-α, C-reactive protein), fasting glucose metabolism, and adiponectin.

Methods: Data from 390 sedentary, overweight/obese …