Public Health Commons^™

Complete Genome Sequence Of A Ctx-M-15-Producing Escherichia Coli Strain From The H30rx Subclone Of Sequence Type 131 From A Patient With Recurrent Urinary Tract Infections, Closely Related To A Lethal Urosepsis Isolate From The Patient's Sister., Timothy J. Johnson, Maliha Aziz, Cindy M. Liu, Evgeni Sokurenko, Dagmara I. Kisiela, Sandip Paul, Paal S. Andersen, James R. Johnson, Lance B. Price

Environmental and Occupational Health Faculty Publications

We report here the complete genome sequence, including five plasmid sequences, of Escherichia coli sequence type 131 (ST131) strain JJ1887. The strain was isolated in 2007 in the United States from a patient with recurrent cystitis, whose caregiver sister died from urosepsis caused by a nearly identical strain.

Don't Ask For Fair Treatment? A Gender Analysis Of Ethnic Discrimination, Response To Discrimination, And Self-Rated Health Among Marriage Migrants In South Korea., Yugyun Kim, Inseo Son, Dainn Wie, Carles Muntaner, Hyunwoo Kim, Seung-Sup Kim

Environmental and Occupational Health Faculty Publications

BACKGROUND: Ethnic discrimination is increasingly common nowadays in South Korea with the influx of migrants. Despite the growing body of evidences suggests that ethnic discrimination negatively impacts health, only few researches have been conducted on the association between ethnic discrimination and health outcomes among marriage migrants in Korea. This study sought to examine how ethnic discrimination and response to the discrimination are related to self-rated health and whether the association differs by victim's gender.

METHODS: We conducted two-step analysis using cross-sectional dataset from the 'National Survey of Multicultural Families 2012'. First, we examined the association between perceived ethnic discrimination and …

Acceptability Study On Hiv Self-Testing Among Transgender Women, Men Who Have Sex With Men, And Female Entertainment Workers In Cambodia: A Qualitative Analysis, Khuondyla Pal, Chanrith Ngin, Sovannary Tuot, Pheak Chhoun, Cheaty Ly, Srean Chhim, Siyan Yi

Background: In Cambodia, HIV prevalence is high while HIV testing rates remain low among transgender women (TG women), men who have sex with men (MSM), and female entertainment workers (FEW). Introducing self-testing for HIV to these key populations (KPs) could potentially overcome the under-diagnosis of HIV and significantly increase testing rates and receipt of the results, and thus could decrease transmission. Therefore, this study aimed to determine the acceptability of HIV self-testing (HIVST) among these three categories of KPs.

Methods: This study was conducted through focus group discussions (FGDs) with TG women, MSM, and FEW in Phnom Penh …

Importance Of Hereditary And Selected Environmental Risk Factors In The Etiology Of Inflammatory Breast Cancer: A Case-Comparison Study., Roxana Moslehi, Elizabeth Freedman, Nur Zeinomar, Carmela Veneroso, Paul H. Levine

Epidemiology Faculty Publications

BACKGROUND: To assess the importance of heredity in the etiology of inflammatory breast cancer (IBC), we compared IBC patients to several carefully chosen comparison groups with respect to the prevalence of first-degree family history of breast cancer.

METHODS: IBC cases (n = 141) were compared to non-inflammatory breast cancer cases (n = 178) ascertained through George Washington University (GWU) with respect to the prevalence of first-degree family history of breast cancer and selected environmental/lifestyle risk factors for breast cancer. Similar comparisons were conducted with subjects from three case-control studies: breast cancer cases (n = 1145) and unaffected controls (n = …

Interruptions Of Antiretroviral Therapy In Children And Adolescents With Hiv Infection In Clinical Practice: A Retrospective Cohort Study In The Usa., Natella Rakhmanina, Kam S Lam, Jaclyn Hern, Heather A. Young, Alex Walters, Amanda D. Castel

Epidemiology Faculty Publications

INTRODUCTION: Changes in combination antiretroviral therapy (cART) throughout childhood challenge the continuity of paediatric HIV treatment. This study aimed to evaluate the prevalence of treatment interruption (TI), including lamivudine (3TC) monotherapy, and the relationship of TI to virologic and immunologic parameters in HIV-infected paediatric patients.

METHODS: Nested within a prospective observational study of a city-wide cohort of HIV-infected persons in the District of Columbia, this sub-study collected retrospective data on antiretroviral therapy, enrolment (endpoint) and historic (lifelong) CD4 counts and HIV RNA viral load (VL) of the paediatric cohort. TI was defined as interruption of cART ≥4 consecutive weeks. Data …

Arsenic In Drinking Water And Lung Cancer Mortality In The United States: An Analysis Based On Us Counties And 30 Years Of Observation (1950-1979)., Hamid Ferdosi, Elisabeth K Dissen, Nana Ama Afari-Dwamena, Ji Li, Rusan Chen, Manning Feinleib, Steven H Lamm

Epidemiology Faculty Publications

Background. To examine whether the US EPA (2010) lung cancer risk estimate derived from the high arsenic exposures (10-934 µg/L) in southwest Taiwan accurately predicts the US experience from low arsenic exposures (3-59 µg/L). Methods. Analyses have been limited to US counties solely dependent on underground sources for their drinking water supply with median arsenic levels of ≥3 µg/L. Results. Cancer risks (slopes) were found to be indistinguishable from zero for males and females. The addition of arsenic level did not significantly increase the explanatory power of the models. Stratified, or categorical, analysis yielded relative risks that hover about 1.00. …

Direct Measurement Of Bisphenol A (Bpa), Bpa Glucuronide And Bpa Sulfate In A Diverse And Low-Income Population Of Pregnant Women Reveals High Exposure, With Potential Implications For Previous Exposure Estimates: A Cross-Sectional Study., Roy R. Gerona, Janet Pan, Ami R. Zota, Jackie M. Schwartz, Matthew Friesen, Julia A. Taylor, Patricia A. Hunt, Tracey J. Woodruff

Environmental and Occupational Health Faculty Publications

BACKGROUND: Bisphenol A (BPA) is a ubiquitous, endocrine-disrupting environmental contaminant that increases risk of some adverse developmental effects. Thus, it is important to characterize BPA levels, metabolic fate and sources of exposure in pregnant women.

METHODS: We used an improved liquid chromatography-tandem mass spectrometry (LC-MS/MS) analytic method to directly and simultaneously measure unconjugated BPA (uBPA), BPA glucuronide and BPA sulfate in the urine of a population of ethnically and racially diverse, and predominately low-income pregnant women (n = 112) in their second trimester. We also administered a questionnaire on dietary and non-dietary sources of exposure to BPA.

RESULTS …

An Analysis Of Water Collection Labor Among Women And Children In 24 Sub-Saharan African Countries., Jay Graham, Mitsuaki Hirai, Seung-Sup Kim

Environmental and Occupational Health Faculty Publications

BACKGROUND: It is estimated that more than two-thirds of the population in sub-Saharan Africa (SSA) must leave their home to collect water, putting them at risk for a variety of negative health outcomes. There is little research, however, quantifying who is most affected by long water collection times.

OBJECTIVES: This study aims to a) describe gender differences in water collection labor among both adults and children (< 15 years of age) in the households (HHs) that report spending more than 30 minutes collecting water, disaggregated by urban and rural residence; and b) estimate the absolute number of adults and children affected by water collection times greater than 30 minutes in 24 SSA countries.

METHODS: We analyzed data from the Demographic Health Survey (DHS) and the Multiple Indicator Cluster Survey (MICS) (2005-2012) to describe water collection labor in 24 SSA countries.

RESULTS: Among households spending more than …

Redrawing The Us Obesity Landscape: Bias-Corrected Estimates Of State-Specific Adult Obesity Prevalence., Zachary J Ward, Michael W. Long, Stephen C Resch, Steven L Gortmaker, Angie L Cradock, Catherine Giles, Amber Hsiao, Y Claire Wang

Prevention and Community Health Faculty Publications

BACKGROUND: State-level estimates from the Centers for Disease Control and Prevention (CDC) underestimate the obesity epidemic because they use self-reported height and weight. We describe a novel bias-correction method and produce corrected state-level estimates of obesity and severe obesity.

METHODS: Using non-parametric statistical matching, we adjusted self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS) 2013 (n = 386,795) using measured data from the National Health and Nutrition Examination Survey (NHANES) (n = 16,924). We validated our national estimates against NHANES and estimated bias-corrected state-specific prevalence of obesity (BMI≥30) and severe obesity (BMI≥35). We compared these results with previous …

Legal Space For Syringe Exchange Programs In Hot Spots Of Injection Drug Use-Related Crime., Sean T Allen, Monica S. Ruiz, Jeff Jones, Monique M Turner

Prevention and Community Health Faculty Publications

BACKGROUND: Copious evidence indicates that syringe exchange programs (SEPs) are effective structural interventions for HIV prevention among persons who inject drugs (PWID). The efficacy of SEPs in supporting the public health needs of PWID populations is partially dependent on their accessibility and consistent utilization among injectors. Research has shown that SEP access is an important predictor of PWID retention at SEPs, yet policies exist that may limit the geographic areas where SEP operations may legally occur. Since 2000 in the District of Columbia (DC), SEP operations have been subject to the 1000 Foot Rule (§48-1121), a policy that prohibits the …

Optimising Text Messaging To Improve Adherence To Web-Based Smoking Cessation Treatment: A Randomised Control Trial Protocol, Amanda L. Graham, Megan A. Jacobs, Amy M. Cohn, Sarah Cha, Lorien C. Abroms, George D. Papandonatos, Robyn Whittaker

Prevention and Community Health Faculty Publications

Introduction Millions of smokers use the Internet for smoking cessation assistance each year; however, most smokers engage minimally with even the best designed websites. The ubiquity of mobile devices and their effectiveness in promoting adherence in other areas of health behaviour change make them a promising tool to address adherence in Internet smoking cessation interventions. Text messaging is used by most adults, and messages can proactively encourage use of a web-based intervention. Text messaging can also be integrated with an Internet intervention to facilitate the use of core Internet intervention components.

Methods and analysis We identified four aspects of a …

Smoking Cessation Support For Pregnant Women: Role Of Mobile Technology., Christina L Heminger, Jennifer M. Schindler-Ruwisch, Lorien C. Abroms

Prevention and Community Health Faculty Publications

BACKGROUND: Smoking during pregnancy has deleterious health effects for the fetus and mother. Given the high risks associated with smoking in pregnancy, smoking cessation programs that are designed specifically for pregnant smokers are needed. This paper summarizes the current landscape of mHealth cessation programs aimed at pregnant smokers and where available reviews evidence to support their use.

METHODS: A search strategy was conducted in June-August 2015 to identify mHealth programs with at least one component or activity that was explicitly directed at smoking cessation assistance for pregnant women. The search for text messaging programs and applications included keyword searches within …

Enhancing Access To Alcohol Use Disorder Pharmacotherapy And Treatment In Primary Care Settings: Adapt-Pc., Hildi J Hagedorn, Randall Brown, Michael Dawes, Eric Dieperink, Donald Hugh Myrick, Elizabeth M Oliva, Todd H Wagner, Jennifer P. Wisdom, Alex H S Harris

Health Policy and Management Faculty Publications

BACKGROUND: Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation …

Enhancing Access To Alcohol Use Disorder Pharmacotherapy And Treatment In Primary Care Settings: Adapt-Pc., Hildi Hagedorn, Randall Brown, Michael Dawes, Eric Dieperink, Donald Hugh Myrick, Elizabeth Oliva, Todd Wagner, Jennifer P. Wisdom, Alex Harris

Health Policy and Management Faculty Publications

BACKGROUND: Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation …

Building Capacity In Implementation Science Research Training At The University Of Nairobi., George O Osanjo, Julius O Oyugi, Isaac O Kibwage, Walter O Mwanda, Elizabeth N Ngugi, Fredrick C Otieno, Wycliffe Ndege, Mara Child, Carey Farquhar, Jeremy Penner, Zohray Talib, James N Kiarie

Health Policy and Management Faculty Publications

BACKGROUND: Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science.

METHODS: This paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training …

Workforce Planning And Development In Times Of Delivery System Transformation, Patricia Pittman, Ellen Scully-Russ

Health Policy and Management Faculty Publications

Background

As implementation of the US Affordable Care Act (ACA) advances, many domestic health systems are considering major changes in how the healthcare workforce is organized. The purpose of this study is to explore the dynamic processes and interactions by which workforce planning and development (WFPD) is evolving in this new environment.

Methods

Informed by the theory of loosely coupled systems (LCS), we use a case study design to examine how workforce changes are being managed in Kaiser Permanente and Montefiore Health System. We conducted site visits with in-depth interviews with 8 to 10 stakeholders in each organization.

Results

Both …

A New Look At Care In Pregnancy: Simple, Effective Interventions For Neglected Populations, Stephen Hodgins, James M. Tielsch, Kristen Rankin, Amber Robinson, Annie Kearns, Jacquelyn Caglia

Global Health Faculty Publications

Background

Although this is beginning to change, the content of antenatal care has been relatively neglected in safe-motherhood program efforts. This appears in part to be due to an unwarranted belief that interventions over this period have far less impact than those provided around the time of birth. In this par, we review available evidence for 21 interventions potentially deliverable during pregnancy at high coverage to neglected populations in low income countries, with regard to effectiveness in reducing risk of: maternal mortality, newborn mortality, stillbirth, prematurity and intrauterine growth restriction. Selection was restricted to interventions that can be provided by …

Knowledge, Confidence, Intention, And Motivation: Hegemonic Masculinity's Influence Upon Nutritional Habits Of Males, Sara Chizmar

Honors Undergraduate Theses

With the increasing incidence of chronic diseases such as Type 2 Diabetes Mellitus and cardiovascular disease and the growing obesity epidemic, the need to increase nutritional literacy amongst the general public is paramount. Men tend to lack a strong base of nutritional knowledge. Masculinity is one of the factors preventing many men from making good nutritional choices.

The aim of this study was to investigate hegemonic masculinity in relation to current level of nutritional knowledge as well as perceptions and attitudes regarding dietary behaviors and intention to eat a healthy diet among a sample of males. A convenience sample of …

Clinician Mindfulness Practice And The Implications For Burnout Mitigation: Mindfulness As A Values Component Of Self-Care, Stephanie Wachter

Counselor Education Theses

Over 40 years after Freudenberger (1975) introduced the term, burnout remains a critical concern among mental health clinicians. Many researchers in recent decades have focused their attention upon burnout prevention, exploring the practices of clinicians, and proposing the possible factors at-play in counselor, therapist, and social workers’ resiliency in the face of vicarious trauma, and other burnout factors. Mindfulness is a growing area of interest in this course of study, with yoga, meditation, and visualizations as some of the exercises associated with the practice and its apparent benefits. This qualitative study examined mindfulness as a component of mental health clinician …

Understanding Hiv-Related Vulnerabilities And Stigma Among Egyptian Youth, Nahla G. Abdel-Tawab, Doaa Oraby, Sally Saher, Sarah Ismail

Poverty, Gender, and Youth

The overall objective of this study is to provide an evidence-based description and interpretation of the HIV-related risks and vulnerabilities faced by different subgroups of youth in Egypt. The report is part of a six-country study that was conducted by the Population Council in Egypt, Kenya, Nigeria, Senegal, South Africa, and Uganda. The study examines social, economic, cultural, and legal factors that may contribute to youth’s increased vulnerability to HIV and documents the situation of the policy and programmatic responses. The study identified poverty, unemployment, delayed marriage, and gender inequality as examples of factors that increase young people’s risk-taking behavior …

Addressing Intimate Partner Violence And Power In Relationships In Hiv Testing Services: Results Of An Intervention Piloted In Nairobi, Kenya, Nicole Haberland, Charity Ndwiga, Katharine Mccarthy, Margaret Makanyengo, Rose Kosgei, Cecilia Choi, Julie Pulerwitz, Sam Kalibala

HIV and AIDS

The overarching goal of this study was to pilot an approach to HIV testing services (HTS) that addresses intimate partner violence (IPV) and sexual relationship power (SRP) inequalities, and explores the intervention’s potential for improving uptake and retention of antiretroviral therapy and prevention of mother-to-child transmission services. The project was implemented in Kenyatta National Hospital’s (KNH) antenatal care (ANC) clinic, and examined intermediate indicators of effect, as well as operational issues around incorporating attention to IPV in hospital procedures, especially in high-volume, high-need settings like KNH’s. The findings from this study suggest that providing some minimal IPV/SRP counseling to all …

An Integrated Peer Outreach And Clinic-Based Intervention To Improve The Sexual Health Of Young Men Who Have Sex With Men In Myanmar: A Link Up Evaluation, Population Council

HIV and AIDS

This brief describes an evaluation that assessed the impact of a peer-driven intervention for young men who have sex with men (MSM) in Myanmar, designed to improve the sexual health and rights of this marginalized community. The intervention and evaluation activities were conducted as part of Link Up, a global consortium led by the International HIV/AIDS Alliance aimed at improving sexual and reproductive health and rights among young vulnerable communities in Africa and Asia. In collaboration with the Burnet Institute, the Population Council–led evaluation study sought to assess whether the Link Up intervention improved sexual and health-seeking behaviors, and whether …

Impact Of Peer Education And On-Site Clinical Services For Female Sex Workers In Bangladesh Brothels: A Link Up Evaluation Study, Population Council

HIV and AIDS

This brief describes an evaluation of a brothel-based HIV and sexual and reproductive health and rights (SRHR) intervention that combined peer outreach with the provision of on-site clinical services in several Bangladesh brothels. The aim of this evaluation was to assess whether peer educator one-on-one or group sessions and on-site satellite clinics improved SRHR knowledge and behaviors among women who sell sex in three Bangladesh brothels. The study was conducted by the Population Council as part of the Link Up project, a global consortium led by the International HIV/AIDS Alliance aimed at improving the SRHR of young people. The findings …

Reducing Provider-Held Stigma And Improving Young Client Satisfaction In Bangladesh: Findings From A Link Up Evaluation, Population Council

HIV and AIDS

To address HIV stigma in Bangladesh, a training program was designed and evaluated among service providers as part of Link Up, a global project led by the International HIV/AIDS Alliance designed to improve the sexual and reproductive health and rights (SRHR) of young people. These trainings aimed at sensitizing healthcare providers to the needs and rights of young people at high risk of stigmatization—such as sex workers, sexual minorities, or young people who engage in premarital sex. The Population Council collaborated with Marie Stopes International Bangladesh (MSIB) to evaluate whether stigma-reduction trainings improved provider attitudes toward these young marginalized populations, …

Sexual And Reproductive Health And Rights Needs Of Young Men Who Live In The Streets In Dhaka City: A Link Up Exploratory Study, Population Council

HIV and AIDS

Under the Link Up project—a global consortium led by the International HIV/AIDS Alliance and supported by the Dutch Ministry of Foreign Affairs—the Population Council conducted an exploratory study of the HIV and sexual and reproductive health and rights (SRHR) needs of young men who live in the streets of Dhaka City, Bangladesh. The study investigated their knowledge, behaviors, needs, and service utilization related to HIV and SRHR. The findings elucidate the substantial vulnerabilities and risks faced by young men who live in the streets of Dhaka City, most notably in terms of sexual risk and physical violence. Participants reported very …

Using Peers To Improve Sexual And Reproductive Health And Rights Of Young People Living With Hiv In Uganda: Findings From A Link Up Evaluation, Population Council

HIV and AIDS

Link Up, a global consortium led by the International HIV/AIDS Alliance, sought to meet the immediate HIV care needs and also the broader sexual and reproductive health and rights (SRHR) for Ugandan young people living with HIV (YPLHIV), by creating linkages between comprehensive community- and facility-based HIV and SRHR services. In addition, Link Up delivered health education, counseling, and peer support tailored to the needs of YPLHIV in order to educate and empower them to recognize their rights, and feel confident in seeking health services. This brief presents findings from the Population Council’s evaluation of Link Up activities among YPLHIV …

Building Evidence To Guide Prep Introduction For Adolescent Girls And Young Women, Nanlesta Pilgrim, Sanyukta Mathur, Ann Gottert, Naomi Rutenberg, Julie Pulerwitz

HIV and AIDS

This document was developed by the Population Council, with support from the Bill & Melinda Gates Foundation, to provide DREAMS country teams with practical guidance on building evidence to guide pre-exposure prophylaxis (PrEP) introduction for adolescent girls and young women (AGYW). The primary audiences for this document are health policymakers and program planners who will be making decisions about how PrEP is introduced and the researchers who will assess AGYW’s specific needs and experiences. Our aim is to complement emerging global guidance on PrEP and ongoing work regarding delivery platforms, marketing, and policy and regulatory frameworks for PrEP introduction more …

How To Reduce Hiv Risk Among Adolescent Girls And Young Women In Sub-Saharan Africa? Implementation Science Around The Dreams Initiative, Population Council

HIV and AIDS

The Population Council, with funding from the Bill & Melinda Gates Foundation and the US Agency for International Development through Project SOAR, is leading the implementation science portfolio of the timely and innovative DREAMS partnership in 10 sub-Saharan countries, producing evidence to strengthen DREAMS activities and other community-based programming. The Council’s research focuses on how best to reach the most vulnerable adolescent girls and young women (AGYW) and their male partners and engage them in activities and services, and how to roll out pre-exposure prophylaxis (PrEP) for HIV prevention among AGYW. By examining these critical HIV prevention issues, the Council’s …

Impact Of A Community-Based, Hiv Intervention On Antiretroviral Treatment Retention And Adherence In Tanzania, Project Soar

HIV and AIDS

Project SOAR is contributing to the evidence base on community-based care models by conducting implementation research in Tanzania, a country where 1.5 million people are in need of HIV care services, and where clients eligible for antiretroviral therapy (ART) often drop out or are lost to follow up. While the country has a cadre of community-based HIV service (CBHS) providers, they remain largely informal. Project SOAR and its partners are evaluating a coordinated, integrated model in which CBHS providers deliver an enhanced service package to HIV-positive clients. The evaluation will advance understanding of the value of CBHS providers in improving …

Project Soar's Voluntary Medical Male Circumcision Portfolio, Project Soar

HIV and AIDS

Project SOAR has developed an extensive voluntary medical male circumcision (VMMC) portfolio to support multiple countries with data to make informed policy and programmatic decisions about VMMC that address their specific needs and environments. A critical component of this portfolio is research utilization. At the country level, Project SOAR seeks to generate data to support planning, implementing, and monitoring VMMC programs and increase access to and use of this data through user-friendly interfaces and dissemination strategies. Simultaneously, SOAR aims to advance VMMC as a vital prevention strategy by filling important data gaps in the global discourse around VMMC. This brief …