Public Health Commons^™

Perceived Barriers To Oral Health Care Access For Massachusetts' Underserved Parents, Doudelyne Cenafils-Brutus

Walden Dissertations and Doctoral Studies

Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data …

Knowledge, Attitudes, And Beliefs About Preconception Care Among American Adolescent Females, Lynette Collins Collins

Walden Dissertations and Doctoral Studies

Despite an initiative to provide preconception care (PCC) and reproductive life planning (RLP) for all women of childbearing age, many women, especially those with low incomes, are not receiving it. As a result, there continues to be a high rate of infant morbidity and mortality in this population. Furthermore, low income adolescent females have not been adequately studied regarding this phenomenon. The purpose of this phenomenological study was to explore low income adolescent females' knowledge, attitudes, and beliefs about PCC and RLP in order to serve them more effectively. Five low income adolescent females, aged 18 to 21, were recruited …

Delaying First Pregnancies: Canadian Women's Knowledge And Perception Of The Consequences, Deborah Haynes

Walden Dissertations and Doctoral Studies

Many women aged 20-30 are postponing their first pregnancies until their mid 30s and beyond, which has resulted in compressed childbearing years and/or infertility. Little is known about the knowledge and understanding that Canadian women of advanced age (age 35-45) possess of their reproductive capacity. This phenomenological study sought to explore these women's knowledge and perception of their reproductive capacity in relation to the timing of first pregnancy. Research questions using the constructs of Ajzen's theory of planned behavior were developed to explore how the behavioral, normative, and control beliefs of women's childbearing behaviors were based on their perceptions of …

Disparities In Arkansas Mandated Immunization Coverage Among Natural Home And Foster-Care Adolescents, Jerome Essono Ngundue

Walden Dissertations and Doctoral Studies

Anecdotal evidence indicated vaccine coverage disparities among foster-care (FCA) and natural-home adolescents (NHA). Arkansas laws require 5 vaccines for school entry (FVSE) to prevent 9 common childhood diseases. The study problem was that Pulaski County, Arkansas adolescent birth cohort (PCABC) immunization rates were low compared to U.S. adolescents for these FVSE. This study examined the extent to which (1) PCABC immunization rates were significantly different from those estimated for U.S. adolescents in 2006–2008, (2) NHA and FCA immunization rates were different in 2003– 2008; (3) sociodemographic variables mediate associations between home of residence (HOR), NHA or FCA, and up to …

Interrelationships Of Colorism, Violence, And Sexual Behaviors Among Southern African American Women., Phaedra Christensen

Walden Dissertations and Doctoral Studies

Two significant public health concerns that threaten both the physical and mental health of African-American women are Intimate Partner Violence (IPV) and Human Immunodeficiency Virus (HIV). African-American women (AAW) in the south carry the greatest burden of HIV and disproportionately represent the region with an incidence of 71% for new HIV infections, and elevated rates of morbidity and mortality. In 2013, the murder rate among AAW was 2.5 times higher than it was among Caucasian women. Most of the published studies that explored the association between IPV and HIV had mixed populations, did not explore topics unique to AAs, or …

The Effect Of Federal Reporting Regulations On Hospital Investment In Community Building, Dorothy Magasis Escobar

Walden Dissertations and Doctoral Studies

The role of hospitals as partners in community health improvement is changing, especially for nonprofit hospitals receiving tax exemptions in exchange for providing benefits to the community. There are examples of reported health improvement activities funded through hospitals' charitable donations, but there's a gap in the literature on the effect of policy and legislation on hospitals' investments in community building activities that address the social determinants of health. Grounded in eco-social theory, this quantitative, correlational study compared secondary data from CA's nonprofit hospitals' annual 2009 and 2012 reports to determine what, if any, changes have occurred in the hospitals' investments …

Risk Factors For Hypertension Among African-Born Immigrants In The United States, John Ojih

Walden Dissertations and Doctoral Studies

Essential hypertension (HTN) has been and continues to be a serious public health problem across the globe, particularly among Black races, with an estimated morbidity rate of over 1 billion people and an estimated mortality rate of 9.4 million people worldwide. Essential HTN can lead to a host of chronic diseases including cardiovascular disease (CVD), stroke, myocardial infarction, brain damage, kidney failure, and retinopathy. The main purpose of this quantitative, descriptive, nonexperimental study was to investigate the association of physical inactivity, length of stay in the United States, immigrants' health status, and food security as risk indicators in the development …

Environmental Factors Associated With Body Mass Index Among Long Haul Truck Drivers, Charlotte Hughes Huntley

Walden Dissertations and Doctoral Studies

In 2009–2010, the prevalence of obesity among U.S. adults was 40%, and the prevalence was 69% among long haul truck drivers. Researchers have not established a clear relationship between working environment and weight among truck drivers. This quantitative cross-sectional study, using an ecological framework, evaluated the relationship between the working environment (sleep performance, food choices, driving environment, and activity level) and weight severity (e.g., body mass index [BMI]) among long haul truck drivers. One hundred and twenty six adults (46 + 10, years of age), including both genders (male = 97 and females = 29) completed an online questionnaire evaluating …

Rural Obese African American Women And Depression, Food Culture, And Binge Eating, Tracee Tamiko Smith

Walden Dissertations and Doctoral Studies

The rural African American population has a high incidence of severe psychosocial problems and a skewed perception of obesity, despite obesity's extremely high prevalence rate in this population. Despite the acknowledgements of these problems, there is a gap in literature relative to the effective treatments for obese African Americans diagnosed with depression. This study measured correlations between obesity and depression, binge eating, and food culture amongst African American women residing in Jefferson County, MS. The health belief model was used to guide an assessment of beliefs, perceptions, susceptibility, cues to action, and self-efficacy. A cross-sectional design was used based on …

Chronic Pain Causal Attributions In An Interdisciplinary Primary Care Clinic: Patient-Provider And Provider-Provider Discrepancies, Bryan Jensen

Theses and Dissertations

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed …

Perceptions Of Infertility Among Arab Women In The U.S, Zena Hamdan

Walden Dissertations and Doctoral Studies

Infertility is a serious public health issue. Infertile couples may perceive infertility differently based on their own cultural background. There is a paucity of literature about how infertility is perceived among Arab women living in the United States. The purpose of this study was to be able to understand how Arab women who live in Dearborn, Michigan feel about infertility and to understand their concerns and worries about their health status. The primary research questions asked Arab women how they perceive infertility and how infertility may impact their future. This qualitative case study was guided by the social support theory …

History Of Pregnancy-Loss And Maternal Socioeconomic Factors As Predictors Of Under-Five Child Mortality, Henry Chukwunonso Debem

Walden Dissertations and Doctoral Studies

Nigeria is one of the countries with the highest Under-5 Mortality rates (U5M) estimated at 117 deaths/1000 live births. Despite public health control initiatives, no significant improvement in U5M has been demonstrated. The purpose of the study was to determine whether history of Adverse Pregnancy Outcomes (APO) and maternal socioeconomic factors could predict the death of children before their fifth birthday, using the life course health development and fetal programming theories. The study population was women in their reproductive age (15- 49 years). The study was a secondary data analysis of the datasets obtained from three Nigeria Demographic and Health …

Exploring Obesity Risk Factors In Five Regions Of Virginia, Karen Toth Carpenter

Walden Dissertations and Doctoral Studies

Obesity continues to weaken our nation physiologically, psychologically and financially with an overall prevalence rate of 34.9% or 78.6 million Americans affected. Variance in obesity prevalence rates, in the state of Virginia, account for over a 15% difference from one health district to the next. The purpose of this research was to better explore the regional obesogenic factors that may exist among five health districts in the state of Virginia. The socio ecological theory provides the conceptual framework of the study to understand the variance in regional obesity rates, as a function of the contributing risk factors that a region …

Influence Of Public Insurance On Healthcare Access And Cancer Care, Wafa W. Tarazi

Theses and Dissertations

Medicaid expansion under the Affordable Care Act (ACA) facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Tennessee’s Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults in 2005. Pre-ACA expansions were associated with better access to and utilization of healthcare services. However, little is known about the effect of these policy changes on improvement in health outcomes for women diagnosed with breast cancer, access to care for cancer survivors, and the effect of generosity and duration of expansion on access to care.

This dissertation has three …

Development And Evaluation Of A Peer-To-Peer Intervention To Increase Self-Management Among Adult In-Center Hemodialysis Patients, Jennifer J. St Clair Russell

Theses and Dissertations

Background: Peer-to-peer (P2P) support programs have the potential to assist ESRD patients in managing their disease and improve outcomes. Yet, there is little research examining P2P programs’ impact on psychosocial outcomes and disease management behaviors.

Methods: A 4-month P2P mentoring intervention was designed and piloted in a facility serving 249 in-center hemodialysis patients in Lynchburg, Virginia. Preceded by a social marketing effort, which included a program naming contest and participant recruitment, the intervention included: (1) mentor training, (2) pairing of mentees and mentors, (3) kick-off social mixers, (4) ongoing meetings between mentees and mentors, (5) mentor training booster, and (6) …

Motivating Parents Of Kids With Asthma To Quit Smoking: The Effect Of The Teachable Moment And Increasing Intervention Intensity Using A Longitudinal Randomized Trial Design, Belinda Borrelli, Erin M. Tooley

Arts & Sciences Faculty Publications

Aims—We tested two aims: 1) The Teachable Moment (TM): whether second hand smoke exposure (SHSe) feedback motivates cessation in parents of children with asthma vs. parents of healthy children (HC) and 2) whether greater intervention intensity (Enhanced-PAM) produces greater cessation than a previously tested intervention (Precaution Adoption Model; PAM).

Design and interventions—Aim 1: Two home visits (asthma education or child wellness), and cessation induction using Motivational Interviewing and SHSe feedback. Aim 2: Post home-visits, parents with asthmatic children were randomized to PAM (n=171; 6 asthma education calls) or Enhanced-PAM (n=170; 6 asthma education/smoking cessation calls + repeat SHSe …

Prevalence, Reasons For Use, And Risk Perception Of Electronic Cigarettes Among Post-Acute Coronary Syndrome Smokers, Andrew M. Busch, Erin M. Tooley

Arts & Sciences Faculty Publications

Purpose—The use of electronic cigarettes (e-cigarettes) has risen dramatically in recent years. However, there is currently no published data on use of e-cigarettes among cardiac patients. The current study reports on the prevalence, reasons for use, and perceived risks of e-cigarettes among post-Acute Coronary Syndrome (ACS) patients. The relationship between e-cigarette use and post- ACS tobacco smoking cessation is also explored.

Methods—Participants were drawn from a randomized trial of smoking cessation treatments following hospitalization for ACS. The current study focuses on 49 participants that completed e- cigarette questions at 24 weeks post-ACS.

Results—51.0% of participants reported ever …

Comparison Of Secondhand Smoke Exposure In Minority And Non-Minority Children With Asthma, David A. Fedele, Erin M. Tooley

Arts & Sciences Faculty Publications

Objective—Determine if secondhand smoke exposure (SHSE) is related to asthma-related functional morbidity by examining racial/ethnic differences in Non-Latino White (NLW), African American, and Latino families and whether racial/ethnic SHSE differences across families persist when accounting for smoking factors.

Methods—Participants were 305 caregiver smokers of children with asthma. Two passive dosimeters measured SHS: one in the home and one worn by the child.

Results—Higher SHSE was related to greater asthma-related functional morbidity. African Americans had higher levels of home SHSE than Latinos (p = .003) or NLWs (p = .021). SHSE as assessed by the child …

Cancer Health Literacy And Hospitalization In The First Five Years Following A Cancer Diagnosis, Laura A. Cartwright

Theses and Dissertations

BACKGROUND: The field of health literacy research has been focused recently on developing more accurate measurement tools and understanding the relationship between health literacy and health outcomes. Individuals with lower levels of health literacy have worse health outcomes, including hospitalization rates, compared to those with adequate health literacy. This relationship has yet to be examined in the cancer patient population, although significant relationships between health literacy and cancer knowledge, screening behavior and quality of life have been found. This study is the first to examine the relationship between health literacy and hospitalization rates in a cancer patient population, and the …

Burnout In Firefighters: A Word On Methodology, Irvin Sam Schonfeld, Renzo Bianchi

Publications and Research

At least three methodological problems affect the study by Katsavouni et al. (2016). First, there are currently no diagnostic criteria for burnout, neither in the DSM-5, nor in the ICD-10. Second, one extremely important variable was omitted from this study of firefighters, namely, depression. Third, the authors did not control for relevant nonoccupational factors such as stressors occurring outside of work.

Data Management And Data Facilitation In Multi-Center Large Cohort Health Care Studies, Wei Wang

Dissertations, Master's Theses and Master's Reports

Data management and data facilitation is the foundation and a critical part for scientific investigations, especially with large cohort studies on health care, which may have multiple components collected from different institutes or different areas due to efficiency, cost, enrollment considerations. In this thesis, I consider how to design and to implement data management with multi-center health care research data. The research project that I joined focuses mainly on environmental health science, and the primary goal is to investigate the impact of nutritional and toxicant exposures in environment during fetal and early postnatal life on individual’s health outcomes over the …

The Case For Health Literacy Research In Qatar: Identifying Avenues For Progress, Yasar Alani

Theses

Abstract This thesis studies the attitudes of healthcare provider and consumer groups in Qatar towards health literacy via health promotion. Using Q methodology, data from healthcare providers and consumers was analysed to determine relative attitudes towards previous and future health campaign strategies in Qatar. Consumer data was also collected to determine attitudes towards current health promotion campaigns and the perceived effectiveness of campaigns in encouraging behaviour change. The research also investigates the obstacles that prevent healthcare consumers from adopting the healthier lifestyle choices advocated by some of these campaigns. Participants were residents of Qatar.

The concept of health literacy was …

Progesterone-Only Oral Contraceptive Pill, Breast Cancer, Heart Disease, And Stroke, Marsha Ema Samson

Theses and Dissertations

There is evidence from earlier studies that oral contraceptive pills may be a risk factor for certain chronic diseases, including heart disease, stroke, and breast cancer. Previous studies mainly focus on the estrogen component of combined (estrogen+ progestin) oral contraceptives (COCs) due to their popularity. This focus limits our understanding of progestin-only contraceptives and its relationship to commonly occurring chronic diseases. To provide insight into alternative methods of oral contraception, this dissertation explores the relationship between progestin-only oral contraceptive (POC) pills and heart disease, stroke, and breast cancer. We hypothesize that women using POCs are less likely to have certain …

Social Capital And Social Networks: The Importance Of Social Ties For Health Among Residents Of Disadvantaged Communities, Stephanie Child

Theses and Dissertations

Access to social capital via social networks is important for health and may be linked with chronic disease, including obesity and hypertension. Socioeconomic status (SES) may influence access to social capital and social network characteristics, and may also moderate the relationship between social capital, social networks, and health. Yet few studies have explored relationships between social capital, social networks, and chronic disease among resource poor individuals.

Respondent-driven sampling was employed to recruit participants (n=430) from low-income communities in the US South for a household survey as part of the Greenville Healthy Neighborhoods Project. The survey collected information about participants’ SES …

Enteric Fever: A Slow Response To An Old Plague, Carlos Franco- Paredes, M. Imran Khan, Esteban Gonzalez- Diaz, Jose I. Santos- Preciado, Alfonso J. Rodriguez Morales, Eduardo Gotuzzo

Centre of Excellence in Women and Child Health

Man is irremediably embedded in nature with complex interactions with all living organisms. Historically, the establishment of contemporary human societies has been influenced by our coexistence with other microorganisms living in highly interconnected habitats and ecologies. As a result, with the progression from unicellular to multicellular life, bacteria have coexisted with humans. In this biological journey, while there are important benefits provided by bacterial guests to the human host living in complex relationships and becoming part of their microbiome, some organisms are able to cause a wide spectrum of diseases. Among the large Enterobacteriaceae family, the genus Salmonella, a …

Status Of Paratyphoid Fever Vaccine Research And Development, Laura B. Martin, Raphael Simon, Calman A. Maclennan, Sharon M. Tennant, Sushant Sahastrabuddhe, M. Imran Khan

Centre of Excellence in Women and Child Health

Salmonella enterica serovars Typhi and Paratyphi (S. Paratyphi) A and B cause enteric fever in humans. Of the paratyphoid group, S. Paratyphi A is the most common serovar. In 2000, there were an estimated 5.4 million cases of S. Paratyphi A worldwide. More recently paratyphoid fever has accounted for an increasing fraction of all cases of enteric fever. Although vaccines for typhoid fever have been developed and in use for decades, vaccines for paratyphoid fever have not yet been licensed. Several S. Paratyphi A vaccines, however, are in development and based on either whole cell …

Nontyphoidal Salmonella Disease: Current Status Of Vaccine Research And Development, Sharon M. Tennant, Calman A. Maclennan, Raphael Simon, Laura B. Martin, M. Imran Khan

Centre of Excellence in Women and Child Health

Among more than 2500 nontyphoidal Salmonella enterica (NTS) serovars, S. enterica serovar Typhimurium and S. enterica serovar Enteritidis account for approximately fifty percent of all human isolates of NTS reported globally. The global incidence of NTS gastroenteritis in 2010 was estimated to be 93 million cases, approximately 80 million of which were contracted via food-borne transmission. It is estimated that 155,000 deaths resulted from NTS in 2010. NTS also causes severe, extra-intestinal, invasive bacteremia, referred to as invasive nontyphoidal Salmonella (iNTS) disease. iNTS disease usually presents as a febrile illness, frequently without gastrointestinal symptoms, in both adults and children. Symptoms …

Creating A Community Of Practice To Prevent Suicide Through Multiple Channels: Describing The Theoretical Foundations And Structured Learning Of Pc Cares, Lisa Wexler, Diane Mceachern, Gloria Difulvio, Cristine Smith, Louis F. Graham, Kirk Dombrowski

Department of Sociology: Faculty Publications

It is critical to develop practical, effective, ecological, and decolonizing approaches to indigenous suicide prevention and health promotion for the North American communities. The youth suicide rates in predominantly indigenous small, rural, and remote Northern communities are unacceptably high. This health disparity, however, is fairly recent, occurring over the last 50 to 100 years as communities experienced forced social, economic, and political change and intergenerational trauma. These conditions increase suicide risk and can reduce people’s access to shared protective factors and processes. In this context, it is imperative that suicide prevention includes—at its heart— decolonization, while also utilizing the “best …

Disparities In Access To Preventive Health Care Services Among Insured Children In A Cross Sectional Study, Christian King

Department of Nutrition and Health Sciences: Faculty Publications

Children with insurance have better access to care and health outcomes if their parents also have insurance. However, little is known about whether the type of parental insurance matters. This study attempts to determine whether the type of parental insurance affects the access to health care services of children. I used data from the 2009–2013 Medical Expenditure Panel Survey and estimated multivariate logistic regressions (N=26,152). I estimated how family insurance coverage affects the probability that children have a usual source of care, well-child visits in the past year, unmet medical and prescription needs, less than 1 dental visit per year, …

Depression Intervention Programs In Low-Income High Schools, Gopika Hari

Undergraduate Research Posters

It is estimated that 2.6 million adolescents suffer from major depressive episodes each year. Research has noted that symptoms in youth have become indicators of mental health complications later in life. Studies reveal that low income is a risk factor for depression and that socioeconomically-disadvantaged teenagers are more than twice as likely to develop mental illnesses. Only roughly 25% of children with mental illnesses receive adequate help and 80% of these resources come from schools. This study focuses on establishing the importance of depression intervention programs in low-income high schools and on designing novel guidelines for effective protocols. A compilation …