Public Health Commons^™

Improving Glycemic Control In Adult With Type 2 Diabetes, Basirat Romoke Triplett

Walden Dissertations and Doctoral Studies

Ninety percent of people with diabetes have Type 2 diabetes mellitus (T2DM). T2DM is a complex disease that affects every organ in the body, which makes effective management of the disease imperative. The American Association of Clinical Endocrinologist (AACE) and American College of Endocrinology (ACE) strongly recommended early treatment initiation among the target population to delay disease progression and complications. The purpose of this evidence-based project was to examine the impact of using the T2DM management algorithm for effective management of adults with T2DM over a 3-month period. The shared experience decision-making model and the chronic care model were used …

Examining The Role Of Perceived Benefits And Barriers In Physical Activity Behavior For Cancer Prevention And Control, Matthew Cole Ainsworth

All ETDs from UAB

Physical activity (PA) is important for health outcomes like breast cancer, but most U.S. adults do not meet recommended guidelines. Behavioral theories like the Social Cognitive Theory (SCT) have demonstrated success in PA behavior change, but perceived benefits and barriers are understudied. PA time barriers are shared between healthy and cancer survivor populations, and study of time use in breast cancer survivors using mobile phone technology like the Life in a Day (LiaD) app would support future intervention development. We conducted 3 studies to investigate benefits and barriers to PA in adults and time use among breast cancer survivors to …

Effects Of Medicare Reimbursement Policies On The Quality Of Hospital Care, Monica Aswani

All ETDs from UAB

This dissertation is composed of two papers related to the role of social risk factors in the Hospital Readmissions Reduction Program (HRRP). As value-based initiatives like the HRRP become more commonplace, there is growing need to understand the relationship between performance in these programs and social risk factors, such as race and poverty, which are not incorporated in the program’s risk adjustment methodology. To address this gap in the literature, this dissertation specifically focuses on three areas: 1) how hospital and community factors are related to average HRRP penalties, taking the context of geography into account, 2) how hospital and …

Parental Decision-Making In Use Of Complementary And Alternative Medicine, Meka B. Astin

All ETDs from UAB

One health care trend is the growing public interest in, and use of, complementary and alternative medicine (CAM). Research in the United States suggests that significant numbers of children are involved in various forms of alternative medicine. The purpose of this dissertation is to assess the predictors of parental decision-making of CAM use for their child using five categories of CAM therapies: alternative medical systems, biologically- based, mind-body, manipulative, and a separate and distinct category to include all CAM medical systems. Andersen’s health care Utilization Model (HUM), which holds that health service use is a function of predisposing, enabling, needs …

Association Between Local Health Departments’ Engagement In Phab Accreditation And Budget Cuts Prevention, Ghadeer M. Albashir

College of Graduate Studies: Theses & Dissertations

Objectives: The primary purpose of this study is to examine whether engagement in Public Health Accreditation Board (PHAB) accreditation process and its requirements are associated with budget cuts prevention for local health departments (LHDs). Methods: For this study, we performed multinomial logistic regression using the 2016 National Profile of Local Health Departments Survey conducted by the National Association of County and City Health Officials. Results: While budget did not change for a majority of LHDs in comparison with previous year (48.6%), there were 28.7% that reported budget increase, and almost a quarter of LHDs had reduced budget (23%). The multinomial …

Cutting The Cords: Provider, Payer, Policy And Maternity Outcomes In Selected U. S. States, Courtney Gustin

College of Graduate Studies: Theses & Dissertations

Objective: The purpose of this study was to determine if there is variation in interventions and complications in the labors of women cared for by nurse midwives compared with physicians after controlling for medical risks and sociodemographic factors in pregnant women in Georgia, New Mexico, Illinois, Virginia, and Alaska.

Methods: The study was based on a secondary analysis of 2015 Birth Certificate Data from the National Center for Health Statistics. The outcome variables included VBAC, induction/augmentation of labor, third and fourth-degree laceration, and chorioamnionitis. The exposure of interest was provider type- nurse-midwife or physician. Multiple logistic regression was used to …

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 …

The Evolving Landscape Of Mechanical Circulatory Support In The United States: Observations From National Registries, Ryan Segler Cantor

All ETDs from UAB

Mechanical circulatory support (MCS) is a rapidly evolving field. This dissertation describes trends in patient selection, device utilization, and outcomes for adult and pediatric patients receiving MCS in the United States by examining data from two national registries. Trends in adult MCS device recipients and their support outcomes were evaluated using data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), a national registry collecting detailed information for patients implanted with Food and Drug Administration (FDA)-approved durable MCS devices. Between June 2006 and December 2016, INTERMACS enrolled more than 19,000 patients. During this time, the widespread use of devices …

Psychosocial Job Stress And Oxidative Stress In Emergency Department Nurses, Rupkatha Bardhan

All ETDs from UAB

Job stress often causes work-related physical injuries and chronic exposure to such environment may lead to poor health outcomes. Job stress in recent years has grown significantly within the workforce due to performance pressure, long work hours and poor pay structures. Nurses work in the forefront to save patients’ lives. High job demand in this noble profession often leads to progressive decline in physical and mental health. There are existing reports that nurses in the United States (US) suffer from “burnout” syndrome which may also negatively affect patient care. There are very few studies that measured work-related stress in nurses …

Immunosuppression And Risk Prediction Of Sepsis Following Solid Organ Transplantation, John Patrick Donnelly

All ETDs from UAB

Solid organ transplant (SOT) recipients typically need immunosuppressive therapy (IST) to protect graft function and regimens may include an induction agent (e.g., anti-thymocyte globulin [ATG] or alemtuzumab) with maintenance medications (e.g., tacrolimus, mycophenolate mofetil [MMF], mycophenolic acid [MPA], or azathioprine [AZA]). Sepsis, or organ dysfunction resulting from a dysregulated host response to infection, is a common complication among SOT recipients. Using national data from the United States Renal Data System (USRDS), we sought to determine the associations of IST regimens and maintenance medication exposure with sepsis risks and outcomes among kidney transplant recipients (KTRs). Using USRDS and single center data, …

Psychological Well-Being And Smoking Cessation, Christopher Thorne

All ETDs from UAB

Introduction: The substantial death toll from smoking combined with the low success rates of current treatment approaches warrants further investigation into mechanisms that promote cessation. While the role of negative affect has been studied extensively in relationship to smoking cessation, the role of psychological well-being (PWB; e.g., life satisfaction, optimism, positive affect, purpose in life, resilience) has received little attention. Treatment outcomes might improve with a better understanding of PWB’s role in smoking cessation. Methods: Relationships between smoking and PWB were examined in three studies. First, using panel data from the biennial, longitudinal Health and Retirement Study, I developed separate …

Assessing Barriers And Facilitators To Appropriate Care For Chronic Pain And Prescription Opioid Abuse, Allyson Varley

All ETDs from UAB

The objective of this study was to understand and assess barriers and facilitators to the uptake of appropriate care for co-occurring chronic noncancer pain (CNCP) and opioid use disorder. Rates of CNCP and opioid overdose have doubled in the past decade. When a patient transitions from appropriate use to misuse, significant changes must be made to their treatment plan. Considering most CNCP is treated with opioids in the primary care setting, primary care providers (PCPs) are potential change agents to remediate the epidemic of opioid abuse. Although studies have explored opioid stewardship, we still lack an understanding of the factors …

Assessment Of A Peer Mentoring Program At Lawson State Community College, Teneasha Washington

All ETDs from UAB

ABSTRACT Colleges and universities have begun implementing mentoring programs to offset rising attrition rates; however, the literature on the benefits of these programs is limited particularly among community colleges with peer mentoring programs serving minority students. Further limiting our understanding of post-secondary peer mentoring programs is the lack of research on mentor’s as well as mentee’s perspectives on the mentoring experience. As mentors and mentees serve in a variety of capacities within the mentoring program, it is often difficult to identify outcomes that can be assessed within the mentoring program. Although the success of peer mentoring programs is directly affected …

Visual, Attentional, And Cognitive Risk Factors For Motor Vehicle Collision Involvement Among Older Adults, Carrie Huisingh

All ETDs from UAB

Motor vehicle collisions are a major public health problem for older adults in the United States. In 2013, there were 5,671 older adults killed and an estimated 222,000 injured in motor vehicle crashes. After adjusting for miles driven, the risk of crashing increases rapidly after age 70, nearly equal to that of younger drivers whose crash rate is the highest among all age groups. Driving is a highly complex task that relies on a variety of visual and cognitive functions. A large body of work has demonstrated that drivers with visual sensory impairments and/or higher-order visual-cognitive processing deficits, those who …

Applying Polytomous Rasch Analysis To Validate Parenting Related Scales, Lei Huang

All ETDs from UAB

This study applies Rasch analysis to validate two scales in the Parenting for the First-time project: Beck Depression Inventory (BDI-II) and Parenting Stress Index (PSI). The main purpose of this study is to evaluate quality of the two scales by using Rasch analysis to examine the unidimensionality, reliability, fit statistics, group and time invariance, and optimal response categories. Meanwhile, this study also compares the results of Rasch model and Classical Test Theory (CTT) to assess the advantages of Rasch analysis. Result: Both Rach analysis and CTT show the evidence of unidimensionality of BDI-II in the three administrative periods: Prenatal, 6 …

Heart Failure In A Contemporary Biracial Cohort, Matthew Mefford

All ETDs from UAB

Heart failure (HF) is the inability of the heart to meet the perfusion needs of the body. HF is a leading contributor to the burden of cardiovascular disease (CVD) and remains a public health concern. Hypertension is a major modifiable risk factor for the prevention and management of HF. Hypertension develops earlier, is less controlled, and has a stronger association with some CVD and renal outcomes among blacks versus whites. These disparities may extend to HF. In addition, adults with HF often have complex treatment regimens due to multimorbidity, making medication adherence an issue. The goal of this dissertation was …

Hiv Disclosure, Retention In Hiv Care, And Viral Load Suppression : A Study Among New To Hiv Care Patients, Riddhi Modi

All ETDs from UAB

HIV remains a major ongoing public health problem globally and in the United States (US). Despite the advances in the antiretroviral therapy (ART), new HIV cases continue to occur. Hence, understanding the factors that influence patient’s decision to HIV treatment and prevention is of paramount. HIV disclosure, an important modifiable behavior, is a barrier to linkage and engagement in HIV care. Thus far, studies examining HIV disclosure and its impact on HIV related outcomes, retention in care (RIC) and viral load (VL) suppression among HIV patients newly initiating care are scant. While these studies provide insights on risk factors of …

Exploring The Relationship Between Social Support, Pharmacy Access And Medication Adherence, Favel Leah Mondesir

All ETDs from UAB

Barriers of medication adherence exist among people with coronary heart disease (CHD) and CHD risk factors, including, poor social support, poor pharmacy access and other patient, social/economic, therapy, condition, and health-care system/health-care team-related factors. However, there are few data on influence of these factors on medication adherence among people with CHD risk factors other than diabetes. Therefore, this dissertation aimed to investigate associations of medication adherence with social support (n=17,113) and pharmacy access (n=8,250) quantitatively using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (black and white adults with CHD or CHD risk factors ≥45 …

Assessing The Comparative Effect Of Tocilizumab On Risk Of Cardiovascular Disease Among Rheumatoid Arthritis Patients Using Claims Data: A Direct Comparison Among Biologic Disease-Modifying Antirheumatic Drugs, Fenglong Xie

All ETDs from UAB

ASSESSING THE COMPARATIVE EFFECT OF TOCILIZUMAB ON RISK OF CARDIOVASCULAR DISEASE AMONG RHEUMATOID ARTHRITIS PATIENTS USING CLAIMS DATA: A DIRECT COMPARISON AMONG BIOLOGIC DISEASEMODIFYING ANTIRHEUMATIC DRUGS FENGLONG XIE PhD-EPID ABSTRACT Tocilizumab is a humanized monoclonal anti-body against the interleukin-6 receptor and is effective in the treatment of rheumatoid arthritis (RA) [1]. Multiple studies have observed unfavorable changes in the lipid profile of tocilizumab-treated RA patients. Few studies have compared the cardiovascular disease (CVD) risk associated with tocilizumab to other biologic disease-modifying antirheumatic drugs (bDMARDS). Due to limitations in existing studies, the real-world association of tocilizumab with CVD risk remains uncertain. …

Cigarette Smoking Among Hiv-Positive Patients In Routine Clinical Care, Cosmas Mudenda Zyambo

All ETDs from UAB

People living with HIV (PLWH) are two to three times more likely to be current smokers, less likely to quit smoking and more likely to relapse than those in the general population. Although smoking status, prescription of smoking cessation medications (SCMs), smoking cessation and relapse has been explored in this population, few have investigated using a large sample of PLWH receiving routine HIV care. Using data from a large observational cohort of PLWH receiving routine care in Birmingham, we determined: 1) Factors associated with smoking status; 2) Factors associated with prescription of SCMs; 3) Predictors of smoking cessation and; 4) …

The Effect Of Wearing A Lumbar Belt On Biomechanical And Psychological Outcomes Related To Maximal Flexion-Extension Motion And Manual Material Handling, Ali Shahvarpour, Richard Preuss, Michael J.L. Sullivan, Alessia Negrini, Christian Larivière

Études primaires

Workers with low back pain (LBP) may benefit from wearing a lumbar belt (LB), but the biomechanical and psychological mechanisms involved are not fully understood. Two types of flexible LB (extensible and non-extensible) were compared to a control condition (no LB) regarding pain-related (pain, fear of pain and catastrophizing) and biomechanical (range of motion – ROM) outcomes related to two tasks: maximal trunk flexion-extension and manual material handling. Healthy controls and participants with LBP were tested. During both tasks, the two LBs reduced the lumbar ROM in participants with LBP in the same way as healthy controls. This was observed …

Influence Of Psychological Capital And Thinking Perspectives On Construction Safety Climate And Performance, Anne-Perrine Pascale Cades

Walden Dissertations and Doctoral Studies

Understanding safety factors in construction is critical to reducing accident frequency and severity. Grounded in the safety performance model, this study was conducted to examine the impact of psychological capital (PsyCap), which consists of the shared variance of hope, efficacy, resilience and optimism, and Past, Present, and Future thinking perspectives, on safety climate and performance. A nonexperimental quantitative design was used to determine whether PsyCap and thinking perspectives of construction project employees predicted safety performance and/or moderated the relationship between safety climate and performance across construction sites in different countries. 411 construction employees were recruited via a multistage and clustering …

Poverty Rate And Occurrence Of Foodborne Illness Risk Factors In Retail Facilities, Margolite Joseph Cesar

Walden Dissertations and Doctoral Studies

Despite the efforts of food safety regulations and rules, food contamination remains a public health concern and prevalent vehicle of pathogens. This study identifies the predictors of food risk in different types of food establishments in Miami Dade County, Florida during the period November 2014 - November 2016. Guided by the epidemiologic triangle model, this correlational study analyzed the log number of risk factor violations and failure rates controlling for US Census sociodemographic data (2010 to 2014) for the food establishment neighborhoods by using linear and logistic regression. Results indicated that most of food entity types are significant predictors of …

Physical Activity And Veteran Status In Obesity And Chronic Obstructive Pulmonary Disease, Erin Mcguire Kren

Walden Dissertations and Doctoral Studies

There are few data available regarding the relationship between physical activity and veteran status in those with combined chronic obstructive pulmonary disease (COPD) and obesity. COPD is a common illness and a leading cause of death in the United States. Veterans represent a distinct subpopulation in the United States and are more likely to have COPD, which is a disease with a high rate of comorbidities such as obesity. Physical activity can improve outcomes for those with COPD and obesity. However, recommendations for physical activity for those with COPD and obesity are vague. This study, based on the self-determination theory, …

Association Between Age Of Women When Diagnosed With Endometriosis And Infertility, Whitney Kennedy

Walden Dissertations and Doctoral Studies

Abstract

Because endometriosis is considered to be the primary cause of infertility in women and

the diagnosis is known to be delayed by many years, it is important to understand the

association between endometriosis and infertility. The purpose of this cross-sectional,

secondary data analysis study was to determine whether there was an association between

the age of women when diagnosed with endometriosis and infertility. Using the general

model of total patient delay (i.e., the Andersen model) as a theoretical foundation, data

for this study was collected by assessing patient medical records of women with

endometriosis at multiple OB-GYN clinics in …

Time Banks As Aging-In-Place Initiatives, Calli Sajnani

Walden Dissertations and Doctoral Studies

There has been growing concern over how state and federal governments can support the increasing population of aging Americans and their need for long-term care. Current insurance funding models cover acute hospitalization and skilled care only, leaving unskilled care needs and homemaker services at the full expense of those in need. Time banking allows individuals to exchange or barter time for goods or services without monetary payment. There is insufficient evidence to determine if members believe time banks to be a viable alternative to support aging-in-place care needs. This phenomenological study explored time banking as a potential vehicle for nonskilled …

Strategies To Reduce Occupational Injuries And Illnesses In Government Agencies, Sandra Montgomery

Walden Dissertations and Doctoral Studies

Despite regulatory efforts of the Occupational Safety and Health Administration (OSHA), 104 cases of nonfatal occupational illnesses and injuries (OIIs) per 10,000 full-time workers required time away from work in 2015. Although OII rates in private and public sectors are high, the rates among state and local government agencies were over 50% higher than private sector rates in 2015, especially in the healthcare industry. OIIs can lead to reduced organizational productivity and performance. Guided by the leader member exchange theory (LMXT) and risk homeostasis theory (RHT), the purpose of this single case study was to explore effective strategies that supervisors …

Understanding Parenting Styles Of Second-Generation Parents Of Residential School Survivors Within Treaty 8 Reserves, Judy Kim-Meneen

Walden Dissertations and Doctoral Studies

Approximately 150,000 First Nation, Metis, and Inuit children attended Canadian residential schools from the 1840s to 1996. Most residential school children had negative experiences of physical, verbal, and sexual abuse that led to parenting repercussions once these children became parents. These repercussions of residential schools led to a rate of neglect for First Nation children 12 times higher than non-First Nation children. The purpose of this qualitative phenomenological descriptive study was to explore the lived experiences of second generation parents, who were schooled in residential schools as children and their current parenting styles. The conceptual frameworks of trauma theory and …

Predictors Of Blood Pressure And Lipids Levels Among African Americans, Frank Lanor

Walden Dissertations and Doctoral Studies

African Americans disproportionately develop cardiovascular disease risk factors including high blood pressure and high cholesterol levels in comparison to European Americans. The purpose of this study was to examine the associations of diet quality and physical activity with blood pressure levels and cholesterol levels among African Americans. The social ecological model was the theoretical foundation for the study. Research questions were designed to examine the extent to which diet quality and physical activity predict blood pressure levels and cholesterol levels. The research design was quantitative cross-sectional secondary analysis of 959 participants. After controlling for demographic factors, body mass index, and …

Dissertation: Sociodemographics And Pancreatic Cancer Survival Rate, Sylvester Lewis

Walden Dissertations and Doctoral Studies

Pancreatic carcinoma or pancreatic cancer (PaCa) is an insidious disease with a prognosis of 6- to 12-month survival time for a late stage diagnosis. This problem has become crucial given that no study to date had been able to establish a definitive association between independent factors (other than a few diseases) and the survival rate of pancreatic cancer. The purpose of this quantitative, cross-sectional study was to determine whether an association exists between the independent, sociodemographic variables (marital status, age, education, income, and employment) and the outcome variable of survival rate. The social cognitive theory was the framework that provided …