Public Health Commons^™

Identifying Challenges Different Provider Group Encounter In Managing Opioid Use Disorder, Chinonye Anumaka

Muskie School Capstones and Dissertations

The Centers for Disease and Control (CDC) describes opioid use disorder (OUD) also known as opioid addiction as the problematic pattern of opioid use leading to clinically significant impairment or distress. In 2016, about 2.1 million people were diagnosed of OUD in the US. In Maine, York County has the third highest drug overdose response and had 166 deaths occurring between 2012-2016. York County is a designated medically underserved area and has a shortage of provider workforce and limited treatment infrastructure. To further understand the challenges providers in York County encounter in managing patients with OUD, 6 focus groups was …

For Our Health: Partnerships In Maine, Joanna Morrissey

Muskie School Capstones and Dissertations

The Maine Shared Community Health Needs Assessment (Maine Shared CHNA) has created a mature network of local collaborations that come together every three years to conduct a statewide needs assessment. This capstone looks into whether there have been successful partnerships that continue collaborating on health improvement planning and implementation post CHNA. Key questions included, “Where there were successful collaborations, what was it that made them successful? What are the challenges to forming and maintaining a collaboration and how have groups overcome those challenges?” A comparative case study approach was used in order to compare and contrast two sites, each demonstrating …

A Comparative Analysis Of Primary Care Practice Payment Models: Practice And System Level Implications, Travis Masood

Muskie School Capstones and Dissertations

EXECUTIVE SUMMARY

The purpose of this capstone was to (1) assess the likely effects of various primary care practice reimbursement models on quality of care and costs, (2) assess each reimbursement model’s applicability relative to practice size, and (3) analyze each model’s practice and system level implications. This was done through the conduction of a comparative analysis of current practice reimbursement models. The questions addressed in this analysis include:

• What are the primary, practice reimbursement models currently being used?
• What are the implications of these models on quality and costs?
• Are these reimbursement models applicable in all practice types (e.g. …

Recommendations For Creating A Certification System For Community Health Workers In Maine, Lyvia Gaewsky

Muskie School Capstones and Dissertations

Executive Summary

The following report was developed to inform the Maine Community Health Worker Initiative (MECHWI) on the processes used by five other states to create a Community Health Worker (CHW) certification system. An assessment of the current situation in Maine as it pertains to certification development was also conducted and a set of recommendations to guide the MECWHI in furthering CHW certification efforts is provided. In summary, the processes used to develop a CHW certification system in Massachusetts, Oregon, Texas, Rhode Island and Indiana tended to involve the following activities: outreach to CHWs and CHW employers, engagement of key …

Medicaid Spending Burden Among Beneficiaries With Treatment-Resistant Depression., Dominic Pilon, John J. Sheehan, Holly Szukis, David Singer, Philippe Jacques, Dominique Lejeune, Patrick Lefebvre, Paul E. Greenberg

College of Population Health Faculty Papers

AIM: To evaluate Medicaid spending and healthcare resource utilization (HRU) in treatment-resistant depression (TRD).

MATERIALS & METHODS: TRD beneficiaries were identified from Medicaid claims databases (January 2010-March 2017) and matched 1:1 with major depressive disorder (MDD) beneficiaries without TRD (non-TRD-MDD) and randomly selected patients without MDD (non-MDD). Differences in HRU and per-patient-per-year costs were reported in incidence rate ratios (IRRs) and cost differences (CDs), respectively.

RESULTS: TRD beneficiaries had higher HRU than 1:1 matched non-TRD-MDD (e.g., inpatient visits: IRR = 1.41) and non-MDD beneficiaries (N = 14,710 per cohort; e.g., inpatient visits: IRR = 3.42, p < 0.01). TRD beneficiaries incurred greater costs versus non-TRD-MDD (CD = US$4382) and non-MDD beneficiaries (CD = US$8294; p < 0.05).

CONCLUSION: TRD is associated …

Is Breastfeeding Truly Best? Evolutionary, Physiological, & Cultural Factors That Shape Breastfeeding Practices, Emily J. Green 19

Honor Scholar Theses

No abstract provided.

When Public Health Gets Shut Down, All Americans Suffer, And The Most Vulnerable Are First, Alfredo Morabia

Publications and Research

No abstract provided.

Theorizing Indigenous Student Resistance, Radical Resurgence, And Reclaiming Spiritual Teachings About Tma’Áakni (Respect), Michelle M. Jacob, Kelly L. Gonzales, Chris Finley, Stephany Runninghawk Johnson

OHSU-PSU School of Public Health Faculty Publications and Presentations

Indigenous dispossession and environmental devastation are intertwined outcomes of settler colonialism’s cycle of violence. However, indigenous people continue to draw from cultural and spiritual teachings to resist such forms of violence, and engage in what Leanne Simpson calls “radical resurgence.” Our paper analyzes the Yakama elders’ teachings about Tma’áakni (Respect), to examine principles and forms of indigenous resistance and resurgence, demonstrated by indigenous students in support of the NoDAPL(No Dakota Access PipeLine) movement. Elders’ teachings, which are rooted in spiritual traditions held by indigenous peoples since time immemorial, are useful for understanding and articulating the importance of the contemporary indigenous …

Growing Healthy Together: Protocol For A Randomized Clinical Trial Using Parent Mentors For Early Childhood Obesity Intervention In A Latino Community, Byron A. Foster, Kelsey Weinstein, Jackilen Shannon

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Latino children in the US experience high rates of obesity, increasing their risk of subsequent diabetes. There are few clinical trials among low-income, Latino families to test interventions that account for and address their unique situation.

Methods/design: This trial, conducted in a Head Start (early childhood education) setting, randomly assigns children 2–5 years of age who have obesity by CDC (Centers for Disease Control and Prevention) guidelines (at least 95th percentile body mass index) and their parents to one of three conditions: (1) control, (2) parent mentor with an experimental curriculum, or (3) parent mentor with a …

Overcoming Barriers To Adopting And Implementing Pharmacotherapy: The Medication Research Partnership, Raina Croff, Kim Hoffman, Kelly Alanis-Hirsch, Jay Ford, Dennis Mccarty, Laura Schmidt

OHSU-PSU School of Public Health Faculty Publications and Presentations

Pharmacotherapy includes a growing number of clinically effective medications for substance use disorder, yet there are significant barriers to its adoption and implementation in routine clinical practice. The Medication Research Partnership (MRP) was a successful effort to promote adoption of pharmacotherapy for opioid and alcohol use disorders in nine substance abuse treatment centers and a commercial health plan. This qualitative analysis of interviews (n = 39) conducted with change leaders at baseline and at the end/beginning of 6-month change cycles explains how treatment centers overcame obstacles to the adoption, implementation, and sustainability of pharmacotherapy. Results show that barriers to …

Activist Framing Of Abortion And Use For Policy Change In Peru, Cynthia Beavin, Deborah L. Billings, Susana Chávez

Faculty Publications

Identifying how activists frame the topic of abortion is key to unpacking their understanding of “abortion” in Peru. It is important to explore how and why certain frames are privileged in attempts to shift policy and social norms. In 2016, the authors conducted qualitative interviews with 10 activists in Lima, Peru to develop a deep understanding of these issues. Activists worked through different approaches and lenses, including law, medicine, sociology, psychiatry, journalism, non-governmental organisational management, LGBTQ rights, and indigenous rights. Four common frames emerged through the analysis and those frames shifted based on whether activists were speaking to the general …

Predictors Of Good Functional Outcome At Discharge In Stroke Patients With Depression In The Fl-Pr Collaboration To Reduce Stroke Disparities, Amy Starosciak

All Publications

No abstract provided.

Expanding Immediate Postpartum Contraceptive Options: South Carolina’S Medicaid Policy, Amy Mattison-Faye

Theses and Dissertations

Offering contraceptives is essential to allow women the opportunity to plan for pregnancy and help prevent mistimed or unintended pregnancy. Intrauterine devices and implants, also known as long-acting reversible contraceptives (LARC), are the most effective methods of contraception. South Carolina Medicaid in 2012 launched an innovative policy expanding contraceptive access and coverage for women delivering in hospitals to have the option to receive a LARC immediately postpartum. However, in order for this policy to be successful, it relies on the capacity of hospitals and providers to adopt and implement without assistance. Identifying the provisions necessary in order for successful policy …

Identifying Predictors Of Racial Disparity In Treatment And Mortality Among Patients Diagnosed With Breast Cancer In South Carolina, Oluwole Adeyemi Babatunde

Theses and Dissertations

Introduction: Despite a lower incidence of breast cancer (BrCA) among Black women in the U.S. compared to White women, Black women experience consistently higher mortality rates. The aims of this study were 1) to assess the relationship between race and diagnosis-to-treatment times 2) to assess racial disparity in mortality among Black and White BrCA patients in SC and 3) assessment of the validity of the Mortality-to- incidence ration (MIR) as a proxy for survival and geospatial investigation of racial disparity among breast cancer (BrCA) patients.

Methods: Breast cancer cases diagnosed between 2002-2010 were obtained retrospectively from the SC Central Cancer …

Understanding Wellness In A University Setting: Insight Through The Experiences Of Frequently, Physically Active Students Engaged In Resistance Training, Alia T. Sadek, Payal Shah, Michael Lagomarsine

Senior Theses

The health and wellness of undergraduate students at the local and national level is a growing public health concern, especially as college enrollment rates increase. Although wellness-based approaches are utilized to improve undergraduate health, current methods and adopted frameworks vary and lack conformity across universities making it difficult to identify effective means to improving this issue. One aim of this study was to explore a novel method of understanding wellness at the undergraduate level using both a traditional wellness questionnaire and semi-structured interviews. Using these methods, the wellness of undergraduate students attending a large, south-eastern university was evaluated across two …

The Impact Of Nutritional Changes On Dietary Inflammatory Index: New Soul Study, Callie Mclean

Senior Theses

The Impact of Nutritional Changes on Dietary Inflammatory Index: NEWSoul

Callie McLean; Gabrielle Turner-McGrievy, PhD, MS, RD; Michael Wirth, PhD; Anthony Crimarco, MS

Background: Historically, a soul food diet consisted of mainly plant-based foods in West Africa and evolved to a mostly meat-based diet in the Southeastern United States. As a result, many soul foods today often exceed the recommended dietary guidelines for saturated fats and cholesterol. This is important to consider for dietary interventions focusing on African American populations, since they are at a greater risk for cardiovascular disease and chronic illness compared to all other ethnic groups. One …

Factors Associated With Rapid Repeat Pregnancy Among Women In A Healthy Start Program In Kent County, Michigan, Sarah Jane Schmidt

Masters Theses

Strong Beginnings (SB) is a federal Healthy Start Program aiming to improve the health and well-being of black and Hispanic families by promoting racial equity and eliminating racial disparities in birth outcomes, including rapid repeat pregnancy (secondary pregnancy within 18 months of index birth). To better prevent the occurrence of rapid repeat pregnancy (RRP), this study explores individual, social, and environmental factors associated with RRP. De-identified data for this study included information from SB, the Maternal Infant Health Program, Medicaid claims, and birth certificates. The sample includes women enrolled in SB with an index birth between 2013 and 2015. Chi-square …

Quality Over Quantity: A Comparative Analysis Of The Quality Measures And Performance Between Switzerland And The United States, Lexi Farina

Independent Study Project (ISP) Collection

Even in the best health systems, poor quality of care continues to cause harm to patients and prevent them from receiving the best treatment possible. Thus, it is important to record and report quality of care measures because they can help inform policy changes and improve performance. In this paper, a comparative analysis between the United States and Switzerland is conducted to understand the process for defining and assessing quality indicators in each country as well as compare their quality of care performance results. The methods for this study include a literature review of relevant background information relating to quality …

Understanding Sexual Pleasure And Health: A Study Of Urban Middle-Class Women’S Narratives In New Delhi, India, Solana Chertow

Independent Study Project (ISP) Collection

The following study seeks to explore how urban-middle class women in Delhi understand, value, and access sexual pleasure. Simultaneously, it looks to understand the relationship between ideas of agency, power, and pleasure. This project was prompted by the lack of colloquial conversation happening on these subjects both globally, and in the communities familiar to the researcher. Although sex and pleasure, in both theory and practice, are extremely prominent in the lives of people around the world, discussion remains stigmatized. With these constraints in mind, this study investigates how a certain population of women became knowledgeable, and are still learning about …

My Body, Their Choice: Childbearing Attitudes And Practices In Jamkhed, Maharashtra, Sienna Sewell

Independent Study Project (ISP) Collection

Understanding the beliefs and practices of women and their families during pregnancy and childbirth is fundamental to the creation of successful public health interventions that target maternal and infant mortality. This study explores the childbearing practices of women in rural Jamkhed, as well as the social and economic factors that influence family planning, reproductive health-seeking, and delivery. Interviews and quantitative surveys were conducted with women in villages that have partnered with the Comprehensive Rural Health Project (CRHP) to examine how and why women access prenatal care during pregnancy. The influence of CRHP’s “Jamkhed Model” on healthcare access is considered in …

Exploring Mobility Help-Seeking Behavior Among People With Physical Disabilities: A Case Study Of Jaipur Foot, Alex Podell

Independent Study Project (ISP) Collection

It is estimated that as many as 90 million people living in India experience some sort of disability (The World Bank, 2007). As India’s population keeps growing and aging, not only will the medical aspects, but also the societal impacts of disability need to be brought to the forefront of discussion, developmental strategy, and policy implementation. This study sought to analyze factors influencing the process of seeking help from formal and informal sources for people with physical disabilities. Data was collected from 10 people with physical disabilities receiving a variety of mobility aids from the NGO, Bhagwan Mahaveer Viklang Sahayata …

Pasantía En Red Oss: Más Que Una Clínica, Saad Ehsan

Independent Study Project (ISP) Collection

RED OSS es una organización en Conchalí, Santiago que provee pruebas rápidas de VIH y actualiza otras pruebas para ETS en una manera gratuita desde 1991. Durante mi pasantía, investigué como una organización disminuye las desigualdades de salud. También aprendí sobre el financiamiento de RED OSS, las pruebas rápidas y el nicho de RED OSS en un país con un sistema pública. Utilicé observaciones y entrevistas para estudiar la clínica. Tuve oportunidades para asistir los talleres para prevenir homofobia y ver las consejerías con un voluntario. También actualicé el sitio web para reflejar los servicios que RED OSS ofrece. En …

Social Support And Discrimination: The Experiences Of Recovering Heroin Addicts In Kunming, China, Phoebe Li

Independent Study Project (ISP) Collection

Opioids have had a long, complex position in Chinese society, dating all the way back to the Ming dynasty. In 1949, 5% of the overall Chinese population and 25% of the population in Yunnan smoked opium regularly, which led to societal collapse and economic downturn. Since then, the Chinese government has used many different methods to attempt to control drug use and trafficking, including registering all users, executing traffickers, and using Compulsory Rehabilitation Centers. Starting in 2008, the government switched to a harm reduction approach and began to invest in methadone clinics, community support groups, and needle exchange programs. Because …

When Crayons Meet Tibetan Living Room Walls: Early Childhood In Exile, Emma Hart

Independent Study Project (ISP) Collection

This study aims to understand early childhood caregiving among Tibetan refugees living in Nepal. Due to the brain’s enormous developmental plasticity from ages zero to three, children’s experiences during this period are extremely important to explaining their future learnings in school, interactions with people, and engagements with their surroundings. Through interviews and observations, Tibetan parents shared their conceptions of early childhood, parent-child interaction norms, dreams for their children, and how their status as refugees in Nepal affects these. Research was conducted in two Pokhara district Tibetan settlements and one settlement in Mustang. Connected by the flow of children and adults …

Voices Unheard: Women And Their Children In Nepal’S Incarceration System, Aune Nuyttens, Mikayla Rose

Independent Study Project (ISP) Collection

This research project focused on women in Nepal’s incarceration system. Our goal was to hear and share their stories with the hopes of humanize and de-stigmatize perceptions of female prisoners in and outside of Nepal. A central component to these stories, as we learned, was also the story of prisoner’s children and the NGOs who provide assistance to this vulnerable group of women and their children. The researchers travelled to the east and west of Kathmandu to visit rural and urban prisons in Nepal, and visited various children homes, however the research was based out of Kathmandu, where many of …

Nutrition Risk Among An Ethnically Diverse Sample Of Community-Dwelling Older Adults, Patricia M. Sheean, Isabel C. Farrar, Suela Sulo, Jamie Partridge, Linda Schiffer, Marian Fitzgibbon

Parkinson School of Health Sciences and Public Health

Objective

To assess the prevalence of nutritional risk among an ethnically diverse group of urban community-dwelling older adults and to explore if risk varied by race/ethnicity. Design

Demographic characteristics, Katz’s activities of daily living and health-care resource utilization were ascertained cross-sectionally via telephone surveys with trained interviewers. Nutrition risk and nutrition symptomology were assessed via the abridged Patient Generated Subjective Global Assessment (abPG-SGA); scores of ≥6 points delineated ‘high’ nutrition risk. Descriptive statistics and logistic regression analyses were conducted. Setting

Urban. Participants

White, Black or Hispanic community-dwelling adults, ≥55 years of age, fluent in English or Spanish, residing in the …

Effect Of Severe Economic Recession On The Psychological Distress: Evidence Of Modifying Effect Of Risky Behaviors And Insurance Status, Lumi Bakos

Theses and Dissertations

The investigation identified the effect of the 2007-2009 economic recession on the level of psychological distress (PD) as modified by engaging in risky behaviors and insurance status. The objective was to determine if engaging in risky behaviors and insurance status had an impact upon the level of psychological distress experienced during a recession; the timeframe for the study is 2007 representing pre-recession to beginning of recession year, to 2009 representing the recession year, to 2012-2013 representing post-recession years. The study involved the use of a nationwide non- institutionalized adult population, the Mental Health and Stigma optional module found in the …

Factors Associated With Advance Care Plans And End-Of-Life Care Choices Among Elderly Americans: An Analysis Of Health And Retirement Study Data, Agha Ajmal

Theses and Dissertations

Introduction

Advance care plans (ACP) allow people to plan for their end-of-life care before they become incompetent to make their treatment decisions. The umbrella term Advance Care Plans (ACP) includes the three most commonly used end-of-life care plans: Advance Care Planning Discussions (ACP discussions) and two advanced directives: living will and Durable Power of Attorney for Health Care (DPAHC). The ACP discussions are the verbal discussions about end-of-life plans, whereas the advance directives are written documents.

ACPs are distinct nuances of end-of-life care planning. ACP discussions address a wide array of end-of-life care issues, including terminal care, funeral, burial and …

Adverse Birth Outcomes Among Women With Physical Disabilities: A Retrospective Cohort Study In South Carolina, Iffat Nahar

Theses and Dissertations

Motherhood is precious in women’s lives. Among women, ages 21-64, 12.5% are living with a disabling condition, according to the Disability Status report: SC 2008. Although childbearing among women with disabilities is increasing, there are limited publications about the pregnancy outcomes. The objective of this study is to document the adverse neonatal outcomes of the pregnancies and to evaluate if early prenatal care is a protective factor for low birthweight and prematurity among the women with physical disabilities. This study used a retrospective cohort study design, with data from linked hospital discharge records and vital records (birth certificates) for all …

Role Of Resources For Care In Improving Care Behaviors, Children’S Nutritional Status And Early Childhood Development In Low- And Middle-Income Countries, Sulochana Basnet

Theses and Dissertations

Poor child growth and suboptimal early childhood development are global health problems. Provision of appropriate care may help to achieve optimum child growth and development. Maternal resources for care such as education, knowledge, health, autonomy, reasonable workload, and social support may be needed to provide appropriate care behaviors, and improve children’s nutritional status, and early childhood development. The overall goal of this research was to understand the role of resources for care in improving care behaviors, child nutritional status, and early childhood development. The baseline Alive & Thrive household surveys from Bangladesh, Vietnam, and Ethiopia were used. We examined the …