Public Health Commons^™

Knowledge Of Emergency Contraception Among Women Of Childbearing Age At A Teaching Hospital Of Karachi, Farhana Irfan, Syed Irfan Karim, Saman Hashmi, Sajid Ali, Syed Arif Ali

Department of Family Medicine

OBJECTIVES: To assess knowledge and attitudes about Emergency Contraception among women of childbearing age in Karachi, Pakistan.

METHODS: A questionnaire based survey was conducted on 400 married women, attending the family practice clinics at a teaching hospital in Karachi, Pakistan from July to December 2006. Questionnaire was administered to women at the family practice clinic-seeking level of knowledge of emergency contraception (EC) and attitudes towards its use, Ethical requirements of informed consent and confidentiality were ensured Data was entered into Epi data and analyzed in SPSS.RESULTS: Eighty-eight percent of women were not aware of EC. 83% were housewives. Only a …

Prevention Of Mother-To-Child Transmission (Pmtct) Of Hiv In The Sub-Saharan Africa Region With A Focus On Uganda, Emily K. Franks

Senior Honors Theses

With the rise of the HIV/AIDS epidemic in the past thirty years, people of all ages, infants to elderly alike, all over the world, suffer from its adverse effects. Even an unborn baby in-utero can contract this virulent infection by means of mother-to-child transmission (MTCT) (Sweeney, 2005). Infants and children diseased in this way comprise 90% of the estimated 800,000 new cases of HIV in children seen each year, but the region hit hardest, however, is Sub-Saharan Africa, with the country of Uganda historically having the highest incident rate for a time (Stringer, E.M., et al. 2008). Therefore, the purpose …

Children's Health Insurance Program: The Dynamics Of Federalism And Health Care Policy, Erik White

Political Science Theses and Capstones

On February 4^th, 2009, President Obama signed into law the reauthorization of the Children Health Insurance Program. The federal government will now spend 30 billion dollars towards the goal of ensuring that more children in the United States are insured. I investigate this particular health care policy and look at the different dynamics that affect the ultimate goal of universal health insurance for children. Because this program allows for state flexibility under broad federal guidelines, one is able to look at individual states, and their particular actions and characteristics, to determine the best approach to insuring the most …

Interdisciplinary, Translational, And Community-Based Participatory Research: Finding A Common Language To Improve Cancer Research, James R. Hébert, Heather M. Brandt, Cheryl A. Armstead, Swann Arp Adams, Susan E. Steck

Faculty Publications

Preventing cancer, downstaging disease at diagnosis, and reducing mortality require that relevant research findings be translated across scientific disciplines and into clinical and public health practice. Interdisciplinary research focuses on using the languages of different scientific disciplines to share techniques and philosophical perspectives to enhance discovery and development of innovations; (i.e., from the “left end” of the research continuum). Community-based participatory research (CBPR), whose relevance often is relegated to the “right end” (i.e., delivery and dissemination) of the research continuum, represents an important means for understanding how many cancers are caused as well as for ensuring that basic science research …

Inflammatory Biomarkers And Subclinical Atherosclerosis In African-American Women With Systemic Lupus Erythematosus (Sle), Edith M. Williams, Carlos J. Crespo, Joan Dorn

Community Health Faculty Publications and Presentations

Women with lupus are at increased risk for developing cardiovascular disease (CVD). Previous studies of atherosclerosis in SLE have not been representative of the minority groups most affected by lupus and its complications. Therefore, a study of 41 lupus cases and 83 controls was conducted to investigate the relationship between carotid atherosclerosis and inflammation in African-American women. Participation consisted of a questionnaire, physical examination, fasting blood draw, and ultrasound of the carotid arteries. There were observed differences between cases and controls with regard to carotid intima media thickness (IMT) and traditional cardiovascular risk factors, although few reached statistical significance. Tumor …

Tuberculosis Por Los Ojos De La Vida Aymara: La Correlación Entre Estilo De Vida Y Tuberculosis En Los Aymara Del Norte De Chile, Sam Percy

Independent Study Project (ISP) Collection

Background: Explanations for disparities in health between groups of people are complex, and based in differences in genetics, environment, access to medical care, socioeconomic, educational, and cultural factors. In short a person’s lifestyle is inextricably related to a person’s health and their propensity to contract disease. Members of the indigenous group Aymara who live in Arica, Chile have 6 times the rate of morbidity from Tuberculosis (TB) as non-Aymara and 9 times the rate of mortality from the disease. This study examined if there was a link between the rate of TB amongst the Aymaran people and the way Aymarans …

La Calidad Del Agua Potable En Arica, Con Respecto A La Salud, Emily Lubell

Independent Study Project (ISP) Collection

Water is essential to sustain life, and the availability of safe drinking water is a concern throughout the world. This study examines the potential negative health effects related to drinking the potable water in Arica, Chile. It also looks at who has access to purified water. This study was implemented over a span of four weeks in which information was collected from different local resources including, the potable water distributor, private water vendors, professors, and public health service workers. In comparison with 2001, 2009 levels of boron, total hardness and total dissolved solids are higher in concentration. In both 2001 …

“The Womb People” : Detection, Treatment, And Prevention Of Cervical Cancer With The Khayelitsha Cervical Cancer Screening Project In Khayelitsha, South Africa, Kirsten Lynch

Independent Study Project (ISP) Collection

The current policy concerning cervical cancer screenings is not effectively addressing the specific needs of the female South African population. The program, as outlined by the South African Department of Health, is not sufficiently accessing women due to problems in availability, access, organization, and education. As women are living longer with HIV/AIDS, due to antiretroviral (ARV) treatment, they are becoming more susceptible to opportunistic infections that can lead to cervical cancer, such as Human strains of the virus can be prevented with administration of an HPV vaccination and advancement of precancerous lesions can be detected and treated with current technology. …

Mitigating The Impact Of Aids On A Rural Community: Observations Of The Inner Workings Of A Rural Non-Governmental Organization, Kara Huselton

Independent Study Project (ISP) Collection

The purpose of this study project was to understand the impact of HIV/AIDS on a community and to assess the ability of a non-governmental organization to mitigate the negative effects of disease and poverty in the spaces where the government has failed to address community needs. The author observed employees at the Bhekuzulu Self Sufficient Project in rural KwaZulu Natal over a period of three and a half weeks in order to gain an understanding of the work done there. Secondary research was done to supplement these observations and better understand the social and economic impact of HIV/AIDS on a …

Mandatory Measles Vaccination Program: Is There A Place For One In Switzerland?, Anne Rushman

Independent Study Project (ISP) Collection

The investigation of this topic began as a curiosity from the measles outbreak in the canton of Vaud, Switzerland in early 2009. As I began to gain a deeper knowledge of the subject of measles and measles vaccination in this community I saw the potential it held as a topic to explore my interests in the juncture of public policy and public health. As I approached the topic of measles vaccination from not only a public health perspective but also from that of political and ethical perspective I was able to make an analysis of potential changes in the health …

Public Health Ethics: Establishing “Durable Solutions” Within The Global Polio Eradication Initiative In Nigeria, Tiffany T. Mason

Independent Study Project (ISP) Collection

Discussions on public health ethics often appeal to the same codes of conduct established in the field of bioethics. Principles of bioethics contribute to the morality of the study of public health—proposing an optimal code of conduct in the medical care and human research aspects of the field. For example, public health researchers are aware of their obligations to consider informed consent, confidentiality, and the equal distribution of risks and benefits in the implementation of their studies and interventions. However, public health practice extends far beyond medical care and human research. Thus, it is inappropriate to assume that codes established …

Soil Zinc Content, Groundwater Usage, And Prostate Cancer Incidence In South Carolina, Sara E. Wagner, James B. Burch, Jim Hussey, Tom Temples, Susan Bolick-Aldrich, Catishia Mosley-Broughton, Yuan Liu, James R. Hébert

Faculty Publications

Background

Prostate cancer (PrCA) incidence in South Carolina (SC) exceeds the national average, particularly among African Americans (AAs). Though data are limited, low environmental zinc exposures and down-regulation of prostatic zinc transporter proteins among AAs may explain, in part, the racial PrCA disparity.

Methods

Age-adjusted PrCA rates were calculated by census tract. Demographic data were obtained from the 1990 census. Hazardous waste site locations and soil zinc concentrations were obtained from existing federal and state databases. A geographic information system and Poisson regression were used to test the hypothesis that census tracts with reduced soil zinc concentrations, elevated groundwater use, …

Gst Polymorphism And Excretion Of Heterocyclic Aromatic Amine And Isothiocyanate Metabolites After Brassica Consumption, Susan E. Steck, James R. Hébert

Faculty Publications

Brassica vegetable intake has been associated with decreased risk and well-done meat intake has been associated with increased risk of cancers at multiple organ sites in epidemiologic studies. Experimental studies suggest a role of modulation of phase I and phase II metabolizing enzymes as one mechanism for these associations. Heterocyclic aromatic amines (HAAs) are carcinogens formed in meat that has been cooked to well-done and at high temperatures. Phase I metabolizing enzymes catalyze the activation of HAAs, and phase II metabolizing enzymes serve to detoxify the active carcinogens. The glutathione S-transferase (GSTs) are a family of phase II metabolizing enzymes …

Pah-Dna Adducts, Cigarette Smoking, Gst Polymorphisms, And Breast Cancer Risk, Kathleen M. Mccarty, Regina M. Santella, Susan E. Steck, Rebecca J. Cleveland, Jiyoung Ahn, Christine B. Ambrosone, Kari North, Sharon K. Sagiv, Sybil M. Eng, Susan L. Teitelbaum, Alfred I. Neugut, Marilie D. Gammon

Faculty Publications

BACKGROUND: Polycyclic aromatic hydrocarbon (PAHs) may increase breast cancer risk, and the association may be modified by inherited differences in deactivation of PAH intermediates by glutathione S-transferases (GSTs). Few breast cancer studies have investigated the joint effects of multiple GSTs and a PAH biomarker.

OBJECTIVE: We estimated the breast cancer risk associated with multiple polymorphisms in the GST gene (GSTA1, GSTM1, GSTP1, and GSTT1) and the interaction with PAH-DNA adducts and cigarette smoke.

METHODS: We conducted unconditional logistic regression using data from a population-based sample of women (cases/controls, respectively): GST polymorphisms were genotyped using …

A Human Capital Approach To Reduce Health Disparities, Saundra H. Glover, Sudha Xirasagar, Yunho Jeon, Keith T. Elder, Crystal N. Piper, Harris Pastides

Faculty Publications

Objective: To introduce a human capital approach to reduce health disparities in South Carolina by increasing the number and quality of trained minority professionals in public health practice and research.

Methods: The conceptual basis and elements of Project EXPORT in South Carolina are described. Project EXPORT is a community based participatory research (CBPR) translational project designed to build human capital in public health practice and research. This project involves Claflin University (CU), a Historically Black College University (HBCU) and the African American community of Orangeburg, South Carolina to reduce health disparities, utilizing resources from the University of South Carolina (USC), …

The Dynamics Of Income And Neighborhood Context For Population Health: Do Long Term Measures Of Socioeconomic Status Explain More Of The Black/White Health Disparity Than Single-Point-In-Time Measures?, D. Phuong Do

Faculty Publications

Socioeconomic status, though a robust and strong predictor of health, has generally been unable to fully explain the health gap between blacks and whites in the Untied States. However, at both the individual and neighborhood levels, socioeconomic status is often treated as a static factor with only single-point-in-time measurements. These cross-sectional measures fail to account for possible heterogeneous histories within groups who may share similar characteristics at a given point in time. As such, ignoring the dynamic nature of socioeconomic status may lead to the underestimation of its importance in explaining health and racial health disparities.

In this study, I …

Cardiorespiratory Fitness And Digestive Cancer Mortality: Findings From The Aerobics Center Longitudinal Study (Acls), J. Brent Peel, Xuemei Sui, Charles E. Matthews, Swann Arp Adams, James R. Hébert, James W. Hardin, Timothy S. Church, Steven N. Blair

Faculty Publications

Although higher levels of physical activity are inversely associated with risk of colon cancer, few prospective studies have evaluated overall digestive system cancer mortality in relation to cardiorespiratory fitness (CRF). The authors examined this association among 38,801 men aged 20−88 years and who performed a maximal treadmill exercise test at baseline in the Aerobics Center Longitudinal Study (Dallas, Texas) during 1974−2003. Mortality was assessed over 29 years of follow-up (1974−2003). 283 digestive system cancer deaths occurred during a mean 17-year of observation. Age-adjusted mortality rates per 10,000 person-yrs according to low, moderate, and high CRF groups were 6.8, 4.0, and …

Health Educator Job Analysis Project: Timeline Report, Eva Doyle, Beverly S. Mahoney

Faculty Publications and Presentations

No abstract provided.

The Effect Of Semantic Set Size On Word Learning By Preschool Children, Holly L. Storkel, Suzanne M. Adlof

Faculty Publications

Purpose - The purpose was to determine whether semantic set size, a measure of the number of semantic neighbors, influenced word learning, and whether the influence of semantic set size was broad, showing effects on multiple measures both during and after learning.

Method - Thirty-six preschool children were exposed to 10 nonobjects, varying in semantic set size, paired with 10 nonwords, controlling phonotactic probability and neighborhood density. Nonobject-nonword pairs were presented in a game format. Learning was measured in naming and referent identification tasks administered before, during, and 1 week after training.

Results - Results showed no differences in naming …

Adult And Child Semantic Neighbors Of The Kroll And Potter (1984) Nonobjects, Holly L. Storkel, Suzanne M. Adlof

Faculty Publications

Purpose - The purpose was to determine the number of semantic neighbors, namely semantic set size, for 88 nonobjects (J. F. Kroll & M. C. Potter, 1984) and determine how semantic set size related to other measures and age.

Method - Data were collected from 82 adults and 92 preschool children in a discrete association task. The nonobjects were presented via computer, and participants reported the first word that came to mind that was meaningfully related to the nonobject. Words reported by two or more participants were considered semantic neighbors. The strength of each neighbor was computed as the …

Beliefs And Behaviors Regarding Substance Use And Hiv Risk Among Men Who Have Sex With Men (Msm) In A Mid-Sized U.S. Community, David A. Patterson Silver Wolf (Adelv Unegv Waya) Phd, Martin Hall Mssw, Seana Golder Phd

Brown School Faculty Publications

This paper explores the beliefs and behaviors surrounding substance use and HIV risk among a convenience sample of 98 MSM in a mid-size community located in the central U.S. Several interesting patterns were identified in the descriptive analyses. Multivariate analysis identified two variables, belief that recreational drug use made sexual experiences better and reports that most MSM friends drank alcohol or took recreational drugs that were significant predictors of engagement in substance using behavior. Models accounted for 24% of the variance in drinking behavior and 15% of the variance in drug using behavior. Suggestions for HIV/AIDS prevention and intervention and …

Elder Abuse: A Policy Analysis, Cortni Davis

Undergraduate Research Conference

Elder abuse is a growing social problem in the United States. It takes on many forms, and is prevalent throughout various cultures. Elder Abuse Reporting Laws have been enacted throughout various states to prevent and intervene in elder abuse cases. California’s Financial Abuse Reporting Act of 2005 is one among many laws in the United States which was formed to help ensure social justice for the elderly citizens of America.

Nonparametric Incidence Estimation From Prevalent Cohort Survival Data, Marco Carone, Masoud Asgharian, Mei-Cheng Wang

COBRA Preprint Series

Incidence is an important epidemiologic concept particularly useful in assessing an intervention, quantifying disease risk, and planning health resources. Incident cohort studies constitute the gold-standard in estimating disease incidence. However, due to material constraints, data are often collected from prevalent cohort studies whereby diseased individuals are recruited through a cross-sectional survey and followed forward in time. We discuss the identifiability of measures of incidence in the context of prevalent cohort survival studies and derive nonparametric maximum likelihood estimators and their asymptotic properties. The proposed methodology accounts for calendar-time and age-at-onset variation in disease incidence while also addressing common complications arising …

What Do Young Adults Know About The Hiv/Aids Epidemic? Findings From A Population Based Study In Karachi, Pakistan., Syed Farid-Ul-Hasnain, Eva Johansson, Gunilla Krantz

Community Health Sciences

Background: HIVAIDS is spreading globally, hitting the younger generations. In Pakistan, the prevalence of HIV in high-risk subpopulations is five per cent or higher. This poses a serious threat of a generalised epidemic especially among the younger population. In the wake of HIVAIDS epidemic this is worrying as a well informed younger generation is crucial in restricting the spread of this epidemic. This study investigated Pakistani young adults' (male and female) knowledge and awareness of the HIV/AIDS disease. Methods: A population-based, cross-sectional study of 1,650 male and female adults aged 17-21 years living in Karachi was conducted using a structured …

The Importance Of Scale For Spatial-Confounding Bias And Precision Of Spatial Regression Estimators, Christopher J. Paciorek

Harvard University Biostatistics Working Paper Series

Increasingly, regression models are used when residuals are spatially correlated. Prominent examples include studies in environmental epidemiology to understand the chronic health effects of pollutants. I consider the effects of residual spatial structure on the bias and precision of regression coefficients, developing a simple framework in which to understand the key issues and derive informative analytic results. When the spatial residual is induced by an unmeasured confounder, regression models with spatial random effects and closely-related models such as kriging and penalized splines are biased, even when the residual variance components are known. Analytic and simulation results show how the bias …

Smoking Enhances Risk For New External Genital Warts In Men, Dorothy J. Wiley, David Elashoff, Emmanuel V. Masongsong, Diane M. Harper

Dartmouth Scholarship

Repeat episodes of HPV-related external genital warts reflect recurring or new infections. No study before has been sufficiently powered to delineate how tobacco use, prior history of EGWs and HIV infection affect the risk for new EGWs. Behavioral, laboratory and examination data for 2,835 Multicenter AIDS Cohort Study participants examined at 21,519 semi-annual visits were evaluated. Fourteen percent (391/2835) of men reported or were diagnosed with EGWs at 3% (675/21,519) of study visits. Multivariate analyses showed smoking, prior episodes of EGWs, HIV infection and CD4+ T-lymphocyte count among the infected, each differentially influenced the risk for new EGWs.

Shelter-In-Place: Indoor Exposure Assessment During An Airborne Chemical, Biological, Radiological, And Nuclear (Cbrn) Event, Robert D. Schmidtgoessling

Theses and Dissertations

The goal of Shelter-In-Place (SIP) is to reduce human exposure to chemical, biological, radiological, and nuclear (CBRN) agents in the event of an accidental or intentional airborne release into the outdoor environment. The Air Force Bioenvironmental Engineering (BE) career field is responsible for providing hazard identification, evaluation, and control capabilities as well as executing health risk assessments to recommend appropriate courses of action to commanders pre-, trans-, and post-incident. Specifically, BE is responsible for providing sampling, identification, and quantification input to hazard prediction models and supporting evacuation plan development to provide risk-based control recommendations. This also includes providing exposure and …

Field Evaluation Of A Novel Exposure Assessment Strategy Using Respirable Coal Dust Exposures During Heat Plant Coal Receiving Operations, Timothy W. Batten

Theses and Dissertations

An exposure assessment strategy (EAS) determines the number of samples required to characterize an occupational health exposure’s acceptability. A novel EAS (AFIT-EAS) was developed with the objective of maximizing the sensitivity for detecting unacceptable exposures, while minimizing the total number of samples needed. The purpose of this field evaluation was to use data from a comprehensive sampling campaign (SC) to compare the AFIT-EAS with two commonly used EASs: the Occupational Safety and Health Administration’s (OSHA-EAS) and the American Industrial Hygiene Association’s (AIHA-EAS). 10 randomly sampled replicates were selected from the SC. The number of samples selected per replicate was in …

Patterns Of Mortality In Indigenous Adults In The Northern Territory, 1998–2003: Are People Living In More Remote Areas Worse Off?, Karen Andreasyan, Wendy E. Hoy

Aboriginal Policy Research Consortium International (APRCi)

Objective: ToquantifyIndigenousmortalityintheNorthernTerritorybyremotenessof residence.

Design, setting and participants: Australian Bureau of Statistics mortality data were used to compare rates of death from chronic disease in the NT Indigenous population with rates in the general Australian population over the period 1998–2003. Rates were evaluated by categories of remoteness based on the Accessibility/Remoteness Index of Australia: outer regional areas (ORAs), remote areas (RAs) and very remote areas (VRAs). Main outcome measures: Mortality from cardiovascular disease, diabetes and renal disease; standardised mortality ratios (SMRs); percentage change in annual death rates; changes in mortality between 1998–2000 and 2001–2003.

Results: In 1998–2000, SMRs for all-cause mortality …

Health Care-Associated Infections: Is There An End In Sight?, Lisa Sprague

National Health Policy Forum

Health care–associated infections (HAIs) have emerged as a significant concern in policy as well as clinical circles. An HAI is an infection acquired during treatment for another condition. Some of the HAI-causing bacteria have become drug-resistant; methicillin-resistant Staphylococcus aureus, or MRSA, is a familiar example. Tied to perhaps 100,000 deaths and $20 billion in health care costs each year, HAIs have given rise to state laws, legislative proposals at the federal level, public-private initiatives, and work at the hospital system and individual hospital level. However, much remains to be done. This issue brief reviews the prevalence of HAIs and the …