Community Health and Preventive Medicine Commons^™

Moving Beyond Traditional Cost Containment For Glp-1 Coverage Within Oregon's Proposed Universal Health Plan, Manoj Rajesh

University Honors Theses

In 2022, Oregon voters passed Measure 111, constitutionally mandating access to affordable health care. As the Universal Health Plan Governance Board (UHPGB) designs the state's proposed single-payer system, it faces an unprecedented financial vulnerability: the clinical demand for GLP-1 receptor agonists. These high-cost, indefinite-use medications for obesity and metabolic syndrome threaten to overwhelm fixed public budgets. Historically, both the Oregon Health Plan's Medicaid framework and commercial private insurers have relied on static cost-containment models—categorical exclusions, step therapy, and aggressive utilization management—that achieve short-term fiscal solvency at the expense of comprehensive preventative care. This thesis argues that to fulfill the mandate …

Understanding The U.S. Maternal Healthcare System At The Intersection Of Asian American Birth Outcomes And The Model Minority Stereotype: A Literature Review, Sophia Hevel

University Honors Theses

This thesis aims to explore the maternal healthcare system in the United States as it pertains to Asian American birthing people, the ways in which their racial, ethnic, and cultural identities are interacted with within the U.S. Healthcare system, and subsequently the detrimental effects of the medical system's devaluation of culturally specific birthing and postpartum practices have on Asian American birthing experiences. This will be accomplished through an exploration of the United States' maternal healthcare system, or rather, its crisis; how Asian Americans navigate a system that has not been structured to support their specific needs; and lastly, a discussion …

Applying The One Health Approach To Study The Policy And Institutional Determinants To Control And Prevent Zoonoses In A Low-Resource Setting, Lisset Dumet, Erin S. Kenzie, Veronika Merino, Vanessa Cruz, Ruth Atto, Percy Vilchez, Seth O'Neal, Julia Goodman

OHSU-PSU School of Public Health Faculty Publications and Presentations

Zoonoses - diseases transmitted between animals and people - disproportionally affect low-resource countries (LRCs). The complex nature of zoonoses adds substantial barriers to implementing multisectoral policies to address them. Research on the policy process could help illuminate the significant factors influencing policy change among the complex systems involved in managing zoonoses. We applied the One Health (OH) approach to describe the policy process among the systems involved in preventing and controlling zoonoses in Peru. The study's purpose is to (1) describe the priority-making process and the driving or limiting factors, (2) describe the process for selecting policy solutions and (3) …

Exploring Muslim American Attitudes Toward Genetic Testing: Perceptions, Barriers, And Ethical Considerations, Hannah Mahmoud

University Honors Theses

This thesis explores perceptions and attitudes toward genetic testing within the Muslim American community, a group often underrepresented in genomic research and public health discourse. Using a community-distributed digital survey, data was collected from 50 self-identified Muslim Americans on their familiarity with genetic testing, reproductive and ethical considerations, and the influence of religious factors. While only 18% had undergone genetic testing themselves, many were familiar through family or friends, and most expressed cautious interest—especially when results could influence future family planning. Education level, age, and religious values shaped both comfort and understanding.

A key theme was the desire for culturally …

Digesting The Details: How Cooking Shapes The Microbiome And Influences Obesity, Tracy Lieu

University Honors Theses

Obesity is a growing global health concern linked to chronic diseases and changes in the gut microbiome. While diet is known to affect gut microbes, less attention has been given to how food processing methods, such as heating, fermentation, and cold processing, change food in ways that influence the gut microbiome and health. This thesis reviews research on how different cooking and preparation techniques affect the availability of nutrients for microbial fermentation and the resulting effects on microbial diversity and metabolism. The findings show that fermentation and cold processing are the most supportive of gut health. These methods help preserve …

Primary Place To Go For Health Care And Its Association With Hpv Prevalence In Us Adults: Results From Nhanes 2013-2016, Amy L. Mcveety, Miyuki Sun

OHSU-PSU School of Public Health Annual Conference

Background: While access to health care is a known risk factor for many infectious diseases, including sexually transmitted infections, little research has investigated the relationship between access to primary care services and prevalent human papillomavirus (HPV) infection. Given HPV’s prevalence in the general population and lack of available treatments, it is necessary to understand possible risk factors to identify areas for intervention. This study uses primary place to go for health services as a proxy measure for access to care, in order to understand which sources of health care are serving patients with the highest prevalence of HPV infections and …

Exploring Health Equity With Culturally Specific Providers Of Permanent Supportive Housing, Judith Solomon

University Honors Theses

Chronic homelessness is an important public health issue. Permanent Supportive Housing (PSH) is a promising opportunity for transitioning people experiencing homelessness into housing, however there remain unaddressed racial inequities in service provision and outcomes. The aim of this study is to better understand the role of culturally specific (CS) providers of PSH in improving health equity. I analyzed interviews with CS PSH providers for themes related to health and healthcare. Providers spoke about the importance of connecting clients to healthcare. Providers stressed the importance of honesty and lived experience, highlighting the strong sense of responsibility to the community. Providers also …

Neuroscience-Based Harm Reduction Education For College Students In Portland, Or, Catriona Swallow

University Honors Theses

Harm reduction (HR) is a movement focused on reducing the harms of the opioid overdose crisis through education, advocacy, and community engagement. A key component of HR is naloxone, a medication which reverses opioid overdoses when administered. Due to increased fentanyl contamination, opioid overdose deaths have been on the rise among adolescents in the U.S and HR practices are crucially important at this point in time. In recent years, alternative curricula of HR education have included a neuroscience-based approach to the topic of substance use. While both traditional and alternative programs have had success increasing substance use literacy among adolescents, …

Biofeedback Gaming For Substance Use Disorder, Rebecca L. Chevrel

University Honors Theses

Substance Use Disorder (SUD) and stress are often predictive of one another, bidirectionally causal, and mutually intensifying. This thesis describes the bi-directional connection between physiological stress-modulating systems and Substance Use Disorder, and explores some emerging biofeedback stress-reduction gaming technology as a potential adjunct to recovery treatments. Improving autonomic balance, often described by Heart Rate Variability, has been shown to be beneficial for physical and psychological recovery, as well as improving self-control. For this reason, regular biofeedback for stress relief could be helpful in augmenting SUD treatment and preventing relapse. This exploration found that presenting it through a gaming lens may …

Gut Feelings: A Literature Review On The Gut-Brain Axis And Its Potential Influence On Mood, Grace Johnson

University Honors Theses

In recent decades, research on the gut-brain axis has evolved due to an increasing interest in the connection between gut health and mental health. The gut-brain axis presents a new frontier of health for both medical professionals and psychologists as there is expanding evidence illustrating the comorbidity of gut disorders and mood disorders. Due to the complex nature of studying the gut-brain axis and the myriad of influences on mood disorders such as depression, research has yet to find significant results definitively tying the two together. Nonetheless, the current body of literature on the topic provides a promising outlook on …

Risk Factors Of Dental Anxiety And Exploration Of Interventions, Katelin Hancock

University Honors Theses

Within this literature review, the root causes of dental anxiety, current intervention methods, and possible preventative interventions are discussed. Dental anxiety affects millions of individuals across diverse backgrounds and can be detrimental to oral health. This issue can arise from various sources, however, different socioeconomic and sociodemographic factors can contribute to an individual's risk of developing dental anxiety. Understanding what predisposes certain populations to become more likely to develop dental anxiety is imperative to holistically address the concern. Investigating the relationship between lack of access, oral health, and anxiety levels allows for an understanding of the root causes of anxiety. …

Final (Year 2) Report To Oha On Sogi Demographic Standards For Minors, Martin Arrigotti, Nell Carpenter, Kieran Chase, Alysia Cox, Itai Jeffries, Alexis Dinno

OHSU-PSU School of Public Health Faculty Publications and Presentations

Executive Summary

The report synthesizes thoughtful recommendations of the authors to the Oregon Health Authority (OHA) about routine data collection of SOGI† (sex, sexual orientation, and gender) demographic data in minors for clinical and reporting purposes. We see five primary motivations to routinely collect SOGI data, including to:

1. create an inclusive practice in order to welcome and make space for people from historically excluded genders, sexes, and sexual orientations,
2. promote health equity between minority and majority SOGI identities,
3. direct group-specific services towards those who need them,
4. represent the actual diversity of Oregon, and its communities, and
5. shift normative expectations about …

Humanity In Trauma, Alyssa K. Thompson

University Honors Theses

The main objective of the literature review is to use the trauma-informed care paradigm to argue that the current implementation of trauma-informed care reinforces hierarchies of harm, leading to feelings of moral obligation and moral injury while perpetuating othering. This literature review criticizes trauma-informed care, emphasizing lived experiences against the characteristics trauma-informed care aspires to reflect. The review centers on the broad themes of understanding, universality, and acceptance of the present trauma-informed care paradigm. The critique comes from the silently excluded group of healthcare workers, with a personal perspective from a professional who worked in an urban hospital emergency department …

Relationship Between Chinese Herbal Medicine Use And Risk Of Sjögren’S Syndrome In Patients With Rheumatoid Arthritis: A Retrospective, Population-Based, Nested Case-Control Study, Hou-Hsun Liao, Hanoch Livneh, Miao-Chiu Lin, Ming-Chi Lu, Ning-Sheng Lai, Hung-Rong Yen, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Background and Objectives: Sjögren’s Syndrome (SS) is a common extra-articular feature among subjects with rheumatoid arthritis (RA). While Chinese herbal medicine (CHM) has been used to treat symptoms of RA for many years, few studies have examined its efficacy in guarding against the SS onset. This study aimed to compare risk of SS for RA patients with and without use of CHM. Materials and Methods: Data obtained for this nested case-control study were retrieved from Taiwanese nationwide insurance database from 2000–2013. Cases with SS claims were defined and matched to two randomly selected controls without SS from the recruited RA …

Paid Sick Leave, Chronic Disease, And Systemic Racism: A Systematic Review, Lauren Yee

University Honors Theses

The purpose of this systematic review is to assess the impact of paid sick leave (PSL) availability on chronic disease prevention, treatment, and recovery. Furthermore, this study aims to investigate the role of race on this relationship as a possible source of systemic racism. The findings of this review show a growing body of evidence that affirms the statistically significant association between PSL and chronic disease-related outcomes. The availability of PSL has the potential to remove financial barriers allowing employees to access preventative services for chronic diseases. Access to PSL also increases work resumption by improving financial stability after being …

Building The Foundation For A Community Generated National Research Blueprint For Inherited Bleeding Disorders: Research Priorities In Health Services; Diversity, Equity, And Inclusion; And Implementation Science, Vanessa R. Byams, Judith Baker, Cindy Bailey, Alexis Dinno, Multiple Additonal Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: The National Hemophilia Foundation (NHF) conducted extensive all-stakeholder inherited bleeding disorder (BD) community consultations to inform a blueprint for future research. Sustaining and expanding the specialized and comprehensive Hemophilia Treatment Center care model, to better serve all people with inherited BDs (PWIBD), and increasing equitable access to optimal health emerged as top priorities. Research Design and Methods: NHF, with the American Thrombosis and Hemostasis Network (ATHN), convened multidisciplinary expert working groups (WG) to distill priority research initiatives from consultation findings. WG5 was charged with prioritizing health services research (HSR); diversity, equity, and inclusion (DEI); and implementation science (IS) research …

“I Don’T Have A Pile Of Money To Take Care Of Things”: Financial Stress And Housing Insecurity Among Low-Income Hispanic/Latinx Immigrant Families During Covid-19, Marisa Westbrook

OHSU-PSU School of Public Health Faculty Publications and Presentations

Housing, the single largest expense for low-income individuals, is inherently tied to economic security. During the COVID-19 pandemic, Hispanic/Latinx and Black communities experienced the highest rates of income loss, basic needs insecurity, and COVID-19 hospitalization and mortality. As part of an ethnographic case study, I conducted serial interviews over two years with 35 predominantly low-income Hispanic/Latinx immigrant families in one Denver, Colorado neighborhood during the COVID-19 pandemic. These interviews revealed that very few of these individuals were able to access governmental financial support as a result of limited dissemination despite facing unemployment, underemployment and rising rents. Although governmental financial support …

Association Of Maternal Age 35 Years And Over And Prenatal Care Utilization, Preterm Birth, And Low Birth Weight, Mexico 2008–2019, Laura Jacobson, Evelyn Fuentes-Rivera, Raffaela Schiavon, Blair Darney

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective:

We compared prenatal care utilization, preterm birth, and low birth weight neonates among women 35 years and older compared to women 20-34 years old in Mexico, 2008-2019.

Methods:

We used birth certificate data and conducted a historical cohort study of all singleton live births in Mexico from 2008-2019. Study outcomes were inadequate prenatal care (timing of initiation of care and number of visits), preterm birth, and low birth weight. We compared outcomes among women 35-39, 40-44, and 45-49 with births to women 20-34. We used logistic regression to account for individual and contextual confounders.

Results:

We included a total …

On Epidemiology As Racial-Capitalist (Re)Colonization And Epistemic Violence, Ryan J. Petteway

OHSU-PSU School of Public Health Faculty Publications and Presentations

This commentary reflects upon power-knowledge dynamics and matters of epistemic, procedural, and distributive justice that undergird epidemiological knowledge production related to racial health inequities in the U.S. Grounded in Foucault’s power-knowledge concepts—“objects”, “ritual”, and “the privileged”—and guided by Black feminist philosopher Kristie Dotson’s conceptualization of epistemic violence, it critiques the dominant positivist, reductionist, and extractivist paradigm of epidemiology, interrogating the settler-colonial and racial-capitalist nature of the knowledge production/curation enterprise. The commentary challenges epidemiology’s affinity for epistemological, procedural, and methodological norms that effectively silence/erase community knowledge(s) and nuance in favor of reductionist empirical representations/re-presentations produced by researchers who, often, have never …

Preliminary (Year 1) Report To Oha On Pediatric Sogi: Executive Summary. Report To The Oregon Health Authority, Office Of Equity And Inclusion, Martin Arrigotti, Kieran Chase, Alexis Dinno

OHSU-PSU School of Public Health Faculty Publications and Presentations

Overview: The enclosed report is the result of collaboration between the authors and the Oregon Health Authority. The report synthesizes the thinking and recommendations of the authors about routine data collection of SOGI data in minors for clinical and demographic purposes. Primary motivations to routinely collect SOGI data include: (1) inclusive practice in order to welcome and make space for people from historically excluded genders, sexes, and sexual orientations, (2) to promote health equity between minority and majority SOGI identities, and (3) to direct group-specific services towards those who need them.

Investigation and Findings: These recommendations are informed …

The Impact Of Maternal Nutrition On The Development And Severity Of Generalized Anxiety Disorders In Rodent And Non-Human Primate Studies, Esmeralda H. Cardoso

University Honors Theses

Generalized anxiety has become more prevalent among children and adolescents in the United States which impacts their health and livelihood. Maternal nutrition during pregnancy is purported to play a role in cognitive development and mental health during childhood, adolescence, and into adulthood. The Developmental Origins of Health and Disease theory suggests maternal nutrition before and during pregnancy influences transgenerational susceptibility, onset, and severity of disease through epigenetic mechanisms that then impact the child’s overall health, including cognitive development and mental health later in life. A literature review of rodents and non-human primate studies was conducted to explore the association between …

Investigating The Efficacy & Implications Of Abstinence-Based Drug Education, Sophia Hanken

University Honors Theses

The United States has a long and complex history surrounding substance use. Drug education programs have become widely implemented in American schools and the media. Policy, rhetoric, and ideology have directly affected the curriculum of drug education programs. Drug education in the United States centers around substance abstinence. While well-intended, abstinence-based drug education is not a pragmatic solution for reducing substance-related harm or promoting health. The purpose of this thesis is to critique two of the most widely used abstinence-based drug education programs; Drug Abuse Resistance Education (D.A.R.E) and Project ALERT. These programs often emphasize the dangers of substance use …

Association Of Patient- Provider Language Concordance With Health Care Comprehension Among Latino/As In Oregon: Work In Progress, Grace Parra

OHSU-PSU School of Public Health Annual Conference

Authors: Grace Parra, Sara Diaz-Anaya, & Blair G. Darney PhD, MPH.

Title

Association of patient- provider language concordance with health care comprehension among Latino/as in Oregon: Work in progress

Background

Language concordance in a healthcare setting is a clinical encounter where the patient and provider speak the same language. Health care comprehension is the degree to which individuals understand health-related information given by the provider. Research to date suggests that language barriers in health care negatively impact quality of care .The purpose of this study is to describe need and preferences for language concordant care and test the association …

Prevalence Of Perceived Weight Stigma And Its Psychological Impact On Obese People In Saudi Arabia, Wafi Albalawi

OHSU-PSU School of Public Health Annual Conference

No abstract provided.

“It’S Like 1998 Again”: Why Parents Still Refuse And Delay Vaccines, Jiana L. Ugale, Heather Spielvogle, Christine Spina, Cathryn Perreira, Ben Katz, Barbara Pahud, Phd Amanda F. Dempsey Md, Jeffrey D. Robinson Phd, Kathleen Garrett Ma, Mph Sean T. O’Leary Md, Mph Douglas J. Opel Md

Communication Faculty Publications and Presentations

We conducted a qualitative study from 2018 to 2019 to update the reasons why US parents’ refuse or delay vaccines. Four focus groups and 4 semi-structured interviews involving 33 primary care pediatric providers were conducted in Washington and Colorado. A thematic analysis was conducted to identify themes related to reasons for parental refusal or delay. Five predominant themes were identified: (1) vaccine safety, (2) relative influence of information sources, decision-makers, and timing, (3) low perceived risk of contracting vaccine-preventable disease, (4) lack of trust, and (5) religious objection. Vaccine safety was the theme mentioned most frequently by providers (N = …

The Digital Divide And Health: Examining Digital Access As A Social Determinant Of Health, Elizabeth Melissa Withers

Dissertations and Theses

This dissertation is comprised of three papers that consider ways in which one's level of digital access may impact self-rated health. Data are from multiple years of three separate nationally representative cross-sectional surveys: National Health Interview Survey, General Social Survey, and Health Information National Trends Survey to address the primary overarching research question: Is there an association between digital access and health? The examination of the relationship between digital access and health is situated within a social determinants of health perspective and draws on van Dijk's (2005) causal and sequential model of digital access. Education, income, race and ethnicity, work …

Quarantine Ethics: From Past To Covid-19, Chrystal Barnes

OHSU-PSU School of Public Health Annual Conference

Quarantines have been a preventative measure for reducing communicable disease spread for centuries. The method of implementation can vary widely and to some extent requires some level of judgement from enforcing powers, often state police power. As such, historically, some quarantines have been unfairly enforced based on discriminatory practices. COVID-19 has brought about the most widespread and extended quarantine in U.S. history, which makes evaluating the ethics all the more critical. In addition, it is well established that COVID-19 impacts have disproportionately caused harm to populations, such as those who are of a low socioeconomic status and people of color. …

Nhanes Iii Mortality Follow Up: Social Determinants Creating Disparity Within The Health Outcomes Of Persons With Diabetes, Claire B. Adams

University Honors Theses

Given the recent research into the social determinants affecting health outcomes, the goal of this thesis is to examine whether a non-urban setting, among other social determinants of health, increases the risk of mortality among the United States diabetic population. We examined the relationship of urban and non-urban diabetes rates among those aged 40-74 years using a national sample of diabetic and nondiabetic Americans. The data was pulled from the Third National Health and Nutrition Examination Survey (NHANES III) which was conducted from 1988 to 1994. After excluding pregnant women, those who did not complete a fasting AM glucose, and …

Understanding The Impact Of The Sars-Cov-2 Pandemic On Hospitalized Patients With Substance Use Disorder, Caroline King, Taylor Vega, Dana Button, Christina Nicolaidis, Jessica Gregg, Honora Englander

School of Social Work Faculty Publications and Presentations

Background: The SARS-COV-2 pandemic rapidly shifted dynamics around hospitalization for many communities. This study aimed to evaluate how the pandemic altered the experience of healthcare, acute illness, and care transitions among hospitalized patients with substance use disorder (SUD).

Methods: We performed a qualitative study at an academic medical center in Portland, Oregon, in Spring 2020. We conducted semi-structured interviews, and conducted a thematic analysis, using an inductive approach, at a semantic level.

Results: We enrolled 27 participants, and identified four main themes: 1) shuttered community resources threatened patients' basic survival adaptations; 2) changes in outpatient care increased reliance on hospitals …

A Comparison Of Safety, Health, And Well-Being Risk Factors Across Five Occupational Samples, Ginger C. Hanson, Anjali Rameshbabu, Todd Bodner, Leslie Hammer, Diane S. Rohlman, Ryan Olson, Nancy Perrin, Bradley Wipfli, Kuehl S. Kerry, Lindsey Alley, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: The aim of this study was to present safety, health and well-being profiles of workers within five occupations: call center work (N = 139), corrections (N = 85), construction (N = 348), homecare (N = 149), and parks and recreation (N = 178).

Methods: Baseline data from the Data Repository of Oregon’s Healthy Workforce Center were used. Measures were compared with clinical healthcare guidelines and national norms.

Results: The prevalence of health and safety risks for adults was as follows: overweight (83.2%), high blood pressure (16.4%), injury causing lost work (9.9%), and reported pain (47.0%). Young workers were least …