Community Health and Preventive Medicine Commons^™

The Wright Brothers And Their Genetic Susceptibility To Typhoid Fever, John D. Bullock, H Bradford Hawley

Population and Public Health Sciences Faculty Publications

Importance: Typhoid fever gravely sickened Orville Wright in 1896 and the disease killed his older brother, Wilbur, in 1912. The occurrence of typhoid fever among other Wright family members has never been explored.

Objective: To investigate the number of cases of typhoid fever in the Wright brothers’ family and determine if they had a predisposition to typhoid fever that might have had a genetic basis.

Methods: Biographical information concerning the Wright brothers was examined and a family tree was constructed. Using an estimated untreated case fatality rate of 20%, typhoid fever mortality data from decennial U.S. censuses (1850-1920) was converted …

Proactive Psychiatry: Innovating The Delivery Of Consultation-Liaison Services In A Pediatric Hospital, Elizabeth Schindler, Katherine Winner, Ramzi W. Nahhas, Gianni Maione, Aisha Jamison, Kelly Blankenship

Population and Public Health Sciences Faculty Publications

Background: The benefits of a proactive consultation-liaison psychiatry service have been well documented in the adult population, including decreased length of stay (LOS), increased satisfaction among physicians, and enhanced collaborative care. However, there is no available research on the effectiveness of this model in pediatric hospitals. Objective: This study compared patients aged 5–18 years on a general medical floor receiving a proactive psychiatry consult to concurrent controls receiving no consult and to historical controls receiving traditional reactive consults. Methods: New admissions to two pediatric general medical hospital teams were reviewed on weekday mornings to identify those with active psychiatric concerns. …

Climate Change And Mental Health: An Interactive Educational Session, Andrea Costin, Daniel Fisher, Bethany Harper, Ramzi W. Nahhas, John Sullenbarger

Population and Public Health Sciences Faculty Publications

Introduction: Climate change is the single biggest health threat facing humanity, with direct and indirect impacts on mental health, yet health impacts of climate change remain notably absent from most medical school curricula. We describe a timely interactive educational session on climate change and mental health that was implemented and studied on a medical student clinical psychiatry rotation. Methods: We developed a 1-hour introductory session on the mental health impacts of climate change and potential solutions. The session was delivered to third-year medical students on their 4-week clinical psychiatry rotation and included pre- and postsession survey questions assessing their knowledge, …

Comparing The Impact Of Food Insecurity, Access To Exercise Opportunities, And County Classification On Obesity Rates In Ohio, Ankur Parekh, Deborah Lee

Scholarship in Medicine - All Papers

Objective: We completed a study to determine how food insecurity, access to exercise opportunities, and county classification (rural or urban) impacted obesity rates in Ohio. We hypothesized that the county classification impacted obesity the most followed by food insecurity and access to exercise opportunities.

Methods: We obtained data on food insecurity, access to exercise opportunities, and obesity from County Health Rankings and county classification data from the United States Department of Agriculture Census. We analyzed correlations between obesity and food insecurity and obesity and access to exercise opportunities in both county types. We also analyzed changes in obesity rates in …

Vision And Hearing Loss Associated With Lifetime Drug Use: Nhanes 2013–2018, Amanda M. Hinson-Enslin, Ramzi W. Nahhas, Heather F. Mcclintock

Population and Public Health Sciences Faculty Publications

Background: One in four American adults has a disability. Individuals with disabilities are more likely to have mental health issues and use substances and are less likely to attend substance use rehabilitation compared to individuals without disabilities. However, most research about substance use and substance use rehabilitation does not focus specifically on sensory disabilities. Objective: The purpose was to test the association between vision and/or hearing loss, lifetime drug use, and lifetime drug rehabilitation. Methods: Data files from National Health and Nutrition Examination Survey cycles (2013–2014, 2015–2016, 2017–2018) were combined. Ordinal logistic regression was used to test the association between …

Utilization Of Psychotherapeutic Interventions By Pediatric Psychosocial Providers, Cynthia Fair, Amanda Thompson, Marie Barnett, Stacy R. Flowers, June Burke, Lori Wiener

Family Medicine Faculty Publications

One of the Standards of Psychosocial Care for Children with Cancer and their Families recommends that all youth with cancer and their family members have access to psychotherapeutic interventions and support throughout the cancer trajectory. This study was created to identify the psychosocial interventions and services provided to children with cancer and their family members, to ascertain whether there are differences in interventions provided by age of the patient and stage of treatment, and to learn about barriers to psychosocial service provision. An online survey was disseminated to psychosocial providers through the listservs of national and international professional organizations. The …

Addressing Distress Management Challenges: Recommendations From The Consensus Panel Of The American Psychosocial Oncology Society And The Association Of Oncology Social Work, Teresa L. Deshields, Sharla Wells-Di Gregorio, Stacy R. Flowers, Kelly E. Irwin, Ryan Nipp, Lynne Padgett, Brad Zebrack

Family Medicine Faculty Publications

Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients’ quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a …

Addressing Covid 19 Among Vulnerable Populations, Tim Crawford, Sydney Silverstein, Craig Woolley, Laura M. Luehrmann

Population and Public Health Sciences Faculty Publications

This is the fifth installment in the Shelter in Place (SiP) Lecture series. This installment deals with the impact and implications of the Shelter in Place order on differing populations. It discusses how a variety of populations have differing experiences with social distancing, the virus, and other implications of the current pandemic.

Association Between Sports Participation And Levels Of Physical Fitness, Jordan Italiano

Scholarship in Medicine - All Papers

Objective: Physical activity is a major component of overall health, especially in children. Increased physical activity in children provides many health benefits, and organized sports provide a great opportunity to meet the physical activity recommendations. In fact, participation in organized sports provides further health advantages, such as lower BMIs, compared to those who engaged in self organized physical activity and has shown to promote continued healthy habits throughout life. However, there has not been research looking at which sports are associated with the greatest level of fitness and provide the greatest health benefit for participants. In this study, we examine …

Video Games, Screen Time, And The Impact On Body Mass Index And The Cardiovascular Fitness Of Adolescence, Joshua Sylvan

Scholarship in Medicine - All Papers

Objective: To determine the effect of screen time/video gameplay has on the BMI and cardiovascular fitness of adolescence between the ages of 12 and 15 years old.

Methods: All data were collected and analyzed based on the CDC’s NHANES National Youth Fitness Survey (NNYFS).

Results: Analysis showed that there was no significant difference between body mass index and time spent using a computer as well as no significant difference between estimate maximal O2 uptake (primary endpoint for cardiovascular fitness) and time spent using a computer.

Health Care Provider Personal Religious Preferences And Their Perspective On Advance Care Planning With Patients, Marjorie A. Bowman, Sarah St. Cyr, Adrienne Stolfi

Population and Public Health Sciences Faculty Publications

Objective:

To understand how health-care providers’ (HCPs) religious preferences influence their willingness to undertake advance care planning (ACP) with patients and their acceptance of other HCP’s involvement.

Methods:

Online anonymous survey distributed to HCPs in hospital, ambulatory offices, and hospice settings in Dayton, Ohio. We evaluated the associations of HCP religion with their personal ACP, willingness to facilitate ACP, and acceptance of other HCPs’ ACP participation.

Results:

704 respondents: nurses (66.2%), physicians (18.8%), other HCPs (15.0%), white (88.9%), and primarily Catholic (23.3%) or Protestant (32.0%). “No religion” was marked by 13.9%. Respondents were favorable to ACP with patients. Religious respondents …

Persistence Of Macrocytosis After Discontinuation Of Zidovudine In Hiv-Infected Patients, Inski Yu, Richard N. Greenberg, Timothy N. Crawford, Alice C. Thornton, Thein Myint

Family Medicine Faculty Publications

The duration of macrocytosis after stopping zidovudine (ZDV) is unknown. Among 104 HIV-infected patients treated with ZDV for more than 1 year, 84 patients had macrocytosis at ZDV discontinuation. The median mean corpuscular volume (MCV) was 114.6 fL (range 100-128 fL). Patients were divided into 2 groups: those who did (resolved macrocytosis, n = 36) and did not (persistent macrocytosis, n = 48) normalize MCV at 3 to 6 months after ZDV discontinuation. Alcohol use (P =.02), smoking (P =.03), and lower (but within normal range) folic acid levels (P =.05) were related to the persistence of macrocytosis. A persistence …

Post-Traumatic Stress Symptoms In Pathological Gambling: Potential Evidence Of Anti-Reward Processes, Cheryl L. Green, Ramzi W. Nahhas, Arielle A. Scoglio, Igor Elman

Population and Public Health Sciences Faculty Publications

Background: Excessive gambling is considered to be a part of the addiction spectrum. Stress-like emotional states are a key feature both of pathological gambling (PG) and of substance addiction. In substance addiction, stress symptomatology has been attributed in part to "anti-reward" allostatic neuroadaptations, while a potential involvement of anti-reward processes in the course of PG has not yet been investigated. Methods: To that end, individuals with PG (n = 22) and mentally healthy subjects (n = 13) were assessed for trauma exposure and post-traumatic stress symptomatology (PTSS) using the Life Events Checklist and the Civilian Mississippi Scale, respectively. Results: In …

Ptsd Symptom Severities, Interpersonal Traumas, And Benzodiazepines Are Associated With Substance-Related Problems In Trauma Patients, Jeffrey Guina, Ramzi W. Nahhas, Adam J. Goldberg, Seth Farnsworth

Population and Public Health Sciences Faculty Publications

Background: Trauma is commonly associated with substance-related problems, yet associations between specific substances and specific posttraumatic stress disorder symptoms (PTSSs) are understudied. We hypothesized that substance-related problems are associated with PTSS severities, interpersonal traumas, and benzodiazepine prescriptions. Methods: Using a cross-sectional survey methodology in a consecutive sample of adult outpatients with trauma histories (n = 472), we used logistic regression to examine substance-related problems in general (primary, confirmatory analysis), as well as alcohol, tobacco, and illicit drug problems specifically (secondary, exploratory analyses) in relation to demographics, trauma type, PTSSs, and benzodiazepine prescriptions. Results: After adjusting for multiple testing, several factors …

Sharing Medicine: The Candidacy Of Medicines And Other Household Items For Sharing, Dominican Republic, Michael N. Dohn, Hugo Pilkington

Population and Public Health Sciences Faculty Publications

Background:

People share medicines and problems can result from this behavior. Successful interventions to change sharing behavior will require understanding people’s motives and purposes for sharing medicines. Better information about how medicines fit into the gifting and reciprocity system could be useful in designing interventions to modify medicine sharing behavior. However, it is uncertain how people situate medicines among other items that might be shared. This investigation is a descriptive study of how people sort medicines and other shareable items.

Methods and Findings:

This study in the Dominican Republic examined how a convenience sample (31 people) sorted medicines and rated …

Alcohol Use And Church Attendance Among Seventh Through Twelfth Grade Students, Dominican Republic, 2011, Michael N. Dohn, Santa Altagracia Jimenez Mendez, Maximinia Nolasco Pozo, Elizabet Altagracia Cabrera, Anita L. Dohn

Population and Public Health Sciences Faculty Publications

Excessive alcohol consumption increases the years of life lost to premature death and disability worldwide. Religion is a mitigating factor in alcohol consumption. A survey in the Dominican Republic showed increasing church attendance by middle and high school students (N = 3,478) was associated with a delay in age at first alcoholic drink, fewer students who had consumed alcohol in the past month (current drinkers), lower alcohol consumption levels, fewer episodes of inebriation, and less heavy episodic alcohol consumption (all P < 0.0001). The results suggested that it may be useful to conceive of church-attending youth as a subset of the adolescent social network when planning primary alcohol prevention programs for young people.

Leveraging Practice-Based Research Networks To Accelerate Implementation And Diffusion Of Chronic Kidney Disease Guidelines In Primary Care Practices: A Prospective Cohort Study, James W. Mold, Cheryl B. Aspy, Paul D. Smith, Therese M. Zink, Lyndee Knox, Paula Darby Lipman, Margot Krauss, D. Robert Harris, Chester Fox, Leif I. Solberg, Rachel Cohen

Family Medicine Faculty Publications

Background

Four practice-based research networks (PBRNs) participated in a study to determine whether networks could increase dissemination, implementation, and diffusion of evidence-based treatment guidelines for chronic kidney disease by leveraging early adopter practices.

Methods

Motivated practices from four PBRNs received baseline and periodic performance feedback, academic detailing, and weekly practice facilitation for 6 months during wave I of the study. Each wave I practice then recruited two additional practices (wave II), which received performance feedback and academic detailing and participated in monthly local learning collaboratives led by the wave I clinicians. They received only monthly practice facilitation. The primary outcomes …

Impact Of Poor Retention In Hiv Medical Care On Time To Viral Load Suppression, Timothy N. Crawford, Wayne T. Sanderson, Alice Thornton

Family Medicine Faculty Publications

Objective: The purpose of this study was to evaluate how poor retention in HIV care impacts time to viral suppression after initiating highly active antiretroviral therapy. Methods: A retrospective cohort study design, employing a medical chart review, was conducted at an academic infectious disease clinic at the University of Kentucky. Patients seeking care between 2003 and 2011 were included in the study. A log-normal model was employed to determine the factors associated with time to viral suppression. Results: Of the 532 patients in the study, 426 (80.1%) patients were virally suppressed. Controlling for insurance status, race, baseline CD4 counts, and …

Flipping The Global Health Challenge To The Classroom, Cristina Redko

Population and Public Health Sciences Faculty Publications

Much of the debate concerning global health education remains focused on building effective training programs. This paper emphasizes the development of teaching strategies specific to global health education. Inspired by the active learning process of “flipped classrooms” where critical thinking happens in the classroom and fact finding happens outside, this paper describes the experience of bringing the real global health challenge of high maternal mortality in Somaliland directly into the North American classroom in a public health graduate program.

The Likelihood Of Khat Chewing Serving As A Neglected And Reverse ‘Gateway’ To Tobacco Use Among Uk Adult Male Khat Chewers: A Cross Sectional Study, Saba Kassim, Nikki Lynn Rogers, Kelly Leach

Population and Public Health Sciences Faculty Publications

Background

Chewing khat leaves is often accompanied by tobacco use. We assessed aspects of tobacco use and explored factors associated with tobacco use patterns (frequency of use per week) among khat chewers who used tobacco only when chewing khat (“simultaneous tobacco and khat users”, STKU).

Methods

A sample of 204 male khat chewers was recruited during random visits to khat outlets. Data collected included socio-demographic items, tobacco use and khat chewing behaviours. Both psychological and physical dependence on khat were assessed using the Severity of Psychological Dependence on Khat (SDS-Khat) Scale, the Diagnostic Statistical Manual IV (DSM-IV) and adapted items …

Health Disparities Report, Sara J. Paton, Sylvia Ann Ellison, Nikki Lynn Rogers

Population and Public Health Sciences Faculty Publications

Through a Centers for Disease Control and Prevention Community Transformation Grant (CTG), Public Health – Dayton & Montgomery County (PHDMC) is working to improve the health of our community by reducing preventable chronic diseases such as lung cancer, heart disease, stroke, and type 2 diabetes. Our CTG initiatives focus on engaging community partners to implement policy, systems, and environmental (PSE) changes to promote tobacco-­free living, active living and healthy eating, and clinical preventive services. These PSE changes are intended to reduce death and disability due to tobacco use, rate of obesity, and death and disability due to heart disease and …

Systematic Examination Of Infant Size And Growth Metrics As Risk Factors For Overweight In Young Adulthood, Andrew O. Odegaard, Audrey C. Choh, Ramzi W. Nahhas, Bradford Towne, Stefan A. Czerwinski, Ellen W. Demerath

Population and Public Health Sciences Faculty Publications

Objective:To systematically examine infant size and growth, according to the 2006 WHO infant growth standards, as risk factors for overweight status in young adulthood in a historical cohort. Specifically, to assess: Whether accounting for length (weight-for-length) provides a different picture of risk than weight-for-age, intervals of rapid growth in both weight-for-age and weight-for-length metrics, and what particular target ages for infant size and intervals of rapid growth associate most strongly with overweight as a young adult.Patients/Methods:Data analysis of 422 appropriate for gestational age white singleton infants enrolled in the Fels Longitudinal Study. Odds ratios (OR) for overweight and obesity in …

Future Competencies Needed For The Direct Service Workforce, William Spears, Carla Clasen, Katherine L. Cauley

Population and Public Health Sciences Faculty Publications

The aging of the baby boom generation and health care policy changes represented by the Affordable Care act create challenges for the long term care industry in America. In 2011 the first of the baby boomers turned 65 years old. By 2030 a total of 78 million baby boomers, 19% of the population, will be 65 or more years old and eligible for Medicare (U.S. Census Bureau 2010). Discussions of potential health care worker shortages often focus on the need for more physicians and nurses to care for an aging population. These changes are putting pressure on long term care …

Family Violence Quality Assessment Tool For Primary Care Offices, Therese M. Zink

Family Medicine Faculty Publications

Dr. Zink will discuss the Family Violence Quality Assessment Tool for Primary Care Offices, a modified version of Dr. Coben's Delphi Instrument. The tool may be used to assess family violence efforts in primary care at the beginning and intermittently. It is meant to be a tool for identifying deficiencies so they can be remedied and the care to patients living with violence and abuse can be improved.

Role And Effectiveness Of Community Health Workers Among Underserved Us Populations, Hibo H. Noor

Master of Public Health Program Student Publications

The role of the Community Health Workers (CHWs) in the health care system has great value both domestically and internationally. CHWs have training in healthcare; they are members of the community in which they serve. They have in depth understanding of the barriers to health care the community faces; they can speak the same language, and can promote and improve health status, quality of care and assist managing chronic disease. This paper focuses on the role and documented effectiveness of CHWs in terms of quality, health care services, cost health services, as well as health behaviors and knowledge about the …

Primary Care Survival Skills In An Age Of Reform, Therese M. Zink, Peter Harper, Nancy Arnston, Jean Jansen

Family Medicine Faculty Publications

The Triple Aim - improved outcomes/quality of care, improved patient experience, and reduced cost - is driving health care reform in Minnesota and nationally. Minnesota is among those states moving quickly to new payment models that reward practices for meeting these three goals and is gradually reducing payments based only on increased volume of services. Primary care is growing into a new leadership role to meet these new demands while managing the reality that full funding for population based care is developing more slowly than the rhetoric. There are many encouraging signs, including an expanding interest in primary care medical …

Are Maternal Child Health Outcomes Affected By Adequacy Of Prenatal Care In Montgomery County, Oh?, Amy Rouse

Master of Public Health Program Student Publications

Background: Prenatal Care has been recommended by the World Health Organization for all pregnant women in order to improve health outcomes of the mother and the child. However, recommendations for the number of visits required to provide adequate health care and improve outcomes continue to be debated. Understanding if adequate prenatal care is improving maternal child outcomes is essential before making these recommendations. This research aims to determine if in Montgomery County, OH the adequacy of prenatal care influenced gestational age at birth, birth weight, breastfeeding rate, rate of cesarean sections, and smoking cessation rates.

Methods: De-indentified birth data was …

Food Deserts And Their Association With Obesity And Diabetes In Ohio, Alexis Holmes, Detra Thompson

Master of Public Health Program Student Publications

Objective- The purpose of this study was to explore the association of food access, and availability, on prevalence of diabetes and obesity in Ohio census tracts designated as food deserts.

Methods- County and census tract-level data were combined from the USDA Food Environment Atlas and USDA Food Desert Locator respectively. Statistical analysis was conducted using IBM Statistical Package for Social Sciences (SPSS). Non-normally distributed variables were assessed using the Mann-Whitney nonparametric U-test and Spearman’s correlation coefficient. Significance was considered at the p

Results- The mean rate of obesity and diabetes in Ohio in food deserts are 29.5% and 10.7%, when …

Fostering Aging In Place: "Healthy Naturally Occurring Retirement Community" (H-Norc) Qualities In A Southwest Ohio Suburb, Laura A. Previll

Master of Public Health Program Student Publications

This community assessment uses the concept of “H-NORCs” or Healthy Naturally Occurring Retirement Communities as a framework to analyze supports for aging (Masotti, Johnson-Masotti, Fick, & MacLeod, 2006) in Kettering, Ohio -- a first tier suburb of Dayton where the proportion of people over the age of 60 was 23.8% in 2010. In this study, I used focus groups and interviews to collect qualitative data on five H-NORC attributes: (1) economic policies that benefit seniors; (2) types of transportation support for seniors; (3) neighborhood design for physical activity; (4) opportunities for social integration and sense of belonging; and (5) health …

Differences In Immunity Offered By The Influenza Vaccination Among Active Duty Us Air Force Personnel From 2007-2011, Billy D. Pruett

Master of Public Health Program Student Publications

OBJECTIVE: To investigate the potential difference in vaccine effectiveness among Active Duty Air Force (ADAF) personnel vaccinated against influenza from 2007-2011. Particularly, to determine if any difference in the protection offered is based on sex, vaccine type, or both.

METHODS: The proposed study incorporated a cross-sectional design using the Department of Defense’s (DoD) comprehensive databases. Laboratory-confirmed influenza and other Influenza-Like Illness (ILI) cases were identified for each of the four influenza seasons of interest, vaccination status and history was then verified, and 2x2 tables were constructed in order to calculate odds ratios.

RESULTS: No consistent difference in vaccine effectiveness in …