Health and Medical Physics Commons^™

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …

The Yearly Financing Need Of Providing Paid Maternity Leave In The Informal Sector In Indonesia, Adiatma Y. M. Siregar, Pipit Pitriyan, Donny Hardiawan, Paul Zambrano, Mireya Vilar-Compte, Graciela Ma Teruel Belismelis, Meztli Moncada, David Tamayo, Grace Carroll, Rafael Perez-Escamilla, Roger Mathisen

Department of Public Health Scholarship and Creative Works

Background: The economic cost of not breastfeeding in Indonesia is estimated at US$1.5–9.4 billion annually, the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia (15–49 years) are informal employees, meaning they are working as casual workers or they are self-employed (small scale business) and assisted by unpaid/family worker(s). No specific maternity protection entitlements are currently available for WRA working informally in Indonesia. This study aims to estimate the financing need of providing maternity leave cash transfer (MCT) for WRA working in the informal sector in Indonesia. Method: The costing methodology …

Breastfeeding Media Coverage And Beliefs During The Covid-19 Pandemic In Mexico: Implications For Breastfeeding Equity, Mireya Vilar-Compte, P. Gaitán‐Rossi, E. C. Rhodes, V. Cruz‐Villalba, R. Pérez‐Escamilla

Department of Public Health Scholarship and Creative Works

Background: Because breastfeeding offers short- and long- term health benefits to mothers and children, breastfeeding promotion and support is a public health priority. Evidence shows that SARS-CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are thought to be contained in breastmilk of mothers with history of COVID-19 infection or vaccination. WHO recommends direct breastfeeding as the preferred infant feeding option during the COVID-19 pandemic, even among women with COVID-19; but conflicting practices have been adopted, which could widen existing inequities in breastfeeding. This study aims to describe how information about breastfeeding was communicated in Mexican …

La Migración Como Determinante De La Obesidad Infantil En Estados Unidos Y Latinoamérica, Mireya Vilar-Compte, Arturo V. Bustamante, Nancy López-Olmedo, Pablo Gaitán-Ross, Jaqueline Torres, Karen E. Peterson, Graciela Teruel, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

La migración internacional tiene consecuencias económicas y en la salud. El proceso de aculturación en el país de acogida puede estar relacionado con la obesidad infan-til. Utilizamos el marco conceptual del balance energético comunitario (CEB, por sus siglas en inglés) para analizar la relación entre migración y obesidad infantil en los hogares mexicanos con migrantes internacionales. Utilizando datos longitudinales de la Encuesta Nacional de Niveles de Vida de los Hogares de México (ENNViH), exami-namos cómo influyen las redes de migrantes sobre la obesidad infantil en las comuni-dades de origen. También revisamos programas de salud binacionales que podrían ser eficaces para …

Migration As A Determinant Of Childhood Obesity In The United States And Latin America, Mireya Vilar-Compte, Arturo V. Bustamante, Nancy López-Olmedo, Pablo Gaitán-Rossi, Jaqueline Torres, Karen E. Peterson, Graciela Teruel, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

International migration has economic and health implications. The acculturation process to the host country may be linked to childhood obesity. We use the Community Energy Balance (CEB) framework to analyze the relationship between migration and childhood obesity in Mexican households with international migrants. Using longitudinal data from the Mexican Family Life Survey (MxFLS), we examine how migrant networks affect childhood obesity in origin communities. We also review binational health programs that could be effective at tackling childhood obesity in migrant households from Mexico. Children embedded in migrant networks are at greater risk of developing overweight or obesity, suggesting a significant …

Implementation Of Childhood Obesity Prevention And Control Policies In The United States And Latin America: Lessons For Cross-Border Research And Practice, Rafael Perez-Escamilla, Mireya Vilar-Compte, Elizabeth Rhodes, Olga L. Sarmiento, Camila Corvalan, Rachel Sturke, Susan Vorkoper

Department of Public Health Scholarship and Creative Works

Progress has been made in the development and widespread implementation of effective interventions to address childhood obesity, yet important challenges remain. To understand how the United States and Latin American countries achieved success in implementing obesity policies and programs (PAPs) and identify improvement opportunities using implementation science principles. We identified three comparative case studies: (1) front-of-food package labeling (Mexico and Chile); (2) Open Streets/play streets (Colombia and the United States); and (3) the Baby-Friendly Hospital Initiative (Brazil and the United States). Information from multiple sources (e.g., scientific and gray literature and key informant interviews) was synthesized to describe barriers, facilitators, …

Food Insecurity Measurement And Prevalence Estimates During The Covid-19 Pandemic In A Repeated Cross-Sectional Survey In Mexico, Pablo Gaitán-Rossi, Mireya Vilar-Compte, Graciela Teruel, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Objective: To validate the telephone modality of the Latin American and Caribbean Food Security Scale (ELCSA) included in three waves of a phone survey to estimate the monthly household food insecurity prevalence during the COVID-19 pandemic in Mexico. Design: We examined the reliability and internal validity of the ELCSA scale in three repeated waves of cross-sectional surveys with Rasch models. We estimated the monthly prevalence of food insecurity in the general population and in households with and without children and compared them with a national 2018 survey. We tested concurrent validity by testing associations of food insecurity with socio-economic status …

How Much Can Mexican Healthcare Providers Learn About Breastfeeding Through A Semi-Virtual Training? A Propensity Score Matching Analysis, Mireya Vilar-Compte, Rafael Pérez-Escamilla, Meztli Moncada, Diana Flores

Department of Public Health Scholarship and Creative Works

Background: Mexico has shown a worrisome decrease in breastfeeding indicators, especially in the lowest socioeconomic level. Improving breastfeeding protection, promotion, and support services through workforce development is a key area of intervention. The objective of this study is to assess the influence on breastfeeding knowledge and abilities of a semi-virtual training for primary healthcare providers assisting beneficiaries of PROSPERA in Mexico, which is one of the largest conditional cash-transfer programs in the world. Methods: Two independent cross-sectional samples of healthcare providers were drawn at baseline and post-intervention in three states of Mexico. Baseline data were collected among primary physicians, registered …

Costs Of Maternity Leave To Support Breastfeeding; Brazil, Ghana And Mexico, Mireya Vilar-Compte, Graciela M. Teruel, Diana Flores-Peregrina, Grace J. Carroll, Gabriela S. Buccini, Rafael Perez-Escamilla

Department of Public Health Scholarship and Creative Works

Objective To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico. Methods We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used the unit cost of maternity leave based on working women’s weekly wages; the number of additional weeks of maternity leave to be analysed for a given year; and the weighted population of women of reproductive and legal working age in a given …

Costing Of Actions To Safeguard Vulnerable Mexican Households With Young Children From The Consequences Of Covid-19 Social Distancing Measures, Mireya Vilar-Compte, Víctor Pérez, Graciela Teruel, Aranzazu Alonso, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

COVID-19 has imposed unprecedented challenges to society. As the pandemic evolves, the social distancing measures that have been globally enforced, while essential, are having undesirable socioeconomic side effects particularly among vulnerable populations. In Mexico, families who depend upon informal employment face increased threats to their wellbeing, and households who in addition have young children may face long-term consequences. The Mexican government has not yet taken actions, but a coalition of non-governmental organizations is advocating in partnership with academic institutions for social protection actions such as a cash transfer and basic services subsidies for families with young children, subsisting from the …

¡Sí, Yo Puedo Vivir Sano Con Diabetes! A Self-Management Randomized Controlled Pilot Trial For Low-Income Adults With Type 2 Diabetes In Mexico City, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Roberta Delvy, Sangchoon Jeon, Soraya Burrola-Méndez, Mariana Pardo-Carrillo, Annel Lozano-Marrufo, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system.

Objectives: We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City.

Methods: Participants were recruited at public …

Development Of A Diabetes Self-Management + Mhealth Program: Tailoring The Intervention For A Pilot Study In A Low-Income Setting In Mexico, Robin Whittemore, Mireya Vilar-Compte, Soraya Burrola-Méndez, Annel Lozano-Marrufo, Roberta Delvy, Mariana Pardo-Carrillo, Selene De La Cerda, Ninfa Pena-Purcell, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: Type 2 diabetes (T2D) is a public health pandemic disproportionately affecting low- and middle-income countries. The purpose of this formative research was to adapt evidence-based diabetes self-management education programs to the context of Seguro Popular clinics in Mexico. A theory-based mHealth (pictorial text messaging) component was developed.

Method: Our formative research and development of the program protocol consisted of six phases: (1) interviews and focus groups with stakeholders on the challenges to T2D management, curriculum content needs, and the use of mHealth as a supplement to a DSME program; (2) review of the theoretical underpinning, curriculum, and interactive strategies …

Association Between Breastfeeding And Child Stunting In Mexico, Ana Paola Campos, Mireya Vilar-Compte, Summer Sherburne Hawkins

Department of Public Health Scholarship and Creative Works

Background: Globally, the prevalence of child stunting has been decreasing over the past decades. How-ever, in low-and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting. Objective: To examine the association between breastfeeding (defined as never breastfed, any breast-feeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under –2 standard deviations of the World Health Organization child growth standards’ median) in Mexico. Methods: Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6–35 months with information on previously identified risk and protective factors for stunting. We conducted fixed-and mixed-effects logistic regression models sequentially controlling for each level of factors. Findings: Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breast-feeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models. Conclusions: According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.

Challenges To Diabetes Self-Management For Adults With Type 2 Diabetes In Low-Resource Settings In Mexico City: A Qualitative Descriptive Study, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Denise Marron, Rosabelle Conover, Roberta Delvy, Annel Lozano-Marrufo, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City.

Methods: This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach.

Results: The …

Short Relative Leg Length Is Associated With Overweight And Obesity In Mexican Immigrant Women, Mireya Vilar-Compte, James Macinko, Beth C. Weitzman, Carlos M. Avendaño-Villela

Department of Public Health Scholarship and Creative Works

Background: Prior research suggests that undernutrition and enteric infections predispose children to stunted growth. Undernutrition and infections have been associated with limited access to healthy diets, lack of sanitation, and access barriers to healthcare - all associated with human rights. Stunting has also been documented to be a major determinant of subsequent obesity and non-communicable diseases. Short leg length relative to stature during adulthood seems to be a good proxy indicator tracking such barriers, and has been reported to be associated with adverse health effects during adulthood. Our objective was to examine the association between relative leg length (as measured …

Sub-Region Based Radiomics Analysis For Survival Prediction In Oesophageal Tumours Treated By Definitive Concurrent Chemoradiotherapy, Congying Xie, Pengfei Yang, Xuebang Zhang, Lei Xu, Xiaoju Wang, Xiadong Li, Luhan Zhang, Ruifei Xie, Ling Yang, Zhao Jing, Hongfang Zhang, Lingyu Ding, Yu Kuang, Tianye Niu, Shixiu Wu

Health Physics and Diagnostic Sciences Faculty Research

Background: Evaluating clinical outcome prior to concurrent chemoradiotherapy remains challenging for oesophageal squamous cell carcinoma (OSCC) as traditional prognostic markers are assessed at the completion of treatment. Herein, we investigated the potential of using sub-region radiomics as a novel tumour biomarker in predicting overall survival of OSCC patients treated by concurrent chemoradiotherapy. Methods: Independent patient cohorts from two hospitals were included for training (n = 87) and validation (n = 46). Radiomics features were extracted from sub-regions clustered from patients' tumour regions using K-means method. The LASSO regression for ‘Cox’ method was used for feature selection. The survival prediction model …

An Iterative Process For Training Design And Implementation Increased Health Workers' Knowledge For Taking Nutrition Behavior Change To Scale, Wendy Gonzalez, Anabelle Bonvecchio Arenas, Armando García-Guerra, Mireya Vilar-Compte, Alejandría Villa De La Vega, Laura Quezada, Cynthia Rosas, Ana Lilia Lozada-Tequeanes, Amira Hernández

Department of Public Health Scholarship and Creative Works

The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The …

Need For Cognition And Message Complexity In Motivating Fruit And Vegetable Intake Among Callers To The Cancer Information Service, Pamela Williams-Piehota, Judith Pizarro, Stephanie A. Navarro Silvera, Linda Mowad, Peter Salovey

Department of Public Health Scholarship and Creative Works

This field experiment examined the impact of an individual's need for cognition (NFC; the tendency to enjoy thinking deeply about issues), complex versus simple messages, and the interaction of NFC and message type on encouraging fruit and vegetable consumption. Callers to the Cancer Information Service of the National Cancer Institute (N = 517) were asked to participate in the experiment at the end of their call. Individual NFC was assessed, and participants were assigned randomly to receive a telephone message promoting fruit and vegetable consumption that was either complex and multifaceted or simple and straightforward. Similarly constructed brochures were mailed …