Public Health Education and Promotion Commons^™

Sex Differences In Cardiovascular Disease And Associated Factors In People Living With Hiv: Evidence From All Of Us Program, Hao Zhang, Huiyi Xia, Fanghui Shi, Qingyang Li, Sharon Weissman, Xiaoming Li, Xueying Yang

Faculty Publications

Background

People living with HIV (PLWH) face a higher risk of cardiovascular disease (CVD), with significant sex differences in outcomes. However, it is unclear whether these differences are driven by distinct risk factor profiles or by a differential impact of shared risk factors. This study aimed to identify factors associated with CVD among PLWH and to specifically assess for effect modification by sex using a large, diverse nationwide database.

Methods

We utilized data from the All of Us Research Program (AoU). The primary outcome was a composite of coronary artery disease or stroke. We used multivariable logistic regression to identify …

Sex Differences In Cardiovascular Disease And Associatedfactors In People Living With Hiv: Evidence From All Of Us Program, Hao Zhang, Huiyi Xia, Fanghui Shi, Qingyang Li, Sharon Weissman, Xiaoming Li Ph.D., Xueying Yang

Faculty Publications

Background

People living with HIV (PLWH) face a higher risk of cardiovascular disease (CVD), with significant sex differences in outcomes. However, it is unclear whether these differences are driven by distinct risk factor profiles or by a differential impact of shared risk factors. This study aimed to identify factors associated with CVD among PLWH and to specifically assess for effect modification by sex using a large, diverse nationwide database.

Methods

We utilized data from the All of Us Research Program (AoU). The primary outcome was a composite of coronary artery disease or stroke. We used multivariable logistic regression to identify …

Perceived Risks, Reasons For Use, And Barriers To Cessation Among Youth Who Use Multiple Tobacco Products, Sierra L. Patterson, Isabellle Duguid, Sonia A. Clark, Seth M. Noar, Allison J. Lazard, Jim F. Thrasher Ph.D., Ma, Ms, Adam O. Goldstein, Sarah D. Kowitt

Faculty Publications

Background

Many interventions aim to reduce youth tobacco use, but few have focused on youth who use multiple tobacco products (MTPs). This qualitative study sought to understand how youth who use MTPs view tobacco product risks, describe reasons for MTP use, and perceive barriers and facilitators to cessation.

Methods

We conducted seven virtual focus groups with 30 US youth ages 14–20 years who reported using e-cigarettes and smoking a combustible tobacco product in the past 30 days. We used a semi-structured focus group guide to ask youth about perceived health risks of tobacco products, reasons for MTP use, and thoughts …

Social Determinants Of Self-Reported Health In Vulnerable Populations During A Polycrisis In Lebanon, Rindala Fayyad, Marie Elizabeth Ragi, Hala Ghattas Ph.D., Stephen J. Mccall

Faculty Publications

Importance: In the context of a polycrisis, which is characterized by multiple interconnected and mutually reinforcing crises, humanitarian and health needs increase. It is therefore crucial to identify social determinants impacting health and well-being of vulnerable populations to better inform appropriate interventions.

Objective: To assess the association between social determinants and pain frequency, self-rated health, and depression over time among vulnerable populations during a polycrisis in Lebanon.

Design, Setting, and Participants: In this population-based longitudinal cohort study, data were collected in Sin-El-Fil, a suburb of Beirut, Lebanon, in 4 waves: June 28 to October 26, 2022; September 8 to December …

Food Insecurity And Social Connection Of Nicaraguan Refugees And Asylum Seekers In Costa Rica: A Qualitative Study, Keren Herran

Theses and Dissertations

Background

Given the physical and mental health consequences of food insecurity, solutions should be evidence-based and seek to prioritize vulnerable populations. This qualitative study adds to limited literature on how refugees and asylum seekers use their social connections to mitigate food insecurity by investigating how Nicaraguan refugees and asylum seekers in Costa Rica foster social connections and use these connections to acquire and manage food.

Methods

In fall 2024, 35 in-depth semi-structured interviews were conducted in San José, Costa Rica. Participants were recruited through six migrant-serving nonprofit organizations. For study inclusion, participants had to: 1) be 18 or older; 2) …

Fit For Success: Exploring Physical Activity Promotion And Effects On Students At The University Of South Carolina Through A Podcast Series, Maia Schwarzmueller

Senior Theses

College students face unique challenges when trying to maintain physical activity levels, such as time constraints, stress, and lack of proper facilities. The Fit for Success podcast will explore how physical activity is a powerful tool towards enhancing self-perception, academic success, and stress management as well as delve into the specific barriers that University of South Carolina students face to physical activity. The podcast will also explore different aspects of physical activity promotion including group fitness, competition, and built environment. The goal of the podcast is to help students to see physical activity as an important component of many facets …

Monitoring Nutrition Security: Perspectives From A Workshop On Nutrition Security Measurement, Ximena Perez-Velazco, Edward A. Frongillo Jr. Ph.D., Joanne F. Guthrie, Alisha Coleman-Jensen, Mariah D. Ehmke, Christian Gregory, Hilary K. Seligman

Faculty Publications

Nutrition security, an emerging concept distinct from and complementary to food security, has gained increasing interest as a focus of efforts to reduce hunger, improve nutrition, and prevent diet-related health conditions. Yet, unlike food security, which has well-established measures, nutrition security lacks standardized measures for assessment. This gap hinders the ability to evaluate progress in improving nutrition security both in the United States and globally. In September 2024, a workshop to explore how to measure nutrition security was hosted by the United States Department of Agriculture Economic Research Service, in collaboration with the Southern University Agricultural Science Center of Excellence …

Sleep Quality, Emotional Moods, And Cognitive Outcomes Among People Living With Hiv: An Ecological Momentary Assessment Study, Shan Qiao Ph.D., Abhishek Aggarwal, Camryn Garrett, Arielle N’Diaye, Atena Pasha, Irene Esu, Chih Hsiang Yang Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Introduction Although studies have explored the relationship between sleep quality, mood, and cognitive outcomes among people living with HIV (PLWH), few use ecological momentary assessment (EMA) techniques to evaluate within-person associations between sleep quality and emotional/cognitive outcomes among PLWH at the day level. This study investigated the association between previous night’s sleep quality and momentary psychological outcomes in participants’ natural setting. Methods Study participants were PLWH in South Carolina who were at least 18 years old, diagnosed with HIV for at least 2 years, and able to operate a cellphone. Participants were sampled using posters posted in AIDS Service organizations, …

Editorial: Disclosure In Sexual And Reproductive Health, Pooja Chitneni, Shan Qiao Ph.D., Simon M. Manga, Janet M. Turan

Faculty Publications

No abstract provided.

Exploring The Association Between Smartphone-Based Place Visitation Data And Neighborhood-Level Coronary Heart Disease In The United States, Temitope Akinboyewa, Zhenlong Li, Huan Ning, M. Naser Lessani, Louisa M. Holmes, Shan Qiao Ph.D.

Faculty Publications

Coronary Heart Disease (CHD) is the leading cause of death in the United States, affecting over 20.5 million adults. Previous studies link health behaviors – such as dietary behavior, physical activity, smoking, and alcohol consumption – to CHD risk. These studies typically use surveys and interviews, which, despite their benefits, are resource-intensive and limited by small sample sizes. Using large-scale national level anonymized smartphone-based location data, our study examines whether health behaviors that are proxy measured by place visitation are associated with CHD prevalence across US census tracts. This study utilized data from multiple sources, including demographic and socioeconomic characteristics, …

Changes In Mental Health Care Utilisation Before And During The Covid-19 Pandemic Among People Living With Hiv In The Usa: A Retrospective Cohort Study Using The All Of Us Dataset, Atena Pasha, Shan Qiao, Jiajia Zhang Ph.D., Ruilie Cai, Buwei He, Xueying Yang, Chen Liang Ph.D., Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Introduction Despite the profound impact of the COVID-19 pandemic on people living with HIV (PLWH) mental health, large-scale, real-world data on mental healthcare utilisation and associated factors among PLWH remain limited. This study explores mental healthcare utilisation and associated factors among PLWH during the COVID-19 pandemic.

Methods Using a retrospective cohort design, we identified and included 4575 PLWH through computational phenotyping based on relevant Observational Medical Outcomes Partnership Common Data Model concept sets from the All of Us programme between March 2018 and March 2022. Mental healthcare utilisation was measured using the yearly count of mental healthcare visits and compared …

Mental Distress And Resource Insecurity In The Kingdom Of Tonga After The 2022 Volcanic Eruption: Associations Of Water And Food Insecurity With Mental Distress, Hilary J. Bethanancourt, Indira Bose, Lupe Moala Tupou, Melissa Meinhart, Edward A. Frongillo Jr. Ph.D., Amelia Greaves, Sera L. Young

Faculty Publications

Background Water and food insecurity can harm mental health; all 3 may, in turn, be exacerbated by humanitarian crises. The linkages between food insecurity, water insecurity, and mental health are gaining attention but have not been investigated after a natural disaster.

Objective To investigate the associations between food insecurity, water insecurity, and mental distress, and how these relationships may differ between women and men, in the aftermath of the January 15, 2022, volcanic eruption in the Kingdom of Tonga.

Design Secondary analysis of nationally representative cross-sectional data from the Equality Insights Rapid survey collected 4 to 5 months after the …

Resilience Mediates The Association Between Discrimination And Psychological Distress Among Rural, Black Women In South Carolina: A Structural Equation Model, Camryn Garrett, Abhisheak Aggrawal, Huiyi Xia, Cheuk Chi Tam, Bankole Olatosi Ph.D., Sarah Wilcox Phd, Xiaoming Li Ph.D., Shan Qiao Ph.D.

Faculty Publications

Introduction

The marginalization of intersecting racial, gender, and rural identities compounds the structural vulnerabilities (e.g., discrimination, stigma, health disparities) experienced by Black women in South Carolina’s rural areas. Discriminatory experiences can deteriorate mental health; however, resilience can potentially reduce the ill effects of discrimination by decreasing associated psychological distress. This study examines the mediating role of resilience in the association between discrimination and psychological distress among rural, Black women in South Carolina in the post-pandemic era.

Methods

Black women (n = 300, mean age = 48.6) living in rural South Carolina were recruited from January to February 2024 using …

Impact Of Food Insecurity Resource Navigation For Primary Care Patients With Diabetes And Hypertension: A Matched Cohort Study, Deeksha Gupta, Darin Thomas, Stella Self, Edward A. Frongillo Jr. Ph.D., Alain H. Litwin, J. Alex Ewing, Lynnette Ramos-Gonzalez, A. Carolina Rudisill

Faculty Publications

Background

Food insecurity contributes to poor health and increased healthcare costs among patients with chronic diseases. Resource navigators can facilitate community-based resource connections, addressing food insecurity, but the impact on healthcare costs and quality of life remains unclear.

Objective

To examine whether food insecurity resource navigation improves clinical outcomes, healthcare charges, and quality of life for patients with diabetes and/or hypertension.

Design

Matched-control quasi-experimental study.

Patients

Patients underwent screening for food insecurity from July 12, 2021, to December 31, 2022, in South Carolina’s largest health system. Eligible patients (18 + years, having food insecurity, and diabetes and/or hypertension) enrolled for …

Community And School Programs, Policies And Environments Related To Child Dietary Intake:The Healthy Communities Study, Gail Woodward-Lopez, Alexander C. Mclain, Edward A. Frongillo Jr., Natalie Colabianchi, Vicki Collie-Akers, Lorrene D. Ritchie

Faculty Publications

Background

To reverse the epidemic of unhealthy eating and related chronic disease in the United States, intervening early in life is essential.

Objective

Identify features of community- and school-based programmes, policies and environments related to child intake of fruits and vegetables (FV) and sugar-sweetened beverages (SSB).

Methods

Dietary intake of children 4–15 years old (n = 5138) from elementary and middle schools in 130 US communities was collected by survey (of parent and/or child) in 2013–2015. Features of community programs and policies (CPPs) and school environments were collected by staff surveys, direct observation, key informant interviews, and/or document review. …

The Influence Of Sex Education On Sexual Behaviors From Adolescence To Young Adulthood In South Carolina, Megan Elizabeth Austin

Theses and Dissertations

Sex education in South Carolina (SC) is known to be limited, which may influence adolescent sexual behaviors, leading to a higher likelihood of lower ages of sexual initiation, more sexual partners, and more experiences of sexual violence. These behaviors are associated with many negative health outcomes.

A political content analysis of bills, laws, and educational standards provides insight to changes in political discourse around sex education from when the Comprehensive Health Education Act (CHEA) was passed in 1988 until 2024. A variable created through this analysis is used along with SC Youth Risk Behavior Survey data to assess changes in …

Relocation Post-Dobbs Among Clinicians Providing Abortions, Dana Howard, Marta Bornstein Phd, Mph, Jocelyn Wascher, Alison H. Norris, Katherine Rivlin

Faculty Publications

Introduction

Intensifying state-level abortion restrictions following the Dobbs v Jackson Women’s Health Organization (2022) decision could lead clinicians to leave states that ban abortion.¹ While large-scale changes are not yet apparent among obstetrician-gynecologists, the abortion care workforce may be uniquely at risk.² We examined the proportion of abortion-providing clinicians who changed primary state of practice, comparing those who left states that banned abortion with those who left states that did not ban abortion after Dobbs, and the ban status of the states to which they relocated.

Methods

This survey study was approved by The Ohio State University …

Prevalence And Predictors Of Intimate Partner Violence Against Men In Kisumu Slums, Kenya, Elizabeth Akello Odemba, Edward A. Frongillo Jr. Ph.D., Sheri D. Weiser

Faculty Publications

Background

Men in sub-Saharan Africa experience intimate partner violence, with few reporting their cases to the legal authorities or coming out for assistance. Consequently, data on the prevalence and drivers of intimate partner violence in different parts of sub-Saharan Africa are inadequate. Therefore, this study was designed to investigate the prevalence and predictors of intimate partner violence against men in Kisumu slums, Kenya.

Methods

This retrospective cross-sectional study included 398 randomly selected men in intimate relationships aged 18–54 years and residing in Kisumu slums. The sampling frame used was from Community Health Volunteers covering the area of study. Data collection …

Social Exclusion And Mental Health Of Youths Affected By Parental Hiv/Aids In China: Based On A Serial Mediating Model, Jiaojiao Wan, Lili Ji, Zheqian Wang, Junfeng Zhao, Xiaoming Li

Faculty Publications

The mental health of youth living with patients with HIV needs focused attention. The primary source of psychological distress they experience may stem from social exclusion. Therefore, the current study was designed to explore the relationship between social exclusion and mental health among youths affected by parental HIV/AIDS in rural China.

Methods

297 youths affected by parental HIV/AIDS were recruited to completed questionnaires of social exclusion, perceived stress, future orientation and mental health. The bootstrap method was used to examine the mediation effects.

Results

It showed that: (1) the social exclusion (M = 32.48, SD = 15.25) significantly and …

What, When, And How Food And Beverage Are Advertised On Ghanian Television, Morgan Boncyk, Krystal K. Rampalli, Marian N. Winters, Muskaan K. Makkar, Silver Nanema, Gideon S. Amevinya, Amos Laar, Edward A. Frongillo Ph.D., Christine E. Blake

Faculty Publications

Food marketing has increased volume, precision, and reach to influence viewers’ food attitudes, beliefs, and eating behaviors. What and how much people eat has implications for health. While many countries regulate food advertising to protect consumers and encourage healthy eating, Ghana has none. Understanding the content and framing of food and beverage advertisements can inform the development of effective policies and practices that encourage healthier diets. This content analysis examines the foods and beverages advertised, their timing, and marketing techniques on Ghanaian television. From February to May 2020, 486 hours of advertisements were recorded. Advertisements with ≥1 actors were coded …

Implementation Outcomes And Associated Constructs From The Consolidated Framework For Implementation Research Among Churches Trained Online To Implement Faith, Activity, And Nutrition In A National Implementation Study, Sara Wilcox Phd, Ruth P. Saunders Phd, Andrew T. Kaczynski Ph.D., Caroline Rudisill Ph.D., Msc, Ye Sil Kim Phd, Jasmin Parker-Brown, Kelsey R. Day

Faculty Publications

Churches hold promise for reaching populations with high rates of chronic disease, yet few faith-based large-scale implementation studies exist. The study purpose was to examine 12-month implementation outcomes and associated Consolidated Framework for Implementation Research (CFIR) constructs after converting in-person training to online for an evidence-based intervention designed to improve church organizational practices related to physical activity (PA) and healthy eating (HE). US churches recruited from 2020 to 2022 participated in eight online lessons prior to implementation. Each church’s coordinator completed an online baseline and 12-month survey assessing church practices for PA/HE components targeted in the Faith, Activity, and Nutrition …

Generative Ai For Thematic Analysis In A Maternal Health Study: Coding Semistructured Interviews Using Large Language Models, Shan Qiao, Xingyu Fang, Junbo Wang, Ran Zhang, Xiaoming Li, Yuhao Kang

Faculty Publications

Study Objectives: The coding of semistructured interview transcripts is a critical step for thematic analysis of qualitative data. However, the coding process is often labor-intensive and time-consuming. The emergence of generative artificial intelligence (GenAI) presents new opportunities to enhance the efficiency of qualitative coding. This study proposed a computational pipeline using GenAI to automatically extract themes from interview transcripts. Methods: Using transcripts from interviews conducted with maternity care providers in South Carolina, we leveraged ChatGPT for inductive coding to generate codes from interview transcripts without a predetermined coding scheme. Structured prompts were designed to instruct ChatGPT to generate and summarize …

Podcasts In Mental, Physical, Or Combined Health Interventions For Adults: Scoping Review, Elizabeth M. Dascombe, Philip J. Morgan, Ryan J. Drew, Casey P. Regan, Gabrielle Turner-Mcgrievy, Myles D. Young

Faculty Publications

Background:

The increasing prevalence of poor mental and physical health in adults is a global health concern. Given the scope of this problem, scalable and effective treatment interventions are needed. While podcasts (online digital audio files) are becoming more popular, the extent of podcast use in mental, physical, or combined health interventions has not been reviewed.

Objective:

This scoping review primarily aims to summarize the available evidence regarding the use of podcasts in health promotion interventions. A series of 5 research questions was designed to systematically review and accurately represent podcast use in current research interventions.

Methods:

We conducted a …

Investigating The Suitability Of Dichotomous Responses For The Water Insecurity Experiences (Wise) Scales Using Nationally Representative Data From 39 Countries, Indira Bose, Joshua D. Miller, Hilary J. Bethancourt, Olga P. García, Hugo R. Melgar-Quiñonez, Rosana Salles-Costa, Mauro E. Delgrossi, Scott M. Miller, Tessa L. Durham, Teresa Shamah-Levy, Pablo Gaitán-Rossi, Sera L. Young, Edward A. Frongillo Jr. Ph.D.

Faculty Publications

The Water Insecurity Experiences (WISE) Scales have been validated to comparably measure water insecurity globally. The scales consist of 12 items that can be administered in approximately 3 minutes. There is interest in developing more rapid versions of the tools for when time is limited. One alternative is to use a subset of 4 items, which has been validated, but has some drawbacks. Here we investigate another alternative: dichotomous (yes/no) response options instead of the original four levels of frequency-based (polytomous) responses. We used nationally representative data from 39 countries to simulate dichotomized responses by collapsing the four levels of …

Tobacco Package Health Warnings About Product Manipulations: An Experimental Study Among Australian Adults Who Smoke, Emily Brennan, Claudia Gascoyne, Kimberley Dunstone, Amanda Vittiglia, Gayathri Srinivasan, Jim Thrasher Ph.D., Ma, Ms, Janet Hoek, Melanie Wakefield, Sarah Durkin

Faculty Publications

The tobacco industry manipulates cigarettes to provide sensory cues that mislead people who smoke. We assessed the effectiveness of health warnings (HWs) focussed on the impact of misleading product attributes, including filter ventilation, menthol, and roll-your-own tobacco, which were called Product Attribute HWs. Australian adults who smoke (n = 2544) were randomly assigned to view: control medication warnings; new Standard HWs with smoking harm images; Product Attribute HWs; or Product Attribute HWs plus a video. At baseline, participants were exposed to seven condition-specific warnings (+ video for those in the Product Attribute HWs + Video condition), then they were …

Research Priorities For Drivers Of Food Choice For Food System Transformation In South Asia: Proceedings Of A Collaborative Workshop, Christine E. Blake Ph.D., Rd, Sunny S. Kim, Edward A. Frongillo Ph.D., Purnima Menon

Faculty Publications

Agrifood systems in South Asia are highly productive, but substantial challenges including poverty, climate change, and environmental degradation complicate progress toward achieving sustainable healthy diets for all. The dynamics of food systems and the consequence of their rapid transformation for food choice behaviors that contribute to healthy and unhealthy diets are not well understood. Food choice is defined as a decision-making process through which individuals and households consider, acquire, prepare, distribute, and consume foods and beverages. Understanding drivers of food choice (DFC) is important for achieving sustainable healthy diets, but evidence is lacking. This article outlines collectively derived priorities for …

Telehealth Or In-Person Hiv Care? Qualitative Study Findings On Decision-Making From People With Hiv And Hiv Care Providers In South Carolina During The Covid-19 Pandemic, Valerie Yelverton, Salome Joelle Gass, Daniel Amoatika, Christopher Cooke, Jan Ostermann, Nabil Natafgi, Nicole L. Hair Ph.D., Bankole Olatosi Ph.D., Otis L. Owens, Shan Qiao Ph.D., Xiaoming Li Ph.D., Caroline Derrick, Sharon Weissman, Helmut Albrecht

Faculty Publications

The COVID-19 pandemic disrupted HIV care services across the United States. Telehealth was rapidly implemented to ensure HIV care continuity. Despite the evidence of unequal telehealth uptake among some people with HIV (PWH), the decision-making processes to determine who received telehealth or in-person care are under-researched. This study assessed which decision criteria and processes determined which HIV care visit type was used by PWH and HIV care providers during the COVID-19 pandemic. Qualitative in-depth interviews with 18 PWH and 10 HIV care providers from South Carolina assessed PWHs’ and HIV care providers’ decision-making criteria and processes for telehealth HIV care …

Shifting Healthcare In Rural South Carolina: A Study Of Media Coverage Of The Effects Of Hospital Closures, Morgan Harper

Senior Theses

Rural hospital closures have become an increasingly urgent issue in healthcare across the United States. These closures have impacted access to healthcare, the job market, and general community health. Most hospitals have been forced to close due to low patient volumes, financial struggles, and corporate ownership. Immediate implications of closures include the displacement of healthcare workers, community concern about lacking a central healthcare facility, and increased travel times to access care.

This thesis examines South Carolina’s healthcare landscape in areas with hospital closures since 2012 and explores the effects of and responses to these closures as discussed in newspapers and …

"Health Gatekeepers": The Influence Of Women On Health Practices In Rural, Central Appalachia, Reese Lycan

Senior Theses

Women have historically assumed leadership roles in familial and community health promotion, intervention, and facilitation. While the role of women in family health is globally understood and the historical importance of female leadership has been documented, there remains a gap in knowledge regarding the role of women as “health gatekeepers”. Furthermore, when considering the Appalachian region, there are limited studies regarding women’s place in leadership as far as health is concerned. Therefore, this study employs a hermeneutic phenomenological framework to explore the lived experiences of women in relation to their family and community’s health in rural, Central Appalachia- a region …

Role Of Race And Ethnicity In The Development, Diagnosis, And Treatment Of Gestational Diabetes Mellitus, Gabrielle D. Shupard

Senior Theses

Gestational diabetes mellitus (GDM) is the most common metabolic disorder of pregnancy, and rates of this disease have been steadily increasing over the past ten years. GDM disproportionately impacts racial and ethnic minorities at higher rates than their Caucasian counterparts. In this study, the PRECEDE model framework was employed during a literature review to gain a greater understanding of the complex risk factors contributing to differences in the development, diagnosis, and treatment of GDM among these population subgroups. The second part of this study concentrated on reviewing the extent to which current literature evaluates the role of race and ethnicity …