Public Health Education and Promotion Commons^™

Testing Cessation Messages For Cigarette Package Inserts: Findings From A Best/Worst Discrete Choice Experiment, Jim Thrasher, Farahnaz Islam, Rachel E. Davis, Lucy Popova, Victoria Lambert, Yoo Jin Cho, Ramzi G. Salloum, Jordan Louviere, David Hammond

Faculty Publications

This study assessed smokers’ responses to different smoking cessation topics and imagery for cigarette package inserts. Adult smokers from Canada (n = 1000) participated in three discrete choice experiments (DCEs): DCE 1 assessed five cessation benefit topics and five imagery types; DCE 2 assessed five messages with tips to improve cessation success and five imagery types; DCE 3 assessed four reproductive health benefits of cessation topics and four imagery types. In each DCE, participants evaluated four or five sets of four inserts, selecting the most and least motivating (DCEs 1 & 3) or helpful (DCE 2) for quitting. Linear mixed …

Can Integrated Interventions Create The Conditions That Support Caregiving For Better Child Growth?, Purnima Menon, Edward A. Frongillo Jr.

Faculty Publications

No abstract provided.

Investigating Drug-Related Violence In Indian Country: The Lumbee Tribe Of North Carolina, Asa Alena Revels

Theses and Dissertations

Drug-related violence (DRV) impacts the over-all wellbeing of communities, with disparate health outcomes observable in many poor, minority communities. The purpose of this study was to better understand the multi-level social and environmental factors influencing elevated rates and prevention of DRV within the Lumbee, a southeastern American Indian Tribe. This was accomplished via in-depth, one-on-one interviews with 37 Lumbee Tribal Members and Key Leaders. The findings align with existing research, revealing the influence of such factors as poor socioeconomic conditions, coping strategies, broken family structures, and the influence of federal policy. Of interest was the substantial influence of the local …

Racism, Black College Students’ Mental Health, And The Efficacy Of Diversity And Inclusion Initiatives: A Case Study., Kaleea R. Lewis

Theses and Dissertations

Black college students who attend predominantly White institutions of higher education (PWIs) regularly encounter subtle and explicit forms of racism on campus. These daily experiences of prejudice and discriminatory behaviors can have an adverse impact on their mental health. This study examines the intersections of racism and mental health, particularly within an environment where racism is socially unacceptable. More specifically, this study uses qualitative methods to explore how Black college students who attend a predominately White institution of higher education (PWI) make meaning of their experiences with racial discrimination and its impact on their mental health, as well as their …

Understanding The Mechanisms Linking Gendered Intrahousehold Bargaining Power And Child Nutrition In Rural Nepal, Shibani Kulkarni

Theses and Dissertations

Child undernutrition is a serious issue in Nepal as 36% of children below five years of age are chronically undernourished. Reducing child undernutrition is an important priority to prevent adverse effects through the life course that perpetuate the cycle of undernutrition and poverty.

Women’s intra-household bargaining power is an important determinant of child nutrition. Intra-household bargaining power is an individual’s relative social and economic position within the household to access and control resources, and influence decision-making. In our research, we use women’s intra-household bargaining power as a resource for care, which enables women to be exposed to nutrition information, gain …

Body Mass Index Trajectories And The Relationship Between Stressful Life Changes And Nutrition-Related Health Outcomes Among United States Army Soldiers, Julianna Marie Jayne

Theses and Dissertations

Body mass index (BMI) has risen among members of the military, though to a lesser degree than in civilian populations. BMI as an anthropometric tool has been essential for population surveillance and documenting the obesity epidemic and its health consequences. One use for BMI in population surveillance is to model the BMI trajectories of a population over time. Many studies are available on the BMI trajectories and determinants of BMI in civilians, but few studies of this nature in military populations exist. Establishing the shape and determinants of BMI trajectories among Soldiers is critical given the importance of weight management …

The Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among Insured Elderly, Min Jee Lee

Theses and Dissertations

Background: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning on January 1, 2011. This study investigated the effect of the ACA’s removing of financial barriers on the receipt of colonoscopies among insured elderly, who are predominantly covered by Medicare. Moreover, this study examined how income-related disparities in colonoscopy use have changed over the past decade and attempted to quantify various contributions to income-related disparity in the use of colonoscopies among insured elderly. Methods: Five cycles (2008, 2010, 2012, 2014, and 2016) of the Behavioral Risk Factor Surveillance System (BRFSS) were utilized to …

A Qualitative Exploration Of Experiences And Motivations For Diabetes Self-Management In African American Men Between The Ages Of 40-85 With Type 2 Diabetes, Anthony Q. Walker

Theses and Dissertations

Diabetes is a devastating disease that can affect an individual’s health and quality of life, but if managed properly, individuals with diabetes can have a good quality of life. Diabetes strikes African American men at a high rate. This study used a qualitative design to explore African American men between the ages of 40-85 with type 2 diabetes (T2DM) and their definition of diabetes and motivation, their experience of living with diabetes, their self-management behaviors, their motivations for managing diabetes, and what they and healthcare providers believe motivates them to self-manage diabetes and to attend diabetes self-management education (DSME) programs. …

Healthy Motivations For Moms-To-Be (Healthy Mom2b) Study: A Mobile Health Intervention Targeting Gestational Weight Gain Among U.S. Women, Alicia Anne Dahl

Theses and Dissertations

INTRODUCTION: Almost one-half of all pregnant women in the U.S. exceed the Institute of Medicine’s (IOM) gestational weight gain (GWG) guidelines. Healthy GWG is critical for reducing adverse health outcomes associated with excessive GWG for the mother and infant. Electronic health (e-health) interventions delivered through mobile apps and websites hold potential as readily available resources for targeting health behaviors and monitoring GWG during pregnancy. The development of the Healthy Motivations for Moms-To-Be (HM2B) intervention was informed by health behavior theories, a systematic review of existing in-person and technology mediated interventions (Aim 1 of this dissertation), and results of an online …

Interpersonal Communication About Cigarette Warning Labels Among U.S. Smokers: Differences Between Latinos And Whites, Victoria Catherine Lambert

Theses and Dissertations

Pictorial health warning labels (HWLs) on cigarette packs are used worldwide to curb cigarette smoking, the leading preventable cause of death in the United States While individual-level mediators of HWLs’ effects on cessation have been thoroughly studied, interpersonal communication about HWLs has received less attention in HWL research. However, results from one study demonstrated the importance of interpersonal communication, finding that conversations about HWLs predicted quit attempts in Australia, Canada, and Mexico. That study also found that smokers in Mexico, where most smokers are Latino, reported more conversations than smokers in Australia and Canada, where most smokers are non-Latino White. …

Intervention For Women In Costa Rica Who Are Discouraged And Have Food Insecurity And Excess Body Weight, Tatiana Martínez-Jaikel

Theses and Dissertations

ntroduction: The coexistence of food insecurity and excess body weight has been wellrecognized by researchers, and it has been documented in women, but not men. Both food insecurity and excess body weight have multiple consequences for physical and mental health. Concerns have been raised about interventions aimed to reduce food insecurity because these programs might contribute to excess body weight, particularly in adult women. Our previous in-depth qualitative research in Costa Rica showed that discouragement was the primary link in the coexistence of food insecurity and excess body weight among Costa Rican women, and that the family and existing gender …

Examining Faith-Based Communities As Leverage Points For The Prevention Of Childhood And Adolescent Obesity, Caroline Glagola Dunn

Theses and Dissertations

Faith-based research and partnerships are becoming more popular as an approach to address the health of underserved populations including racial and ethnic minorities and rural populations. Despite growing interest in faith-health partnerships, little research is available assessing faith-based interventions as potential leverage points for the prevention of childhood and adolescent obesity and the promotion of healthy behaviors. This research aimed to examine the potential for such partnerships within the context of ongoing research partnerships in South Carolina. Specifically, the first study assessed current peer-reviewed literature to determine reporting of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM elements) in faith-based nutrition …

The Effect Of Neighborhood Characteristics And Acculturation On Vegetable Intake Among U.S. Hispanics, Anna Victoria Mesa

Theses and Dissertations

The growing prevalence of chronic disease among the U.S. Hispanic population has drawn increasing attention to modifiable behaviors such as diet in an effort to curb the burden of disease among this population. While factors affecting dietary intake among U.S. Hispanics have been largely studied, this study broadens the scope of existing analyses from examining the role of individual-level factors, including acculturation, to also include environmental factors such as neighborhood ethnic composition. Multilevel mixed modeling was employed to test the interaction of individual acculturation with neighborhood ethnic composition to predict vegetable intake among a sample of U.S. Hispanics. Individuals who …

The Impact Of False Positive Mammography Results On Breast Cancer Screening Intention Among Black Women, Deeonna E. Farr

Theses and Dissertations

Extensive research indicates that false-positive mammograms (FPM) have been associated with negative psychosocial and cancer-related beliefs, but only a handful of studies examine Black women’s reactions to this experience. Additionally, these studies do not investigate how organizational and provider-level factors in concert with individual patient characteristics shape Black women’s experiences and reactions to FPM results. The purpose of this study was to determine the impact of organizational, provider, and individual-level factors on the processes and outcomes associated with FPM results in Black women. This study had two specific aims:

1) To describe, using a mixed methods approach, the organizational and …

Blood Pressure Self-Monitoring In Pregnancy: Examining Feasibility In A Prospective Cohort Study, Katherine L. Tucker, Kathryn S. Taylor, Carole Crawford, James A. Hodgkinson, Clare Bankhead, Tricia Carver, Elizabeth Ewers, Margaret Glogowska, Sheila M. Greenfield, Lucy Annang Ingram Phd, Lisa Hinton, Khalid S. Khan, Louise Locock, Lucy Mackillop, Christine Mccourt, Alexander M. Pirie, Richard Stevens, Richard J. Mcmanus

Faculty Publications

BACKGROUND: Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide, and a high proportion of affected women develop pre-eclampsia. This study aimed to evaluate the feasibility of self-monitoring of BP in pregnancy in women at higher risk of pre-eclampsia. METHODS: This prospective cohort study of self-monitoring BP in pregnancy was carried out in two hospital trusts in Birmingham and Oxford and thirteen primary care practices in Oxfordshire. Eligible women were those defined by the UK National Institute for Health and Care Excellence (NICE) guidelines as at higher risk of pre-eclampsia. A total of 201 participants were recruited between 12 …

Introduction Of Iodised Salt Benefits Infants’ Mental Development In A Community-Based Cluster-Randomised Effectiveness Trial In Ethiopia, Karim Bougma, Frances E. Aboud, Tizita M. Lemma, Edward A. Frongillo Jr., Grace S. Marquis

Faculty Publications

The effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4–6 months later. The primary outcome was children’s mental development scores on the Bayley Scales. This was an intention-to-treat analysis using …

Examining The Relationship Between Park Neighborhoods, Features, Cleanliness, And Condition With Observed Weekday Park Usage And Physical Activity: A Case Study, Kerry Hamilton, Andrew T. Kaczynski, Melissa L. Fair, Lucie Levesque

Faculty Publications

Background. Little research has comprehensively explored how park features, quality indicators, and neighborhood environments are associated with observed park usage and physical activity (PA). This case study examined whether weekday park usage and PA differ by neighborhood type, across numerous categories of park features, and according to park feature condition and cleanliness. Methods. Direct observation was used to capture the number of users and PA levels within 143 park features in 6 parks (3 urban, 3 suburban) over the course of six weeks. Audits of park environments assessed the type, condition, and cleanliness of all features and amenities. …

The Association Between Gastro-Oesophageal Reflux Disease And Subsequent Rheumatoid Arthritis Occurrence: A Nested Case–Control Study From Taiwan, Herng-Ching Lin, Sudha Xirasagar, Cha-Ze Lee, Chung-Chien Huang, Chao-Hung Chen

Faculty Publications

Objective Gastro-oesophageal reflux disease (GORD) is a common comorbidity among patients with rheumatoid arthritis (RA). While GORD has been attributed to the antirheumatic medications, no studies of human cohorts have investigated a link between GORD and RA. This study investigates whether GORD is associated with a subsequent RA diagnosis over a 5-year follow-up using a population-based dataset.

Setting Taiwan

Participants We used data from the Taiwan Longitudinal Health Insurance Database. The study group consisted of 13 645 patients with an ambulatory claim showing a GORD diagnosis. We used propensity score matching to select 13 645 comparison patients (one per study …

Examining The Need & Potential For Biomedical Engineering To Strengthen Health Care Delivery For Displaced Populations & Victims Of Conflict, Devika Nadkarni, Imad Elhajj, Zaher Dawy, Hala Ghattas Ph.D., Muhammad H. Zaman

Faculty Publications

Conflict and the subsequent displacement of populations creates unique challenges in the delivery of quality health care to the affected population. Equitable access to quality care demands a multi-pronged strategy with a growing need, and role, for technological innovation to address these challenges. While there have been significant contributions towards alleviating the burden of conflict via data informatics and analytics, communication technology, and geographic information systems, little has been done within biomedical engineering. This article elaborates on the causes for gaps in biomedical innovation for refugee populations affected by conflict, tackles preconceived notions, takes stock of recent developments in promising …

Evaluation Of Programs To Improve Complementary Feeding In Infants And Young Children, Edward A. Frongillo Jr.

Faculty Publications

Evaluation of complementary feeding programs is needed to enhance knowledge on what works,to document responsible use of resources, and for advocacy. Evaluation is done during program conceptualization and design, implementation, and determination of effectiveness. This paper explains the role of evaluation in the advancement of complementary feeding programs,presenting concepts and methods and illustrating them through examples. Planning and investments for eval-uations should occur from the beginning of the project life cycle. Essential to evaluation is articu-lation of a program theory on how change would occur and what program actions are required for change. Analysis of program impact pathways makes explicit …

College Freshmen Students’ Perspectives On Weight Gain Prevention In The Digital Age: Web-Based Survey, Courtney M. Monroe, Gabrielle Turner-Mcgrievy, Chelsea A. Larsen, Karen Magradey, Heather M. Brandt, Sara Wilcox, Beth Sundstrom, Delia Smith West

Faculty Publications

BACKGROUND: College freshmen are highly vulnerable to experiencing weight gain, and this phenomenon is associated with an increased risk of chronic diseases and mortality in older adulthood. Technology offers an attractive and scalable way to deliver behavioral weight gain prevention interventions for this population. Weight gain prevention programs that harness the appeal and widespread reach of Web-based technologies (electronic health or eHealth) are increasingly being evaluated in college students. Yet, few of these interventions are informed by college students' perspectives on weight gain prevention and related lifestyle behaviors. OBJECTIVE: The objective of this study was to assess college freshmen students' …

Integrating Nutrition Interventions Into An Existing Maternal, Neonatal, And Child Health Program Increased Maternal Dietary Diversity, Micronutrient Intake, And Exclusive Breastfeeding Practices In Bangladesh: Results Of A Cluster-Randomized Program Evaluation, Phuong Hong Nguyen, Sunny S. Kim, Tina Sanghvi, Zeba Mahmud, Lan Mai Tran, Sadia Shabnam, Bachera Aktar, Raisul Haque, Kaosar Afsana, Edward A. Frongillo Jr., Marie T. Ruel, Purnima Menon

Faculty Publications

Maternal undernutrition is a major concern globally, contributing to poor birth outcomes. Limited evidence exists on delivering multiple interventions for maternal nutrition simultaneously. Alive & Thrive addressed this gap by integrating nutrition-focused interpersonal counseling, community mobilization, distribution of free micronutrient supplements, and weight-gain monitoring through an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh. We evaluated the effect of providing nutrition-focused MNCH compared with standard MNCH (antenatal care with standard nutrition counseling) on coverage of nutrition interventions, maternal dietary diversity, micronutrient supplement intake, and early breastfeeding practices. We used a cluster-randomized design with cross-sectional surveys at baseline (2015) …

Reproductive, Maternal, Neonatal And Child Health In Conflict: A Case Study On Syria Using Countdown Indicators, Jocelyn Dejong, Hala Ghattas Ph.D., Hyam Bashour, Rima Mourtada, Chaza Akik, Amelia Reese-Masterson

Faculty Publications

Introduction Women and children account for a disproportionate morbidity burden among conflictaffected populations, and yet they are not included in global accountability frameworks for women's and children's health. We use Countdown to 2015 (Millennium Development Goals) health indicators to provide an up-to-date review and analysis of the best available data on Syrian refugees in Jordan, Lebanon and Turkey and internally displaced within Syria and explore data challenges in this conflict setting.

Methods We searched Medline, PubMed, Scopus, Popline and Index Medicus for WHO Eastern Mediterranean Region Office and relevant development/humanitarian databases in all languages from January 2011 until December 2015. …

Future Orientation, Social Support, And Psychological Adjustment Among Left-Behind Children In Rural China: A Longitudinal Study, Shaobing Su, Xiaoming Li, Danhua Lin, Maoling Zhu

Faculty Publications

Existing research has found that parental migration may negatively impact the psychological adjustment of left-behind children. However, limited longitudinal research has examined if and how future orientation (individual protective factor) and social support (contextual protective factor) are associated with the indicators of psychological adjustment (i.e., life satisfaction, school satisfaction, happiness, and loneliness) of left-behind children. In the current longitudinal study, we examined the differences in psychological adjustment between left-behind children and non-left behind children (comparison children) in rural areas, and explored the protective roles of future orientation and social support on the immediate (cross-sectional effects) and subsequent (lagged effects) status …

Breastfeeding Practices, Beliefs, And Social Norms In Low-Resource Communities In Mexico: Insights For How To Improve Future Promotion Strategies, Tessa M. Swigart, Anabelle Bonvecchio, Florence L. The´Odore, Sophia Zamudio-Hass, Maria Angeles Villanueva-Borbolla, Jim Thrasher

Faculty Publications

INTRODUCTION:

Breastfeeding is recommended exclusively for the first 6 months after birth, with continued breastfeeding for at least 2 years. Yet prevalence of these recommendations is low globally, although it is an effective and cost-effective way to prevent serious infections and chronic illness. Previous studies have reported that social support greatly influences breastfeeding, but there is little evidence on perceived social norms in Mexico and how they affect actual behavior.

OBJECTIVE:

Our objective was to investigate breastfeeding intention, practices, attitudes, and beliefs, particularly normative, among low-resource communities in central and southern Mexico.

METHODS:

We performed a secondary analysis using the …

Individual And Structural Environmental Influences On Utilization Of Iron And Folic Acid Supplementation Among Pregnant Women In Harare, Zimbabwe, Chiwoneso B. Tinago, Lucy Annang Ingram, Christine E. Blake, Edward A. Frongillo Jr.

Faculty Publications

Micronutrient deficiencies are prevalent among Zimbabweans with serious health and social implications. Due to alack of a national micronutrient food fortification policy, the Zimbabwe Ministry of Health and Child Careestablished a policy for the prevention of maternal micronutrient deficiencies, which centres on pregnant womenreceiving daily iron and folic acid (IFA) at theirfirst antenatal care visit and throughout pregnancy. Despite theseefforts, utilization of IFA supplementation in pregnancy in Zimbabwe is low. This study aimed to understand theexperiences and knowledge of IFA supplementation among pregnant women and healthcare workers in Harare,Zimbabwe, and the influence of health-service and social environments on utilization. Semi-structured …

Implications Of Synchronous Ivr Radio On Syrian Refugee Health And Community Dynamics, R. Talhouk, T. Bartindale, K. Montague, S. Mesmar, C. Akik, A. Ghassani, M. Najem, Hala Ghattas Ph.D., P. Olivier, M. Balaam

Faculty Publications

With 1,033,513 Syrian refugees adding a strain on the Lebanese healthcare system, innovation is key to improving access to healthcare. Our previous work identified the potential for technology to improve access to antenatal care services and increase refugee agency. Using (1) paper mock ups and a mobile based prototype, (2) process mapping, (3) focus groups and interviews and (4) key informant meetings, we explored the concept of refugee led community radio shows to deliver peerled healthcare.1We observed the influence of community radio shows on Syrian refugee health education, community dynamics and community agency in relationships between healthcare providers and refugees. …

Association Of Alzhemier's Disease With Hepatitis C Among Patients With Bipolar Disorder, Herng-Ching Lin, Sudha Xirasagar, Hsin-Chien Lee, Chung-Chien Huang, Chao-Hung Chen

Faculty Publications

Associations of hepatitis C virus infection with Alzheimer’s disease have not been studied among higher risk, bipolar disorder patients. This population-based case-control study investigated the risks of hepatitis C virus infection among Alzheimer’s disease patients with bipolar disorder in the years preceding their Alzheimer’s disease diagnosis. We used 2000–2013 data from the Longitudinal Health Insurance Database in Taiwan. Among patients with bipolar disorder, 73 were diagnosed with Alzheimer’s disease (cases), who were compared with 365 individuals with bipolar disorder but without Alzheimer’s disease (randomly selected controls matched on sex, age, and index year with cases). Prior claims (before the diagnosis …

Dietary Inflammatory Index In Relation To Sub-Clinical Atherosclerosis And Atherosclerotic Vascular Disease Mortality In Older Women, Nicola P. Bondonno, Joshua R. Lewis, Lauren C. Blekkenhorst, Nitin Shivappa, Richard J. Woodman, Catherine P. Bondonno, Natalie C. Ward, James R. Hébert, Peter L. Thompson, Richard L. Prince, Jonathan M. Hodgson

Faculty Publications

Arterial wall thickening, stimulated by low-grade systemic inflammation, underlies many cardiovascular events. As diet is a significant moderator of systemic inflammation, the dietary inflammatory index (DIITM) has recently been devised to assess the overall inflammatory potential of an individual’s diet. The primary objective of this study was to assess the association of the DII with common carotid artery–intima-media thickness (CCA–IMT) and carotid plaques. To substantiate the clinical importance of these findings we assessed the relationship of DII score with atherosclerotic vascular disease (ASVD)-related mortality, ischaemic cerebrovascular disease (CVA)-related mortality and ischaemic heart disease (IHD)-related mortality more. The study was conducted …

Changes In The Policy Environment For Infant And Young Child Feeding In Vietnam, Bangladesh, And Ethiopia, And The Role Of Targeted Advocacy, Jody Harris, Edward A. Frongillo Jr., Phuong H. Nguyen, Sunny S. Kim, Purnima Menon

Faculty Publications

Background

There is limited literature examining shifts in policy environments for nutrition and infant and young child feeding (IYCF) over time, and on the potential contribution of targeted advocacy to improved policy environments in low- and middle-income countries. This study tracked changes in the policy environment over a four-year period in three countries, and examined the role of targeted nutrition and IYCF advocacy strategies by a global initiative.

Methods

Qualitative methods, including key informant interviews, social network mapping, document and literature review, and event tracking, were used to gather data on nutrition and IYCF policies and programs, actor networks, and …