Medicine and Health Commons^™

Adverse Maternal Outcomes For Women With Different Health Insurance Statuses In Nevada, Jay J. Shen, Hong Wei

Nevada Journal of Public Health

Objective. Nevada women with unfavorable health insurance status may face greater barriers than women in the rest of the nation, since the development of healthcare infrastructure in Nevada is running behind population growth. This study examines the relationship between health insurance status and adverse maternal outcomes in Nevada.

Methods. Hospital discharge information of 33,149 women aged 13 or older who delivered in 2004 was abstracted from the 2004 State Inpatient Data for Nevada. A total of 13 measures of complications associated with pregnancy were identified, including preterm labor, hypertensive disorders of pregnancy, gestational diabetes, ante-partum hemorrhage, membrane disorders, cesarean section, …

A Study To Determine If University Athletic Teams In Desert Environments Experience Risky Diet-Related Behaviours, Susan Meacham, Christine Bergman, Marcia M. Ditmyer, Kyle Wilson, Connie Mobley

Nevada Journal of Public Health

Training and competing in desert environments may exacerbate concerns related to disordered eating, supplement use, and hydration in some student athlete populations. A survey administered equitably to both genders solicited self-reported responses from members of 18 different teams over four years from a southwestern United States university athletic program. More than 1,700 athletes responded to 42 items on the questionnaire. Teams, not individual student athletes, were the units of measure for statistical analyses. Initial analysis of results indicated that there were no overt concerns regarding dietary behaviors due to training and competing in the desert environment. Further analysis subjected the …

The Administrative Prevalence Of Autism Spectrum Disorders In Nevada School Districts: A Pooled Time Series Analysis, 1996-2004, John P. Tuman, Sheniz Moonie, Danielle Roth-Johnson

Nevada Journal of Public Health

Objective: To examine the administrative prevalence of Autism Spectrum Disorders (ASD) in all seventeen school districts in Nevada during the period of 1996 to 2004.

Methods: Normalized administrative prevalence rates (per 1,000 children ages 6-17) for ASD, Mental Retardation (MR), Learning Disability (LD), and Speech and Language Impairment (SLI) were calculated. Covariates for board certified pediatricians per 1,000 students, Federal special education funding per student, and other measures of school resources were employed. Models were estimated with pooled Ordinary Least Squares (OLS) regression with panel corrected standard errors. A separate analysis compared pooled OLS results to results from Latent Growth …

The Effects Of Television Food Advertising On Childhood Obesity, Aleathia Cezar

Nevada Journal of Public Health

Children’s food choices are influenced by the media, television advertising, focusing directly at infants and toddlers. This literature review presents multiple studies that explain how TV advertising of fast food, sugary cereals and other foods high in calories, fat, sugar, sodium and low in nutrients are contributing to the increase rates of childhood obesity. It is concluded that children are exposed to high amounts of food advertisements which affect young children’s food choices and poor food consumption. Due to the growing numbers of hours that children sit in front of the television, less physical activity and the epidemic of childhood …

Prevalence And Antimicrobial Agent Susceptibility Of Methicillin-Resistant Staphylococcus Aureus In Healthy Pediatric Outpatients In Las Vegas, Echezona E. Ezeanolue, Mark P. Buttner, Patricia Cruz, Joanne L. Henry, Chad L. Cross, Linda D. Stetzenbach

Nevada Journal of Public Health

Colonization and infection by community-associated resistant strains of Staphylococcus aureus are being reported in epidemic proportions. The purpose of this study was to determine the local prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in children and to characterize the MRSA isolates in the laboratory with regard to antimicrobial agent susceptibility patterns, and the presence of the mecA and the Panton-Valentine leukocidin (PVL) genes. Nasal swabs were collected at two pediatric clinics from a total of 505 children during health maintenance visits. A brief questionnaire was administered to collect demographic data and pertinent medical, family, and social history. Samples were cultured …

First-Year Compliance With The Nevada Clean Indoor Air Act, Leslie Elliott, Dana Loomis, Andrew B. Bridgforth, Stephanie O’Mara, Louise T. Brock, Brian Hansen, Melanie Marie Minarik, Kathryn Louderback

Nevada Journal of Public Health

Objectives: We quantitatively evaluated compliance with the Nevada Clean Indoor Air Act (NCIAA) by different types of businesses in Nevada and determined whether compliance affected indoor concentrations of benzene and 3-ethenyl pyridine (3-EP), markers of tobacco smoke.

Methods: Managers of 181 businesses in Washoe County, Nevada, were interviewed about business characteristics and practices and policies related to smoking. During unannounced visits, compliance data and air samples (n=66) were collected from interviewed businesses and from an additional sample (n = 56) of businesses without knowledge of the study.

Results: Overall compliance, as defined by the NCIAA, was low (28.2%). Benzene concentrations …

"Homelike" Characteristics Of Maine's Residential Services: A Survey Of Maine's Residential Service Settings (2010), Julie T. Fralich Mba, Eileen Griffin Jd, Catherine Mcguire Bs

Disability & Aging

To better understand the nature of the residential facilities serving more than 19 percent of Maine’s Long Term Services and Supports (LTSS) population, the Maine Department of Health and Human Services commissioned the Muskie School to conduct a survey of residential facilities as part of its update to Maine’s LTSS profile. The goal of the Maine Residential Settings Characteristics Survey, conducted between July and September 2010, was to measure the "homelike" characteristics of residential settings.

The survey sample comprised a total of 636 facilities which included all licensed residential care facilities or private non-medical licensed institutions. The survey response rate …

Health Care Insurance And Advance Directive Completion: A Population Based Study, Wei Yang, Sally P. Hardwick, Noel Tiano, Clare T. Pettis

Nevada Journal of Public Health

Background: The relationship between advance directive (AD) completion and health insurance status is rarely studied.

Method: AD completion information was collected through the 2008 Nevada Behavior Risk Factor Surveillance System (BRFSS), a statewide cross-sectional telephone survey. Nevada non-institutionalized population over 18 were randomly selected as a population sample. Respondents were divided to “health care plan group” (HCPG) and “no health care plan group” (NHCPG). Demographic and behavior risk factors were also collected. Weighted multiple logistic regressions were utilized to assess the relationships between ADs, healthcare coverage and other factors.

Results: Of 4,461 respondents completing the survey, HCPG were six times …

Blood Lead Levels In Nevada Children, Arthur F. Di Salvo, Terry R. Hall

Nevada Journal of Public Health

The purpose of this study was to assess the prevalence of plumbism in children one to six years of age in Nevada. During a four-year period from 1992 – 1996, 10,700 children were screened for evidence of blood lead intoxication. The capillary specimens were analyzed by atomic absorption spectrometry. All children with a lead level => 10 ug/L were retested using venous blood. Ninety three percent of the children had blood lead levels < 10 µg/dL

Carbohydrate Consumption And Fatigue: A Review, Jennifer R. Pharr

Nevada Journal of Public Health

Fatigue is a condition that negatively impacts quality of life and occurs in about twenty four percent of adults worldwide. Many factors may contribute to fatigue. One factor is the macronutrient composition of a person’s diet, particularly, the amount of simple carbohydrates. This paper is a review of the current literature and examines the relationship of carbohydrate consumption and fatigue to determine if a diet low in simple carbohydrates results in an improvement in fatigue ratings. Results of studies regarding carbohydrate consumption and fatigue vary, the preponderance demonstrate a positive relationship between simple carbohydrate consumption and fatigue. Additionally, diets low …

Barriers To The Effective Implementation Of Immunization Information Systems In A Private Provider Setting, Echezona E. Ezeanolue, Ineada Jack, William Downey, Benjamin Hart, Chad L. Cross

Nevada Journal of Public Health

One of the goals of Healthy People 2010 is to increase the proportion of children less than 6 years of age with two or more vaccinations recorded in a fully operational population-based immunization information system to 95%. In 2008, we piloted the Nevada web-based immunization information system (WEBIZ) in a large private pediatric clinic in north-west Las Vegas. Our objectives were: (1) to determine compliance with the recommendation that all vaccine providers report immunization activities to the WEBIZ without a state mandate and (2) to determine perceived barriers to compliance and suggestions on how to overcome expressed barriers. We documented …

Adverse Maternal Outcomes In Nevada: Does Asthma Matter?, Jay J. Shen, Hong Wei, Robin Mukalian

Nevada Journal of Public Health

Objective. Asthma is a common clinical complication of pregnancy and women with asthma are at greater risk of having complications. This study compared adverse maternal outcomes between women with asthma and women without asthma in Nevada.

Methods. A total of 64,664 hospital discharges of delivery were abstracted from the Nevada 2003-2004 hospital discharges and thirteen adverse maternal outcomes were examined. Logistic regression was applied to compare the maternal outcomes between women with and without asthma.

Results. Women with asthma were more likely to have pre-eclampsia (OR [CI] 1.73 [1.13, 2.65]), transient hypertension of pregnancy (OR [CI] 1.76 [1.11, 2.78]), pregnancy-induced …

The Economic Impact Of The Nevada Clean Indoor Air Act In Clark County, Nevada – Preliminary Findings, Robin Mukalian, Fang Lin, Christopher R. Cochran, Jay J. Shen, Nancy L. York

Nevada Journal of Public Health

Objective. The primary purpose of this exploratory study was to quantitatively evaluate the economic impact of the Nevada Clean Indoor Air Act (NCIAA) on businesses in Clark County.

Methods. The goal of this research was to assess economic indicators over a ten year period utilizing measurable data points, including restaurant and drinking establishment employment rates, taxable sales, openings and closings, as well as slot gaming revenues. This ten year time period consisted of a seven year span prior to the enactment of the NCIAA, and three years post enactment. Researchers conceived this study as a means to independently evaluate and …

The Long-Term Coercive Effect Of State Community Benefit Laws On Hospital Community Health Orientation, Charles B. Moseley, Jay J. Shen, Gregory O. Ginn

Nevada Journal of Public Health

This study is an examination of the long-term coercive effect of state community benefit laws (CB Laws) on the provision of community health activities in U.S. acute care hospitals. The sample included all the not-for-profit and investor owned acute care hospitals for which 1994 and 2006 AHA Annual Survey data were available. A panel design was used to longitudinally examine the effect that state CB Laws had on hospital community health orientation activities and the provision of health promotion services, after controlling for the influence of other organizational and environmental variables that might affect these activities and services. The authors …

Prevalence And Antimicrobial Susceptibility Of Methicillin-Resistant Staphylococcus Aureus In Pregnant Women And Their Newborns In Las Vegas, Nevada, Mark P. Buttner, Echezona E. Ezeanolue, Patricia Cruz, Joanne L. Henry, Ineada Jack, Chad L. Cross

Nevada Journal of Public Health

Colonization and infection by resistant strains of Staphylococcus aureus are being reported in epidemic proportions. The goal of this study was to determine the local prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in pregnant women in southern Nevada and how it correlates with colonization and infection of their neonates. Signed consent was obtained, and a brief questionnaire was administered by the medical staff to each pregnant woman to collect demographic data and pertinent medical, family and social history. Nasal and vaginal specimens were obtained from pregnant women at ≥35 weeks gestation, and nasal and umbilicus specimens were obtained from their …

Effects Of The Master Settlement Agreement On Smoking Among Nevada Teens: A Decade After Implementation And Implications Of Reduced Funding, Christina A. Demopoulos, Christopher R. Cochran

Nevada Journal of Public Health

Background: Tobacco control programs that have adapted the Centers for Disease Control and Prevention (CDC) Best Practices for a Comprehensive Tobacco Control Program (CTCP) have been effective in reducing the rates of tobacco use. This paper investigates the effectiveness that Nevada’s tobacco control programs have had on teen tobacco use and rates to date and examines changes to programs given reduced Master Settlement Agreement (MSA) funding.

Methods: Aggregate data from the Nevada Department of Health and Human Services/Fund for a Healthy Nevada program was analyzed to determine if the tobacco control programs adapted the CDC’s Best Practices for a CTCP. …

Analysis Of Lead Levels In Deciduous Teeth From Children In Clark County, Nevada., Kristin Murphy, Jennifer Berger-Ritchie, Shawn L. Gerstenberger, Amol B. Amin, Jason K. Nitta, Frederick G. More, Jeanne A. Hibler, Karl Kingsley

Nevada Journal of Public Health

Background: Elevated blood lead levels (EBLL) are declining in the United States, although some population subgroups continue to exhibit significant health disparities. A childhood lead poisoning prevention program was recently started in Nevada, and many efforts have been made to support this program and increase the screening rates.

Methods: To expand the potential pool of children screened for EBLLs, a pilot study was performed to evaluate lead concentrations in extracted deciduous teeth using Graphic Furnace Atomic Absorption Spectrometry (GFAAS), Inductively Coupled Plasma Mass Spectrometry (ICP-MS), and X-Ray Fluorescence (XRF) analysis.

Results: Lead concentrations as determined by GFAAS and ICP-MS were …

Chronic Disease And Risk Factors Among Nevadans With Disabilities: A 2009 Brfss Study, Jennifer R. Pharr, Sheniz Moonie

Nevada Journal of Public Health

Previous research has found that people with disabilities are more likely to have chronic diseases (coronary artery disease, stroke, cancer, asthma, diabetes), secondary conditions (high blood pressure, high cholesterol) and risk factors for chronic disease (physical inactivity and obesity) (Havercamp, Scandlin, & Roth, 2004; Kinne, Patrick, & Doyle, 2004; Nosek, Hughes, Petersen et al., 2006; Reichard, Stolzle, & Fox, 2011). The purpose of this study was to conduct a secondary analysis using data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to identify differences in chronic disease risk factors and chronic disease/ secondary conditions between adults with and without …

Utilization Of Preventative Health Services By Nevadans With Disabilities, Jennifer R. Pharr, Sheniz Moonie

Nevada Journal of Public Health

Health disparities are differences in access to health care, quality of health care and health outcomes observed between population-specific groups of people (Health Resources and Services Administration, 2000). Previous research has found that people with disabilities experience unequal access to preventative health care services. The purpose of this study was to conduct a secondary data analysis using data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) to determine differences in utilization of preventative health services between adults with and without disabilities in Nevada. Nevadans with disabilities were significantly more likely to have access to health insurance and to have …

Nutrition Education In Clark County, Nevada, Matt Bittle, Mildred Mcclain, Jeanne A. Hibler, Marcia M. Ditmyer

Nevada Journal of Public Health

Over 51 million school hours are missed annually by school-aged children due to a dental problem or visit, with 117 hours missed per 100 children (NIDCR, 2002). Approximately half a million of California's 7.2 million school-age children missed at least one day of school in 2007 because of dental issues such as toothaches (Pourat, & Nicholson, 2009). Independent research regarding various educational and intervention programs have been conducted in elementary schools across the country that focus on nutrition and/or physical activity, some of which have found that the programs positively impacted students’ dietary behaviors (Edwards, Mauch, & Winkelman, 2011; Muth, …

Filling The Gap: An Examination Of Hiv/Aids Treatment And Prevention At Uganda Cares Masaka, Andrew Robert Mcasey

Independent Study Project (ISP) Collection

A six week internship was conducted at Uganda Cares Masaka, a HIV/AIDS treatment organization, to learn about the development issues surrounding the HIV/AIDS pandemic. The internship was aimed at gaining practical experience at an HIV/AIDS clinic to learn about the challenges faced and the strategies used by Uganda Cares as wells as the effectiveness of their strategies. Uganda Cares represents a collaborative relationship between the private, international HIV treatment and advocacy group, the AIDS Healthcare Foundation (AHF), and the public Ministry of Health (MOH) in Uganda. A final objective of the internship was to gain an inside perspective on this …

Racial And Ethnic Health Disparities In Incarcerated Populations, Meghan E. Borysova, Ojmarrh Mitchell, Dawood H. Sultan, Arthur R. Williams

Journal of Health Disparities Research and Practice

Alarming disparities in population health and wellness in the United States have led to multi-disciplinary research efforts to create health equity. Identifying disparities, elucidating the etiological bases of disparities, and implementing solutions to eliminate disparities are part of the U.S. national health agenda. Racial and ethnic disparities have been identified throughout the cancer control continuum, in cardiovascular disease, diabetes and a multitude of other conditions. The causes of disparities are complex, condition specific, and conjectured to result from combinations of biological and socio-behavioral factors. Racial and ethnic health disparities within the vast incarcerated communities have been excluded from most studies, …

An Innovative Approach For Community Engagement: Using An Audience Response System, Jenna L. Davis, Kara E. Mcginnis, Margaret L. Walsh, Coni Williams, Kevin B. Sneed, Julie A. Baldwin, B. Lee Green

Journal of Health Disparities Research and Practice

Community-based participatory research methods allow for community engagement in the effort to reduce cancer health disparities. Community engagement involves health professionals becoming a part of the community in order to build trust, learn from the community and empower them to reduce disparities through their own initiatives and ideas. Audience Response Systems (ARS) are an innovative and engaging way to involve the community and obtain data for research purposes using keypads to report results via power point. The use of ARS within communities is very limited and serves to widen the disparity gap by not delivering new advances in medical knowledge …

Emerging Disparities Among Self-Pay Trauma Patients, Michelle Chino Dr, Deborah A. Kuhls, Mark K. Markarian, Sam Holland, John J. Fildes

Journal of Health Disparities Research and Practice

Preliminary results from a study of trauma patients in Southern Nevada are yielding some unexpected findings with implications for both trauma centers and the growing Hispanic population. Hispanic patients are more likely to be self pay irrespective of income level and employment status when compared to non-Hispanic patient groups. Further, self pay Hispanics, unlike their non-Hispanic, self pay counterparts, tend to be employed, have families, and report stable living conditions. The implication is that the financial and social cost of traumatic injury may place a significant burden on trauma centers, patients, their families and the community.

Disparities In Mental Health Utilization Among Persons With Chronic Diseases, Saundra Glover, Keith Elder, Sudha Xirasagar, Jong-Deuk Baek, Crystal Piper, Dayna Campbell

Journal of Health Disparities Research and Practice

This study used Aday and Andersen’s Behavioral Model of Health Services Use to examine the role of chronic disease and the joint impact of race and chronic disease type on mental health utilization. Using data from Community Tracking Survey Household Survey, we tested the assumption that chronic disease, chronic disease type, and race are related to lower rates of mental health visits when adjusted for predisposing, enabling, and need factors. After adjusting for population characteristics, we found that race significantly moderated the impact of chronic disease type on mental health utilization, showing that African Americans with cardiovascular disease were half …

Assessing Behavioral Health Risks, Health Conditions, And Preventive Health Practices Among American Indians/Alaska Natives In Nevada, Gwen Hosey, Shirley A. Llorens-Chen, Fares Qeadan, Daryl Crawford, Charlton Wilson, Wei Yang

Journal of Health Disparities Research and Practice

The 2004 Behavioral Risk Factor Surveillance System (BRFSS) survey was administered to American Indian/Alaska Native (AI/AN) adults in Nevada to determine whether health disparities exist between AI/ANs and the state’s general population. Results showed AI/ANs were 1.5 times more likely to smoke cigarettes, 3.5 times more likely to be exposed to secondhand smoke, 3.2 times more likely to lack leisure-time physical activity, 9.7 times more likely to report fair/poor health status, and 7.7 times more likely to have a disability. In addition, AI/ANs were more likely to have current asthma (OR=5.0) and diabetes (OR=1.8). AI/AN women were 4.8 times as …

The Hiv/Aids Pandemic In African American Msm: Targets For Intervention, Kelly Neff

Journal of Health Disparities Research and Practice

The Centers for Disease Control and Prevention estimated in 2005 that 46% of African American men who have sex with men (MSM) are HIV positive. This review explores the unique factors that contribute to risky sexual behavior and the spread of HIV within this population, suggesting that the disparate prevalence of HIV among African American MSM is rooted in experiences of stigmatization from multiple sources and lack of social support from society at large as well as from within the African American community. Beliefs in HIV conspiracy myths are also thought to hinder HIV education, awareness and prevention for African …

Racial Differences In Preventive And Complementary Health Behaviors And Attitudes, Steven E. Shive, Grace X. Ma, Yin Tan, Jamil I. Toubbeh, Lalitha Parameswaran, Lalitha Parameswaran, Joe Halowich

Journal of Health Disparities Research and Practice

Screening tests have been developed for many diseases—the presence of cancer, especially—but are differentially utilized among racial/ethnic groups. In addition to standard medical screening techniques, some patients opt to use Complementary and Alternative Medicine (CAM) for prevention and treatment. The purpose of the current study is to examine racial/ethnic disparities in primary and secondary preventive health behaviors, determine differences in use of complementary and alternative health regimens, and determine which health attitudes and health self-management factors are associated with use of complementary alternative medicine. If differences among ethnic/racial groups in perceived health status, preventive health care behaviors, and use of …

Equal Care, Unequal Outcomes: Experiences Of A Reach 2010 Community, Diane Neal, Barbara Carlson, Carolyn Jenkins, Gayenell Magwood

Journal of Health Disparities Research and Practice

Diabetes is growing in prevalence and costs. Guidelines for care have been available since 1983, yet diabetes care and outcomes remain less than ideal. CDC’s Racial and Ethnic Approaches to Community Health 2010 (REACH 2010) identified diabetes in African Americans as a priority for action. This article documents the activities, interventions, and current progress of the REACH 2010 diabetes coalition formed in Charleston and Georgetown counties, South Carolina, in reducing health care disparities and describes next steps for improving outcomes. The Chronic Care Model guided many of the implementation activities, and chart audits were used to document outcomes. Ambulatory care …

Transdisciplinary Approaches To Ameliorating Racial Disparities In Prostate Cancer Outcomes, Chanita H. Halbert, Katrina Armstrong, John Holmes, David Fenstermacher, Janet Weiner, Carmen Guerra, J. S. Schwartz, Jerry C. Johnson, Edmund Weisberg, Chantal Montagnet, Benita Weathers, Charnita Zeigler-Johnson, Ernestine Delmoor, Timothy R. Rebbeck

Journal of Health Disparities Research and Practice

Though prostate cancer is the second leading cause of cause cancer deaths among men in the US, it ranks first among African American men in terms of incidence, morbidity, and mortality. To address this and other complex health issues, some researchers advocate transdisciplinary research as a framework for analysis; however, few examples exist that indicate how the framework should be applied. This report uses prostate cancer outcomes as a paradigm to describe how such a framework can be used to identify determinants of racial disparities. By integrating diverse scientific disciplines, methods, and analytic approaches from psychology, sociology, epidemiology and genetics, …