Public health informatics: A consensus on core competencies

Richards, Janise Elaine The University of Texas at Austin 2000 해외박사(DDOD)

This descriptive study identified competencies and the supporting skills and knowledge in public health informatics for public health informaticians and for general public health practitioners. Within the study's integrationist research design, which combines both qualitative and quantitative methods, the methods used were telephone interviews and a web-based Delphi survey. The interviews were substituted for round one of the traditional Delphi method. The interview data were analyzed using a constant comparison method and the final results were used to develop the Delphi survey items. A snowball sampling technique identified the study participants who met the selection criteria of expertise in public health informatics, public health education, public health practice or informatics education. Nine experts participated in the interview process and 23 in the Web-based Delphi. The interview results provided a new definition for public health informatics: Public health informatics is the innovative application of information science, computer science and information technology to improve management of information in public health practice and research, ultimately improving the health of the community. The interview results also indicated that public health informatics had four core domains: organizational and systems management, information systems, information technology, and public health sciences. Within these domains were 12 competencies and 60 supporting skills and knowledge items. After two rounds of the Web-based Delphi survey, the items reached consensus. Nine of the 12 competencies were determined to be critical and three were determined to be important for public health informaticians. For the general public health practitioner, two competencies were determined to be important, eight moderately important, and two insignificant. Of the supporting skills and knowledge, 55% were considered critical, 42% important, and 3% moderately important for public health informaticians. For general public health practitioners 20% were critical, 26% important, 36% moderately important and 18% insignificant or not important. This research can provide a foundation for developing public health informatics curricula in graduate programs and schools of public health and public health workforce training programs.

Mexican American women's struggle to create health

Mendelson-Klauss, Cindy F The University of Arizona 2000 해외박사(DDOD)

Mexican Americans constitute one of the fastest growing populations in the United States. Within Mexican American families, women are the primary caretakers and are responsible for managing family health. Many activities of health work fall within the household and domestic spheres. These activities include, providing a clean, safe environment providing nutritious foods, teaching hygienic practices, diagnosing and treating illnesses, and deciding when to seek outside health care. Until recently, household health work was not recognized as a factor in health knowledge and had been excluded from the discourse of health and healing. The purpose of this study was to describe health perceptions and health production among Mexican American women. This research was a descriptive ethnographic study of the health perceptions and health production of a sample of 13 English speaking Mexican American women. Informants participated in three in-depth interviews conducted over a two to four month period. The Household Production of Health was the conceptual model that guided this research and the World Health Organization definition of health was used to frame questions about health perceptions. Data analysis was directed towards identifying themes and sub-themes that were organized into categories that answered the three research questions. The informants integrated physical and mental health into an overarching concept of being healthy. Health included maintenance of the physical body, the mind, and the spirit. The informants identified a variety of health producing and help-seeking activities that were contextualized throughout their lives and were consistent with their health perceptions. In addition to outside employment, the informants took primary responsibility for health creation. Their roles were predominantly domestic in nature and included parenting, providing for health care, and managing and maintaining the household. This research has significance for nursing in three areas: (a) it explicates the importance of routine activities in health maintenance; (b) it provides a framework for community health nurses to analyze the entirety of health activities that occur within the household; and, (c) it suggests the importance of focusing health education on wellness behaviors such as stress reduction and coping strategies.

Teaching preventive mental health skills to functional college students: A comparison of three classroom-based interventions

Brown, Stephen L University of Maryland College Park 2001 해외박사(DDOD)

Mental illness, especially anxiety and depression, causes lower individual and national productivity and has become a major public health concern. This suffering and expense is a tragedy since research clearly demonstrates the efficacy of the treatments currently available. Leading mental health groups are calling for more emphasis for: removing stigmas associated with mental illness, researching and delivering preventive measures, and improving access to effective treatments. Small-group educational approaches may partially fill these therapy gaps. Unfortunately, research regarding such preventative interventions has been scarce. This is partially due to the commonly held belief that psychological skills can be effectively taught only by licensed counselors. However, Albert Ellis and others argue that these skills can and should be taught by trained educators. The college classroom may provide an ideal setting for teaching preventive mental health skills. This study examined the degree to which three different classroom-based interventions lowered reported symptoms of anxiety and depression and increased reported self-esteem. The groups consisted of all willing participants in one of three college courses: a mental health skills course [MENTAL] (n = 27), a conventional stress management course [STRESS] (n = 72), and a non-stress or mental health-related course, death education [CONTROL] (n = 92). High internal-consistency reliability was observed for all the measures used in the study. The three groups were found to be statistically equivalent on all but two demographic variables: GRADE LEVEL and TIME WORKING, which were slightly higher for the groups drawn from 400 level classes. Analysis of Covariance showed significant differences between the MENTAL group and the CONTROL group on the anxiety measure and one of two depression measures. Significant differences were also observed between the MENTAL group and the STRESS group on the same measures plus a self-esteem measure. Although the effects in this study were small to moderate, the intervention used in the MENTAL group appears to hold some promise as a cost-effective strategy for primary prevention of mild to moderate mental health problems. Further research should use more rigorous design, employ longer follow-up, and attempt to isolate which components or skills in the intervention are the most powerful.

The relationship between early health and poverty and later welfare dependency in an urban African American community: A life course perspective

Nielsen-McPherson, Marcia J The Johns Hopkins University 2000 해외박사(DDOD)

This research uses a life course perspective (from infancy through adulthood) to examine the relationship between early health and poverty and later welfare dependence, defined as more than five years of welfare receipt, in an urban African American community. Using logistic regression, two types of analyses were conducted with longitudinal data containing numerous measures of health and social environment spanning more than thirty years. First, the theoretical relationship between early health and poverty and adult welfare dependence was tested using three social science theories: health selection, social causation, and bio-social. The bio-social theory, which states that biological factors, such as birth weight, interact with social factors, such as poverty, best characterized the pathway to later welfare dependency and adult poor health. These findings suggest that this theory merits further study to explain the disparity in health status by income, and welfare prevention policies should be comprehensive and targeted to those who suffer high rates of both poverty and illness throughout their life course. Second, the timing of early poor health and poverty were examined as predictors of later adult welfare dependency or receipt of Supplemental Security Income (SSI). The findings differed by gender, possibly due to the small number of welfare dependent males in the sample. For females, there were several factors associated with welfare dependency: being chronically poor during the early life course, being a teen mother who dropped out of high school, and having adult poor health. For males, poor childhood health and educational status were significantly related to welfare dependence. In terms of SSI receipt, only education was predictive of later receipt of SSI among females. For males, not having children was associated with SSI receipt, as was poor adult health. Thus, while worthwhile federal goals for preventing welfare dependency include delaying parenthood and promoting educational attainment, decreasing early poverty and improving adult health status are also important in helping individuals move from welfare toward self-sufficiency.

Ability to work and its relationship with health status and health behaviors in nursing assistants employed in North Carolina nursing homes

Melekwe, Obiajulu E The University of North Carolina at Chapel Hill 2014 해외박사(DDOD)

Purpose: Research in health and productivity management link health to the ability to work. Employees' ability to work affects work productivity. Approximately US$260 billion are lost each year due to health-related productivity loss. Workers that engage in physically demanding jobs and experience health problems may also have increased presenteeism (decreased on-the-job performance due to the presence of health problems) and absenteeism (time missed from work because of health problems). Certified nursing assistants (CNAs) employed in nursing homes perform many physically and emotionally demanding tasks and they could have health problems or engage in health behaviors that affect their ability to work. The purpose of this study is to describe the ability to work in CNAs and investigate the relationships among key variables (self-reported health status, select health conditions and health behaviors), and CNAs' ability to work. Methods: A cross-sectional correlational survey is used to describe the relationships between CNAs ability to work and self-reported health status, health conditions and health behaviors. Results: CNAs in five nursing homes (N=106; response rate 88%) responded to a pencil and paper survey. Forty percent of the respondents' reported at least some impairment in their ability to work. Self-reported health status, diagnosed depression and current smoking were associated with impairment in the ability to work. Implications: Employers of CNAs need to recognize that health-related impairment in the ability to work is prevalent and they need to develop strategies to assist CNAs in optimizing their health and improving their ability to work.

The importance of time and place: Neighborhoods and health throughout the life course

Jokinen-Gordon, Hanna The Florida State University 2014 해외박사(DDOD)

This research contributes to medical sociology, neighborhood research, and life course studies by synthesizing relevant concepts from each field in order to offer a more complete understanding of how and why place impacts health. This achieved through the use of a life course framework that examines the influence of neighborhoods on self-rated health and allostatic load from adolescence through the transition into adulthood using a longitudinal, nationally representative data set that includes detailed information on early life health, as well as detailed data regarding adult health and well-being. Specifically, this dissertation contributes to the aforementioned by examining the following questions: 1) What are the effects of neighborhood structural characteristics on two measures of physical health at three different time points and 2) What mediating mechanisms account for their effects? The findings of this research further bolster existing evidence regarding the importance of the neighborhood environment for physical health. However, the results also extend the existing knowledge base in important ways. This work demonstrates that neighborhood structural characteristics, measured as disadvantage, affluence, and immigrant concentration, influence both subjective and objective measures of physical health at multiple points throughout the life course. Health outcomes such as allostatic load, self-rated health, and mean health are sensitive to compositional structural attributes of the community environment, but there are differences in which aspects of place matter most, the timing of the neighborhood effects, as well as differences in the way that traditional identified mediating mechanisms operate.

Social determinants of disparities in primary care access

Prentice, Julia Christine University of California, Los Angeles 2004 해외박사(DDOD)

Disparities in health outcomes by social position, race and ethnicity and geographic space are a major focus of research and policy in the United States. Access to high quality primary care may diminish these disparities in health. This dissertation increases our understanding of primary care access by examining two rarely examined predictors: health insurance transitions and neighborhood effects on primary care access. Research has consistently found that health insurance predicts primary care use. However, most research has only examined predictors of current health insurance coverage. Due to this cross-sectional approach, the social processes behind gaining and losing insurance coverage and the length of time spent in an uninsured or insured state are largely unknown. Using a two-year retrospective history from the Los Angeles Family and Neighborhood Survey (L.A. FANS), I used survival analysis to estimate how long adults remain uninsured or insured. I compared predictors of current health insurance coverage to predictors of health insurance transitions through multivariate logistic regression. Predictors of health insurance transitions generally match predictors of cross-sectional health insurance coverage and are associated with insurance eligibility. Yet, the lengths of uninsured and insured spells have been underestimated. The most effective policies to decrease uninsurance will focus on expanding insurance eligibility. Past research has focused on individual level predictors of health care access, including health insurance, but has not considered how neighborhood environment might affect an individuals' primary care access. I examined whether neighborhood environment affects primary care access among adults in L.A. FANS using multi-level fixed and random effects logit models. Neighborhood environment affects primary care access even when controlling for individual characteristics. Neighborhood health behavior norms and social capital explain some of the effect of neighborhood environment on having a regular source of care. Neighborhood demand for health care resources significantly predicts receiving a check-up. These analyses support the implementation of both micro and macro-level policies to address disparities in primary care access and provide new directions for future research.

A quasi-experimental study of a health and wellness group intervention for adolescents in residential treatment facilities (RTFs) and examination of risk factors as treatment success predictors

Maggiulli, Laura Rae Greyber State University of New York at Buffalo 2014 해외박사(DDOD)

Background: Prevalence rates of overweight and obesity in children and adolescents are alarming, and even more so in populations with serious emotional disturbances (SEDs) living within residential settings. Integrated health and wellness interventions are necessary to address comorbid physical and mental health disorders that are commonplace for youth living in RTFs with SEDs and high rates of a history of trauma, clinical risk factors, and environmental and psychosocial stressors. Expanding services to include health and wellness interventions may in fact produce overall change in areas of wellness beyond just mental health, and thus impact treatment success at discharge. Specific Aims: Specific aim one of the present study was to test that effectiveness of a health and wellness intervention on body mass index (BMI) and treatment outcomes including success at discharge and discharge level of improvement. The second specific aim was to examine the impact of demographic and risk factors on BMI and treatment success at discharge. Methods: The present study was a quasi-experimental design with an intervention and a treatment-as-usual comparison RTF. Secondary data was collected from closed records for youth who were admitted and discharged from one of the two RTFs within a three year time frame. Sample: The full sample consisted of 144 youth across both RTFs and the matched sample resulted in 62 youth across both RTFs. Intervention: The intervention was a health and wellness intervention that consisted of psychoeducation, family engagement, behavioral skills training, meal and snack protocol, and a fitness and activity protocol. Additionally, the intervention youth participated in community projects and were provided with resources to participate in physical activity. The TAU group received normal services including individual, group, family, recreational, educational, and clinical therapy. Data Analyses: Data was analyzed using descriptive statistics including cross-tabulations, standard deviations, means, and frequencies. Inferential statistical methods included logistic, ordinal, and linear regression as well as repeated measure ANOVA. A propensity score-matched analysis was used to match youth across the two RTFs. Results: For specific aim one, results show that the intervention did not have a significant impact on BMI (range, category, raw score, and percent). Additionally, the intervention did not impact level of improvement at discharge, but did however impact success at discharge. Youth in the intervention RTF were significantly more likely to be successfully discharged relative to the TAU RTF youth (p=.001). For predictor variables, there were no significant predictors of BMI. Conversely, the diagnoses of mental retardation or borderline intellectual functioning and gender significantly predicted success at discharge. Specifically, youth without this diagnosis and youth who were male were more likely to be successful at discharge relative to youth with the diagnoses and females. Conclusions: Though results from this study are mixed, it has important implications not only for clinical practice, but also future research. Results for specific aim one indicated that the intervention was not particularly effective in improving BMI. However, results indicate that the intervention had a significant impact on treatment success at discharge, which suggests that the intervention improved skills, goal attainment, well-being, and mental and behavioral health.

The relationship of police-reported intimate partner violence during pregnancy and maternal and neonatal health outcomes

Lipsky, Sherry University of Washington 2002 해외박사(DDOD)

<italic>Background</italic>. Intimate partner violence (IPV) is a significant public health problem of particular concern during pregnancy. Adverse maternal and neonatal health outcomes may be associated with IPV although studies to date have been inconsistent. This study employed a novel approach to identify IPV exposure with the use of police records. <italic>Methods</italic>. This is a retrospective cohort study of women reporting IPV during pregnancy from 1995 through 1998. Police records and Washington State birth and hospitalization files were linked and police records outcomes. A new reference for small-for-gestational-age (SGA) infants was also developed. Unconditional logistic regression was used in bivariate and multivariate analyses to calculate odds ratios (OR) and 95% confidence intervals (CI). <italic>Results</italic>. Women reporting any IPV were significantly more likely than women who did not report IPV to have a low birth weight (LBW) infant (adjusted OR [aOR] 1.70, CI 1.20, 2.40), a very LBW infant (aOR 2.54, CI 1.32, 4.91), a preterm birth (PTB) (aOR 1.61, CI 1.14, 2.28), a very PTB (aOR 2.90, CI 1.38, 6.12), and a neonatal death (aOR 3.18, CI 1.32, 7.63). Women reporting physical IPV also had a significantly greater risk of LBW, very LBW, and very PTB. Neonatal death was associated with both physical and nonphysical IPV. Only very LBW and very PTB were significantly associated with moderate physical IPV. Hospitalization during pregnancy was strongly associated with any IPV (aOR 2.39, CI 1.77, 3.24), particularly with substance abuse and mental health-related diagnoses. Premature rupture of membranes and abruptio placenta were associated with nonphysical IPV and moderate physical IPV. <italic>Conclusions</italic>. IPV during pregnancy is significantly associated with adverse maternal and neonatal health outcomes. The findings in this study point to the critical need to identify pregnancy and provide health information and referrals to women at the time of an IPV incident and during subsequent contact with community service and domestic violence programs. These findings may also serve to better inform the legal and justice systems of the potential impact of IPV on the health of pregnant women and their offspring.

Nonlinear Relationships between the Environment and Health

Bonnell, Levi N ProQuest Dissertations & Theses The University of 2023 해외박사(DDOD)

Relationships between the environment and health outcomes are complex and likely nonlinear in nature. However, until recently, most studies used ordinary linear regression to model these relationships. The overall goal of this research was to investigate nonlinear relationships between the environment and health. To accomplish this goal, we used several large, national datasets across varying populations and local environments.Destination accessibility is an important measure of the built environment that is associated with active transport and body mass index (BMI). In the first study, we sought to determine the relationship between the density of nonresidential destinations (a proxy for walkability) and BMI, allowing for the possibility of a nonlinear relationship. We merged information from 17.2 million driver’s license records with the locations of 3.8 million nonresidential destinations and census tract socioeconomic data from six states. BMI peaked in the middle density, with significantly lower values in both the low and high-density extremes—a markedly nonlinear relationship.Next, we confirmed our previous nonlinear findings in an independent sample of 2,405 primary care patients with multiple chronic conditions from 13 states, and extended our analysis to include mental and physical health outcomes, in addition to BMI. Several statistical methods were used to confirm the nonlinear relationship between nonresidential destinations and BMI. We also established novel nonlinear relationships between nonresidential destinations and mental health. All three health measures were significantly worse in middle density areas with better values on either extreme.Then, we extended the previous analyses to the natural environment. We used data on 3,409 adults from 119 US counties and the natural amenities scale, a county-level measure of the natural environment, to assess the relationship between the natural environment and health at the intersection of various demographic and social factors, allowing for the possibility of a non-linear relationship. Health was generally worse in areas with poor natural environments; however, this relationship was not linear. In areas with low natural amenities, greater amenities were associated with better physical and mental health, but only for advantaged populations. Meanwhile greater amenities in high amenity areas was associated with a decrease in mental and physical health for disadvantaged populations.Finally, in the review paper, we described the current state of the literature on the nonlinear relationships between walkability and health. We argue that using linear regression techniques to model nonlinear relationships could introduce bias and be partially responsible for the conflicting findings in the literature. We conclude that there are nonlinear relationships between the environment and health. Complex relationships require complex modelling. Ignoring the possibility of a nonlinear relationship could obscure the true relationship and lead researchers and public health officials to draw incorrect conclusions. Future research should confirm these findings and investigate the mechanisms driving these relationships.