- Atlanta, Georgia, United States
Laura Gaydos
Emory University, School of Public Health, Faculty Member
Very little data is available to understand the drivers of burnout amongst health care workers in the pediatric intensive care unit. This is a survey-based, cross-sectional, point-prevalence analysis within a single children's health... more
Very little data is available to understand the drivers of burnout amongst health care workers in the pediatric intensive care unit. This is a survey-based, cross-sectional, point-prevalence analysis within a single children's health system with two free-standing hospitals (one academic and one private) to characterize the relationship of demographics, organizational support, organizational culture, relationship quality, conflict and work schedules with self-reported burnout. Burnout was identified in 152 (39.7%) of the 383 (38.7%) respondents. No significant relationship was identified between burnout and demographic factors or work schedule. A more constructive culture (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.77–0.90; p < 0.001), more organizational support (OR, 0.94; 95% CI, 0.92–0.96; p <0 0.001), and better staff relationships (OR, 0.54, 95% CI, 0.43–0.69; p < 0.001) reduced odds of burnout. More conflict increased odds (OR, 1.25; 95% CI, 1.12–1.39; p < 0.001). Less organizational support ( Z β = 0.425) was the most important factor associated with burnout overall. A work environment where staff experience defensive cultures, poor relationships, more frequent conflict, and feel unsupported by the organization is associated with significantly higher odds of burnout in pediatric critical care. The effect of targeted interventions to promote constructive cultures, collegiality, and organizational support on burnout in pediatric intensive care should be studied.
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Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient safety. Although burnout is prevalent in pediatric intensive care settings, the limited data on environmental contributors precludes creation... more
Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient safety. Although burnout is prevalent in pediatric intensive care settings, the limited data on environmental contributors precludes creation of data driven, targeted solutions. We sought to delineate factors within the work environment and their contribution to burnout across multiple pediatric ICU environments and professions. Methods: Survey based, cross-sectional, multidisciplinary pointprevalence study across five intensive care units in a children’s hospital system including neonatal, pediatric, and cardiac intensive care units. The primary outcome is burnout, defined as endorsement of symptoms related to emotional exhaustion or depersonalization at least once a week. Factors assessed included demographics, organizational culture and support, relationship quality, conflict frequency and work schedules. Results: The usable survey response rate was 38.7% (383) of whom39.7% (152) reported burnout. Burnout did not vary significantly by demographic, full-time status, ICU experience or work schedule. Respiratory therapists had 2.35 times odds of burnout to physicians [95% CI (1.03-5.57), p = 0.042]. Working in the NICU was associated with approximately half the odds of burnout compared to other unit types [PICU OR: 0.53 (0.32, 0.84), p = 0.007; CICU OR: 0.52 (0.28, 0.98), p=0.043]. Greater perceptions of aggressive-defensive cultures and more conflict were associated with increased odds of burnout [OR 1.15 (1.071.22), p< 0.001 and OR 1.26 (1.13-1.40), p< 0.001, respectively]. Greater perceptions of organizational support, constructive culture, and better relationship quality were all associated with reduced odds of burnout [OR: 0.94 (0.92, 0.96), p < 0.001, OR: 0.84 (0.78, 0.90), p < 0.001 and OR: 0.56 (0.45, 0.70), p < 0.001, respectively]. Conclusions: This is the first side-by-side multi-disciplinary analysis of the specific environmental factors contributing to burnout in the pediatric critical care workforce. Identification of specific environmental factors associated with burnout across multi-professional groups may facilitate derivation and testing of targeted interventions.
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The online Executive MPH (EMPH) Program at Emory University offers three majors, and prior to 2015, all integrated learning experiences (ILE) required theses. In 2015, the Program adjusted the ILE requirement based on each major’s... more
The online Executive MPH (EMPH) Program at Emory University offers three majors, and prior to 2015, all integrated learning experiences (ILE) required theses. In 2015, the Program adjusted the ILE requirement based on each major’s intended career outcomes: Applied Epidemiology (Epidemiology: research thesis); Applied Public Health Informatics (Informatics: program-focused capstone courses instead of thesis); Prevention Science (Prevention: choice of research or program-focused thesis or program-focused capstone courses). Our goal was to describe major-specific curricular changes of the ILE requirement aimed to reduce time-to-graduation. We compared three cohort years before (2012–2014) and after (2015–2017) the 2015 curricular change using registrar data of time-to-graduation (339 students) and students’ self-reported satisfaction with their thesis experience (152 students). Informatics and Prevention majors had significantly more students (34%–35%) graduate on time in the 2015–2017, compared to the 2012–2015, cohorts. There was no significant difference by cohorts in perceived student thesis satisfaction in Informatics and Prevention majors and a decrease in satisfaction in Epidemiology majors. Before 2015, the main theme reported as a detractor to thesis satisfaction was lack of Program thesis support. After 2015, this detractor theme was not mentioned and instead a motivator theme was continuous thesis support. After 2015, the main detractor theme was difficulty with time management. Consistent motivator themes across 2012–2015 included thesis committee support and students’ self-fulfillment due to their thesis learning experience. The curricular strategies described can inform other online and residential programs that have a thesis requirement for the ILE.
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Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient safety. Although burnout is prevalent in pediatric intensive care settings, the limited data on environmental contributors precludes creation... more
Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient safety. Although burnout is prevalent in pediatric intensive care settings, the limited data on environmental contributors precludes creation of data driven, targeted solutions. We sought to delineate factors within the work environment and their contribution to burnout across multiple pediatric ICU environments and professions. Methods: Survey based, cross-sectional, multidisciplinary pointprevalence study across five intensive care units in a children’s hospital system including neonatal, pediatric, and cardiac intensive care units. The primary outcome is burnout, defined as endorsement of symptoms related to emotional exhaustion or depersonalization at least once a week. Factors assessed included demographics, organizational culture and support, relationship quality, conflict frequency and work schedules. Results: The usable survey response rate was 38.7% (383) of whom39.7% (152) report...
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Although partnerships between community-based mental health (MH) organizations and school systems to deliver MH services on school grounds (i.e., expanded school mental health, ESMH services) are growing, qualitative research is needed... more
Although partnerships between community-based mental health (MH) organizations and school systems to deliver MH services on school grounds (i.e., expanded school mental health, ESMH services) are growing, qualitative research is needed about stakeholders' perspectives on ESMH services. This study collected qualitative data from caregivers, MH providers, and MH administrators recruited from three MH organizations to understand their perspectives regarding potential advantages and challenges associated with ESMH services. The three MH organizations were located in three regions of Georgia and the majority of youth served by the organizations were enrolled in Medicaid. We conducted four focus groups with 33 caregivers and 13 semistructured interviews with MH administrators and providers, and we implemented a thematic content analysis. Caregivers, providers, and MH administrators described how ESMH services could improve MH services by (a) facilitating appointment attendance through the reduction of logistical barriers to care (including geographic barriers, missed class time, and missed work time) and (b) enhancing communication between providers and teachers. However, some participants also described logistical issues with ESMH services including school space constraints and challenges scheduling appointments. In addition, some caregivers expressed concerns about peer stigma if MH services are delivered at school (vs. the clinic). Providers and MH administrators discussed problems with low caregiver engagement and challenges collaborating with school personnel that stem from lack of understanding of MH problems and treatment. Although ESMH services can improve MH treatment among low-income youth, MH providers and MH administrators may consider collaborating with school personnel to proactively develop strategies to address challenges to its success. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Introduction: Socio-cultural-economic barriers limit Black women's decision about reproductive health. These barriers also lead Black women to choose unintended pregnancy. We employed a multidisciplinary, two-phase study to examine... more
Introduction: Socio-cultural-economic barriers limit Black women's decision about reproductive health. These barriers also lead Black women to choose unintended pregnancy. We employed a multidisciplinary, two-phase study to examine low- and middle-income, child-bearing, urban Black women's reproductive health and religion/spirituality. Purpose: To identify religion/spirituality's influences on reproductive choices of Black women in a southeastern urban community in Atlanta. Method: PhaseI samples 16 women from a shelter for intensive interviews, over 16 months. PhaseII samples 441 women through surveys and focus groups, collected from the health department. Results: Research revealed dynamic links between religion/spirituality and reproductive health. Religion/spirituality affected women's engagement in sexual activity. Women's spirituality/religiosity is tied to their beliefs about contraceptives. 23.68% identified at least one method of contraception against th...
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Research Interests: Psychiatry, Child and adolescent mental health, Public Health, Adolescent, Medicine, and 15 moreComorbidity, Humans, Child, Alcoholism, Female, Male, Health surveys, Child and Adolescent Mental Health, Cross Sectional Studies, Insurance Coverage, Combined Modality Therapy, Health Services Accessibility, Psychology and Cognitive Sciences, Medical and Health Sciences, and Major Depressive Episode
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Separate from scholarship in religion and medicine, a burgeoning field in religion and population health, includes religion and reproductive health. In a survey of existing literature, we analyzed data by religious affiliation,... more
Separate from scholarship in religion and medicine, a burgeoning field in religion and population health, includes religion and reproductive health. In a survey of existing literature, we analyzed data by religious affiliation, discipline, geography and date. We found 377 peer-reviewed articles; most were categorized as family planning (129), sexual behavior (81), domestic violence (39), pregnancy (46), HIV/AIDS (71), and STDs (61). Most research occurred in North America (188 articles), Africa (52), and Europe (47). Article frequency increased over time, from 3 articles in 1980 to 38 articles in 2008. While field growth is evident, there is still no cohesive "scholarship" in religion and reproductive health.
Research Interests: Geography, Health Behavior, Domestic Violence, Research Design, Population Health, and 15 morePublic Health, Peer Review, Medicine, Pregnancy, Humans, Reproductive health, Female, Male, Religion and psychology, Family Planning, Scholarship, North America, Religion Health, Religion and Sex, and Reproductive health services
Research Interests: Decision Making, Focus Groups, Qualitative Research, Medicine, Social Class, and 15 moreHumans, Female, Pediatrics and Child Health, Sleep, Infant, Patient Compliance, Mothers, Risk factors, African Americans, Maternal child health, Adult, Ethnic Group, Risk Factors, Infant Care, and Medical and Health Sciences
Responding to the 2016 Council on Education for Public Health foundational competency requirement that students demonstrate the ability to “perform effectively in interprofessional teams,” the distance-based executive master’s program at... more
Responding to the 2016 Council on Education for Public Health foundational competency requirement that students demonstrate the ability to “perform effectively in interprofessional teams,” the distance-based executive master’s program at Emory University developed an innovative interprofessional education (IPE) experience for geographically dispersed mid-career professionals. Because executive students are mid-career professionals from a variety of disciplines, they participated in this experience representing their professional roles and titles. IPE student groups represented at least three distinct disciplines. The executive program created a four-part online experience consisting of (1) a self-paced didactic module, (2) a synchronous case study group discussion, (3) small (three to five students) group development of a video solution to the case study, and (4) peer review of other groups’ case study solutions. The first-year pilot program was evaluated via standard online course ...
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A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco use to their employees. Despite their potential to price-discriminate, little systematic empirical evidence of the impacts of these tobacco... more
A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco use to their employees. Despite their potential to price-discriminate, little systematic empirical evidence of the impacts of these tobacco surcharges has been published. We attempted to assess the impact of a health insurance surcharge for tobacco use on cessation among enrollees in Georgia&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s State Health Benefit Plan (GSHBP). We identified a group of enrollees in GSHBP who began paying the tobacco surcharge at the program&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s inception in July 2005. We examined the proportion of these enrollees who certified themselves and their family members as tobacco-free and no longer paid the surcharge through April 2011, and we defined this as implied cessation. We compared this proportion to a national expected annual 2.6% cessation rate. We also compared our observation group to a comparison group to assess surcharge avoidance. By April 2011, 45% of enrollees who paid a tobacco surcharge starting in July 2005 had certified themselves as tobacco-free. This proportion exceeded the expected cessation based on 3 times the national rate (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The length of enrollment was not statistically different between our observation and comparison groups (p = .427). The reported rates of tobacco cessation among GSHBP enrollees resulting from a tobacco surcharge substantially exceed national rates. These surcharges appear to be effective, but the value of these results, and the effectiveness of health insurance surcharges in changing behavior, are tempered by the important limitation that enrollees&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; certification of quitting was self-reported and not subject to additional, clinical verification.
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Schools and programs of public health are expanding online course offerings, particularly in response to the transition to remote learning due to COVID-19. While previous research in the health professions suggests that online and... more
Schools and programs of public health are expanding online course offerings, particularly in response to the transition to remote learning due to COVID-19. While previous research in the health professions suggests that online and in-person modalities are equally effective in supporting student learning, there is minimal evidence of this in public health education. This evaluation examines the effectiveness of newly developed online or hybrid course sections offered to Master of Public Health (MPH) and Master of Science in Public Health (MSPH) students enrolled in on-campus programs. We compared the effectiveness of these new offerings with that of the on-campus in-person courses and hybrid courses in the Executive MPH program. The purposes of this mixed-methods evaluation were to (1) assess student learning across the three course modalities and (2) examine student, instructor, and staff experiences with the modalities. The data included pre- and postcourse student surveys on 17 se...
The coronavirus pandemic has caused many colleges and universities throughout the United States to pivot from in-person teaching to distance-based instruction, and while this form of education offers many advantages, one challenge facing... more
The coronavirus pandemic has caused many colleges and universities throughout the United States to pivot from in-person teaching to distance-based instruction, and while this form of education offers many advantages, one challenge facing institutions of higher education is how to best prepare their students for success in the online environment. This article describes the approach used by a hybrid executive Master of Public Health (MPH) program to orient its students, who are all working professionals, to the online environment. In addition to a description of the online orientation course, quantitative and qualitative evaluation findings are shared. The article includes recommendations for establishing an online orientation program. Although the orientation described was developed for working professionals earning an MPH degree, the approach can be applied or adapted to other online programs as they face the need to prepare students for online delivery, whether during a time of eme...
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Introduction: Sickle cell disease (SCD) is a genetic blood disorder associated with several clinical complications including multi-organ damage and early mortality. SCD imposes a significant burden on patients and their families and... more
Introduction: Sickle cell disease (SCD) is a genetic blood disorder associated with several clinical complications including multi-organ damage and early mortality. SCD imposes a significant burden on patients and their families and creates disproportionately high health care costs. Hydroxyurea (HU) is the only disease-modifying drug approved for SCD and is shown to decrease SCD complications and mortality rates in children and adults. However, it is estimated that over 60% of eligible patients may not receive or adhere to HU therapy, thus, limiting the impact of HU to improve SCD-related morbidity and mortality. Patient perceptions of HU are an important factor contributing to its underutilization. Understanding these perceptions will help in the development of interventions for increasing HU use and adherence. There has been an increasingly large number of patients with SCD who rely on social media for support and to find health information. User-generated data on social media pla...
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Recently there have been calls to strengthen integration of unintended pregnancy and sexually transmitted infection (STI) prevention messages, spurred by increasing use of long-acting reversible contraception. To assess the extent to... more
Recently there have been calls to strengthen integration of unintended pregnancy and sexually transmitted infection (STI) prevention messages, spurred by increasing use of long-acting reversible contraception. To assess the extent to which public health/clinical messages about unintended pregnancy prevention also address STI prevention, we conducted a content analysis of web-based health promotion information for young people. Websites identified through a systematic Google search were eligible for inclusion if they were operated by a United States-based organization with a mission related to public health/clinical services and the URL included: 1) original content; 2) about sexual and reproductive health; 3) explicitly for adolescents and/or young adults. Using defined protocols, URLs were screened and content was selected and analyzed thematically. Many of the 32 eligible websites presented information about pregnancy and STI prevention separately. Concurrent discussion of the two...
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Long-acting reversible contraceptive (LARC) methods do not require annual clinic visits for continuation, potentially impacting receipt of recommended sexually transmitted infection (STI)/human immunodeficiency virus (HIV) services for... more
Long-acting reversible contraceptive (LARC) methods do not require annual clinic visits for continuation, potentially impacting receipt of recommended sexually transmitted infection (STI)/human immunodeficiency virus (HIV) services for young women. We assess service receipt among new and continuing LARC users versus moderately and less effective method users and non-contraceptors. Using 2011-2015 National Survey of Family Growth data from sexually active women aged 15-24 years (n = 2,018), we conducted logistic comparisons of chlamydia, any STI and HIV testing, and sexual risk assessment in the past year by current contraceptive type. Less than half of respondents were tested for chlamydia (40.9%), any STI (47.3%), or HIV (25.9%); 66.5% had their sexual risk assessed. Differences in service receipt between new and continuing LARC users as compared with moderately effective method users were not detected in multivariable models, except that continuing LARC users were less likely to b...
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ABSTRACT Background: The final rule from CMS for the meaningful use of electronic health records (EHR) leaves unanswered basic questions about how the implementation of different EHR subsystems and the sequence of the implementation... more
ABSTRACT Background: The final rule from CMS for the meaningful use of electronic health records (EHR) leaves unanswered basic questions about how the implementation of different EHR subsystems and the sequence of the implementation influences various treatment outcomes. Objectives: To examine the impact of five EHR subsystems on risk-adjusted mortality rates (RSMRs) in patients with AMI or CHF. Methods: 969 non-federal, acute care hospitals in 12 states were extracted from the linked 2008 American Hospital Association EHR Survey and CMS Hospital Compare Database. Adjusting for major hospital characteristics using least squares regression and propensity scores, we analyzed the impact of both EHR adoption and number of adopted EHR subsystems (clinical documentation, test results viewing system, physician order entry, decision support, bar-code system) on the outcomes of AMI and CHF inpatients. Results: Significant variation exists in the implementation of EHR subsystems across U.S. hospitals. The presence of an EHR in a hospital resulted in significant reductions in RSMRs for both AMI and CHF by as much as 0.59%. Adopting an additional subsystem resulted in a reduction in AMI and CHF RSMRs by 0.24% and 0.13%, respectively. However, optimal results were achieved in AMI when hospitals fully adopted at least 3 subsystems; for CHF, results were optimal when a hospital had adopted all 5 subsystems. Conclusions: Adoption of EHR reduces AMI and CHF mortality rates, but their effectiveness is dependent on how many subsystems are adopted. National implementation efforts may benefit from taking into account the sequence of EHR subsystem adoption in hospitals.
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Literature generally finds no advantages in mortality risk for albumin over cheaper alternatives in many settings. Few studies have combined financial and nonfinancial strategies to reduce albumin overuse. We evaluated the effect of a... more
Literature generally finds no advantages in mortality risk for albumin over cheaper alternatives in many settings. Few studies have combined financial and nonfinancial strategies to reduce albumin overuse. We evaluated the effect of a sequential multifaceted intervention on decreasing albumin use in ICU and explore the effects of different strategies. Prospective prepost cohort study. Eight ICUs at two hospitals in an academic healthcare system. Adult patients admitted to study ICUs from September 2011 to August 2014 (n = 22,004). Over 2 years, providers in study ICUs participated in an intervention to reduce albumin use involving monthly feedback and explicit financial incentives in the first year and internal guidelines and order process changes in the second year. Outcomes measured were albumin orders per ICU admission, direct albumin costs, and mortality. Mean (SD) utilization decreased 37% from 2.7 orders (6.8) per admission during the baseline to 1.7 orders (4.6) during the in...
Research Interests: Nursing, Critical Care, Critical Care Medicine, Prospective studies, Humans, and 13 moreHospital costs, Female, Male, Regression Analysis, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Cost Savings, Intensive Care Units, Hospital Mortality, and Drug utilization review
ABSTRACT Many new mothers lack sufficient information or resources to appropriately care for their infants. As a result, they may inadvertently place their children at risk for negative health outcomes, including sudden infant death... more
ABSTRACT Many new mothers lack sufficient information or resources to appropriately care for their infants. As a result, they may inadvertently place their children at risk for negative health outcomes, including sudden infant death syndrome (SIDS). Looking to identify parenting information needs, we conducted exploratory, qualitative research across the state of Georgia with first-time mothers of low-to-moderate income. We completed 10 focus groups with 92 new mothers and 20 interviews with clinical providers who care for them. Nearly all mothers interviewed indicated they had been informed that infants should be placed on their backs to sleep and should not co-sleep with a parent in a bed. However, few study participants followed these recommendations. African-American women and Latinas in particular saw co-sleeping as a culturally ingrained practice superseding medical recommendations. For sleep safety in particular, it is not a lack of knowledge that determines behavioral decisions of new mothers, but rather other influencing factors. Provider responses echoed focus group findings, indicating that they counsel patients regarding back to sleep, but less on the issue of co-sleeping, in part because of the difficulty of changing behavior with such a strong cultural influence. Several providers also noted that low-income mothers face additional barriers to compliance with sleep recommendations. These findings raise important questions about how to address sleep safety while maintaining a culturally appropriate perspective. These findings will inform the development of new parenting programs and materials in the state and should thus focus on bridging the gap between knowledge and behavior.
This project examines how access issues, ethnicity, and geographic region affect vaccination of children by two years of age in Bolivia. Bolivia's rich variation in culture and geography results in unequal healthcare utilization even... more
This project examines how access issues, ethnicity, and geographic region affect vaccination of children by two years of age in Bolivia. Bolivia's rich variation in culture and geography results in unequal healthcare utilization even for basic interventions such as childhood vaccination. This study utilizes secondary data from the 2008 Demographic and Health Survey for Bolivia to examine predictors of vaccination completion in children by two years of age. Using logistic regression methods, we control for health system variables (difficulty getting to a health center and type of health center as well as demographic and socio-economic covariates). The results indicated that children whose parents reported distance as a problem in obtaining health care were less likely to have completed all vaccinations. Ethnicity was not independently statistically significant, however, in a sub-analysis, people from the Quechua ethnic group were more likely to report 'distance as a problem i...
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Background Patients presenting to the ED with a chief complaint of chest pain are to be considered a high priority. The American College of Cardiologist and the American Heart Association recommend an electrocardiogram be performed and... more
Background Patients presenting to the ED with a chief complaint of chest pain are to be considered a high priority. The American College of Cardiologist and the American Heart Association recommend an electrocardiogram be performed and shown to a physician within ten minutes of the patient's arrival. Clinicians from the Mayo Clinic suggest a physician's first encounter also be within ten minutes. Purpose Examine disparities in waiting times to see a physician for patients having chief complaint of chest pain. Methods Data were extracted from the 2003 2006 National Hospital Ambulatory Medical Care Survey. Only patients with a chief complaint of chest pain were included in the sample. A logit model was employed with a binary dependent variable of waiting less than 10 minutes or more than 10 minutes. Further the sample was stratified by triage status of emergent and non-emergent. The stratified sample used the dependent variable wait time and utilized a negative binomial regres...
Many new mothers lack sufficient information or resources to appropriately care for their infants. As a result, they may inadvertently place their children at risk for negative health outcomes, including sudden infant death syndrome... more
Many new mothers lack sufficient information or resources to appropriately care for their infants. As a result, they may inadvertently place their children at risk for negative health outcomes, including sudden infant death syndrome (SIDS). Looking to identify parenting information needs, we conducted exploratory, qualitative research across the state of Georgia with first-time mothers of low-to-moderate income. We completed 10 focus groups with 92 new mothers and 20 interviews with clinical providers who care for them. Nearly all mothers interviewed indicated they had been informed that infants should be placed on their backs to sleep and should not co-sleep with a parent in a bed. However, few study participants followed these recommendations. African-American women and Latinas in particular saw co-sleeping as a culturally ingrained practice superseding medical recommendations. For sleep safety in particular, it is not a lack of knowledge that determines behavioral decisions of ne...
Background: Several health consequences have been associated with informal caregiving; however, caregiving's impact on obesity has not been evaluated. We examined the obesity and mental health burden of informal caregiving in a recent... more
Background: Several health consequences have been associated with informal caregiving; however, caregiving's impact on obesity has not been evaluated. We examined the obesity and mental health burden of informal caregiving in a recent population-based US sample. Understanding and addressing this burden promotes healthy communities because informal caregivers provide essential long-term care that allows aging and disabled individuals to safely remain in their community. Methods: We analyzed the 2009 Behavioral Risk Factor Surveillance System data from DC, Illinois, Louisiana, and North Carolina (n=31,496). Using logistic regression, we examined the likelihood of being obese, and having at least one poor mental health day in the past month, conditional on caregiver status and controlling for demographics, socioeconomic status, health behaviors, healthcare access, and emotional support. We then added caregiving characteristics to this model and re-evaluated our outcomes among careg...
Dual protection (DP) strategies, such as using contraceptives and condoms together, can be effective in preventing unintended pregnancy and disease. The feasibility of DP may be influenced by sociocultural and relationship factors. Ten... more
Dual protection (DP) strategies, such as using contraceptives and condoms together, can be effective in preventing unintended pregnancy and disease. The feasibility of DP may be influenced by sociocultural and relationship factors. Ten focus groups were conducted with African-American women (15-24 years) at 3 reproductive health clinics in Atlanta, GA. Participants discussed concerns about preventing pregnancy and disease before discussing DP. Data analysis identified themes related to contraceptive, condom and DP use. Because many participants viewed pregnancy as normative (e.g., everyone is getting pregnant, even our mothers) and STDs as stigmatized (e.g., girls with STDs are nasty), most were more concerned about STDs than pregnancy. All groups identified benefits to early childbearing and reported that prevention strategies may not be as relevant until after having children of their own. Despite the desire of some to avoid pregnancy and STDs, participants identified barriers to ...
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To develop, evaluate, and improve the reliability and validity of the CDC Worksite Health ScoreCard (HSC). We tested interrater reliability by piloting the HSC at 93 worksites, examining question response concurrence between two... more
To develop, evaluate, and improve the reliability and validity of the CDC Worksite Health ScoreCard (HSC). We tested interrater reliability by piloting the HSC at 93 worksites, examining question response concurrence between two representatives from each worksite. We conducted cognitive interviews and site visits to evaluate face validity of items and refined the instrument for general distribution. The mean question concurrence rate was 77%. Respondents reported the tool to be useful, and on average 49% of all possible interventions were in place at the surveyed worksites. The interviews highlighted issues undermining reliability and validity, which were addressed in the final version of the instrument. The revised HSC is a reasonably valid and reliable tool for assessing worksite health promotion programs, policies, and environmental supports directed at preventing cardiovascular disease.
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Average daily steps (ADS) are a low-technology measurement of activity that is useful for exercise prescription. However, research demonstrates poor validity for ADS as a measure of exercise capability. We present a superior... more
Average daily steps (ADS) are a low-technology measurement of activity that is useful for exercise prescription. However, research demonstrates poor validity for ADS as a measure of exercise capability. We present a superior low-technology measure of exercise capability, which is easily applied by practitioners in clinical or nonclinical settings.
Research Interests: Exercise therapy, Energy Metabolism, Humans, Female, African Americans, and 12 morePhysical Fitness, Middle Aged, Adult, Reproducibility of Results, Cross Sectional Studies, Exercise Tolerance, Metabolic Equivalent, health status indicators, Reference standards, Weights and measures, Medical and Health Sciences, and physical exertion
Within public health and medical anthropology research, the study of women’s agency in reproductive decision making often neglects the role of religion and women’s spirituality. This article is based on ethnographic research conducted at... more
Within public health and medical anthropology research, the study of women’s agency in reproductive decision making often neglects the role of religion and women’s spirituality. This article is based on ethnographic research conducted at a shelter for homeless (mostly African American) mothers in the southeastern United States. We explore the inadequacy of rational choice models that emphasize intentionality and planning, which our research shows are in tension with the vernacular religious and moral ethos of pregnancy as a ‘blessing’ or unplanned gift. Our findings confirm that young and disadvantaged women may view pregnancy and motherhood as opportunities to improve their lives in ways that mediate against their acceptance of family planning models. For these women, the notion of ‘blessing’ also reflects an acceptance of contingency and indeterminacy as central to the reproductive experience. We also question the increasingly popular distinction between ‘religion’ and ‘spirituali...
Research Interests: Abrahamic Religions, Anthropology, Anthropology of Gender, Anthropology of Reproduction, American Religion, and 15 moreAnthropology of Christianity, Agency Theory, African American Religions, African American Studies, Anthropology of Experience, Agency, American Christianity, African American Religious Studies, Anthropology of Violence and Suffering, Anthropological Theory, Anthropology of Sexuality, Anthropology of Religion, Blessing, Anthropology of Homelessness, and Anthropology and Theology
Abstract: Establishing a plausible model of women’s agency in reproductive decision making is crucial to both public health and medical anthropology research. The role of religion and women’s spirituality is one crucial and sometimes... more
Abstract: Establishing a plausible model of women’s agency in reproductive decision making is crucial to both public health and medical anthropology research. The role of religion and women’s spirituality is one crucial and sometimes neglected component of such decisions. This article is based on ethnographic research conducted at a shelter for homeless, mostly African American mothers in the Southeastern United States. Methods included fourteen months of intermittent participant observation that included conversations with residents and staff members and participation in mandatory educational programming and on-site focus groups, one researcher-initiated focus group, and a series of in-depth, semi-structured interviews with sixteen shelter residents aged 18-37. Our research, which constitutes one module of an interdisciplinary study involving anthropologists, public health researchers and religion scholars, demonstrates the inadequacy of rational choice models that emphasize intentionality and planning, but are at odds with the vernacular ethos of pregnancy as a “blessing” or unplanned gift. Our findings confirm previous research that shows young and disadvantaged women may view pregnancy and motherhood as opportunities to improve their lives in ways that mediate against acceptance of family planning models. We also argue that women’s agency may be shaped by religious or spiritual idioms that mediate against a public health ideal of full human control over reproductive outcomes. We suggest that a broader ethnography of women’s reproductive agency should locate “blessing” along a continuum of constructs of indeterminacy (cf. Jackson 2013: 31-33) that also include “luck,” “fate,” and some women’s recognition that agentive capacities are not always realistically concentrated in their hands. With this phenomenological approach in mind, we also question the widespread distinction between “religion” and “spirituality” in contemporary public health discourse.
Keywords: Agency, Contraception, Unintended Pregnancy, Spirituality/Religion, Homelessness, African American Women, Public Health
Keywords: Agency, Contraception, Unintended Pregnancy, Spirituality/Religion, Homelessness, African American Women, Public Health
Research Interests: Religion, Abrahamic Religions, Christianity, Medical Sociology, Sociology of Religion, and 88 moreGender Studies, Anthropology, Medical Anthropology, Philosophy of Agency, Social Anthropology, Theology, Sexual and Reproductive Health, Ethnography, Religion in America, Practical theology, Religion and Sexuality, Social and Cultural Anthropology, Contraception, Contemporary Spirituality, Spirituality, Women's Health, Homelessness, Anthropology of Gender, Fieldwork in Anthropology, Critical Medical Anthropology, Anthropology of Reproduction, History of Public Health, American Religion, Prayer, Anthropology of Christianity, Popular Culture and Religious Studies, Agency Theory, African American Religions, Intentionality, Reproductive Ethics, Ethnography (Research Methodology), Spirituality & Mysticism, Gender and Health, African American Studies, Public Health, Medical Anthropology/ antropología médica, Social Determinants Of Health (Anthropology), Christian Spirituality, Cultural Anthropology, Religious Experience, Ethnography of Religion, Existential Anthropology, Sociology of religion (Religion), Anthropology/Sociology of Pregnancy, Kinship and Relatedness (Anthropology), Theology of Suffering and Evil, Sense of agency, Teenage Pregnancy, Phenomenological Anthropology, Religious Studies, Women and Gender Studies, Maternal and Child Health, Anthropology of Experience, Medical Sociology / Anthropology, Moral Luck, Agency, Reproductive health, Violence and social suffering, Feminist Anthropology, Unwanted pregnancy and abortion, Critical Public Health, American Christianity, African American Religious Studies, Health risk, health and illness, medical anthropology, health promotion, qualitative research, mixed methods, and public health, Poverty Studies, Research and writing on Black and Womanist theologies, Black and Womanist spirituality, African American Religion (s( and spirituality, the Catholic Church and racism, issues of Christianity and race, class, and ender, world religions in the US, Social Suffering, Suffering, Social Suffering and Structural Injustice, Contingency, Family Planning, .Medical Anthropology, Divinity, Poverty, Homlessness, Classism, Theology and Religious Studies, Unplanned Pregnancy, Religion and Public Health, Anthropology of Violence and Suffering, Anthropology of gender and sexuality; youth, production and reproduction, Anthropological Theory, Human Suffering, Anthropology of Sexuality, Anthropology of Religion, Practical Theology, Blessing, Religion In the African American Community, Anthropology of Homelessness, and Anthropology and Theology
Objective The goals of this study were to identify treatment rates among adolescents with co-occurring major depressive episode (MDE) and substance use disorder (SUD), and to examine the role of health insurance in the treatment of these... more
Objective
The goals of this study were to identify treatment rates among adolescents with co-occurring major depressive episode (MDE) and substance use disorder (SUD), and to examine the role of health insurance in the treatment of these disorders.
Method
Seven years of cross-sectional data (2004–2010) were pooled from the National Survey on Drug Use and Health to derive a nationally representative sample of 2,111 adolescents who had both a past-year MDE and SUD and whose insurance status was known. The associations of public and private insurance with MDE and SUD treatment were examined using multinomial logistic regressions that controlled for health status and sociodemographic variables.
Results
Less than one-half (48%) of adolescents received any form of MDE treatment in the past year, and only 10% received any form of SUD treatment. Only 16% of adolescents who received MDE treatment also received SUD treatment. Relative to no insurance, public insurance was associated with an increased likelihood of receiving MDE treatment alone, but not with an increased likelihood of receiving both MDE and SUD treatment. Involvement in the criminal justice system was the major factor affecting the likelihood that an adolescent would receive both MDE and SUD treatment, as opposed to either no treatment or treatment for MDE alone.
Conclusions
Exceptionally low rates of SUD treatment were observed in this high-risk sample. Study findings highlight a missed opportunity to assess and to treat SUD among adolescents with co-occurring MDE and SUD who have received some form of MDE treatment in the past year.
The goals of this study were to identify treatment rates among adolescents with co-occurring major depressive episode (MDE) and substance use disorder (SUD), and to examine the role of health insurance in the treatment of these disorders.
Method
Seven years of cross-sectional data (2004–2010) were pooled from the National Survey on Drug Use and Health to derive a nationally representative sample of 2,111 adolescents who had both a past-year MDE and SUD and whose insurance status was known. The associations of public and private insurance with MDE and SUD treatment were examined using multinomial logistic regressions that controlled for health status and sociodemographic variables.
Results
Less than one-half (48%) of adolescents received any form of MDE treatment in the past year, and only 10% received any form of SUD treatment. Only 16% of adolescents who received MDE treatment also received SUD treatment. Relative to no insurance, public insurance was associated with an increased likelihood of receiving MDE treatment alone, but not with an increased likelihood of receiving both MDE and SUD treatment. Involvement in the criminal justice system was the major factor affecting the likelihood that an adolescent would receive both MDE and SUD treatment, as opposed to either no treatment or treatment for MDE alone.
Conclusions
Exceptionally low rates of SUD treatment were observed in this high-risk sample. Study findings highlight a missed opportunity to assess and to treat SUD among adolescents with co-occurring MDE and SUD who have received some form of MDE treatment in the past year.
Research Interests:
Introduction: A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco use to their employees. Despite their potential to price-discriminate, little systematic empirical evidence of the impacts of... more
Introduction:
A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco use to their
employees. Despite their potential to price-discriminate, little systematic empirical evidence of the impacts of these tobacco
surcharges has been published. We attempted to assess the impact of a health insurance surcharge for tobacco use on cessation
among enrollees in Georgia’s State Health Benefit Plan (GSHBP).
Methods:
We identified a group of enrollees in GSHBP who began paying the tobacco surcharge at the program’s inception in
July 2005. We examined the proportion of these enrollees who certified themselves and their family members as tobacco-free
and no longer paid the surcharge through April 2011, and we defined this as implied cessation. We compared this proportion
to a national expected annual 2.6% cessation rate. We also compared our observation group to a comparison group to assess
surcharge avoidance.
r
esults:
By April 2011, 45% of enrollees who paid a tobacco surcharge starting in July 2005 had certified themselves as
tobacco-free. This proportion exceeded the expected cessation based on 3 times the national rate (
p
< .001). The length of enroll
-
ment was not statistically different between our observation and comparison groups (
p
= .427).
c
onclusions:
The reported rates of tobacco cessation among GSHBP enrollees resulting from a tobacco surcharge substan
-
tially exceed national rates. These surcharges appear to be effective, but the value of these results, and the effectiveness of health
insurance surcharges in changing behavior, are tempered by the important limitation that enrollees’ certification of quitting was
self-reported and not subject to additional, clinical verification
A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco use to their
employees. Despite their potential to price-discriminate, little systematic empirical evidence of the impacts of these tobacco
surcharges has been published. We attempted to assess the impact of a health insurance surcharge for tobacco use on cessation
among enrollees in Georgia’s State Health Benefit Plan (GSHBP).
Methods:
We identified a group of enrollees in GSHBP who began paying the tobacco surcharge at the program’s inception in
July 2005. We examined the proportion of these enrollees who certified themselves and their family members as tobacco-free
and no longer paid the surcharge through April 2011, and we defined this as implied cessation. We compared this proportion
to a national expected annual 2.6% cessation rate. We also compared our observation group to a comparison group to assess
surcharge avoidance.
r
esults:
By April 2011, 45% of enrollees who paid a tobacco surcharge starting in July 2005 had certified themselves as
tobacco-free. This proportion exceeded the expected cessation based on 3 times the national rate (
p
< .001). The length of enroll
-
ment was not statistically different between our observation and comparison groups (
p
= .427).
c
onclusions:
The reported rates of tobacco cessation among GSHBP enrollees resulting from a tobacco surcharge substan
-
tially exceed national rates. These surcharges appear to be effective, but the value of these results, and the effectiveness of health
insurance surcharges in changing behavior, are tempered by the important limitation that enrollees’ certification of quitting was
self-reported and not subject to additional, clinical verification
Research Interests:
The American Academy of Pediatrics recommends that children be placed in the supine position on firm bedding and not bed share with parents or other children. Health professionals increasingly understand that many African-American parents... more
The American Academy of Pediatrics recommends that children be placed in the supine position on firm bedding and not bed share with parents or other children. Health professionals increasingly understand that many African-American parents do not follow these recommendations, but little research exists on provider reactions to this non-compliance. This study was intended to better understand how low-income, African-American mothers understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. We conducted focus groups with 60 African-American, low-income, first-time mothers and telephone interviews with 20 providers serving these populations to explore provider counseling and patient decision making. The large majority of mothers reported understanding, but not following, the safe-sleeping recommendations. Key reasons for non-compliance included perceived safety, convenience, quality of infant sleep and conflicting information from family members. Mothers often take measures intended to mitigate risk associated with noncompliance, instead increasing SIDS risk. Providers recognize that many mothers are non-compliant and attribute non-compliance largely to cultural and familial influence. However, few provider attempts are made to mitigate SIDS risks from non-compliant behaviors. We suggest that counseling strategies should be adapted to: (1) provide greater detailed rationale for SIDS prevention recommendations; and (2) incorporate or acknowledge familial and cultural preferences. Ignoring the reasons for sleep decisions by African-American parents may perpetuate ongoing racial/ethnic disparities in SIDS.
Research Interests:
Identifying the educational and resource needs of new mothers is of paramount importance in developing programs to improve maternal and child health outcomes. The primary purpose of this study was to explore the educational needs of new... more
Identifying the educational and resource needs of new mothers is of paramount importance in developing programs to improve maternal and child health outcomes. The primary purpose of this study was to explore the educational needs of new mothers and identify opportunities to enhance healthcare providers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; current educational efforts. A two-part methodology was utilized to qualitatively explore the topic of parenting information needs for new mothers in Georgia. Data collection included information from 11 focus groups with 92 first-time, new mothers and 20 interviews with healthcare providers who serve new mothers. Discussions with both new mothers and providers clearly indicated that new mothers face a significant informational deficit, especially regarding very basic, daily infant care information and health literacy challenges. Educational materials already exist; however, mothers report difficulty accessing and understanding this information. For this reason, both the mothers and the providers stressed a focus on developing programs or interventions that allow in-person education and/or alternative modalities to access information, as opposed to development of new written materials solely. Information from the focus group and interviews provided important insight regarding what improvements need to be made to help new mothers and their families during the early stages of parenthood. By improving the education of new mothers and their families, it is proposed that maternal and infant health status could be improved.