Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain,... more
Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities. Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities. Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting Area codes. Bivariate analysis for clinical services was conducted by rural/urban status. For each service, the proportions of LHDs that directly performed the service, contracted with other organizations to provide the service, or reported provision of the service by independent organizations in the community was compa...
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Objectives. To examine the differences in adolescent birth rates by deprivation and Health Professional Shortage Areas (HPSAs) in rural and urban counties of the United States in 2017 and 2018. Methods. We analyzed available data on birth... more
Objectives. To examine the differences in adolescent birth rates by deprivation and Health Professional Shortage Areas (HPSAs) in rural and urban counties of the United States in 2017 and 2018. Methods. We analyzed available data on birth rates for females aged 15 to 19 years in the United States using the restricted-use natality files from the National Center for Health Statistics, American Community Survey 5-year population estimates, and the Area Health Resources Files. Results. Rural counties had an additional 7.8 births per 1000 females aged 15 to 19 years (b = 7.84; 95% confidence interval [CI] = 7.13, 8.55) compared with urban counties. Counties with the highest deprivation had an additional 23.1 births per 1000 females aged 15 to 19 years (b = 23.12; 95% CI = 22.30, 23.93), compared with less deprived counties. Rural counties with whole shortage designation had an additional 8.3 births per 1000 females aged 15 to 19 years (b = 8.27; 95% CI = 6.86, 9.67) compared with their u...
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The use of long-acting reversible contraceptive (LARC) methods, such as intrauterine devices (IUDs) and implants has demonstrated high effectiveness in preventing pregnancy. While LARC use in Title X programs has increased over the past... more
The use of long-acting reversible contraceptive (LARC) methods, such as intrauterine devices (IUDs) and implants has demonstrated high effectiveness in preventing pregnancy. While LARC use in Title X programs has increased over the past decade, little is know about the extent to which gains are occurring uniformly across states. We examined state-level changes in LARC use among Title X clients between 2012 and 2016 using a repeated cross-sectional study design. States were characterized by the proportion of reproductive age women in need of publicly funded contraception. Variation in LARC use by level of need was examined using GEE models. Across all states, LARC use in Title X clinics increased from 9.1% to 16.2% during the study period. In 2012, LARC use in the states with the highest and lowest level of need differed by 2.3 percentage points (7.8% compared to 10.1%). By 2015 the gap in LARC use between high and low need states widened to reach 5.3 percentage points, more than dou...
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ABSTRACT The Southern Appalachia Tele-Homecare program seeks to improve CHF outcomes while reducing hospitalization and costs in a rural, medically underserved area. SATH integrates patient participation and progressive self-care,... more
ABSTRACT The Southern Appalachia Tele-Homecare program seeks to improve CHF outcomes while reducing hospitalization and costs in a rural, medically underserved area. SATH integrates patient participation and progressive self-care, tele-monitoring, home healthcare, call center monitoring, and standing physician orders in a multidisciplinary team. SATH employs a randomized control study design and a multi-pronged evaluation to assess quality of care, utilization outcomes, and cost-effectiveness. Results (to be updated for presentation): ENROLLMENT: As of 8/31/12, 289 patients were enrolled; 178 in the treatment and 111 in the control group. Of the 190 patients currently eligible for the satisfaction survey, 172 completed (92% response). Intervention patients were significantly more satisfied with their home health than control patients. For the 6-month quality-of-life assessment, 156 of 180 eligible patients responded. The 12-month assessment was completed by 98 of 131 eligible patients. The average QoL score was 51.9 at 6-months and 49.7 at 12 months (maximum 105), with no significant differences between the two groups. FINANCIAL: While initial costs of care are higher in the treatment group relative to the control group ($3,821 vs. $1,087 per patient), the net savings, due to avoided home health visits and mileage costs, realized in the treatment group was 62% of the cost of care in the control group. CONCLUSION: Tele-homecare can be successfully implemented in rural communities, and adapted to other chronic conditions and geographic locations. ALL FINDINGS WILL BE UPDATED THROUGH THE END OF THE PROJECT PERIOD (MARCH 31, 2013) FOR PRESENTATION.
ABSTRACT
ABSTRACT
Vita. U.M.I. no. 9832914. Thesis (Ph. D.)--Johns Hopkins University, 1998. Includes bibliographical references (leaves 195-207). Microfilm.
Background: While evidence-based guidelines for different types of cancer have been developed, cancer screening continues to be underutilized in rural areas, such as rural Appalachia. The Appalachian region includes a large rural and... more
Background: While evidence-based guidelines for different types of cancer have been developed, cancer screening continues to be underutilized in rural areas, such as rural Appalachia. The Appalachian region includes a large rural and medically underserved population and is characterized by high cancer incidence and death rates and later stage of diagnosis. Residents of rural Appalachia are at high risk for not receiving recommended cancer screening tests including Pap smears, mammograms and colorectal screening. Objectives: To identify key barriers, at the individual and community levels, to receiving guideline-concordant cancer screening in rural Appalachia. Methods: A systematic literature review, guided by the expanded behavioral model of health services utilization, using PubMed and other databases, and combined with the authors' research studies in rural areas. Results: Multi-level barriers to screening are evident in rural Appalachia. At the health care system level, the a...
Background: Although evidence-based screening guidelines for different types of cancer have been developed, screening rates continue to be suboptimal, particularly among vulnerable populations. While a host of individual and community... more
Background: Although evidence-based screening guidelines for different types of cancer have been developed, screening rates continue to be suboptimal, particularly among vulnerable populations. While a host of individual and community factors impact cancer screening, a physician's recommendation and follow-up are key drivers of individuals' receipt of guideline-concordant screening services. Yet, a comprehensive, systems-based model of physician cancer screening decision-making is lacking. Objectives: 1) To systematically review the literature on physician cancer screening decision-making; and 2) to propose an innovative, systems-based framework of physician cancer screening decisions. Methods: We conducted a systematic literature review of physician practice patterns using PubMed and other databases; reviewed behavioral prediction theoretical models; and developed a comprehensive conceptual framework of physician behaviors. Results: Studies of physicians' screening prac...
The Southern Appalachia Tele-Homecare program seeks to improve CHF outcomes while reducing hospitalization and costs in a rural, medically underserved area. SATH integrates patient participation and progressive self-care, tele-monitoring,... more
The Southern Appalachia Tele-Homecare program seeks to improve CHF outcomes while reducing hospitalization and costs in a rural, medically underserved area. SATH integrates patient participation and progressive self-care, tele-monitoring, home healthcare, call center monitoring, and standing physician orders in a multidisciplinary team. SATH employs a randomized control study design and a multi-pronged evaluation to assess quality of care, utilization outcomes, and cost-effectiveness. Results (to be updated for presentation): ENROLLMENT: As of 8/31/12, 289 patients were enrolled; 178 in the treatment and 111 in the control group. Of the 190 patients currently eligible for the satisfaction survey, 172 completed (92% response). Intervention patients were significantly more satisfied with their home health than control patients. For the 6-month quality-of-life assessment, 156 of 180 eligible patients responded. The 12-month assessment was completed by 98 of 131 eligible patients. The a...
Objective: Women with disabilities face many barriers to health care. Preventive services, (e.g., pelvic exams, mammograms), can be difficult to obtain. Literature suggests that women with disabilities receive fewer preventive services... more
Objective: Women with disabilities face many barriers to health care. Preventive services, (e.g., pelvic exams, mammograms), can be difficult to obtain. Literature suggests that women with disabilities receive fewer preventive services than other women. However, research has not focused on vulnerable populations. We examined receipt of preventive services among Medicaid beneficiaries with and without physical disability. Methods: Retrospective analysis of eligibility and claims files of female beneficiaries of Florida Medicaid over past 5 years. Women were 18-65 years with at least one outpatient visit during study period. We excluded women who were 1) not continuously enrolled in Medicaid during study period; 2) dually eligible for Medicaid and Medicare; and 3) eligible for limited benefits only. Using ICD-9 codes for physically disabling conditions and CPT codes for mobility-assistive devices (canes, walkers, wheelchairs), we categorized women into 3 groups: 1) no disability; 2) m...
Mississippi was selected as a pilot state in the national breastfeeding promotion campaign titled Loving Support Makes Breastfeeding Work (LSMBW). To reinforce the national LSMBW project, the Mississippi Women, Infants and Children (WIC)... more
Mississippi was selected as a pilot state in the national breastfeeding promotion campaign titled Loving Support Makes Breastfeeding Work (LSMBW). To reinforce the national LSMBW project, the Mississippi Women, Infants and Children (WIC) Breastfeeding Promotion Project Team developed a comprehensive program that included patient and family education, staff training, public awareness activities, health professional outreach, and partnerships with the community. The program also implemented a breastfeeding-friendly clinic environment project and a videotape project. This study was conducted to evaluate the impact of Mississippi's LSMBW activities among WIC breastfeeding coordinators in the United States. The cross-sectional study was performed with the use of a mailed, self-administered questionnaire. Representatives of 50 state WIC agencies returned the survey. Of these 50 agencies, 36 (72%) had effectively used education materials created by the state of Mississippi. Breastfeedi...
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Research Interests: Program Evaluation, Organizational Change, Primary Health Care, Health Care, Maternal Health, and 14 moreHolistic Health, Pregnancy, Humans, United States, Female, Maternal child health, Adult, Chi Square Distribution, Chi Square Test, Service Provider, Ambulatory Care, Health Care Surveys, Outcome assessment (Health care), and Medical and Health Sciences
Women's health centers are often associated with a comprehensive model of health care that treats the "whole woman." Using data from a nationwide study of 467 women's health centers, we explored how the ideal of... more
Women's health centers are often associated with a comprehensive model of health care that treats the "whole woman." Using data from a nationwide study of 467 women's health centers, we explored how the ideal of comprehensive care was implemented with respect to mental health services. Specifically, we examined the rates of screening and treatment for a subset of mental health and behavioral and social problems in women's health centers and the structural, staffing, philosophical, and patient factors associated with the provision of services. Across 12 services, the overall rates of provision ranged from 7.7% for screening for dementing disorders to 27.6% for smoking cessation counseling and treatment. In a series of logistic regressions, center type (primary care) and having a mental health staff person were consistently associated with service provision; other important variables were having a high percentage of women using the center as their usual source of...
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Background. The association of obesity with the odds of diagnosed prostate cancer (DPC) is inconclusive. Whether grade 2 or grade 3 obesity is associated with increased odds of DPC has not been investigated.Design and Methods.... more
Background. The association of obesity with the odds of diagnosed prostate cancer (DPC) is inconclusive. Whether grade 2 or grade 3 obesity is associated with increased odds of DPC has not been investigated.Design and Methods. Cross-sectional data of 7,974 subjects aged ≥40 years were collected from the National Health and Nutrition Examination Survey 2001–2010. Odds ratios (ORs) of DPC associated with grade 2 or grade 3 obesity were estimated by conducting weighted logistic regression models.Results. The unadjusted rates of DPC did not differ significantly over grades of BMI (P=0.7044). After adjustment for different groups of potential confounding factors, grade 2 or grade 3 obesity was not significantly associated with the odds of DPC with ORs changing from 0.62 to 0.69 for grade 2 obesity and from 0.81 to 1.09 for grade 3 obesity. Moreover, morbid obesity (grade 2 and 3 obesity combined) was not linked to the odds of DPC.Conclusion. Grade 2 or grade 3 obesity was not associated ...
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Research Interests: Technology, Research Design, Health, Health Policy, Population, and 11 moreHumans, Biomedical Research, Health Services, Female, Interpersonal Relations, Developed Countries, Public health systems and services research, Sex Factors, Health Services Accessibility, Quality of health care, and Paediatrics and reproductive medicine
Research Interests: Health Promotion, Poverty, Social Support, Counseling, Multivariate Analysis, and 13 moreHumans, Female, Mississippi, Mothers, Perceived Control, Newborn Infant, Adult, Public health systems and services research, Breast feeding, Retrospective Studies, Low Income, Socioeconomic Factors, and Paediatrics and reproductive medicine
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This study was conducted to assess the impact of a breastfeeding promotion clinic environment project implemented by the state of Mississippi on breastfeeding knowledge, attitudes, and practices of WIC clinic staff. Thirteen pairs of... more
This study was conducted to assess the impact of a breastfeeding promotion clinic environment project implemented by the state of Mississippi on breastfeeding knowledge, attitudes, and practices of WIC clinic staff. Thirteen pairs of matched intervention and comparison WIC clinics participated in the study. Clinical and administrative staff completed pre-test and post-test self-administered questionnaires in 1998 and 1999. A total of 397 staff members provided pre-test data, and 277 staff members provided post-test data. Before project implementation, the intervention and comparison groups were similar overall. The majority of staff had positive attitudes/beliefs about breastfeeding, but gaps in knowledge and practices were noted. Post-test data showed that the project improved knowledge, attitudes/beliefs, and confidence/practice of intervention clinic staff. Clinic environment projects, which combine physical improvements and staff training, are effective in promoting support for breastfeeding among public health clinic staff. Similar interventions may contribute to the overall effectiveness of breastfeeding promotion programs.
Research Interests: Program Evaluation, Nursing, Social Work, Health Promotion, Social Support, and 14 morePublic Health, Counseling, Continuing Medical Education, Humans, Female, Mississippi, Public Health Nursing, Questionnaires, Public Administration and Policy, Public health systems and services research, Breast feeding, Professional Competence, Inservice training, and knowledge attitude and practice
ObjectiveTo reduce prevalence of anaemia in low-income postpartum women.DesignA randomised, non-blind clinical trial was conducted among 959 low-income, postpartum women in eleven clinics in Mississippi. The clinics were randomised to one... more
ObjectiveTo reduce prevalence of anaemia in low-income postpartum women.DesignA randomised, non-blind clinical trial was conducted among 959 low-income, postpartum women in eleven clinics in Mississippi. The clinics were randomised to one of three treatment groups: (i) selective anaemia screening of high-risk women as recommended currently (control); (ii) universal anaemia screening and treatment of anaemic women (group I); and (iii) universal Fe supplementation of 65 mg/d for two months to all low-income women (group II). All study participants within each clinic received the same treatment. Women were followed up at 6 months after delivery. Hb was measured at baseline and at follow-up. The primary outcome variable was the proportion of women with anaemia after treatment.SettingEleven health clinics in Mississippi.SubjectsLow-income, postpartum women.ResultsBaseline characteristics of the three study groups were compared using one-way ANOVA and an appropriate post hoc test for cont...
Research Interests: Public Health Nutrition, Poverty, Adolescent, Pregnancy, Humans, and 15 moreFemale, Young Adult, Mississippi, Dietary Supplements, Iron, Trace Elements, Prevalence, Adult, Analysis of Variance, Chi Square Distribution, Hemoglobins, postpartum period, Pregnancy complications, mass Screening, and Medical and Health Sciences
An important aspect of the changing health care system is the growth of women's health centers--organizations that design and deliver services to women. This growth has generated interest in the behavior of centers, especially... more
An important aspect of the changing health care system is the growth of women's health centers--organizations that design and deliver services to women. This growth has generated interest in the behavior of centers, especially because of increasing awareness of women's health issues. Using data from the 1994 National Survey of Women's Health Centers, the authors examined the association between ownership of centers and 12 measures of community benefits, and 296 nonprofit and 108 for-profit centers were compared. Overall, the nonprofits performed better than the for-profits in terms of serving underserved women, delivering comprehensive primary care services, providing training for health professionals and education services for clients and the community, and involving the community in center governance. Among women's health centers, the results show that ownership matters, and indicate the importance of supporting providers who serve the underserved and developing a standard of community benefits.
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This study evaluates the effectiveness of an innovative breastfeeding promotion video intervention in addressing barriers to breastfeeding among low-income women in the state of Mississippi. The 15-minute video features a diverse group of... more
This study evaluates the effectiveness of an innovative breastfeeding promotion video intervention in addressing barriers to breastfeeding among low-income women in the state of Mississippi. The 15-minute video features a diverse group of women and their families. Survey data were collected from Special Supplemental Nutrition Program for Women, Infants and Children clients in the intervention group (n = 310) before and after watching the video, and from a comparison group (n = 204) that did not watch the video. The 2 groups were comparable at baseline. The intervention significantly improved women's perceptions with regard to the "embarrassment" and "time and social constraints" barriers to breastfeeding. In terms of the "lack of social support" barrier, the video positively affected participants' feelings that the baby's father encouraged breastfeeding but did not change their perceptions of support from female relatives and friends. The authors conclude that the video is an effective method of breastfeeding promotion among low-income women.
Research Interests: Nursing, Health Promotion, Poverty, Social Support, Human, and 15 moreHumans, United States, Female, Mothers, Clinical Sciences, Newborn Infant, Food Services, Survey data, Positive Affect, Adult, Public health systems and services research, Breast feeding, Low Income, Human Lactation, and Video Recording
Cancer fatalism, which can be understood as the belief that cancer is a death sentence, has been found to be a deterrent to preventive cancer screening participation. This study examines factors associated with breast cancer fatalism... more
Cancer fatalism, which can be understood as the belief that cancer is a death sentence, has been found to be a deterrent to preventive cancer screening participation. This study examines factors associated with breast cancer fatalism among women. We analyzed data from a 2003 survey of women 40 years of age. The survey collected information about respondents' knowledge and attitudes regarding breast health. Analyses compared the characteristics of women who reported and those who did not report a fatalistic attitude. Women with a fatalistic attitude were more likely to be African American, to have a family history of breast cancer, to rate their quality of care as fair or poor, to believe that not much could be done to prevent breast cancer, to believe that breast cancer could not be cured if found early, and to believe that treatment could be worse than the disease.
Research Interests: Poverty, Health Care, Breast Cancer, Family history, Quality of Care, and 15 moreHumans, African American, Female, Cancer Screening, Ethnic Groups, Health Status, Aged, Middle Aged, Adult, Health Care System, Public health systems and services research, Health Survey, Socioeconomic Factors, Breast Neoplasms, and healthcare disparities
The goal of this study was to understand the unique needs and barriers to breast cancer control among African American women in the rural South. This population experiences barriers that surpass that of other minorities. Researchers... more
The goal of this study was to understand the unique needs and barriers to breast cancer control among African American women in the rural South. This population experiences barriers that surpass that of other minorities. Researchers conducted 6 focus groups to assess barriers of minority women in Mississippi toward breast cancer prevention and clinical trials. These women had little knowledge of treatment options and negative perceptions of screening and clinical trial participation. This research equips others to identify new health education strategies. Conclusions also provide insight into prevention for other minority populations, such as Latina, Asian, and American Indian women.
Research Interests: Focus Groups, Humans, Female, Mississippi, Risk factors, and 13 moreMiddle Aged, Adult, Public health systems and services research, Patient Participation, Risk Factors, Family and Community Medicine, Family and Community Health and Wellness, Family and Community Health Nursing, Clinical Trials as Topic, Health Services Accessibility, Breast Neoplasms, Rural Population, and mass Screening
Rates of physical disability are higher in women than in men, and economically disadvantaged women are at greater risk for physical disability than women with higher incomes. Chronic diseases increase the risk of physical disability, and... more
Rates of physical disability are higher in women than in men, and economically disadvantaged women are at greater risk for physical disability than women with higher incomes. Chronic diseases increase the risk of physical disability, and people with physical disability experience some added risks of secondary conditions including chronic disease. Yet, little is known about the prevalence of chronic disease among women living with a physical disability who use Medicaid, a particularly disadvantaged population. This study described the prevalence of chronic disease among adult (18-64 years), female, Florida Medicaid beneficiaries living with a physical disability between 2001 and 2005. Using Medicaid eligibility and claims files, we extracted ICD-9 codes for physically-disabling conditions and Current Procedure Terminology codes for mobility-assistive devices to define three levels of physical disability. Participants appeared to be at high risk for both physical disability and chronic diseases. Close to half of the women had been diagnosed with one or more physically-disabling conditions, and 5.3% used mobility devices. One-third of the women had hypertension and sizeable proportions had other chronic diseases. Women with physical disability were more likely to have co-morbid chronic diseases than their able-bodied counterparts. Our findings support the need for improved chronic disease prevention among female Medicaid beneficiaries, particularly those with physical disability. Strategies to improve prevention, screening and treatment in this population may mitigate the trends toward higher physical disability rates in the low-income, working-age population and may prevent high Medicare and Medicaid costs in the long-run.