Aparicio, Elizabeth (PhD)
Kachingwe, Olivia (UMD SPH Behavioral and Community Health)
Kaleipumehana Cabral, Megan
Background: Youth who are homeless and at-risk for homelessness experience high teen pregnancy rates, with half of female homeless youth getting pregnant during adolescence (14-17 years). To address this health disparity, our team developed Wahine (“women”) Talk, which seeks to improve homeless female youth’s sexual health and birth control uptake through four basic components: basic needs services, peer mentoring, sexual health education groups, and sexual healthcare services.
Goal: Our goal is to understand young women’s experience of Wahine Talk and also waiting to start or expand their families during adolescence.
Objectives: To explore youth experiences of a sexual health intervention through a participatory action PhotoVoice project, giving participants a chance to share both their stories and voices.
Approach: Our interdisciplinary team (social work/public health/medicine) delivered Wahine Talk to majority Asian American and Pacific Islander homeless youth aged 14-22 years. At Wahine Talk’s conclusion, youth were invited to participate in a PhotoVoice project, a participatory action approach aimed to share our participants’ stories. The project included three sessions: (1) instructions on photography and project prompts followed by going out and taking photos; (2) looking through photos that were taken and deciding which to keep for the final products; and (3) writing captions for the photos.
Results/Conclusions: This project produced a PhotoVoice booklet featuring a series of captioned photographs of experiences in the Wahine Talk program, youth homelessness, and family planning. Photographs ranged from depicting what is important to participants, including snapshots of their child, with the caption ‘She is all I need,’ to sharing their safe spaces, with snapshots of an outside bench, captioned ‘This is at YO! [the youth outreach program] It’s a safe place. I even slept on this bench once.”
Importance to public health: It is critical to understand homeless youth participants’ experiences of Wahine Talk from their own perspectives to improve individual, family, community, and structural supports. Findings from this study affirm that Wahine Talk addresses an unmet need of accessible, judgement-free, holistic sexual health education for female homeless youth.
Adenaiye, Oluwasanmi (Maryland Institute of Applied Environmental Health)
Milton, Donald (Maryland Institute of Applied Environmental Health)
Background: Influenza and other acute respiratory infections (ARIs) contribute significantly to human morbidity and mortality globally. Addressing this problem is still challenging because of inefficient preventive capacity, diagnostic and screening methods and lack of proper understanding of how transmission occurs. Animal experiments and human challenge studies have not provided an adequate explanation about the relative importance of social, behavioral and physical environment in the transmission of ARIs and are limited due to uncertainty about the generalizability of their findings to a natural infection. Also, household transmission studies seldom characterize all potential transmission covariates e.g. environmental conditions, leaving a gap in the knowledge of transmission mechanisms. If significant progress is to be made, it is critical to thoroughly understand transmission dynamics through effective transdisciplinary collaboration that considers numerous potential covariates of ARI transmissibility.
Goal: We critically appraise the design and show how the findings from such design can be applied to answer most of the vital questions that exist about the transmission of Acute Respiratory Infections.
Objectives: Here, we describe the methods employed in this study. We also describe the cohort, their infections, and some preliminary data about their connectivity. Finally, we critically appraise the college dorm study and suggest ways by which it may be improved upon.
Approach: In the spring semester of 2016/2017 academic session, we performed a prospective study to identify and examine the transmission of influenza and other acute respiratory infections within a selected cohort of college dormitory students. The target study group comprised students of University of Maryland at least 18 years of age who were in their first year and lived on certain floors in one of the dormitories assigned to a university living-learning program. On confirmed cases, we examined exhaled breath, fomites, and nasal swabs. Upon identification of a qPCR-confirmed case of ARI, we enrolled their contacts in order to establish a chain of transmission.
Results/Conclusions: We collected baseline survey data from 75 subjects out of a total of 146 eligible participants. Of the 75 subjects, 9.3% (N=7) did not provide any baseline biological sample and hence were excluded from all analyses while the remaining 68 from whom we obtained complete data were retained in the analyses. 73.5% (N=50) of these provided baseline biological samples at the beginning of the semester between January 31, 2017, and February 5, 2017, and 88.2% (N=60) provided biological samples mid-semester between March 27, 2017, and April 3, 2017, i.e. during the second baseline collection period. Only 67.6% (N=46) of all subjects provided samples at both baseline sampling period (Figure 2). We screened 59 episodes of self-reported illnesses reported by 38 subjects some of whom reported more than one episode during the study period. There were 72 laboratory-confirmed episodes of infections in the cohort. 9 episodes of Influenza A (H3N2) illnesses were detected while 15 episodes of Respiratory Syncytial Virus (RSV) illnesses were detected in the cohort. Adenovirus infection was detected in 15 episodes of illness while Rhinovirus was only detected in 3 illness episodes. Of the 60 contacts surveillances that were carried out, we did not detect any pathogen in 26 throughout their surveillance period while there were 34 surveillance positive contact visits. Out of those 34 episodes, 13 (38%) were already positive on the first day of contact surveillance and 21 were tested positive on subsequent follow-up visits. Of the surveillance positive contacts, there were 5 whose pathogens matched those of the nominating cases. By this metric, the secondary attack rate was 8.3%. In this study, we show how ARI transmission monitoring can be achieved in the student living and learning community and how it can provide a means of characterizing several relevant covariates. Though the study size was relatively small (N=68) we identified some probable secondary transmission. A follow-up phylogenetic analysis of the identified pathogens will help confirm transmissions. We believe this study design provides a unique opportunity to study the relative roles of many important covariates of ARI transmission.
Importance to public health: Upon expansion of the study to a larger cohort, incorporation of environmental monitoring measures improved contact network tracking and confirmation of transmission by phylogenetic analysis, we believe this design will provide a comprehensive data that will provide valuable insights regarding ARI transmission and control measures.
Background: Probiotics are essential bacteria found in the gastrointestinal tract that help balance the body’s microflora. Lactobacillus plantarum (LP ) are among the select probiotics found in animals and humans that can inhibit the growth of opportunistic pathogens. They are commonly found in dairy and in most fermented products. LP are a widespread members of the genus Lactobacillus. They are specifically located in the large intestine and function in a high acidic environment. They inhibit growth of bacterial pathogen in the body by maintaining the environment’s acidity by producing lactic acid. The effect of lactic acid activity is extremely affected when LP are infected by a phage or when bacteriophage infection occurs. Bacteriophages are viruses that infect bacteria and inhibit their normal function.
Goal: The goal of the study is to create a phage resistant LP to help enhance the probiotics ability to prevent illness caused by pathogens that enter the body through ingestion.
Objectives: By creating a phage resistant LP, the study works to understand methods to minimize factors that lowers the effectiveness of its function, and create an enhanced opportunity to fight bacterial pathogens. The bacterial pathogens used to test the effect of the LP are S. Typhimurium, S. Enteritidis, S. aureus, EHEC, and L. monocytogenes . These bacterial pathogens normally enter the body through sources such as raw egg, meat and unpasteurized dairy products. The common symptoms of the bacterial pathogens includes diarrhea, vomit, toxicity, and in some cases death.
Approach: The Lactobacillus plantarum strain was grown in a De Man-Rogosa and Sharpe agar (MRS) plate. The bacterial pathogens S. Typhimurium, S. Enteritidis, S. aureus, EHEC, and L. monocytogenes were grown in a Luria-Bertani (LB) agar. The study followed procedural steps that focused to create a phage resistant bacteria and compare the growth rate of the Lactobacillus plantarum mutant to the wildtype strain. Following, the study tested the phage resistant Lactobacillus plantarum mutant ability to inhibit growth of bacterial pathogen. Then, it determined the effectivity using the bacteria’s CFCS at inhibiting growth of bacterial pathogens at various hours.
Results/Conclusions: The finding of the study suggests that phage resistant Lactobacillus plantarum can be produced to inhibit the growth of bacteriophages. The result of the growth curve test indicated that the transformed Lactobacillus plantarum colony had similarly growth to the wildtype strain.The antibacterial effect test displayed the transformed Lactobacillus plantarum inhibiting the growth of bacterial pathogens. The growth inhibition test displayed the antimicrobial properties of the CFCS through its bacteriophages inhibition property.
Importance to public health: This study helps to surface the idea of using enhanced probiotics to inhibit illnesses caused by foodborne pathogens through ingestion.
Samantha, Ammons (UMD SPH Epidemiology and Biostatistics)
Quynh, Nguyen (UMD SPH Epidemiology and Biostatistics)
Devon, Payne-Sturges (UMD SPH Epidemiology and Biostatistics)
Background: The concentration of privilege in a particular geographic area can determine how vital resources are distributed among certain groups in that area, thus influencing a community’s health. High air pollutant exposure, which is associated with poor lung development in children, is often concentrated in deprived neighborhoods with lack of vital resources. Nevertheless, there is a gap in the literature on how the concentration of air pollution exposure may influence infant mortality rates.
Goal: The objective of this research is to determine whether states with a high concentration of air pollution exposure have an increased likelihood of having higher infant mortality rates in comparison to states with lower concentrations of air pollution exposure.
Objectives: 1. Determine if there is a statistically significant correlation between the exposure to air pollutants and infant mortality rate. 2. Conduct a Poisson regression to determine if any observed associations are retained when air pollution exposure is included in the model adjusting for covariates (education, population density, and smoking prevalence).
Approach: This was an ecological study conducted at the state level. The exposure variable, air pollution exposure, was measured by the Air Quality Index (AQI). The AQI is calculated daily at the county level by the Environmental Protection Agency for major air pollutants. In order to calculate privilege, this study utilized the Index of Concentration of the Extreme (ICE) for each state level AQI. Q1 – Q5 levels were generated with Q5 (most privileged) as the reference. Incidence Rate Ratios and 95% Confidence Intervals were computed using Poisson regression using Statistical Analysis Software (SAS).
Results/Conclusions: There was a strong correlation found between AQI and infant mortality (p-value: <0.0001). States that are in the lowest ICE quintile for AQI have 43% higher infant mortality rates than states that are in the highest ICE quintile for AQI (95%CI:1.22 – 1.70).
Importance to public health: Measuring how air pollution exposure influences infant mortality is important because it can reveal a variety of inequalities that exist in a society and inform health professionals and/or policymakers on how to address health disparities.
Aram, Jonathan (UMD SPH Epidemiology & Biostatistics)
Slopen, Natalie (UMD SPH Epidemiology & Biostatistics)
Background: Between 1999 and 2017, the age-adjusted overdose death rate has increased from 6.2 to 21.8 per 100,000, and over 702,000 people have died of a drug overdose. Although studies have documented excess risk based on age, race, ethnicity, sex and educational attainment, few nationally-representative studies have examined patterns by occupational status, which could inform strategies for prevention.
Goal: Our goal was to identify occupation and employment groups at high risk for poisoning death.
Objectives: We tested two hypotheses: 1. Excess risk of poisoning death in construction occupations will be attenuated by adjustment for covariates. 2. Unemployed and disabled persons will display excess risk of poisoning death.
Approach: Using data from the National Longitudinal Mortality Study (NLMS), we estimate risk of poisoning death by occupation, while controlling for demographic covariates (n=436,359). The NLMS uses baseline demographic data collected by the Census Bureau and linked to the National Death Index. We used the most recent publicly-available data available, which covered 2002-2008. Our exposure variable combined employment status and occupation, as defined and coded by the Bureau of Labor Statistics. We defined our outcome as, “accidental poisoning and exposure to noxious substances,” as reported on death certificates and coded by the CDC, and used Cox proportional hazards regression to estimate hazard ratios.
Results/Conclusions: Between 2002-2008, 157 poisoning deaths occurred during 2,553,626 person-years of observations. Relative to individuals in professional occupations, those in construction (hazard rate ratio (HR)= 1.52, 95% CI=1.46-1.59) and service occupations (HR=1.87, 95% CI=1.80-1.95), and those who were unemployed (HR=4.58, 95% CI=4.40-4.75) and disabled (HR=7.66, 95% CI=7.39-7.94), displayed excess risk of poisoning death, adjusted for age, sex, race/ethnicity, education and income.
Importance to public health: Relative to professional occupations, four groups are at higher risk for poisoning: construction, service occupations, unemployed and disabled. These findings remain strong even after adjusting for covariates. Future research may seek to verify these findings in a more recent timeframe, as efforts to prevent overdose deaths may benefit from focusing on these groups.
Arp, Gabriela (UMD SPH Public Health Science)
Jamison, Amelia (UMD SPH Center for Health Equity)
Quinn, Sandra (UMD SPH Department of Family Science)
Broniatowski, David (GWU)
Dredze, Mark (JHU)
Background: In 2014 Acute Flaccid Myelitis (AFM) emerged as a new, and incurable, condition that primarily afflicts children. As public health agencies and medical experts searched for an explanation, social media became an outlet for the public to introduce lay theories of illness. One of these theories blames vaccination. Our team wanted to explore what theories were being discussed on Twitter, what evidence they were citing, and how these ideas spread across the network.
Goal: To explore how an idea like “Vaccines cause AFM” emerges and spreads across Twitter.
Objectives: Identify lay theories of illness related to AFM Recreate a timeline of major events in medical literature, mainstream media, and on social media. Follow the evolution of two theories related to AFM (vaccines and immigrants) overtime.
Approach: This is a retrospective analysis of Twitter data. Using HealthTweets our team aggregated all relevant tweets using keywords. We used content analysis to identify lay theories of illness. Using a chronological approach, we identified the earliest tweets that expressed lay theories of AFM. We trace how these ideas spread, focusing on networks, users, and sources.
Results/Conclusions: We traced three separate theories on Twitter: 1) the science that links AFM to an enterovirus (EV-D68), 2) user-generated theories that link vaccines to AFM, and 3) user-generated theories that link AFM to immigrants. Official public health narratives introduced scientific explanations as early as 2014, but conspiracy theories related to vaccines started to appear in 2015. Anti-immigrant messaging spiked leading up to the 2018 midterm election.
Importance to public health: In order to combat the spread of misinformation online, it is of vital importance to understand how these lay narratives are created, how they spread across networks, and how they evolve over time.
Jamison, Amelia (UMD SPH Center for Health Equity)
Broniatowski, David (GWU)
Dredze, Mark (JHU)
Quinn, Sandra (UMD SPH Family Science)
Washington, Jana (UMD)
Schmidt, Alexis (UMD)
Awotunde, Oluwatoyin (UMD)
Background: In the past 5 years, several major measles outbreaks have occurred in the US. Twitter has become a popular forum for the public to share opinions related to these outbreaks. We believe that health communications experts would benefit from a longitudinal understanding of the patterns in measles-related Twitter activity, particularly as it changes before, during, and after an outbreak.
Goal: To identify major themes in measles discourse on Twitter and measure the prevalence of these themes over time.
Objectives: 1. Identify major themes in Twitter discourse each month. 2. Identify differences between outbreak periods and non-outbreak periods. 3. Compare themes across specific outbreaks.
Approach: This was a longitudinal study. Using HealthTweets, our team compiled the top tweets containing the word “measles” for each month, sorting by number of retweets and including the top 25%. Our data starts in Nov 2014 and ends in December 2016. Our team developed a codebook of major themes: anti-vaccine, pro-vaccine, news, anti-anti-vaccine, anti-immigrant, pro-immigrant, and not relevant. Three annotators independently assigned each tweet to a category. A fourth team member reconciled annotations. Major events, outbreaks, and media stories were also recorded.
Results/Conclusions: We annotated 2,947 tweets. The period surrounding the 2015 Disneyland outbreak generated the most Twitter activity, with 1,510 tweets, roughly 40% were news reports, followed by 20% each for pro-vaccine sentiment and anti-anti-vaccine sentiment. Anti-vaccine content accounted for >10% of tweets. Outside this period, each month averaged 61 tweets, with varied themates content. Each of the major themes (anti-vaccine, pro-vaccine, anti-immigrant etc.) display distinctive trends over time.
Importance to public health: Twitter activity during and immediately following a measles outbreak is significantly different than activity during non-outbreak periods. This has important connotations for public health messaging.
Smit, J. Carson
Background: Extensive research has provided evidence for the memory benefits of exercise training, but the effects of an acute bout of exercise on long-term memory are not as well understood. Psychological research has strongly documented the memory-enhancing effects of emotional arousal. The central release of stress hormones, specifically norepinephrine, is the neurobiological basis for this enhancement. Furthermore, acute exercise of a sufficient intensity and duration stimulates norepinephrine release.
Goal: The goal of this study was to examine the time-dependent relationship between acute exercise-induced arousal and long-term memory for emotional and neutral material.
Objectives: We aimed to determine whether a single session of high-intensity cycling exercise performed either before or after exposure would benefit long-term memory for pleasant, neutral, and unpleasant images.
Approach: Seventy-two healthy young adults (M = 21.4, SD = 3.5 years old) were randomly assigned to an exercise-before, exercise-after, or rest (control) group. Participants in the exercise groups completed a high-intensity session of cycling exercise before or after viewing pleasant, neutral, and unpleasant images. Exercise intensity was prescribed using Borg’s Ratings of Perceived Exertion scale, and participants were instructed to exercise at an intensity of 15 (‘Hard’). Salivary α-amylase (sAA), a noninvasive biomarker of noradrenergic activation, was measured as an indicator of arousal. A recognition memory test was administered after a 7-day delay.
Results/Conclusions: Evaluation of sAA indicated significant exercise-induced increase in central noradrenergic arousal. Analysis of variance (ANOVA) revealed significant effects of picture type and group on long-term memory performance. Unpleasant images were better recognized than both pleasant and neutral images, and pleasant images were better recognized than neutral images. Comparison of exercise groups indicated that both exercise groups had overall better memory performance compared to the control group. Only the memory improvement observed in the exercise-after group survived correction for multiple comparisons. These results suggest that exercise-induced arousal during the consolidation stage of memory, which occurs immediately after exposure, may benefit memory beyond the benefits offered by pre-encoding exercise.
Importance to public health: The cognitive benefits of exercise are well-documented. This study contributes to a burgeoning body of literature that aims to determine the best type and timing of exercise to observe memory benefits.
Babin, Jordan (UMD SPH Behavioral and Community Health)
King-Marshall, Evelyn (UMD SPH Behavioral and Community Health)
Green, Kerry M. (UMD SPH Behavioral and Community Health)
Background: Background: Rape myths (RM) are widely held false beliefs that shift the blame of a sexually violent act from the perpetrator to the victim. RMs contribute to a culture where sexual assault is normalized. RM Acceptance (RMA) is predictive of victims not acknowledging sexual assault and rape proclivity. Studies indicate that females are more likely to reject rape myths; however, they have not investigated this trend outside of hetero-normative scenarios (e.g., male perpetrator/female victim).
Goal: To understand how high school sex education content and tone are related to rape myth acceptance, in both heteronormative and non-heteronormative scenarios, and current attitudes towards sex.
Objectives: 1. To differentiate rape myth acceptance based on the gender of perpetrator and victim 2. To evaluate the effect of gender on rape myth acceptance
Approach: Methods: 441 college students, average age of 19, 71% female, 68% white, and 17.5% sexual minorities completed an online survey in Fall 2018. Participants completed the Illinois RMA, Struckman-Johnson and Struckman-Johnson (SJ-SJ) Male RMA, and three modified SJ-SJ victim/perpetrator RMA scales that assessed scenarios that included all combinations of males and females as victims and perpetrators.
Results/Conclusions: Results: Those identifying as female demonstrated a significantly greater degree of rape myth rejection in the Illinois RMA (p<.0001), and SJSJ male victim/male perpetrator (p=.001), male/female (p=.001), female/female (p=.001), and female/male (p=.009) scales. Rejection of RMA did not differ by sexual orientation or race. Further analysis found significant (p<.0001) correlations between the 4 scenarios between .72 and .82. Conclusions: Findings suggest that victim/perpetrator gender scenarios affect rejection of RM. Although findings confirm trends found in the literature, the strength of gender association vary across scenarios. This suggests sex education and sexual assault prevention programs should vary portrayals of perpetrator and victim gender, thus addressing male-female stereotypes.
Importance to public health: The disproportionately high prevalence of rape and sexual assault on college campuses is a public health problem. Understanding how high school sex education content and tone is related to rape myth acceptance and current attitudes about sex could provide insight into the culture present on many college campuses that normalizes rape and sexual assault.
Baker, Francine S. (National Cancer Institute)
Minas, Tsion Z. (National Cancer Institute)
Bailey-Whyte, Maeve (National Cancer Institute)
Ambs, Stefan (National Cancer Institute)
Smith, Cheryl J. (National Cancer Institute)
Obadi, Obadi (National Cancer Institute)
Background: Triple negative breast cancer is an aggressive form of breast cancer disproportionally affecting African-American women. Tumor biology is believed to be a contributing factor for why such a disparity exists. We hypothesize that the enzyme cystathionine-beta synthase (CBS), which was found to be upregulated in breast tumors when compared to adjacent normal breast tissue, plays a key role in breast cancer tumor biology.
Goal: We seek to gain a better understanding of breast cancer tumor biology by studying the effects of CBS on human breast cancer cells.
Objectives: Hypothesis #1: CBS effects the proliferation of human breast cancer cell. Hypothesis #2: MYC signaling activates the CBS promoter and upregulates CBS expression.
Approach: Several proliferation assays were used to test the effects of CBS on proliferating breast cancer cells. Each assay was conducted twice, using traditional growth medium and using medium with and without glutamine. Cells used were under three experimental conditions: control, CBSlow and CBShigh. To assess promoter activity, we cloned the CBS promoter next to the firefly gene, so the expression of firefly protein is regulated by the CBS promoter. Human breast cancer cells were transfected with plasmids where the firefly protein expression was under the control of one of the following promoters: full CBS promoter with predicted MYC binding site, full CBS promoter without the predicted MYC binding site, and lacking the entire CBS promoter.
Results/Conclusions: Given normal growth medium, there was no significant difference in proliferation rate between experimental conditions. However, the proliferation rate with cells overexpressing CBS was higher than our control when under glutamine deprivation. This suggests that CBS may have a proliferative advantage in nutrient poor environments. Additionally, our promoter assay suggests that signaling by the MYC oncogene upregulates CBS expression in human breast cancer cells. When we deleted the MYC binding site, CBS promoter activity was decreased, suggesting MYC binding is important for CBS promoter activity.
Importance to public health: Understanding the molecular mechanism by which tumor biology influences cancer health disparities may bring researchers closer to closing the disparities gap and improving health outcomes for African-American women with triple negative breast cancer.
Robinson, Caroline (Innovation Department - LifeBridge Health)
Background: Research at LifeBridge Health and other centers has previously demonstrated that optimizing the patient experience entails providing a seamless transition of care when moving from one setting to another (e.g. from the hospital to the home). Historically, we relied solely on post-discharge phone calls to engage patients seen in our emergency department (ED) or our hospitals, often with mixed success. To improve the way we engage with patients post-discharge while respecting provider workforce capacity, the Innovation Department at LifeBridge Health leveraged GetWell Loop (an app-based communication platform), to stay connected with patients in the days following a home discharge. All patients discharged with a valid email receive an invitation to sign-up on Loop after which they receive a program of automated messages relating to their recent stay. The system filters and highlights high-priority or emergent needs, which receive immediate follow up from our centralized call center.
Goal: Our goal was to identify patients discharged home from our ED and inpatient units requiring assistance with post-discharge care concerns through an app/e-mail-based communication platform.
Objectives: 1. To send more than 10,000 invites to patients within the first 6 months of implementation (July – Dec 2018) 2. To achieve a 30 percent activation rate, as measured by the proportion of patients that activate their GetWell Loop account following the initial invitation 3. To achieve patient engagement with the application as measured by alerts triggered and patient comments/questions indicating discharge care needs 4. To achieve improvement of patient satisfaction scores as measured by HCAHPS
Approach: The innovation team, worked with key clinical and non-clinical stakeholders from the emergency departments and inpatient units at both Northwest and Sinai hospitals during the planning and implementation phases to garner buy-in from staff, and ensure the program would not add additional operational burden. Additional input was leveraged to build specialized care plans to ensure the GetWell Loop solution was customized for their patient populations to include check-in questions, resources, checklists, and reminders each with their own delivery cadence centered around their discharge date. Both Sinai (500 beds) and Northwest (200 beds) went live with the solution for their adult ED and inpatient populations discharged home on 7/18/2018. The LifeBridge Health LifeLink clinical call center was leveraged to handle support for alerts and questions generated by our patients and route escalation cases to the appropriate care teams.
Results/Conclusions: First 6 months - 70% activation rate for post-procedure discharges - 30% activation rate for general medicine discharges and ED visits - 11,000 check-ins - 1,500 alerts and 990 comments and questions submitted by patients requesting support - 84% of patients like using the application and found it valuable, as measured by direct-to-patient survey data
Importance to public health: The results indicate that many general emergency department patients and inpatients require continued support even within the first few days after discharge. The initial data following enterprise-wide rollout is promising for this patient community where transportation and cost are significant barriers to care. Furthermore, this solution can continuously engage all discharged patients, and simultaneously identify patients that require additional support at scale
Bell, Elizabeth (UMD SPH Kinesiology)
Burnett, Jenna (UMD SPH Kinesiology)
Shim, Jae Kun (UMD SPH Kinesiology)
Background: With the growing prevalence and cost of obesity and other chronic diseases in ILEA, it is imperative that clinicians accurately prescribe prosthetic and therapeutic interventions which maximize patient function. Available assessments of ILEA functionality fail to provide patient specific information on what underlying aspects of functionality, such as balance, agility, symmetry, endurance, comfort, maneuverability, load, flexibility, power and strength are limited. These incomplete assessments of functionality create a critical gap in the patient-to-clinician feedback loop, causing clinicians to rely on personal experience and anecdotal knowledge to select prosthetic and therapeutic prescriptions.
Goal: The goal of this project was to gain an analytic understanding of what aspects are important to the functionality of ILEA and if these values are consistent across groups of varying activity levels.
Objectives: This evaluation assessed if importance of underlying aspects of functionality differ as reported by ILEA differ by reported activity level while controlling for amputation level differences across groups.
Approach: We preformed a literature review and exploratory factor analysis to determine 10 underlying aspects of ILEA functionality. We disseminated a preliminary survey to 355 ILEA which provided lay definitions of each underlying term to respondents before they were asked to rate the importance of each capability with respect to their current functionality via a digital Visual Analog Scale. Participants also reported their weekly activity levels under vigorous, moderate, or walking only categories. MANCOVA analysis was used to determine if the ratings pertaining to ILEA functional ability varied collectively by activity group while controlling for amputation level (α = 0.05). Follow-up ANCOVA comparisons were performed to determine which outcome variables differed between all possible activity group pairings.
Results/Conclusions: Results indicated statistically significant differences in ratings of prosthesis flexibility, power, agility and strength. Follow-up ANCOVA tests indicated ratings of flexibility, power, and agility were statistically significantly more important for individuals who participated in vigorous activity and prosthesis strength was significantly more important for ILEA who participated in vigorous activity as compared to walking. These preliminary results indicate clear differences in the underlying aspects of ILEA functionality between groups of differing self-report activity levels. The results from this pilot test support the necessity of more detailed investigations into how subgroups within the ILEA population differ in their self-report of limitations to underlying aspects of functionality
Importance to public health: With the growing prevalence and cost of obesity and other chronic diseases in ILEA, it is imperative that clinicians accurately prescribe prosthetic and therapeutic interventions which maximize patient function. A more comprehensive and methodological approach to patient-oriented evaluations will maximize the ability of the rehabilitation team to improve health outcomes of their patients.
Chen, Jie (UMD)
Background: In the new era of value-based payment models and pay for performance, hospitals are in search of the silver bullet strategy or bundle of strategies capable of improving their overall star rating and reducing their 30-day readmission rates.
Goal: Our objective was to determine if hospitals that self-report consistent use of care coordination strategies have higher overall ratings and less Medicare readmissions.
Objectives: Our hypothesis was that hospitals that self-report consistent use of care coordination strategies would have higher overall ratings and less Medicare readmissions.
Approach: We merged hospital data from the 2015 AHA Annual Survey, 2015 AHA Care Systems and Payment Survey, 2015 and 2016 CMS Hospital Compare, FY 2018 CMS Hospital Readmission Reduction Program (HRRP), and 2015 Area Health Resource File. We operationalized excess 30-day readmission ratios from the HRRP as binary measures comparing hospitals with ratios of 1 or less to hospitals with ratios greater than 1 and used multivariate logistic regression. We ran separate models for each of the 6 condition-specific ratios: COPD, heart failure, pneumonia, myocardial infarction, CABG, and TKA/THA. To evaluate the association between care coordination strategies (e.g., medication reconciliation, follow-up calls, visit summaries) and readmissions more globally, we also ran models with performance on the HCAHPS care transition composite measure and overall hospital (star) ratings as an outcome variable, comparing hospitals rated 4 or 5 to hospitals rated 3 or less. We ran separate models for each of the 12 strategies included in the AHA survey and models with total the number of strategies implemented.
Results/Conclusions: Of the 3305 HRRP hospitals, 696 hospitals answered all twelve care coordination questions on the Care Systems and Payment Survey. The hospitals responding to all 12 questions were more likely to be large, academic, and non-profit, less likely to be in rural or high-poverty communities, and less likely to have excess readmissions. We found that increasing the number of strategies is associated with lower excess readmissions for heart failure (AOR=1.29, se=0.14, p<0.05), COPD (AOR=1.28, se=0.14, p<0.05), pneumonia (AOR=1.34, se=0.16, p<0.05), AMI (AOR=1.24, se=0.13, p<0.05), higher care transition satisfaction (AOR=1.57, se=0.18, p<0.001), and higher overall star ratings (AOR=1.43, se=0.18, p<0.01). However, we found that odds of success had a slight downward trend for AMI readmissions (AOR=0.98, se=0.0, p<0.05), care transition satisfaction (AOR=0.97, se=0.18, p<0.001), overall star ratings (AOR=0.98, se=0.0, p<0.05) when hospitals have more than 7 strategies. We found that hospitals with consistent medication reconciliation, visit summaries, follow-up calls, disease management programs, transitional care programs, and case manager follow-up have significantly higher odds of top star-ratings. None of the strategies were positively associated with lower readmissions for TKA/THA or CABG.
Importance to public health: Based on this preliminary analysis, it appears that care coordination strategies typically used by hospitals may be effective at reducing readmissions for patients initially hospitalized for medical conditions, but less effective for surgical admissions. There also appears to be diminishing returns when implementing more than seven strategies.
Borzekowski, Dina (Behavioral and Community Health)
Background: In July 2018, the UMD-SPH launched the new Global Health Initiative. A goal of the initiative is to increase educational, research, and service opportunities among members of the School of Public Health. It was critical to know where we the school stood at baseline and collect data assessing experience and interest in global public health and travel.
Goal: This study's goal was to collect baseline information among members of the SPH on their experience and interest in global public health and travel.
Objectives: The specific objective of this project was to reveal information among members of the SPH on their experience and interest in global public health and travel.
Approach: A simple online survey was used, asking closed and open ended questions on travel experience and interest. This was done in Fall 2018 and distributed through SPH listserves and links.
Results/Conclusions: Data was collected from 858 participants, including 556 undergraduates (65.5%), 148 graduate students (17.5%), 102 faculty (12.0%) and 42 staff (5.0%). Participants represented different SPH programs and offices (PHS-33.4%, KNES-21.1%, BCH-19.7%, FHS-10.6%, HAS-5.7%, EPI-3.3%, Deans Office-3.4%, MIEH-1.8%). On a five-point scale, respondents were very (22.4%) or extremely interested (18.4%) in global health. There was consistently high interest across SPH role, but there was variation by department affiliation (χ2= 119.5, p< 0.001). Most (91.9%) respondents had traveled outside of the U.S., although the number of countries visited differed by school role (χ2= 79.7, p< 0.001) and department (χ2= 71.2, p< 0.01). Participants wanted to travel for study, work and service, with two-thirds very (23.0%) or extremely (42.6%) interested. Expectations of travel varied. As part of the SPH and UMD experience, 21.9% of undergraduates thought it was extremely likely they would travel abroad in the coming three years, compared to 6.1% of graduate students, 17.6% of faculty, and 7.1% of staff (χ2= 59.9, p< 0.001). This survey offers evidence that members of the UMD-SPH have high levels of interest in global public interest topics and travel. Only a small fraction of the SPH population anticipates that they will travel in the coming years.
Importance to public health: The UMD-SPH Global Health Initiative should take advantage of interest and facilitate travel abroad for students, faculty and staff as part of the School of Public Health experience.
Zhu, Linyan (UMD SPH MIAEH)
Sapkota, Amir (UMD SPH MIAEH)
Rule, Ana (Johns Hopkins Bloomberg School of Public Health Department of Environmental Health and Engineering)
Kavi, Lucy (UMD SPH MIAEH)
Pool, Walkiria (Centro de Apoyo Familiar)
Thomas, Stephen (UMD SPH Center for Health Equity)
Quiros-Alcala, Lesliam (UMD SPH MIAEH)
Background: Phthalates are endocrine disrupting compounds present in many personal care products (PCPs), including hair and skin care products, which have been linked to adverse health effects. Hairdressers may experience elevated exposures to phthalates from routine use of PCPs on themselves and their clients. Still, no studies have assessed phthalate exposures among hairdressers via biomonitoring. Additionally, hairdressers primarily serving clients of African and Latino descent may experience elevated exposures due to the unique products used.
Goal: To assess exposures to phthalates among female hairdressers primarily serving clients of African and Latino descent.
Approach: We recruited 13 female hairdressers from salons in Maryland and quantified urinary concentrations of 9 phthalate biomarkers [Mono-ethyl phthalate, MEP; Mono (3-carboxypropyl) phthalate, MCPP; Mono(2-ethylhexyl) phthalate; MEHP; Mono(2-ethyl-5-hydroxyhexyl) phthalate, MEHHP; Mono(2-ethyl-5-oxohexyl) phthalate, MEOHP; Mono(2-ethyl-5-carboxypentyl) phthalate, MECPP); Mono-n-butyl phthalate, MBP; Mono-isobutyl phthalate, MiBP; and Monobenzyl phthalate, MBzP)] using liquid chromatography tandem mass spectrometry (LC-MS/MS) based methods.
Results/Conclusions: Phthalate metabolites were detected in 77-100% of urine samples. Median (p25, p75) concentrations (ng/mL) were: MEP: 300.8 (79.2, 339.4); MBP: 14.8 (2.8, 25.8), MiBP: 8.8 (1.6, 11.2); MEHP: 4.0 (2.3, 5.3); MEHHP: 6.6 (3.1, 13.2); MEOHP: 4.6 (1.7, 7.5); MECPP: 5.3 (4.0, 10.4); MBzP: 1.2 (0.4, 2.6); and MCPP: 0.9 (0.2, 1.5). Compared to women from the U.S. general population, median concentrations among hairdressers were 1.2-7.3 times higher for several phthalate metabolites (MEP, MBP, MEHP, MEHHP, MEOHP). Notably, median concentrations for MEP, a biomarker for Diethyl-phthalate, which is found in many hair and skin care products, was 7.3 times higher in hairdressers compared to women from the U.S. general population.
Importance to public health: Hairdressers servicing an ethnically diverse clientele may experience elevated phthalate exposures. Larger studies are needed to characterize phthalate exposures among hairdressers and develop exposure mitigation efforts to reduce the risk of potential long-term impacts.
Bugbee, Brittany A. (UMD SPH Behavioral and Community Health)
Barrall, Angelica L. (UMD SPH Behavioral and Community Health)
Vincent, Kathryn B. (UMD SPH Behavioral and Community Health)
Arria, Amelia M. (UMD SPH Behavioral and Community Health)
Background: Among general population samples, marijuana use is associated with increased odds of initiating prescription opioid misuse. This relationship has been less widely studied among college student and young adult populations.
Goal: The aim of this study was to examine the prospective association between marijuana and initiation of other substance use among college students.
Objectives: Marijuana use frequency at college entry was hypothesized to predict incident prescription analgesic misuse and use of other substances during college, after holding constant potentially confounding variables.
Approach: The analytic sample consisted of 953 undergraduates interviewed annually for four years beginning at college entry. Logistic regression models were developed to evaluate the association between past-year marijuana use frequency at Year 1 and incident prescription analgesic misuse, prescription stimulant misuse, tobacco cigarette use, and cocaine use during Years 2-4, holding constant demographics, sensation-seeking, and early conduct problems.
Results/Conclusions: At Year 1, 62% used marijuana during the past year (M=34 days, SD=63 days). The prevalence of incident substance use during Years 2-4 was 11% for prescription analgesic misuse, 10% for cigarettes, 17% for cocaine, and 26% for prescription stimulant misuse. Among participants who were naïve to each substance at college entry, incident use was significantly more prevalent for Year 1 marijuana users compared with non-users. Marijuana use frequency was positively associated with an increased risk for incident use of all four substances. P-values remained significant (p<.05) after adjustment for covariates. The results are consistent with evidence from general population studies showing that marijuana use predicts subsequent misuse of prescription analgesics and other drugs.
Importance to public health: Although more research is needed to elucidate mechanisms underlying this association, prevention and intervention efforts to reduce marijuana use might mitigate escalation of other substance use problems.
Caminita, Mia (UMD SPH Kinesiology)
Garcia, Gina (UMD SPH Kinesiology)
Kwon, Hyun Joon (UMD SPH Kinesiology)
Miller, Ross (UMD SPH Kinesiology)
Shim, Jae Kun (UMD SPH Kinesiology)
Background: Cutaneous sensory feedback is critical for optimal performance of many fine motor tasks. The removal of cutaneous sensory feedback in the fingers using anesthesia has demonstrated decreased maximal and sub-maximal voluntary force production. However, little is known about the role of cutaneous sensory feedback in maximal motor output actions such as vertical jumping.
Goal: The purpose of this study was to investigate the role of cutaneous sensory feedback (reduced via cooling) on Maximal Voluntary Squat Jump (MVSJ) height.
Objectives: We assumed that the relationship between reduced cutaneous feedback and finger force production would generalize to the lower limb, and hypothesized that MVSJ height would decrease following cooling of the plantar surfaces of the feet.
Approach: Participants were first instructed on proper technique for performing a MVSJ. Following practice trials and a brief rest period, the participant performs baseline vertical jumping trials. The soles of the participants’ feet are then submerged in an ice-water bath for 15 minutes to induce cutaneous sensory cooling. Immediately following the cooling procedure participants perform subsequent trials of the MVSJ. The feet were then allowed to warm naturally for 15-minutes and subsequent MVSJ trials are performed. Immediately prior to the completion of the jumping trials for each condition, temperature measurements of the soles of the feet are recorded. Jump height, impulse, average force production and time duration of jump preparation were calculated.
Results/Conclusions: MVSJ height during the cooled condition was lower compared to both the baseline and recovered (p<0.001) and there was no significant difference in jump height between the baseline and recovered conditions. Prior to take-off, impulse and average force for the cooled condition were lower compared to baseline and recovered (p<0.001), while no significant difference was seen between baseline and recovered. The pre- takeoff time duration of jump preparation was greater in the cooled condition compared to baseline (p<0.05). These findings suggest that cutaneous sensory feedback plays a critical role in maximal motor outputs in vertical jumping, which is consistent with the previous reports on fine motor tasks such as maximal finger force production.
Importance to public health: Conditions such as peripheral neuropathy which diminish individuals’ ability to correctly perceive tactile and temperature stimuli, especially in the feet, can limit the ability to produce both sub-maximal and maximal force for various tasks. By understanding the change in performance with reduced cutaneous sensory feedback in the feet, we can begin to understand the necessary rehabilitation considerations to improve quality of life for clinical populations suffering from the loss of peripheral sensation and the relationship between sensory and motor information in the central nervous system.
Channell Doig, Amara (UMD SPH Behavioral and Community Health)
Rodriguez, Matthew (UMD SPH Family Science)
Hurtado, Ali (UMD SPH Family Science)
Background: In 2015-2016, 46% of Latino children and adolescents were overweight or obese, which was the highest compared to other major racial and ethnic groups (Skinner, Ravanbakht, Skelton, Perrin, & Armstrong, 2018). Parents are key players in shaping the physical and social/emotional environments that guide eating and exercise behaviors and consequently their children’s weight status. Common behavior change techniques to engage parents in promoting healthy behaviors have included providing information regarding lifestyle-health relationships and skills around healthy eating and activity (Golley, Hendrie, Slater, & Corsini, 2011). However, few programs target Latino immigrant fathers.
Goal: The goal of Padres Preparados, Jovenes Saludables is to prevent overweight and obesity in adolescent Latinos by improving fathers’ or male caregivers’ positive parenting practices as well as the food and physical activity practices in their home
Objectives: To develop and assess the preliminary effectiveness of a blended program delivery (both in-person and mHealth application) of the Padres Saludables family skills intervention for Latino fathers.
Approach: Padres Preparados, Jóvenes Saludables” is an existing 8-session family-skills intervention for Latino fathers and youth (10-14 years) to improve youth energy balance-related behaviors, and paternal parenting practices with the goal of obesity prevention. The theoretical basis for this intervention was based on social cognitive theory, modeling reasoning and teaching, home availability and accessibility, and social support. In this iteration of the intervention, a mHealth app was developed to create a blended intervention with a total of 5 sessions in person and 3 through the app. The app allows researchers to address barriers to participation in fathers who are unable to attend a weekly intervention meeting. The development of the app used participative and mHealth principles with feedback from a parent advisory board, participants, educators, and multimedia experts. The App content follows an active learning cycle, including: didactic (using videos), reflection, skill building, family plan, and follow-up text messages. The pilot program was conducted by trained educators who introduced the app, provided guidance for its usage, and facilitated reflections of the. Data collection used a mixed methods approach which included end-of-series feedback and attendance logs.
Results/Conclusions: Usability testing was completed at two sites (n=15). Data was collected through live observation as participants navigated the App, think-out-loud feedback on content, format and relevance. Usability test results showed a clear understanding about the learning objectives and flow, navigation comfort was moderate, feedback about images, videos were valuable. Overall, 10 participants were included in the feasibility testing of the app. There were a total of 1,274 pageviews Preliminary results suggest highest App usage on Mondays and Fridays. App activity was highest from 12 to 3 pm Usage was split between Apple (50%) and Android products Most participants used the app on a phone or tablet (92%) instead of the accompanying website.
Importance to public health: Increased engagement through the app suggests greater potential behavior change and suggests great potential for future mHealth studies with this undeserved population.
Hager, Erin (Department of Growth and Nutrition)
Background: Physical inactivity is a significant public health problem. School-ages children and adolescents spend a significant amount of time in schools, where they sit for the majority of the day, therefore schools are an ideal setting for physical activity (PA) promotion initiatives.
Goal: The overall goal of this project was to examine the association between student perceptions of school PA policies/environment and their objectively measured PA during the school day.
Objectives: It was hypothesized that there is a positive association between greater positive student perceptions of the school PA environment and higher student PA during the school day, based on the socio-ecological model.
Approach: Elementary and middle school students were recruited from Baltimore City, Prince George’s County, and Charles County. Height and weight were measured and an Actical accelerometer was placed on the non-dominant ankle [worn for seven consecutive days to measure time spent in sedentary, light, and moderate-vigorous PA (MVPA)]. Students completed the Perceptions of the Environment at School (PEAS) survey on a computer using read-aloud software. Data analysis was conducted with the use of SAS and SPSS in order to create multi-level multivariate models, accounting for clustering within schools. The multivariate model included gender, school-type (elementary vs. middle), and weight status as covariates.
Results/Conclusions: There were a total of 21 schools recruited from the three school systems. From the total 572 participants enrolled in the study, 412 participants were included in this study. About 58% of the sample was made up of females and about 54% of the sample was elementary schoolers. About 15% of the sample was classified as overweight and about 29% of the sample was classified as obese. The participants spent about 46% of the school day engaging in sedentary behaviors, about 50% of the day in light activity, and about 4% in MVPA. The mean PEAS sum score was 21.5 with a standard deviation of 7.8. Adjusted models identified no association between PEAS sum score and either sedentary, light or MVPA. Future directions include to determine whether there was a confounder present in this study and to further explore how decreasing sedentary activity behaviors in schools could improve child health.
Importance to public health: This study displayed patterns of PA that students engage in during the school day and therefore, these results can be used to determine if policy changes need to be made at the school, county, and/or state levels. Furthermore, the PEAS data can be used to determine what components of the school environment need improvement according to the student body.
Conway, C. Andrew (UMD)
Lewin, Amy (UMD)
Background: There is significant literature confirming that adverse childhood experiences (ACEs) increase an individual’s risk for negative health behaviors and mental health issues across the lifespan, representing a clear public health issue. However, the rates and health impacts of ACEs for Latinos remains relatively unexplored, particularly in the Latino immigrant population. This study describes the prevalence of traditional ACEs, and previously unexplored immigrant-specific ACEs, in a Latino immigrant sample.
Goal: This study describes the prevalence of traditional ACEs, and previously unexplored immigrant-specific ACEs, in a Latino immigrant sample, and identifies the relationship between ACEs and individual’s mental health outcomes and behaviors.
Objectives: 1. In a population of adolescent and adult Latino immigrants, describes the prevalence of traditional ACEs, and previously unexplored immigrant-specific ACEs, 2. Explore the relationship between immigrant-specific ACEs and other risk factors including: traditional ACEs, mental health outcomes and risky behaviors.
Approach: The prevalence of traditional ACEs (e.g., abuse, neglect, domestic violence) along with novel immigrant specific ACEs designed to assess the unique experience of Latino immigrants (e.g., forced relocation, state violence, documentation status) was collected from a sample of Latino immigrants receiving services through a community partner organization. Adult parent and adolescent (ages 11-18) participants reported health risk behaviors (e.g., smoking, substance use) and mental health symptoms, allowing for the calculation of odds ratios to determine the risk associated with ACEs exposure for individuals.
Results/Conclusions: 714 Latino youth (6th - 12th grade) reported ACEs at higher rates than those of youth in the US and Maryland. A total of 19% of the youth in the sample endorsed 3+ ACEs compared with 8% in Maryland and 11% in the US. Parental separation as a result of immigration issues was endorsed by 44% of the sample. Endorsement of immigrant specific ACEs were associated with risk factors including higher endorsement of traditional ACEs. From the parent sample (n = 93 Latino immigrant parents) 31% reported 3+ traditional ACEs and potentially relevant items from the immigrant specific ACEs measure were identified. Results suggest that Latinos experience high levels of ACEs, underscoring the need for greater investigation into how these exposures impact this population.
Importance to public health: Findings from this may inform public health researchers who are working to better understand the impact of ACEs in diverse populations by presenting potentially new and important events to investigate. The study may also inform practitioners working with immigrant Latino families about the impact of trauma on the health and well-being of this population.
Chattopadhyay, Suhana (UMD MIAEH)
Rjoub, Younes (Arava Institute for Environmental Studies)
Grief, Jake (Arava Institute for Environmental Studies)
Rosen, David (Arava Institute for Environmental Studies)
Lipchin, Clive (Arava Institute for Environmental Studies)
Mongodin, Emmanuel (UMB School of Medicine)
Amy, Amy R. (UMD MIAEH)
Craddock, Hillary (UMD MIAEH)
Background: The reuse of wastewater for agricultural irrigation is emerging in water scarce regions around the world, including the West Bank, Palestinian Territories. However, to our knowledge, no long-term testing of this water has been undertaken, and overall data on long-term performance of greywater reuse systems as well as antibiotic resistance in greywater is scarce.
Goal: To assess E. coli levels and the presence of antibiotic-resistant bacteria in household greywater and treated effluent, and to compare these levels to those found in farmers’ typical source of water.
Objectives: The purpose of this study was to 1) investigate the safety of agricultural irrigation water produced by off-grid, household greywater treatment systems, 2) investigate the efficacy of these systems in reducing contaminants, 3) evaluate the prevalence of antibiotic-resistant bacteria in influent and effluent, and 4) compare effluent quality to the farmers’ typical source of irrigation water.
Approach: Water samples (greywater influent (n=23), treated effluent (n=23), and irrigation pond water (n=12)) were collected between October 2017 and June 2018 from four farms in the West Bank, Palestinian Territories. E. coli was enumerated using standard membrane filtration, and selected isolates were tested for antibiotic resistance via micro-broth dilution. Hach HQ30D probes were used to test for pH, electrical conductivity, oxidative reduction potential, and dissolved oxygen. A Sper Scientific Lutu-2016 Lutron Turbidity Meter was used to test for turbidity.
Results/Conclusions: The majority of influent (76.5%) and effluent (70.6%) samples had detectable levels of E. coli, and less than one full log reduction was observed from influent to effluent. Resistance was most commonly observed against ampicillin, ampicillin-sulbactam, trimethoprim-sulfamethoxazole, and tetracycline. 15.2% of influent isolates and 33.3% of effluent samples exhibited resistance to two or more antibiotics.
Importance to public health: This work demonstrates that in addition to concerns regarding high levels of bacteria, antibiotic-resistant bacteria are potentially widespread in domestic greywater in the West Bank. Furthermore, treated greywater can contain higher levels of antibiotic-resistant bacteria than conventional irrigation water sources, including groundwater stored in surface ponds, and E.coli levels in effluent violated Palestinian standards for wastewater reuse.
Cruz-Cano, Raul (University of Maryland)
Mead, Erin (University of Connecticut)
Background: The effect of Hurricane Maria on the number of deaths in Puerto Rico has been controversial.The category 4 hurricane made landfall on September 20, 2017, and caused US$90 billion in damages. Early studies of the excess mortality failed to account for long-term trends and seasonal patterns in mortality, and significant secular changes in population size.Time-series analysis has successfully integrated information on secular and seasonal trends into accurate estimates of mortality.
Goal: To determine the number and causes of excess deaths in Puerto Rico after Hurricane Maria made landfall on September 20, 2017.
Objectives: Using 2008-2017 vital statistics data, we applied time-series modeling to quantify the excess mortality in total and by cause, sex, and age from Hurricane Maria in Puerto Rico
Approach: We obtained monthly vital statistics data of all deaths from January 2008 through October 2017. We used time-series analysis to estimate excess mortality in September and October 2017 in total and by age, sex, and cause of death.
Results/Conclusions: Results. We estimated 1,205 excess deaths (95% CI: 707-1,702). Excess deaths were slightly higher in men than women (632 vs. 579 deaths, respectively), and found only in people 60 years or older (1,038 deaths). Most excess deaths occurred from heart disease (253 deaths), “other” causes (204 deaths), diabetes (195 deaths), Alzheimer’s disease (122 deaths), and septicemia (81 deaths). Conclusions. The number of excess deaths was similar to recent government estimates. However, this study is the first to identify the causes of death that were exacerbated by the disaster.
Importance to public health: An accurate estimation of the top causes of excess mortality can help authorities plan resource allocation for the island’s recovery and for the prevention of deaths in future disasters.
Drew, Laura (University of Maryland)
Maring, Elisabeth (University of Maryland)
Bibb, Katrina (Lexical Intelligence)
Background: Public Health Without Borders (PHWB) is a student-led organization at the University of Maryland whose mission is to reduce global health disparities and address health needs in partnering communities. Since 2015, PHWB has conducted needs assessments and delivered public health education workshops to students and adults in the Calaba Town community. Workshop topics include infectious disease prevention, first aid practices, and hygiene. In 2017, we interviewed primary school children to assess their daily health behaviors and hygiene practices.
Goal: We conducted interviews with primary school children to better understand their daily health behaviors and hygiene practices.
Objectives: We assessed the daily health behaviors and hygiene practices of school children.
Approach: In June 2017, we completed 49 interviews with students in grades 5 and 6. All interviews were completed in English, and a translator fluent in Krio and English was used when necessary. Interviews were recorded and responses were transcribed and entered into an excel spreadsheet. Analyses were completed with Stata software, version 12.0.
Results/Conclusions: 27 male and 22 female students completed the interviews. Students were between 9 and 14 years of age. Before coming to school, nearly all students brushed their teeth with toothpaste (94%) and washed their hands with soap and water after going to the bathroom (98%); however, many students did not have breakfast (23%). Almost all students knew they could become sick if they did not wash their hands after going to the bathroom (98%).
Importance to public health: Students demonstrated exceptional knowledge surrounding good hygiene practices; however, many students did not have breakfast before going to school. Future efforts by PHWB should focus on identifying nutritional needs of the community and providing nutrition education.
Gleason, Jessica (UMD SPH Family Science)
Steinberg, Julia (UMD SPH Family Science)
Background: In 2010, the Affordable Care Act (ACA) was enacted, with full provisions in effect by 2014, including expanded Medicaid coverage and new market rules. Given the mandate that insurers must include maternity and contraceptive coverage, it is unknown to what extent utilization of prenatal care has improved, and whether teenage births have declined.
Goal: We conducted an interrupted time series analysis exploring whether the implementation of the ACA was associated with changes in timing of prenatal care and a decline in teenage births by insurance type.
Objectives: We examined whether the implementation of the ACA was associated with an increase in seeking prenatal care during pregnancy, and whether it was associated with a decrease in teenage births.
Approach: We used revised 2009-2017 birth certificate data, restricting to resident women with a Medicaid or privately-paid singleton birth (N=27,748,028). We examined utilization of prenatal care and teenage births over time, using segmented regression analysis to examine changes before and after the ACA, while accounting for secular trends.
Results/Conclusions: Utilization of prenatal care differed by insurance type. Adjusted models revealed that implementation of the ACA was associated with a 4% increase in odds of any prenatal care (OR 1.04, 95%CI 1.01, 1.06) among Medicaid births, and a 21% increase among private births (OR 1.21, 95%CI 1.16, 1.26). However, the trend has since been declining. For teenage births, the ACA was associated with a 23% significant decrease in odds of a teenage birth (OR 0.78, 95%CI 0.77, 0.79) for Medicaid births and 19% decrease (OR 0.81, 95%CI 0.79, 0.83) for private births, with a further declining trend.
Importance to public health: Coverage changes may have qualified more women to obtain private insurance, allowing them to seek prenatal care, while contraceptive coverage may have enabled adolescents to seek reproductive services that were inaccessible prior to ACA implementation. From a population health perspective, efforts to repeal the ACA may have consequences to the health of mothers and infants in the nation.
Deng, Rita (Montgomery County Department of Health and Human Services)
Liu, Chunfu (Montgomery County Department of Health and Human Services)
Safi, Sara (Montgomery County Department of Health and Human Services)
Humayun, Maheen (University of Maryland)
Gayles, Travis (Health Officer)
Background: Though Montgomery County performs better than state and national averages related to maternal and infant health indicators overall, great disparities of pregnancy-related outcomes among population subgroups on race/ethnicity and geographic areas are of particular concerns. DHHS programs play a significant role in providing education and services to reduce adverse pregnancy-related outcomes and improve maternal and infant health in the county.
Goal: Our goal is to utilize the data to enhance our many successful health programs and develop new, innovative and effective programs that are directly applicable to meeting the public health needs of Montgomery County.
Objectives: The report completes a core function of public health surveillance and disseminates information clearly and succinctly. The data can is used to establish evidence-based, innovative practices; policy analysis; drive practice innovation; policy analysis; preventative methods; health promotion messages; and planning activities related to public health. The information brings attention to areas of success and weakness, which can be analyzed by stakeholders to design appropriate programming and interventions to address gaps in outcomes.
Approach: The report includes information and data on maternal and infant health topics in the county and identifies the Department of Health and Human Services (DHHS) role in providing education and services to reduce adverse pregnancy-related outcomes and improve maternal and infant health among county residents . “Maternal and Infant Health in Montgomery County, Maryland, 2008-2017” highlights where Montgomery County stands in comparison to the state and the nation on maternal and infant health topics. Maternal and infant health topics highlighted include births (birth rate, fertility rate, adolescent births), maternal characteristics and behavior (maternal age, marital status, educational attainment, plurality, tobacco use, alcohol use, substance abuse, prenatal care, breastfeeding), birth outcomes (preterm births, low birth weight, congenital anomalies, infant mortality, neonatal mortality, post-neonatal mortality, fetal deaths, neonatal intensive care admissions, Apgar Score), maternal mortality and morbidity (maternal mortality, severe maternal morbidity, adverse birth outcomes, maternal postpartum depression and mental health). Montgomery County Department of Health and Human Services program highlighted in the report include the African American Health Program - Start More Infants Living Equally Healthy(S.M.I.L.E) Program, Community Health Services, Maternal Partnership Program (MPP), Fetal and Infant Mortality Review Board (FIMR), Babies Born Healthy, Maryland Department of Health, and Family Planning.
Results/Conclusions: Main findings of the report include: The county's population has become more diverse over time; the non-Hispanic Black and Hispanic populations have increased while the non-Hispanic White population has decreased. The county performs better on most maternal and infant health indicators than Maryland and the U.S. Non-Hispanic Blacks have higher percentages of preterm and low-weight births than other population subgroups. Non-Hispanic Blacks have higher rates of infant and fetal death than other population subgroups. Though there is a decreasing trend of severe maternal morbidity (e.g. severely complicated pregnancies and deliveries) in the county, non-Hispanic Blacks and Hispanics experienced 60 percent and 46 percent greater risks respectively than their non-Hispanic White counterpart. The link to the report is found via https://www.montgomerycountymd.gov/HHS/Resources/Files/MaternalInfantHealthReport%202008-2017.pdf
Importance to public health: The report completes a core function of public health surveillance and disseminates information clearly and succinctly. The data can is used to establish evidence-based, innovative practices; policy analysis; drive practice innovation; policy analysis; preventative methods; health promotion messages; and planning activities related to public health. The information brings attention to areas of success and weakness, which can be analyzed by stakeholders to design appropriate programming and interventions to address gaps in outcomes.
Drew, Laura (University of Maryland)
Mittal, Mona (University of Maryland)
Thoma, Marie (University of Maryland)
Background: Approximately 200 million women and girls across the globe have undergone female genital cutting (FGC). A few studies have shown FGC is associated with sexually transmitted infections; however, research on sexual behaviors is limited. FGC may impact women’s sexual behaviors by increasing pain during intercourse, thus reducing sexual frequency within a relationship, or by influencing the timing of sexual debut and number of sexual partners due to less autonomy or marital disruption.
Goal: We utilized data from the 2013 Nigeria Demographic and Health Survey to examine the association between FGC and sexual behaviors among women in Nigeria.
Objectives: 1. We examined the variation in demographic characteristics and outcomes of interest by FGC status 2. We assessed the relationship between FGC and the following outcomes: 1) sexual activity in the past four weeks, 2) total lifetime number of sexual partners, and 3) age at first intercourse.
Approach: We utilized data from the 2013 Nigeria Demographic and Health Survey and restricted analyses to women between the ages of 15-49 who were not missing data related to FGC status (N=24,036). Chi-square tests were completed to examine the variation in demographic characteristics and outcomes of interest by FGC status. We performed logistic regression to examine the relationship between FGC and sexual activity in the past four weeks (restricted to women who were married or living with partner). We also performed multinomial logistic regression to examine the relationship between FGC and total lifetime number of sexual partners (1, 2-3, ≥3), as well as age at first intercourse (<15, 15-17, ≥18). Models were adjusted for age, marital status, region, urban/rural setting, religion, ethnicity, education, wealth quintile, and working status.
Results/Conclusions: 38.5% of women in our analytic sample had undergone FGC. The odds of having sex in the past four weeks was less among women with FGC (AOR=0.90, CI: 0.82-0.98). The odds of having 2-3 lifetime sexual partners rather than one was greater for women with FGC (AOR=1.11, CI:1.02-1.20). Women with FGC were also more likely to have been 15-17 years of age at the time of first intercourse, rather than ≥18 (AOR=1.12, CI:1.03-1.22).
Importance to public health: Women with FGC were less likely to have recently had sex with their partner, which may increase risk of relationship dissolution or partner’s seeking other sex partners. In addition, women with FGC were also more likely to have increased risky sex behaviors with higher number of lifetime partners and earlier sexual debut, placing them at higher risk of adverse reproductive health outcomes.
Dwivedi, Pallavi (Faculty assistant)
Nguyen, Quynh (Faculty)
Background: County-level contextual factors (e.g., socioeconomic status, public health policy, and access to health care) have been associated with coronary heart disease, health related quality of life, and obesity. Goods and services provided by businesses can either promote health or represent an additional risk factor.
Goal: We assessed the association between business pattern indicators such as full service restaurants, fast food restaurants, fitness centers, grocery stores, payday loan centers, nature parks, and alcohol outlets and the prevalence of adult obesity, diabetes, physical inactivity, and frequent physical and mental distress.
Objectives: In this study, we examined geographical variation in health-related quality of life using area-level business patterns and demographic characteristics. We hypothesize that areas with more full service restaurants, fitness centers, grocery stores, and nature parks will have better health, whereas areas with more payday loan places (as an indicator of poverty and economic exploitation), alcohol outlets, and limited-service restaurants (i.e., fast food places) will have worse health-related quality of life.
Approach: We explored the relationship between business pattern indicators and health outcomes at county level using the global (Ordinary Least Square regression) and local (Geographically Weighted Regression (GWR)) models in 3108 U.S. counties.
Results/Conclusions: Density of full service restaurants and fitness centers was associated with a significant decrease in adult obesity, diabetes, fair or poor health, physical inactivity, physical and mental distress. Conversely, density of payday loan centers was associated with an increase in these adverse health outcomes. However, our GWR models revealed substantial geographical variations in these relationships across the U.S. counties.
Importance to public health: Better understanding of the association between area-level structures and important health outcomes at the local level is important for developing targeted context-specific policy interventions.
Elspas, Rebecca (UMD SPH Public Health Science Program)
Payne-Sturges, Devon (UMD SPH Maryland Institute for Applied Environmental Health)
Cruz-Cano, Raul (UMD SPH Epidemiology and Biostatistics)
Background: Many personal care products and cosmetics contain chemical ingredients (e.g. BPA, phthalates, parabens) that have been known to disrupt human endocrine and neurological systems, and contribute to infertility and adverse birth outcomes. Yet many college-aged consumers are unaware that their daily routines may increase their exposures to these endocrine disrupting chemicals (EDCs). These young adults may be more prone to use personal care products more frequently which could potentially translate to higher exposures to EDCs, which have not yet been characterized in relation to eating behaviors and personal care product use among college students.
Goal: The goal of this research project was to pilot a survey to examine potential sources of EDC exposures among college students at a large public mid-Atlantic university and to assess their knowledge and awareness of the health effects associated with EDCs.
Objectives: Our specific objectives were to 1) assess the number, type and frequency of personal care products used by students in one day; 2) understand students’ values and beliefs on the importance of their health vis a vis the consumer products they use; and 3) evaluate student’s knowledge of the health effects of EDCs and where they acquire said knowledge. We hypothesized that self-identified female college students would have greater level of awareness of EDCs then self-identified male college students.
Approach: We conducted a cross-sectional survey using a convenience sample of 325 undergraduate students. The survey included questions on demographics, student status, type and frequency of personal care products used consumed within the last 24 hours, and awareness that EDC exposures pose health concerns.
Results/Conclusions: We report on differences in consumer product use and EDC knowledge and awareness scales, as well as trends in purchasing EDCs and levels of concern with them. We calculated results between genders based on χ2 and Kruskall Wallis H tests, Shapiro-Wilks tests, and Non-Parametric and One-Way Analysis of Variance (ANOVA). Statistical significance between males and females were found for soap, shampoo, hair regrowth treatment, cologne, perfume and aftershave. Females were more aware of parabens, which was statistically significant, with a mean response of 1.91 and males at 1.42. Males reported a slightly higher awareness level for BPA and phthalates. Females had an overall more EDC-conscious buying behavior for BPA, phthalates, and parabens. Females demonstrated a higher knowledge level of EDCs, correctly answering true/false questions more often than males, and reporting hearing and sharing information about EDCs from various media and peer sources at much higher rates than males.
Importance to public health: Results from our survey set the stage for health education and intervention programs to limit exposure to EDCs to maximize the long-term endocrine, neurological, and behavioral health among college students and beyond.
Fernando, Nimasha (UMB SOM Epidemiology and Public Health)
Reihani, Amir (George Washington University Milken Institute School of Public Health)
Background: Over 60,000 refugees and special immigrant visa (SIV) holders have arrived in the U.S. from Afghanistan since 2014, approximately 4.8% of whom resettled in Maryland. Prince George’s (PG) County Maryland is the leading resettlement destination for SIV holders and the second leading county for refugee resettlement in the state. Mental health disparities among refugees and specifically Afghans have been well-documented, thus investigation of access to mental health services in resettlement destinations is needed.
Goal: This qualitative study aimed to explore facilitators and barriers to health for Afghan refugees and SIV holders in PG County, Maryland, U.S.A.
Objectives: The aim of this focused analysis was to first identify the facilitators and barriers to access to mental health care discussed by key informants, and second to identify key informants’ recommendations for improving access to mental health services for this community.
Approach: In-depth, semi-structured interviews were conducted with seven key informants who had direct experience working with Afghan refugees and SIV holders in clinical or community-based settings. All interviews were audio-recorded, transcribed, and thematically analyzed with a grounded theory approach using MAXQDA software.
Results/Conclusions: Barriers regarding access to mental health care for Afghan refugees and SIV holders included hesitancy to disclose mental health concerns and not interpreting certain symptoms as able to be addressed by a mental health provider. Facilitators to access to mental health care included increasing awareness of services through formal information sessions and trusting relationships. Recommendations to improve access to these services included referral systems between community organizations and mental health providers, and having providers pursue further training to better address this community’s specific needs.
Importance to public health: Key informants identified barriers and facilitators regarding access to mental health services for Afghan refugees and SIV holders in PG County, as well as recommendations for the health system to improve access to care for this community. Minimizing barriers, strengthening facilitators, and implementing services and policies guided by key informants’ recommendations will improve access to mental health care and help combat mental health disparities among Afghan refugees and SIV holders in PG County and across the U.S.
Gentili, Rodolphe (UMD SPH Kinesiology)
Kontson, Kimberly (Food and Drug Administration)
Background: Research has shown that upper limb prosthetic operation elicits an increase in cognitive workload. This increase in cognitive workload coupled with the additional challenges of using a prosthesis in a social environment may decrease device usability and motor performance. Therefore, there is a need to assess socially relevant signals such as speech as a potential biomarker of cognitive workload.
Goal: To identify components of speech that may index cognitive workload when completing a cognitive task during an upper limb motor task.
Objectives: Determine if engaging in a cognitive task during an upper limb motor task results in a decrement in motor performance. Determine how components of the speech signal vary as a function of cognitive and motor demands.
Approach: In a within subject design, 8 able-bodied participants completed the following 5 tasks: Cognitive Demand Story Recall Task (SRT)- Listen to a 13-15 second short story and recall the pertinent details of the story. Motor Demand- Block Transport Task (BTT)- Transport blocks as fast and as accurately as possible. 16 blocks per trial. Participants completed as many trials as possible for 2 minutes. Shape Transport Task (STT)- Transport shapes as fast and as accurately as possible. 16 shapes per trial for 2 minutes. Participants completed as many trials as possible for 2 minutes. Motor Demand Task + SRT Transport blocks or shapes while concurrently completing the SRT. Behavioral metrics: • Total number of items transported per task • Percentage of key words recalled during tasks that included the SRT • Perceived mental demand (NASA- Task Load Index) Speech metrics: Fundamental frequency, intensity, harmonics to noise ratio, jitter, shimmer and degree of voice breaks.
Results/Conclusions: The preliminary results revealed an increase in cognitive and motor demand led to a decrement in motor performance. Jitter and shimmer decreased while the harmonics to noise ratio increased as cognitive and motor demand increased. Although not statistically significant, fundamental frequency and intensity was higher in motor demand tasks with SRT when compared to SRT alone.
Importance to public health: This work is a first step to determine if components of the speech signal may index cognitive workload during upper limb prosthetic operation.
King-Marsall, Evelyn (School of Public Health - BCH)
Background: There are 43.7 million immigrants living in the United States making up 13.5% of the population, with that number expected to continue to grow. Although often healthier than their native counterparts, research indicates there are variations in the prevalence of chronic diseases.
Goal: What are the rates of chronic diseases among this sample? What are the rates of known risk factors among this sample?
Objectives: The purpose of the study is to investigate the prevalence of and factors associated with chronic diseases among recent and adjustee US immigrants.
Approach: We conducted secondary data analysis of the New Immigrant Survey (NIS); 8,573 participants who became lawful permanent residents between 2003 –2004. Analysis includes bivariate and multivariate analysis of seven chronic disease conditions (diabetes, hypertension, chronic lung disease, stroke, heart disease, arthritis, and cancer) and a composite chronic disease variable.
Results/Conclusions: Participants were average age of 39, 52% were female, and over 16% of the sample had at least one chronic disease. Mexico (13.6%) followed by India (9%) were highest reported countries of birth. 10% reported smoking cigarettes and of those who drink 4.7% felt they should cut down on drinking. Hypertension was most commonly reported (9.5%) and stroke reported the least (0.4%). Older age and education were most commonly associated with the independent chronic disease conditions. BMI was significantly correlated with diabetes, hypertension, cancer and arthritis. BMI, age, and education were significantly associated with the composite chronic disease variable.
Importance to public health: Immigrants in this sample had lower rates of the eight chronic diseases of interest when compared to current statistics for US adults. However, associated risk factors are similar to those found in the literature including, age, education, and BMI. Specific to chronic diseases; findings suggest additional investigation on rates, risk factors, and prevention among immigrant populations are needed.
Ghosh, Rajrupa (UMD SPH Epidemiology & Biostatistics)
Turner, Dr. Paul (UMD SPH Maryland Institute of Applied Environmental Health)
Cruz Cano, Dr. Raul (UMD SPH Epidemiology & Biostatistics)
Dallal, Dr. Cher (UMD SPH Epidemiology & Biostatistics)
Background: Phthalates are a family of frequently used plasticizers in household items and personal care products. They are endocrine disrupters and exposure is associated with metabolic disruption/obesity leading to chronic diseases such as diabetes and cardiovascular disease.
Goal: To better understand the etiology of phthalate induced metabolic syndrome (MetS) by race.
Objectives: To analyze racial differences in the association between urinary phthalate metabolite concentrations and metabolic syndrome (MetS) in US adults.
Approach: A cross-sectional analysis was conducted using data from NHANES 2005-2014, of US adults ages ≥18 years. Eleven urinary phthalate metabolites (MCNP, MCOP, MECPP, MnBP, MCPP, MEP, MEHHP, MEHP, MiBP, MEOHP, MBzP) were analyzed in quartiles. MetS, defined as the presence of ≥ three of five metabolic disturbances was analyzed as a dichotomous outcome. Race was categorized as White (W), African American (AA), and Mexican American/Hispanics (MA). Univariate and bivariate weighted analyses were conducted using Chi square tests. Overall weighted multivariable logistic regression analyses of phthalates in relation to MetS were conducted including adjustment for age, race, sex, education, income, and smoking status. Race and sex stratified multivariable logistic regression analysis are ongoing.
Results/Conclusions: Among 10,924 participants (average age 46 years, 50% females, 20% below poverty level), the race distribution was 68% W, 11% AA, and 13% MA. The prevalence of MetS was 25% (18% W, 3% AA, and 3% MA) and varied significantly by race (p-value <.0001). All 11 phthalate metabolites were significantly associated with sex (p value <0.0001) and race (p value<0.0001) in bivariate analyses, with the exception of MECPP among men (p-value=0.06). There were significant positive associations between higher levels of MCOP (OR= 1.28, 95% CI: 1.04, 1.58) and higher levels MECPP (OR= 1.32, 95% CI: 1.04, 1.62) with the odds of MetS.
Importance to public health: MetS exacerbates cardiovascular disease morbidity and mortality by 50-200%. There is evidence of racial differences in urinary phthalate metabolite concentrations. Assessing association between phthalates and MetS can provide mechanistic insight into racial disparities in exposure and metabolic syndrome, such that more targeted interventions can be developed.
Hatfield, Bradley (UMD SPH Kinesiology)
Background: Self-initiated cognitive strategies for movement preparation include arousal, attentional focus, visualization, and imagery. Torque output responses to mental preparation prior to strength tasks has shown to be elevated when compared to distracting conditions. Understanding this brain-body relationship may yield insights into the dynamics of the cortical processes that underlie the quality associated with musculoskeletal activity and performance outcomes.
Goal: To investigate using self-initiated arousal, the influence of cerebral cortical activation and networking with musculoskeletal activity and maximal voluntary isokinetic contraction.
Objectives: 1. To examine the influence of mental preparation on maximal voluntary torque output while measuring cerebral cortical activation and muscle activation. 2. To examine the relation between attentional condition electroencephalography (EEG) activity and force production.
Approach: Ten healthy young adults (19-30 years of age), were recruited and required to have a minimum of one year strength training experience. Electroencephalography (EEG), electromyography (EMG) and torque output (Isokinetic) were measured. Visit one consisted of informed consent, background questionnaires and baseline measures. EEG, EMG and Isokinetic data were conducted during visit two and participants were exposed to three cognitive conditions, psyching (PSY), mental arithmetic (MA), and reading comprehension (RC). Each condition (PSY, MA, RC) consisted of three maximal effort trials with a 20-second task period provided prior to movement.
Results/Conclusions: EEG analysis revealed PSY (-6.611 ± 1.539) having greater cerebral activation in the central region compared to MA (-5.111 ± 1.628) and RC (-5.592 ± 1.423) as indexed by alpha band power and lessened levels of networking in PSY (0.187 ± 0.004) compared to MA (0.214 ± 0.20) and RC (0.188 ± 0.008) as indexed by alpha band coherence. Average peak torque output within participants for PSY (110.697 ± 7.49) was higher compared to MA (106.135 ± 9.01) and RC (104.823 ±8.30). Average peak torque output following PSY exceeded torque following distraction conditions. Cerebral cortical activity in the central motor regions exhibited elevated activation for PSY compared to MA and RC. Heightened cortico-cortical networking was displayed in MA and RC conditions from the frontal region to all regions of the cortex compared to PSY.
Importance to public health: The study suggests promising results in the use of cognitive strategies (psyching) as a method to improve performance during maximal effort movement.This study could help provide athletes and coaches with the necessary understanding of how to prepare during strength and conditioning training sessions, but may also help the average recreational athlete who is partaking in strength training exercises for health, fitness and wellness reasons.
Bress, Lisa (UMB SOD Dental Hygiene)
Goodwin, Courtney (UMB SOD Dental Hygiene)
Greene, Cassidy (UMB SOD Dental Hygiene)
Hartzell, Amber (UMB SOD Dental Hygiene)
Background: Our group was curious about the level of education provided by hygiene students to their patients regarding community water fluoridation because of its known ability to reduce caries.
Goal: This pilot aimed to identify the percentage of students who educate their patients on CWF to determine the need for the reevaluation of hygiene program curriculum.
Objectives: The pilot identified the current students who educate their patients about CWF and those who did not, with some students providing justification of their lack of doing so. By identifying these students, we were able to gain a better understanding of the gap between the lack of patient education and CWF utilization for caries prevention.
Approach: Current hygiene students were asked the following questions: 1. Do the patients in the community of your hygiene program live in an area with CWF? 2. Do you ask your patients if they drink CWF? 3. Do you educate your patients about consuming fluoridated tap water? A convenience sample was taken at a Dental Hygiene Board Review course in February, with a total of 16 current hygiene students who participated. These students were in hygiene programs located in Maryland, Delaware, New York, and Pennsylvania.
Results/Conclusions: While CWF is included in dental hygiene curriculum, communicating CWF education to patients may not always be enforced. The pilot indicated the need for full-scale investigation of dental hygiene programs.
Importance to public health: CWF is the best method for individuals of all ages and socioeconomic statuses to receive caries-fighting preventative fluoride in a cost-effective way.
Haggerty, Nicole (UMD SPH Epidemiology & Biostatistics)
Carter-Pokras, Olivia (UMD SPH Epidemiology & Biostatistics)
Cruz-Cano, Raul (UMD SPH Epidemiology & Biostatistics)
De Silva, Gretchen (UMD SPH Epidemiology & Biostatistics)
Background: Seasonal influenza places a huge burden on the health and economy of our country every year. However, the influenza vaccination can lessen this burden. The current literature shows evidence of the benefits of ehealth usage on vaccination rates and preventative health behaviors, but little is known about the relationship between ehealth usage and seasonal influenza vaccine uptake.
Goal: The goal of this project is to better understand the role ehealth is playing in healthcare, and any potential it may have to improve preventative health behavior such as influenza vaccine uptake.
Objectives: This project assessed whether adults who use ehealth services have higher rates of seasonal influenza vaccine uptake than other adults who participated in the 2016 National Health Interview Survey.
Approach: This secondary analytic project used publicly available data from the cross-sectional 2016 National Health Interview Survey (NHIS) to assess the impact of ehealth usage on seasonal influenza vaccine uptake in adults (18 or older). Descriptive statistics and logistic regression were performed, taking into account NHIS survey weights and design.
Results/Conclusions: Adults who used ehealth in the past 12 months had significantly higher odds (OR = 1.481) of having received the seasonal influenza vaccine than non-users. Those who accessed health care provider services had twice the odds (OR=2.028) of having received a seasonal influenza vaccine than non-users.
Importance to public health: There is some evidence to suggest influenza vaccine uptake may be related to other preventative health behaviors as the decision-making processes are similar. It is important to understand the growing role ehealth is playing in healthcare, and any potential it may have to improve preventative health behaviors and public health vaccine communication.
Bress, Lisa (UMB School of Dentistry Department of Dental Hygiene)
Smith, Taylor (UMB School of Dentistry Department of Dental Hygiene)
Decker, Rachel (UMB School of Dentistry Department of Dental Hygiene)
Hathaway, Sydnie (UMB School of Dentistry Department of Dental Hygiene)
Background: Homeless and low-income uninsured populations face many barriers to accessing health care including oral health care.Homeless and low–income populations are disproportionately affected by dental caries and periodontal disease.Shelter- based care as is provided Paul’s Place Outreach Center in Southwest Baltimore has been shown to improve health and quality for these undeserved populations.
Goal: To display the results of the pilot project and spark interest in inter-collaborative care.
Objectives: The purpose of this pilot project was three-fold: to assess the dental care needs and history for community members served by Paul’s Place, for UMB dental hygiene and clinical nurse leaders students and faculty to work together to link patients to follow-up dental care services, to investigate communities members’ ability to seek dental care services upon referral to a dental care facility.
Approach: Developed an oral health screening form indicating the level of oral disease for each participant who received an oral health screening. Developed a questionnaire to assess participants’ oral health literacy level, date and type of last dental care service, whether participant has dental insurance. UMSOD dental hygiene students worked collaboratively with Clinical Nurse Leader (CNL) students to provide health screenings (including oral health)for Paul’s Place community members and to provide oral health education and link them to a dental care facility. CNL students followed up with participants to see if they actually received care
Results/Conclusions: Inter-professional collaboration projects to investigate oral health disparities among the homeless have the potential to raise awareness among health professionals inside and outside dentistry of the link between oral health and overall health. Addressing these disparities could improve health outcomes and quality of life for homeless/low-income communities. Medical and oral health professionals can play an important role in identifying communities such as that at Paul’s place in Southeast Baltimore in need of oral health care and case management services linking these individuals to a dental home.
Importance to public health: There are many populations that experience health disparities, the homeless population being one of them. This pilot program exemplified an opportunity to address those dental needs as well as work inter-collaboratively with other professionals.
King-Marshall, Evelyn (UMD SPH Behavioral and Community Health)
Curbow, Barbara (UMD SPH Behavioral and Community Health)
Background: Colonoscopies are a unique screening tool as they can be used to both detect and prevent colorectal cancer. Initial screening results are typically discussed directly after procedure with a full report sent home with the patient. Therefore, it is imperative that patients truly understand the initial report so that they can follow-up appropriately.
Goal: Creating awareness to the fact that patients do have trouble understand and interpreting results of their colonoscopy reports despite the use of pictures and metaphors.
Objectives: 1. To determine what sections of the colonoscopy report ( procedure, findings, impression and recommendations) patients find most important, least important, calming/ reassuring, concerning or worrisome. 2. To compare the effectiveness of just text, text with metaphor usage or text with pictures in colonoscopy reports to increase a patient's understanding of the reports.
Approach: Participants (n=41) were given three colonoscopy case studies of 3 differing severities: 2mm polyps (least), 6mm polyp (moderate), and 5cm likely-malignant tumor (severe). Participants assessed each report section for least important, most important, reassuring or calming, worrisome or concerning, and statements they did not fully understand. Descriptive statistics were used to assess differences in participant conceptualizations of the reports on these domains.
Results/Conclusions: Across all report severities, patients highlighted the Findings section as containing information that was the most important, however, they also found the Findings section to be the most confusing. Participants were more likely to identify ‘most important’ sections (2.25) in the most severe case report compared to the least severe (1.87). Additionally, they also found more sections confusing (1.25) among the severe case, compared to moderate (.92) and least (1.09).
Importance to public health: Participants being most confused by the report section while admitting it was the most important has implications for patient understanding and follow up decision making. Future research should explore how to best present important screening results so that patients can better interpret and act upon them.
Holder, Sharifah (UMD SPH Behavioral and Community Health)
Sifat, Munjireen (UMD SPH Behavioral and Community Health)
Green, Kerry (UMD SPH Behavioral and Community Health)
Kuo, Charlene (UMD SPH Behavioral and Community Health)
Background: The School to Prison Pipeline theory hypothesizes that harsh school disciplinary practices that disproportionately affect African American students and initiate early contact with law enforcement, limit educational attainment and increase risk of incarceration, both of which are associated with negative health outcomes. Research has not fully explored the impact of anxiety, the most prevalent psychiatric disorder among adolescents, on the path between students being pushed out of school and into prisons.
Goal: We explore the role of anxiety and substance use in the association between high school dropout, school discipline, and incarceration and examine factors that may protect anxious youth from incarceration.
Objectives: Adolescents who experience high levels of anxious mood are less likely to have completed high school and more likely to be incarcerated than their peers with fewer symptoms of anxious mood.
Approach: Analyses utilize data from the Woodlawn Study, a longitudinal study of first-grade urban, African-Americans followed since 1966 through adolescence, young adulthood, and midlife. Regression models included adolescent anxious mood, high school graduation, school discipline, marijuana use, their interactions, and school bonding and locus of control factors.
Results/Conclusions: Suspension or expulsion, marijuana use, and high school dropout were independently and significantly associated with incarceration. In gender stratified analysis, males with elevated anxious mood were 2.6 times (95% CI, 1.26-5.50) as likely to be incarcerated than those with low anxiety. Those not graduating high school were 1.9 times (95% CI, 1.05-3.6) as likely to be incarcerated than those who graduated, those who smoked marijuana 10 times or more were 2.3 times (95% CI, 1.27-4.31) as likely as those who had never smoked marijuana and those who were suspended/expelled were 2.3 times (95% CI, 1.34-3.81) as likely as those who had not been suspended/expelled. Racism (95% CI, 1.63-4.93), locus of control in problem solving (95% CI, 0.37-0.92) and preventing bad things from happening (95% CI, 0.44-1.04) predicted incarceration.
Importance to public health: Findings improve overall understanding of the impact of anxiety on the School to Prison Pipeline and provide new research avenues for the role of self-medication with marijuana and ways to help children successfully manage anxiety, build resiliency, graduate high school, and reduce risk of incarceration.
Honarvar, Sara (UMD SPH Kinesiology)
Kwon, Hyun Joon (UMD SPH Kinesiology)
Shim, Jae Kun (UMD SPH Kinesiology)
Background: Coworking behaviors are common in our everyday lives: shaking hands, transporting furniture, playing sports, etc. For stable and accurate performance, two persons should be coordinated by predicting the changes in mechanical variables produced by the other person; however, this could be challenging and relies on sensory information. Understanding how two people use this information to collaborate with each other contributes to the human-robot collaboration field.
Goal: This study aims to address how the haptic feedback shared between two people influences their performance and interpersonal coordination.
Objectives: Studies on individual person tasks show that people tend to use the sensory information that they receive from multiple modalities (i.e. visual, tactile, etc.) in an optimal manner to reduce the error in the task performance. Thus, we speculated that removing the haptic feedback shared between two people increases the error in performance and reduces the coordination between two people.
Approach: We investigate the role of haptic feedback on coworking behaviors during a fine motor task. The co-working task includes finger force production using the index and middle fingers for matching to a constant target force. Thus, the experimental apparatus consists of two monitors on a table separated by a blocker (for blocking participants from the view of their partner) to provide the participants with the visual feedback of the force they are producing and the target force. The 3-D forces produced by each finger (4 fingers X 2 co-workers) are recorded from ATI Nano-17 6-DOF force sensors for the analysis. These sensors are placed on a customized seesaw structure, which is placed on a table in front of the participants. The haptic feedback (e.g. moving seesaw vs fixed seesaw) are systematically manipulated to reveal the mechanisms of co-working influenced by sensory feedback which is assumed to be critical for co-working behaviors. Hierarchical variability analysis is used to investigate the role of haptic feedback on interpersonal coordination and performance.
Results/Conclusions: The preliminary data collected from 8 pairs showed, contrary to our hypothesis, that the performance error increased in the presence of haptic feedback. This could be due to the task constraints which dictates the participants to not only match their force with the target force but to also balance the seesaw; balancing the seesaw made participants amplify the other person’s error which caused less coordination between people.
Importance to public health: The findings of this study are important as it contributes to the field of physical human-robot collaboration control mechanisms such as assistive robots that are extensively used for the purpose of rehabilitation.
Hua, Xinyi (UMD SPH Epidemiology and Biostatistics)
Liu, Hongjie ((Faculty) UMD SPH Epidemiology and Biostatistics)
Dyer, Typhanye ((Faculty) UMD SPH Epidemiology and Biostatistics)
Background: The prevalence of older adults living with HIV has increased significantly over recent decades. This is due to the increasing numbers of primary infections among adults aged 50 years and older as well as the improving longevity in adults who were infected at younger ages and were treated using highly active antiretroviral therapy (HAART). With the availability of this advanced treatment, HIV infection has become a chronic disease, and exposing older adults to great risk of bacterial and viral infections, cancers, cardiovascular diseases, emotional stress, and depression.
Goal: Review journal articles that related to population aging with HIV, then understand the unique physical and psychological health burdens they face and identify future areas of research that address the challenges for this population.
Objectives: The longer the aging HIV positive adults have lived with a diagnosis of HIV, the more likely it will be that they will experience additional physical and psychological challenges as they age.
Approach: This project is a systematic review. The existing literature accumulated over the past 18 years (2000 to 2018), including epidemiological studies and reviews, are examined to assess the current understanding of older adults living with HIV to identify the increasing challenges and quality of life issues of this population. The focus is on the age of diagnosis of HIV. Although quite a few studies focus on the physical and psychological burdens and life quality of older adults living with HIV, most do not distinguish that population by whether they are newly infected older adults or older adults infected at a younger age. After reviewing the relevant journal articles and studies, the project extracts data from relevant journal articles and existing research findings to test the hypothesis that the older adult living with HIV for many years faces additional physical and psychological burdens than the recently diagnosed older adult. Based on the findings of this assessment, a conclusion based on this review is written.
Results/Conclusions: The age of diagnosis is strongly related to the quality of life among adults aged 50 years and older living with HIV. Adults diagnosed with HIV at a younger age are likely to have greater physical and psychological health issues than those diagnosed with HIV over the age of 50. However, once taking the immunological and toxicological response to HAART into account, the results can lead to contradictory conclusions without further investigation as there are few data describing this population’s age and year of diagnosis. Future research to understand the particular burdens facing this population should consider the age and year of initial diagnosis so a better understanding of the potentially important existing research gaps can be achieved.
Importance to public health: Nearly half of the people who living with HIV are adults aged 50 and older. It is necessary to conduct a systematic review on this under-researched group, address the health disparity, and indicate possible future epidemiological studies that can be conducted on this population. This is also a group that is rapidly increasing demographically and which has disproportionately limited financial resources.
Huang, Dina (UMD SPH Epidemiology and Biostatistics)
Khanna, Sahil (UMD Telecommunications)
Pallavi, Dwivedi (UMD SPH Epidemiology and Biostatistics)
Green, Kerry (UMD SPH Behavioral and Community Health)
Slopen, Natalie (UMD SPH Epidemiology and Biostatistics)
He, Xin (UMD SPH Epidemiology and Biostatistics)
Puett, Robin (UMD SPH Maryland Institute for Applied Environmental Health)
Nguyen, Quynh (UMD SPH Epidemiology and Biostatistics)
Background: Social media such as Twitter can serve as a potential data source to characterize the social neighborhood environment for public health research. However, Twitter data features were not extensively used in prior studies and few studies have linked Twitter-derived characteristics to individual level health outcomes.
Objectives: This study aims to assess the association between Twitter-derived characteristics including happiness, physical activity and food with cardiometabolic outcomes such as obesity, diabetes and hypertension using a nationally representative population from the National Health and Nutrition Examination Survey (NHANES).
Approach: We collected a random 1% of Twitter data that were geotagged from April 2015 to March 2016 utilizing the Twitter’s Streaming Application Interface (API). NHANES 2007-2016 were merged to Twitter-derived predictors by zip code. Separate regression analyses were performed for each of the neighborhood characteristics using NHANES 2011-2016 (sub-cohort) and NHANES 2007-2016 (full cohort). Modification effects by demographics (e.g. age, sex, race, annual household income) were assessed and stratified analyses were performed.
Results/Conclusions: In regressions using sub-cohort, Twitter-derived happiness were associated with decreased BMI and lower prevalence of hypertension. The highest level of Twitter-derived food and healthy food were associated with reduced BMI and lower prevalence of obesity and physical activity tweets were inversely associated with hypertension. The results were similar to the regression results using full cohort, where the results suggested twitter-derived happiness, physical activity, food and healthy food were significantly associated with reduced BMI and lower prevalence of obesity and hypertension. Diabetes was not associated with Twitter-derived neighborhood characteristics in regressions of both two cohorts. Age, sex, race and annual household income were significant effect-modifiers.
Importance to public health: Twitter-derived social neighborhood characteristics are associated with individual level cardiometabolic outcomes including obesity and hypertension in a nationally representative population. The results suggest the possibility utilizing Twitter data features in examining individual level health conditions in future public health research.
Huang, Dina (UMD SPH Epidemiology and Biostatistics)
Yu, Weijun (UMD SPH Epidemiology and Biostatistics)
Nguyen, Quynh (UMD SPH Epidemiology and Biostatistics)
Background: A substantial body of evidence has linked neighborhood built environment with the risk of obesity and diabetes. And Twitter-derived social neighborhood characteristics were proved to be associated with the prevalence of obesity and diabetes. However, existing neighborhood studies did not address the impact from family contextual factors in the association between neighborhood built environment and chronic outcomes.
Objectives: In this study, we utilized a family-based design to investigate the relationship between Twitter-derived neighborhood characteristics with obesity and diabetes, accounting for the impact from family contextual factors.
Approach: Twitter-derived happiness, healthy food and exercise were used as zip code level neighborhood characteristics. Administrative and clinical records for adults aged over 20 that have siblings in Utah were included. We performed multilevel models nested within neighborhoods and nested within families. Each Twitter-derived neighborhood characteristics was modeled separately. For the family-based multilevel model, a measure of family mean level of neighborhood characteristics and a measure of intrafamily neighborhood characteristics were constructed. These factors were utilized to investigate the neighborhood impact on both individuals from different families and siblings came from the same family. Intraclass correlations from neighborhood multilevel model and from family-based model were compared to understand the relevance of family contextual factors in the developing of obesity and diabetes.
Results/Conclusions: For Twitter-derived neighborhood happiness and exercise, we observed stronger protective effects on obesity and diabetes from higher levels of family mean happiness and exercise in family-based models than from high level of neighborhood happiness and exercise from neighborhood models, respectively. High levels of Twitter-derived healthy food were associated with lower prevalence of obesity and diabetes and the protective effect on obesity was larger from the neighborhood model than from the family model. Siblings living in neighborhoods that have similar or higher levels of neighborhood characteristics than the family mean level exposure have lower risk of obesity. The intraclass correlation were 26% from family models and were 1% from neighborhood models.
Importance to public health: The impact from family contextual factors are significant in understanding the risk for obesity and diabetes.
Huang, Yuru (UMD SPH Epidemiology and Biostatistics)
Huang, Dina (UMD SPH Epidemiology and Biostatistics)
Nguyen, Quynh (UMD SPH Epidemiology and Biostatistics)
Background: The food environment, including access to grocery stores and different types of restaurants, may shape an individual’s food choices as well as eating habits, which could influence chronic disease outcomes. In the meantime, there is a growing recognition of social media data as being useful for understanding local area patterns.
Goal: The goal is to utilize social media data to predict chronic disease outcomes at census tract level.
Objectives: In this study, we sought to utilize geotagged tweets—specifically, the frequency and type of food mentions—to understand the neighborhood food environment and the social modeling of food behavior. Additionally, we examined associations between aggregated food-related tweet characteristics and prevalent chronic health outcomes at the census tract level.
Approach: We used a Twitter streaming application programming interface (API) to continuously collect ~1% random sample of public tweets in the United States. A total of 4,785,104 geotagged food tweets from 71,844 census tracts were collected from April 2015 to May 2018. We obtained census tract chronic disease outcomes from the CDC 500 Cities Project. We investigated associations between Twitter-derived food variables and chronic outcomes (obesity, diabetes and high blood pressure) using the median regression.
Results/Conclusions: Census tracts with higher average calories per tweet, less frequent healthy food mentions, and a higher percentage of food tweets about fast food had higher obesity and hypertension prevalence. Twitter-derived food variables were not predictive of diabetes prevalence. Food-related tweets can be leveraged to help characterize the neighborhood social and food environment, which in turn are linked with community levels of obesity and hypertension.
Importance to public health: Harnessing information exchanged online can be a cost-effective way of understanding local health trends and providing information necessary for targeted interventions. Neighborhood Twitter studies can help to identify areas at risk, inform chronic disease prevention at a neighborhood level, and further contribute to reducing important and costly chronic diseases.
Nguyen, Quynh (UMD)
Background: Vitamin D is important for health because of its role in development, bone metabolism and muscular functioning. There is growing evidence that vitamin D deficiency is also responsible for disrupting the cardiovascular system. High blood pressure, coronary artery calcification, plasma renin activity and other cardiovascular diseases are associated with lower levels of Vitamin D5. Vitamin D deficiency is considered pandemic with a prevalence rate of 41.6 % in U.S.
Goal: To delineate the relationship between physical activity, Vitamin D level and cardiovascular risk among African American adults in United States.
Objectives: As indicated by prior literature we hypothesize that 1) higher vitamin D levels might increase physical activity, 2) lower vitamin D levels might increase blood pressure 3) physical activity tends to reduce blood pressure among this study population. We also hypothesize that vitamin D deficiency can cause reduction in physical activity, leading to increased cardiovascular disease burden among African Americans
Approach: National Health And Nutrition Examination Survey 2011-12 was utilized to collect data on African American population aged between 20-60 years (n= 1007). We used the reported cumulative serum level of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2, systolic blood pressure and time spent on moderate-intensity sports, fitness or recreational activity to perform regression and mediation analysis.
Results/Conclusions: 63% of this subpopulation is deficient (<50nmol/L) in Vitamin D level. Our findings suggest a negative association, although statistically insignificant, between physical activity and SBP (β = -0.2, p-value = 0.71). A strong negative association was found between SBP and Vitamin D (β = -2.3, p-value = 0.01), while physical activity demonstrates partial mediation of this relationship (indirect effect= 0.02). Physical activity and Vitamin D also show significant positive association (β = 6.5, p-value = 0.02). The study demonstrates that Vitamin D might help promote physical activity and lower blood pressure. Physical activity partially mediates the relationship between Vitamin D and SBP, however this requires further investigation.
Importance to public health: The study demonstrates that Vitamin D might help promote physical activity and lower blood pressure. Physical activity partially mediates the relationship between Vitamin D and SBP, however this requires further investigation.
Ibe, Ngozi (UMD SPH Public Health Science)
Slopen, Natalie (UMD SPH Epidemiology and Biostatistics)
Background: Prior studies have documented oral health disparities based on parental nativity and racial/ethnic group, with children of immigrant parents and racial/ethnic minority children displaying poorer oral health outcomes. To date, few studies have examined whether the excess risk of tooth decay that is observed among children of racial/ethnic groups varies based on immigration status.
Goal: The goal of this study is to examine the degree to which parental nativity status affects pediatric oral health outcomes.
Objectives: - identify the degree to which parental nativity status affects pediatric tooth decay - identify strategies to reduce the oral health disparities among children of immigrant families and racial/ethnic groups - bring more awareness to the importance and connection of oral health to general health
Approach: We used data the 2016-2017 National Survey for Child Health, a nationally representative survey of children ages 0 to 17 years. Our sample included all children who had a dental exam in the past year (n=53,979). Parental nativity was coded as a 3 category variable: both parents born in the U.S., any parent born outside the U.S., and other (child born in the U.S., unknown place of parent birth). Racial/ethnic categories considered where non-Hispanic White, non-Hispanic Black, Hispanics, and Other, non-Hispanic. The outcome was parent-report of the child having a cavity in the past 12 months; chi-square tests were used to test bivariate associations.
Results/Conclusions: Overall, 12.9% of children had a cavity in the past 12 months, and this varied based on parent-nativity status (chi-square p-value=0.0002), where 14.8% of children with any parent born outside of the U.S. had a cavity in comparison to 11.7% of children with both parents born in the U.S. For children of parents who chose not to report place of birth, 18.6% of children had a cavity in the past year. This pattern by parental nativity varied across racial/ethnic groups and stratified analyses indicate that differences are only evident among non-Hispanic White children (p<.0001). This study suggests an association between parental nativity status and pediatric tooth decay, which varies by race/ethnicity. Future research is needed to examine these patterns using adjusted regression models, and to identify strategies to intervene.
Importance to public health: Oral health affects people both physically and psychologically and plays a vital roll in an individual's overall health. Poor oral/dental health can cause severe pain and discomfort. This ultimately affects the way a person develops (orally), how they speak, eat, make facial expressions, and how they appear, thus affecting their overall quality of life.
Emmanuel, PhD (Dr. 'Tayo)
Agaruwa, Mr. Banks (GRA Health Initiatives)
Background: This project was done because as Americans we may take for granted the privilege of having access to inexpensive over-the- counter medications. For some, across the nations, even these inexpensive drugs are not readily accessible which can cause preventable illnesses & ailments.
Goal: To increase OTC medications access to local villagers in Eastern African Country
Objectives: To provide OTC medication and First Aid Supplies to Villagers in Remote Areas of Eastern African Country To utilize interdisciplinary volunteer groups of professionals and students which seek to support the grassroots efforts of GRA Mission Squad. To raise health literacy awareness among local villagers
Approach: Needs Assessment: Initiation Data Collection Analysis
Results/Conclusions: 85% increase in villagers who received access to over the counter medications 89% increase in local villages who received awareness of blood pressure monitoring
Importance to public health: More than 1 billion people around the world do not have access to essential medications. Millions perish from illnesses that could have been easily prevented if there was access to it.
Irvin, Sarah (UMD SPH Epidemiology and Biostatistics)
Wentzensen, Nicolas (National Cancer Institute (NCI) Division of Cancer Epidemiology and Genetics (DCEG))
Members of OCAC, (Ovarian Cancer Association Consortium)
Background: Recent evidence from epidemiologic research suggests that inflammation contributes to epithelial ovarian cancer. Most independent risk factor associations are heterogeneous across ovarian cancer histologic subtypes. To better understand the role of inflammation in ovarian cancer subtypes we are conducting an analysis of combined inflammatory exposures in the Ovarian Cancer Association Consortium (OCAC).
Goal: This project will identify the impact of combined inflammatory exposures on the risk of ovarian cancer overall and by histologic subtype.
Objectives: The OCAC is a large consortium of ovarian cancer studies that have high-quality and complete information on inflammatory exposures and histologic subtypes. We are assessing inflammation-related exposures both independently and jointly across ovarian cancer subtypes (serous, endometrioid, mucinous, clear cell).
Approach: Logistic regression was used to assess individual relationships of inflammatory exposures with risk of ovarian cancer across all studies with data for that exposure. Unsupervised hierarchical clustering of individual odds ratios was used to visualize patterns of exposure across histologic subtype. Multivariate analyses will determine combined exposure associations and evaluate interactions between exposures associated with cancer risk in a core set of studies that collected all exposures of interest.
Results/Conclusions: Sixteen studies (n=18,336 cases and n=30011 controls) were included in phase 1. Aspirin and tubal ligation were associated with reduced risks of ovarian cancer overall (OR 0.90, 95% CI 0.80-1.00; OR 0.73 95% CI 0.66-0.80, respectively) and tubal ligation was associated with reduced risk in all subtypes (ORserous 0.85 95% CI 0.75-0.97; ORendometrioid 0.52 95% CI 0.43-0.64; ORmucinous 0.58 95% CI 0.43-0.78; ORclear 0.48 95% CI 0.36-0.64). Endometriosis and LOC were associated with an increased risk overall (OR 1.51, 95% CI 1.36-1.67; ORQ4vsQ1 1.61 95% CI 1.33-1.96) and risk was elevated in serous, endometrioid and clear cell tumors for both exposures. PCOS showed no association overall or by subtype. Analyses of BMI and PID are ongoing. Hierarchical clustering showed exposure patterns differed by subtype with clear cell and endometrioid tumors similar with respect to inflammatory exposures.
Importance to public health: Ovarian cancer subtypes exhibit different inflammatory exposure patterns and are heterogenous across risk factor associations. In ongoing research, additional inflammatory exposures and interactions between inflammatory exposures in individual subtypes are being evaluated. These results have important implications in elucidating the complex etiology of epithelial ovarian cancer.
Islam, Tasneem (UMD SPH Public Health Science Program)
Dorsey, Brian (Westat)
Jones, Chandria (Westat & UMD SPH Public Health Science Program)
Lentz, Lisa (Westat)
Background: In response to the Medicare Access CHIP Reauthorization Act, the Centers for Medicare and Medicaid Services created the Quality Payment Program to improve quality of care and lower costs for Medicare beneficiaries. Promoting Interoperability is a performance category that physicians are scored upon which encourages patient engagement and electronic exchange of health information through certified health record technology. Annually, through the rulemaking process, stakeholders such as medical associations, specialty societies, universities, clinicians, health systems and health IT vendors and patient advocacy organizations have a period of 60 days to submit comments on proposed policies for the Quality Payment Program.
Goal: The goal of this research is to analyze the changes in the Quality Payment Program considering popular comments from stakeholders.
Objectives: 1. Establish an understanding of the rulemaking process 2. Explore the importance of the role of stakeholders’ voices in public health 3. Identify the concerns of stakeholders regarding the Promoting Interoperability performance category of the Quality Payment Program
Approach: A thematic analysis was conducted in order to examine how stakeholder input changed over the years in the Promoting Interoperability category of the Quality Payment Program. Data that was published in the Federal Register from the proposed and final Quality Payment Program rules for the 2017, 2018 and 2019 performance years were compiled in order to conduct an analysis of popular public comments.
Results/Conclusions: Upon analyzing the public comments regarding the Promoting Interoperability category for the years 2017, 2018, and 2019, there were prominent themes that display stakeholder input: Themes for 2017: 1. Have sufficient time to develop health IT 2. Improve clinical workflow 3. Drive patient-centered use of health IT with a clear definition of meaningful EHR use 4. Increase category scoring flexibility Themes for 2018: 1. Reward and incentivize CEHRT use 2. Clear and simpler category scoring 3. Sufficient time to test EHR system 4. Fairly weight Promoting Interoperability performance category Themes for 2019: 1. Further concerns about requiring the 2015 edition of CEHRT 2. Make the Promoting Interoperability performance category available for all MIPS eligible clinicians 3. Concerns over new performance category scoring structure
Importance to public health: In order to have equity and justice in our healthcare system, it is important to pay attention to the rulemaking process. The role of stakeholder input is significant to public health and plays a key role in the effort to provide quality, efficiency and patient-centered care.
Jardine, Fiona (UMD iSchool)
Background: The rates of exclusive milk expression or pumping (EPing) are increasing. However, little is known about the reasons for EPing initiation and cessation, or the durations achieved by those who breastfeed without nursing.
Goal: The Breastfeeding Without Nursing study as a whole examines the lived experiences of breastfeeders who exclusively pump human milk.
Objectives: Describe the reasons given by EPers for initiating and ceasing EPing and explore the durations of EPing achieved.
Approach: A cross-sectional, self-report, mixed-methods survey was administered online to a convenience sample of current and/or former EPers (N = 2,007). To identify trends, quantitative data were analyzed using descriptive statistics; answers to open-ended questions were thematically coded in Atlas.ti.
Results/Conclusions: Results: 69% (1,394) of respondents reported latch problems as a reason for EPing; 25% (496) reported their infant did not transfer milk well while nursing; 23% (463) had a NICU infant; and 8% (157) “just wanted to.” The health benefits of breastfeeding to their child (98%; 1964) and themselves (43%; 859), as well as the cost of formula (57%; 1,138), were cited as reasons not to exclusively formula feed. Out of 696 (35%) former EPers, reasons for cessation included: reaching their goal (37%; 257); supply issues (low/“drying up”) (35%; 242); logistical difficulties (caring for child/time to pump) (32%; 222); and infant(s) successfully latching (7%, 48). Excluding those who ceased EPing because of latching, mean EPing duration was approximately 8.6 months (SD = 5.18; median = 8; range = >1 week–54 months). Conclusions: Among respondents predominantly recruited from online EPing support groups, EPing was often necessitated by latch problems; few spontaneously chose to EP. The duration of EPing achieved, while greatly varied, provides evidence that EPing is a sustainable long-term breastfeeding option.
Importance to public health: These, and future findings, of this study will identify strategies to improve the information and support provided to EPers, something which is vital to improve the lived experiences of this growing population. My research will be used to develop strategies that adequately support breastfeeders, which will in turn create positive change to both breastfeeding policy and practice. This change will increase the incidence, exclusivity, and duration of breastfeeding and promote children’s and parents’ physical, informational, and emotional wellbeing.
Jenkins, Emily (UMD SPH Epidemiology and Biostatistics)
Background: Feline tooth resorption (TR) may present risk for complications during dental procedures, and it is currently unknown whether oral examination is a valid diagnostic method for TR.
Goal: The overall goal of this thesis research is to identify characteristics associated with feline TR and to examine if felines with TR are at increased risk for complication under anesthesia during a dental procedure.
Objectives: This thesis characterizes felines with tooth resorption (TR), evaluates risk of complication under anesthesia during a dental procedure and validates the oral exam as a diagnostic tool for TR.
Approach: Using existing data from 1,530 felines from a large veterinary hospital in Washington, D.C., I examined the association between TR and complication under anesthesia during a dental procedure, and the validity of oral examination as a diagnostic tool.
Results/Conclusions: Controlling for breed, weight, age, sex, hematocrit, total protein, technician, veterinarian, and presence of oral and systemic disease, TR was associated with a complication under anesthesia during a dental procedure (p<0.0001). Sensitivity (93.1%), specificity (97.6%), positive predictive value (98.5%) and negative predictive value (89.2%) support the reliability of oral examination for diagnosing TR.
Importance to public health: Veterinarians can proactively anticipate lower blood pressures when anesthetizing felines with TR. There are similarities between TR in humans and felines, and further research is needed on the pathophysiology and health implications of TR in both species.
Crowley, Patrick (UMD School of Theatre)
Cork, Stephanie (UMD SPH Kinesiology)
Tricia, Homer (UMD Smith Business School)
Background: For this project we sought to use bodily intelligence to interrupt the typical focus on linguistic engagement in a public health undergraduate classroom. Embodied learning is the concept that refers to this bodily intelligence and, more specifically, is the active process through which shifts in perspectives, behaviors, and/or actions are experienced “in, through, with, and because of the body” (Munro, 2018, p. 6). We used this technique because we found that verbal discussions of discrimination in general, and racism in particular, illicit student discomfort and limit meaningful student engagement.
Goal: The purpose of this project was to explore how embodied pedagogy techniques functioned as an alternative mode to explore sensitive topics, as well as how these techniques might help students better relate and build empathy across difference
Objectives: The objectives of the project are to explore: - how the embodied activity impacted student learning; - how the embodied activity impacted levels of emotional and cognitive empathy; - how the embodied activity impacted student views of the possibility of social change; - student perceptions of the embodied activity
Approach: The embodied pedagogy workshop activity was delivered to UMD public health undergraduate students (N =129) in Fall 2018 as part of a 400-level course. More specifically, we implemented and assessed an embodied learning activity called ‘image of transition’ which is a branch of Boal’s (1979) system called ‘theatre of oppressed.’ Boal’s radical set of theatre techniques seek to put the challenges of people’s social lives at the heart of the theatrical process. ‘Image of transition’ is facilitated by trained theatre professionals, but empowers audience-participants to create, rehearse, perform, and analyze aesthetic enactments of social problems. Data collection entailed a pre-and post-survey conducted the day of the workshop as well as field notes. The survey consisted of Likert Scale questions designed to assess how the workshop impacted: student learning; perceptions of the possibility of social change; and levels of empathy. An open ended question was used to assess student perceptions of the embodied learning activity.
Results/Conclusions: Our results focus on ‘lessons learned.’ We will share two key findings regarding what worked: (1) embodying class concepts through movement opened up multiple interpretations for students, and this thickness evoked robust dialogue that a strictly linguistic approach might not have elicited; and (2) the affective and physical experiences of the participants embodying ideas provided further avenues for analysis and discussion. The shortcomings of our workshop were evidenced by a failure of the group to imagine utopian public health outcomes, and tenuous linkages between systemic inequities and interpersonal manifestations of these inequities.
Importance to public health: This intervention offers a means for students to engage in more critical conversations through using movement to express themselves.
Kachingwe, Olivia (UMD)
Salerno, John (UMD)
Boekeloo, Bradley (UMD)
Fish, Jessica (UMD)
Geddings-Hayes, Melanie (Hearts and Homes)
Aden, Faduma (UMD)
Aparicio, Elizabeth (UMD)
Background: Many youth use social media to meet sexual partners and maintain relationships. However, social media use can increase sexual risk taking, and foster youth may lack the resources needed to appropriately navigate online spaces and respond to challenges. Thus, it is important to understand how foster youth interact with social media platforms and engage with peers online.
Goal: To describe how foster youth conceive of and use social media to meet potential intimate partners and maintain sexual and romantic relationships.
Objectives: Use a community-based participatory action research approach, in partnership with a local foster care agency to 1) understand youth’s relationship with social media, 2) describe ways that social media is used to build and maintain intimate relationships and 3) determine areas in which foster youths express needed support.
Approach: We conducted three focus groups (N=3; two for boys and one for girls) with 16 youth in care aged 16-20 years (M=17.25). Youth were presented with sexual health and hygiene topics commonly discussed in sexual education courses. Participants collectively identified the top three topics that they felt youth in care needed to know more about. A semi-structured interview guide was used to discuss youth’s experiences and needs related to these topics. Audio files were naturalistically transcribed, then systematically analyzed using thematic analysis.
Results/Conclusions: Foster youth participants shared that they were generally cautious of trusting their peers, and building interpersonal relationships through social media was experienced as unsafe. Foster youth described social media as unsafe due to user deceit, lack of privacy, its interference with real-world relationships, and females’ access and vulnerability to older men. Youth ultimately emphasized the need for creating boundaries and demanding respect when using social media.
Importance to public health: Understanding how foster youth engage with social media and identifying areas in which they would like to be supported may attenuate negative relationship outcomes and empower youth to maintain positive online relationships. Programs are needed to help foster youth identify and create safe online spaces, and help caregivers learn how best to support foster youth in these efforts.
Kaplow, Katya (UMD SPH Behavioral and Community Health)
Williams, Randi (UMD SPH Behavioral and Community Health)
Woodard, Nate (UMD SPH Behavioral and Community Health)
Knott, Cheryl (UMD SPH Behavioral and Community Health)
Background: African American churches provide leadership for spiritual matters, social action and community outreach, making them appropriate settings to address health. Health promotion implemented in churches can build knowledge, improve perceptions of preventive care, and enhance individuals’ self-efficacy to make and attend medical appointments
Goal: This analysis examined the association between the level of health promotion activities in 9 local African American churches and 115 female members’ self-reported mammography knowledge, perceptions, and utilization.
Objectives: We hypothesized that health promotion activities in the churches would be positively associated with both breast cancer knowledge scores and mammography utilization, and negatively associated with women’s perceived barriers to mammography.
Approach: A secondary analysis was conducted using data from an implementation trial aiming to increase cancer knowledge and screening in African American churches in Maryland. In each church, level of health promotion was calculated by summing the number of health promotion activities with the number of health topic areas the churches covered in the previous 12 months. Breast cancer knowledge scores represent the sum of correct responses on scale items. Perceived barriers to mammography were identified using validated measures from previous studies. Self-reported mammography was coded as never, more than 12 months ago, less than 12 months ago. We conducted Pearson’s correlations between church health promotion scores and the three variables described above.
Results/Conclusions: There was no significant correlation between health promotion scores and breast cancer knowledge, r = -.15, NS. Additionally, there was no significant correlation between health promotion scores and perceived barriers to mammography, r = -.15, NS. However, there was a small positive correlation between church health promotion scores and self-reported mammography, r = .21, p = .03.
Importance to public health: The results indicate that greater health promotion in the study churches was associated with significantly greater self-reported mammography utilization; affirming the effectiveness of community-engaged health promotion activities in fostering healthy behaviors. This analysis also highlights the need to further investigate how faith-based health promotion influences church member’s health knowledge and perceptions. These results can be used to advocate for faith-based organizations as channels in health promotion initiatives, especially to promote screening for populations experiencing disproportionate rates of preventable disease.
Background: Between 2013 and 2015, approximately 54 million individuals are diagnosed with at least 1 form of arthritis, accounting for 23% of the population, and this number is expected to grow in the next few decades. Working adults are highly affected by these types of conditions with more than half (60%) of those with arthritis being 18-64 years of age. It is leading cause of disability in the U.S, and limits both leisure activity and work. Furthermore, 33% of individuals diagnosed with this health condition stop working 10 years after they are diagnosed with the disease and 8 million individuals say that their ability to work is limited as a result of their arthritis. As a result of limiting work, in addition to the cost of medical care related to arthritis, there are low economic outcomes for individuals with this disease.
Goal: To examine the economic impact that arthritis has on elderly and non-elderly individuals within the population.
Objectives: To investigate the economic impact of arthritis across three different age groups by analyzing a comparison of younger age groups and older age groups to have arthritis.
Approach: This study utilized a cross-sectional survey, NHANES 2013-2014, to examine the relationship between age, arthritis, and income. Our population consisted of non-elderly (40-64 years) and elderly (65+) individuals that were diagnosed with arthritis. The outcome variables of interest were yearly household income and hours worked. Additional sensitivity analyses were conducted with income type and work absence.
Results/Conclusions: There was a significant odds ratio (OR) between arthritis and no arthritis among the non-elderly for household income [OR=0.61, 95% CI, 0.41-0.90]. This difference was not found among the elderly [OR=0.90, 95% CI, 0.65-1.26]. Hours worked was not found to be a significant variable for disease status among either age group. This study indicates that non-elderly individuals that have arthritis face high levels of poverty, in addition to wage and work loss, which was not prevalent in the elderly population.
Importance to public health: The population of interest faces increased future health and economic hardships. Therefore, further studies should be conducted to provide accurate recommendations on programs and interventions for this population.
Kavi, Lucy (UMD SPH Maryland Institute of Applied Environmental Health)
Shao, Yuan (JHU SPH Environmental Health and Engineering)
Boyle, Meleah (UMD SPH Maryland Institute of Applied Environmental Health)
Pool, Walkiria (CAFO)
Thomas, Stephen (UMD SPH Maryland Center for Health Equity)
Wilson, Sacoby (UMD SPH Maryland Institute of Applied Environmental Health)
Rule, Ana (JHU SPH Environmental Health and Engineering)
Quiros-Alcala, Lesliam (UMD SPH Maryland Institute of Applied Environmental Heal)
Background: Hairdressers are exposed to many chemicals found in or emitted from hair products, including volatile organic compounds (VOCs) and particulate matter (PM), which have been associated with adverse health effects. Still, studies on occupational exposures among U.S. hairdressers, including workers servicing African American and Latino clients, are scarce. Exposures among hairdressers servicing African American and Latino clients are of growing concern, as the formulated products used to service their clientele are suspected of containing more toxic ingredients than products used on Caucasian clients
Goal: To characterize indoor air quality in hair salons in Maryland primarily serving African American and Latino clients
Objectives: 1. To conduct environmental monitoring to measure indoor air quality metrics in three hair salons in Maryland primarily serving African American and Latino clients 2.To measure ambient concentrations of VOCs and PM in three hair salons in Maryland primarily serving African American and Latino clients
Approach: We used a combination of low cost and state of the art real-time instruments to conduct air monitoring in each of the salons over three consecutive days to quantify concentrations of formaldehyde, total VOCs (TVOCs), CO, CO2, PM1, PM2.5 and PM10 during the entire work shift. We calculated 8-hour time weighted average (TWA) concentrations and compared them to occupational exposure guidelines available
Results/Conclusions: The daily median (p25, p50) 8-hr TWA for formaldehyde was 0.032 ppm (0.01, 0.05 ppm). Two of the salons monitored exceeded the NIOSH recommended exposure level (REL) for formaldehyde. TVOC concentrations ranged from 0.006-76.8 ppm. Daily CO median concentrations in each salon were generally low (<8.00 ppm). Daily CO2 median concentrations in each salon ranged from 656-1,280 ppm and were below the OSHA permissible exposure limit. Daily PM1, PM2.5, and PM10 median concentrations observed over the 3-day sampling period in each salon ranged from 5-1,010 ug m-3, 6-1,040 ug-m-3 and 9-1,050 ug-m-3, respectively Findings suggest that formaldehyde and PM concentrations could be of concern in hair salons primarily serving African American and Latino clients. Further studies are needed to characterize concentrations of select indoor air pollutants in these settings.
Importance to public health: Findings from this pilot study will be used to design larger exposure, epidemiologic, and intervention studies in an understudied and underrepresented population in both occupational and environmental health research. The focus on workers in salons predominantly serving clients of African American and Latino descent fills critical data gaps as this population may experience elevated exposures to target contaminants
Bell, Caryn (African American Studies)
Background: Black Americans are more likely than White Americans to experience adverse health outcomes despite their socioeconomic status (SES). Previous studies have examined a concept known as the "diminished return theory," which states that the positive health effects of high SES are more significant for White Americans than Black Americans. It is possible that this theory explains why Black Americans are more likely to suffer from adverse health outcomes despite their SES.
Goal: The goal of this project is to examine associations between county-level racial inequalities in SES and obesity and health-related resources at different levels of income for White and Black Americans.
Objectives: - This project aims to assess differences in the association between obesity and health-related resources and racial inequalities in SES among Black and White Americans at different levels of income. - It is hypothesized that counties with a higher black median income will exhibit higher rates of obesity, higher rates of physical inactivity, fewer supermarkets, and more fast food restaurants than counties with the same white median income. -It is also hypothesized that racial inequalities in SES will be greater in counties with a higher black median income than in counties with the same white median income.
Approach: For this project data was collected from various sources to provide county-level health outcomes, health behaviors, health-related resources, and sociodemographics. The dependent variables were obesity and the number of supermarkets and fast-food restaurants. The independent variables were indicators of structural racism, which were racial inequalities in median income, percentage living below the poverty line, the percentage who completed a 4-year college degree, percentage who were unemployed and the percentage who were homeowners. Differences in the association between the independent and dependent variables were examined based on a third stratifying variable which was varying black and white median income. Associations were considered statistically significant if the p-value was less than or equal to 0.05.
Results/Conclusions: In counties where the black median income was high, rates of obesity and physical inactivity were higher than in counties with a high white median income. Counties with a high black median income had fewer grocery stores than counties with a high white median income and counties with a lower white median income. Counties with a high black median income displayed higher rates of percent living in poverty and percent unemployed and lower rates of percent college graduates and percent homeowners. Indicators of structural racism were less frequent in high-income counties regardless of race. In counties where the black median income is high, there was a positive association between obesity and low levels of poverty inequality and unemployment inequality. These results suggest that high-income African Americans are not experiencing that same health benefits as White Americans that make the same income, and they are more likely to remain in counties of lower socioeconomic status. This data also shows that high-income African Americans experience adverse health outcome even when indicators of structural racism are low.
Importance to public health: This project demonstrates that the protective factors of high income are less significant for African Americans. These results suggest that examining and removing methods of structural racism within our society could lead to improved health outcomes for African Americans.
Kondracki, Anthony (UMD SPH Family Science)
Background: Osteoporosis is an important public health issue especially in postmenopausal women. Parity has been suggested as a possible risk factor of osteoporosis, but the associations of lifetime parity with overall loss of bone mineral density (BMD) (greater than 2.5 standard deviations) and osteoporosis remains unclear
Goal: To investigate if age at first and last childbirth is associated with changes in bone mineral density and subsequent risk of osteoporosis in postmenopausal women.
Objectives: The objective of this study is to determine whether age at first and last childbirth and parity have any long-term implications on osteoporosis and fracture risk in postmenopausal women.
Approach: Cross sectional study based on the 2013-2014 National Health and Nutrition Examination Survey (NHANES) of non-institutionalized Americans was conducted on 1,042 postmenopausal women, after excluding women with missing data on reproductive history. Multivariate linear regression assessed the association between the age at childbirth and parity with bone mineral density (BMD) of the lumbar spine (LS) and femoral neck (FN) in four separate models, after controlling for selected confounding variables.
Results/Conclusions: The overall prevalence of osteoporosis was 17.18% (n=179). After adjusting for age and body mass index (BMI), there was a 0.0037 g/cm2 increase in LS BMD (p=0.01) and a 0.0023 g/cm2 increase in FN BMD (p=0.01) for each subsequent year that woman delivered her first child, and an increase in parity was associated with a 0.0146 g/cm2 decrease in LS BMD (p=0.01) and a 0.0044 g/cm2 decrease in FN BMD (p=0.21) per child. The associations no longer remained significant after accounting for additional confounders. Later age at first childbirth is associated with a lower risk of osteoporosis in postmenopausal women and the risk increases with age at each successive delivery. The relationship between parity and osteoporosis of the LS is independent of age at giving birth and BMI, compared to the osteoporosis of the FN, and may be explained by other mechanisms.
Importance to public health: These data offer evidence that parity may not have a beneficial effect on bone health. Further research is needed to determine other factors that influence bone mineral density in postmenopausal women.
Bress, Lisa (University of Maryland School of Dentistry Dental Hygiene Program)
Background: During pregnancy, oral health care is safe, important, and covered by Medicaid (until delivery) in Maryland. However, only 1 in 4 Medicaid-enrolled pregnant women (26%) statewide had a dental visit in 2016. To take advantage of this window of opportunity, the University of Maryland School of Dentistry’s (UMSOD) dental hygiene program collaborated with the University of Maryland School of Medicine Women’s Health Center (UMWHC) to pilot a program to provide OH screenings, education, and case management services to connect obstetric patients to a dental home, the UMSOD.
Goal: Pilot a prenatal oral health program to provide interprofessional education experiences for student health providers and increase access to oral health care for low-income pregnant women.
Objectives: 1. Educate dental, dental hygiene (DH), medical students, about the importance of incorporating OH care into prenatal health care. 2. Raise awareness about the importance of incorporating OH into prenatal health care for registered nurses (RNs), nurse midwives and OB-GYN residents. 3. Increase dental utilization among low-income prenatal patients in a university-based women’s health center. 4. Provide challenging patient care experiences for dental and (DH) students.
Approach: 1. UMSOD dental hygiene students will provide oral health screenings and education for prenatal patients at the UMWHC. 2. Registered nurses at UMWHC will provide OH education and referrals to the UMSOD to prenatal patients. 3. Two UMB Master’s Public Health students will provide case management services to link screened and referred prenatal patients to UMSOD for follow-up dental services. 4. Dental and DH students will provide urgent and comprehensive dental services to prenatal patients from the UMWHC.
Results/Conclusions: 105 prenatal patients were screened by dental hygiene students, 92 patients were referred to UMSOD by RNs, 72 of these patients made appointments at the dental school, 53 of these patients failed to attend their initial appointment while 46 did attend their initial appointment, and 15 patients had completed dental hygiene treatment services prior to delivery. In conclusion, the high failure rate of these patient appointments was the biggest failure to the pilot program. It is important to continue to investigate barriers to scheduling and following through with dental appointments for this underserved population in order for them to receive the care that they need. Finally, the pilot program should be further evaluated in order to considerate it as a model for other health professional campuses around the country with a medical and a dental school.
Importance to public health: Reports indicate 40% of pregnant women have periodontal disease and a higher dental caries rate compared to higher income pregnant patients, and oral health care is covered by Medicaid (until delivery) for pregnant women, yet only a small fraction of this population utilizes the care. It is a crucial to work interprofessionally to not only treat these patient's OB-GYN needs, but also their dental needs because educating, referring, and treating prenatal patients improves not only their overall health, but increases the potential for improving their future child's lifetime of oral health and overall health.
Lee, Clark (UMB SOL Center for Health and Homeland Security)
O'Donnell, Sean (Montgomery County Department of Health and Human Services)
Skidmore, Sue (Arlington County Public Health)
Background: The National Capital Region (NCR) assessed its regional vulnerabilities in providing medical countermeasures (MCM) to its population in response to a wide-spread biological incident. From this assessment, the NCR was able to identify and prioritize 87 potential vulnerabilities relating to 38 MCM Response Operations for its future regional preparedness efforts.
Goal: To better understand the National Capital Region’s (NCR's) current capabilities relating to a regional public health response, the Metropolitan Washington Council of Governments (COG) Public Health Emergency Planners Subcommittee (PHEPS) conducted a systematic assessment of the NCR’s vulnerabilities in providing life-saving medical countermeasures (MCM) to its population in response to a wide-spread anthrax exposure incident.
Objectives: (1) Identify specific MCM response operations likely to occur in the NCR jurisdictions and potential vulnerabilities to successful completion of these operations. (2) Rate and prioritize each identified vulnerability from a region-wide perspective for the NCR’s future regional preparedness efforts.
Approach: The NCR’s MCM Response Vulnerability Assessment was modeled on the Health Hazard Assessment and Prioritization (hHAP) process developed by the Los Angeles County Department of Public Health (2013). PHEPS members met between July 2017 and Feb. 2018 and adopted a consensus approach to collectively: (1) identify specific MCM Response Operations likely to occur in the NCR jurisdictions and Potential Vulnerabilities to successful completion of these operations; and (2) rate each identified Potential Vulnerability from a region-wide perspective using unipolar Likert-type scales of various Vulnerability Impact Components and prioritize each vulnerability based on these ratings.
Results/Conclusions: PHEPS members identified 38 specific MCM Response Operations and 87 potential vulnerabilities to successful completion of these operations for inclusion in the NCR’s MCM Response Vulnerability Assessment. Most of the top-ranked vulnerabilities related to the Public Health Preparedness Capabilities of Medical Countermeasure Dispensing, Emergency Operations Coordination, and Emergency Public Information and Warning. The NCR jurisdictions can use these findings to prioritize local and regional planning efforts for those MCM response vulnerabilities with the greatest impact on the NCR.
Importance to public health: Coalitions or regions elsewhere may adopt this vulnerability assessment process to evaluate their local and regional MCM response readiness.
Li, Yuruo (UMD SPH Epidemiology and Biostatistics)
Liu, Hongjie (UMD SPH Epidemiology and Biostatistics)
Background: Female sex workers (FSWs) in China are known to have low HIV testing uptake. Compared to the clients of FSWs, limited researches have focused on HIV testing among the nonpaying partners of FSWs. Increased HIV testing uptake among FSWs and their partners in China is the first step to prevention crusade.
Goal: We will investigate the influence of social networks on HIV testing behaviors among the older FSWs and their non-paying partners in China to inform further interventions.
Objectives: Using an egocentric network approach, this study examined HIV testing behavior and its potential determinants among Chinese FSWs and their nonpaying. We will investigate how the structure of social support networks influence their HIV testing and care-seeking behaviors.
Approach: A multicenter cross-sectional study was conducted among older female sex workers in China. The network structure was measured effective size, constraint, and transitivity. Logistic regression was used to assess how network structure measurements influenced the HIV testing uptake among FSW.
Results/Conclusions: Among the 1245 FSWs in this study, 61.92% (771) reported having ever tested with HIV in their lifetime. Among 608 currently married FSWs, only 9% (56) of the FSWs’ husbands had ever been tested with HIV in their lifetime. Among 636 FSWs with nonpaying boyfriends, only 9.9% (63) of the FSW’s boyfriends had ever been tested with HIV. Network transitivity was found positively associated with FSW’s HIV testing uptake (OR= 1.77, 95% CI: 1.17-2.48). Network constraints and effective size were not associated with HIV testing.
Importance to public health: FSWs and their nonpaying partners had low HIV testing uptake. The structure of social support network played an important role in FSW’s testing behavior.
Li, Harry (UMD SPH Kinesiology)
Kuzmiak-Glancy, Sarah (UMD SPH Kinesiology)
Background: Heart failure is a disease that affects over 6 million people in the United States, and is characterized by a weakened heart that is unable to meet the demands of the body. A theory behind the pathology of the disease is that elevated sodium levels in cardiac cells are reducing the energetic function of cardiac mitochondria leading to a weakened heart. However, current therapies targeting the cellular environment for sodium have shown modest effectiveness suggesting a more complex mechanistic problem.
Goal: The overall goal of this research project is to improve our understanding of the mechanism behind the pathology of heart failure by investigating the mitochondrial function of healthy cardiac cells subjected to heart failure levels of sodium.
Objectives: 1. To examine oxygen consumption, NADH reduction, and membrane potential in healthy mitochondria to determine the effects of elevated sodium on the oxidative phosphorylation pathway. 2. To determine if the calcium concentration needed to induce maximal mitochondrial activation differs between healthy and failing levels sodium.
Approach: We have isolated mitochondria from hearts of healthy adult rats and subjected them to healthy and failing levels of extramitochondrial sodium. Futhermore, we also subjected half of the aformentioned mitochondria with a dose of calcium to observe any changes to mitochondrial activation and function. Using a custom chamber, we assessed mitochondrial function by measuring oxygen consumption, membrane potential, and NADH fluorescence.
Results/Conclusions: Heart failure levels of extramitochondrial sodium did not elicit any significant changes in mitochondrial function of healthy hearts in the presence or absence of calcium activation. Therefore, we do not believe that elevated sodium alone is sufficient enough to weaken hearts and bring about heart failure.
Importance to public health: Current therapies targeting the cellular environment for sodium have been modestly effective in combating heart failure. It is imperative that we improve our understanding behind the pathology of heart failure so that we may develop better therapies to treat this disease.
Calvin, Lu (UMD)
Background: As stress level increases, there is a cascading effect from the central nervous system to the autonomic nervous system, and then to the peripheral systems such as the cardiovascular systems. One skill that has been identified to reduce stress is the use of paced deep ventilation. This technique is a conscious way to manipulate the autonomic nervous system to bring homeostasis within the body.
Goal: To investigate the acute influence of paced deep ventilation has on heart rate variability (HRV) and electroencephalography (EEG).
Objectives: I. Through the treatment condition, there will be an increase in low frequency and the total frequency of HRV II. Through treatment condition, there will be an increase in alpha power compare to the control condition (Reflecting cortical relaxation)
Approach: Twenty young adults (age 18-30) with no prior experience in ventilation training were recruited from the University of Maryland, College Park. The study required two visits by the participants. Each visit was separated by seven days while the conditions were randomized and counterbalanced. The study first obtained a baseline recording, then the participants underwent an easy condition following by a hard condition of a psychomotor task. The psychomotor task was a Snake® game with two levels of challenge (Easy vs Hard) that lasted five minutes. Afterward, the participants underwent either the treatment condition (paced deep ventilation) or the control condition (coloring task) for 3 trials in a row. Post-intervention or control session the participants then reattempted the hard condition of the psychomotor task.
Results/Conclusions: Findings for the study revealed an alteration of HRV between the two conditions. The treatment condition showed an increase in HRV through an elevation of parasympathetic activities compare to the control condition. Additionally, the treatment condition exhibited an increase in cortical relaxation compared to the control condition.
Importance to public health: The results support the use of paced deep ventilation as a relaxation technique to reduce stress or increase parasympathetic dominance and as a treatment method for individuals with high anxiety disorders.
Slopen, Natalie (UMD)
Background: Adverse childhood experiences can be buffered with adequate caretaker support. However, the lack of caretaker and physician collaboration in the decision-making process within pediatric medicine prompts unwarranted confusion in the child's treatment. As a result, there have been increased rates in hospitalizations and poor quality of life in children, especially those of Non-Hispanic African American and Hispanic descent.
Goal: The goal is to encourage further studies to determine what methods can be enforced to ensure adequate and compassionate healthcare guidelines universally for caregivers within the pediatric care setting.
Objectives: Pediatricians may play a role in perpetuating child health disparities by providing worse treatment to racial/ethnic minority children, and children with younger parents. We examined whether racial/ethnic minority caregivers and younger caregivers received worse treatment at health care visits relative to White and older mothers.
Approach: Drawing on data from the 2016-2017 National Survey of Children’s Health, a representative cross-sectional survey of children 0 to 17 years in the U.S., we examined poor treatment in health care settings based on caregiver race/ethnicity and maternal age at the child’s birth (n=60,204). Poor treatment was measured using five caregiver-report questions about experiences of care in the past year; a dichotomous variable was created to reflect poor treatment.
Results/Conclusions: Overall, 13.11% of caregivers received poor treatment at a pediatric health care visit. Poor treatment was reported by 18.96% and 19.4% of Hispanic and Black caregivers, respectively, in contrast to 8.97% of White caregivers. Poor treatment was inversely associated with maternal age at the child’s birth, with a prevalence of 18.98% for those who were under 21 years, in contrast to 10.10% for those over 31 years. Notably, the pattern of poor treatment by race/ethnicity became more accentuated as maternal age at the child’s birth increased. Minority and younger caregivers face increased risk of poor treatment in the pediatric clinic setting, which could have implications for child health. Further studies are needed to determine what methods can be enforced to ensure adequate and compassionate healthcare guidelines are displayed universally.
Importance to public health: Research has been cited to demonstrate, a contributing factor to the alarming rates of adverse childhood experiences amongst minorities is poor maternal or caretaker treatment in pediatric care settings. Lack of adequate parent-physician interaction results in limited treatment at home due to the caretaker of the child's lack of understanding which ultimately putting the strain on the overall health and well-being of their children.
Malik, Adeena (UMD)
Parikh, Kajal (UMD)
Tesfa, Wayni (UMD)
Jamison, Amelia (UMD)
Quinn, Sandra (UMD)
Broniatowski, David (GWU)
Dredze, Mark (JHU)
Background: No study has done a systematic classification of all vaccine-related messaging on Twitter. Previous studies have been limited to simple sentiment analysis (pro/anti) or have focused only on anti-vaccine messages at the exclusion of other types of content.
Goal: To conduct a systematic classification of vaccine-related messaging on Twitter, utilizing a random sample of 10,000 vaccine-related tweets.
Objectives: -To assess the prevalence of pro-vaccine, anti-vaccine, and vaccine neutral content on Twitter. -To develop a typologies to describe different themes within each group (pro, anti).
Approach: This is an exploratory cross-sectional study. Utilizing HealthTweets, our team analyzed a random sample of 10,000 vaccine-related tweets. Three independent annotators classified each tweet by sentiment: pro-vaccine, anti-vaccine, or neutral. A second round of annotation focused on identifying major themes within anti-vaccine tweets including: natural remedies, civil liberties, safety concerns, morality issues, and conspiracy theories. Sub-themes within the pro-vaccine tweets included: pro-science, vaccine policy, refuting anti-vax, vaccine campaigns, and vaccine safety.
Results/Conclusions: The majority of tweets were neutral (61%) and largely news oriented. There were slightly more anti-vaccine (22%) messages than pro-vaccine (17%) messages. Within anti-vaccine messages, 59% included safety concerns and 40% included conspiracy theories. Other themes appeared with much less frequency. Ongoing research will reveal the trends within pro-vaccine messages.
Importance to public health: This work provides the necessary baseline to assess fluctuations in vaccine-related discourse on Twitter.
Martinez, G. Sofia (UMD)
Chu, Jun (UMD)
Fenelon, Andrew (UMD)
Background: Through the research on social determinants of health we know that factors outside of medical care including a person's neighborhood, social supports, occupation, and education have a large effect on health. To address these issues some community health centers (CHCs), including the Federally Qualified Health Center Mary's Center, have decided to offer non-medical services to their clients. Justifying the costs of these services can be difficult though when the major benefits are not seen by outcomes tracked or do not present themselves until many years in the future.
Goal: To conduct a preliminary fiscal analysis of Mary's Center's Social Change Model (SCM), which provides health care, education, and social services to its participants, who are largely low-income immigrants.
Objectives: To compare the 2017 costs of the SCM services with the financial benefits found in the literature for providing similar services.
Approach: A literature review was conducted through searches on EBSCO and Google Scholar to find the relevant studies that had been conducted on services similar to each component of the SCM model. Searches included terms such as "social services," "community health clinic," "adult ESL classes," and "wrap-around services."
Results/Conclusions: Through the literature we found that most relevant studies had positive outcomes for services similar to those provided in the SCM. However, social services is an area where the evidence-base is particularly lacking due to the wide range of interventions that are tested in this space, making it difficult to compare findings across studies. Thus, the review provides positive support for continued research and data collection on the SCM model, to determine its direct effects for clients.
Importance to public health: This work provides initial evidence to support an innovative model that could be adopted by other CHCs interested in addressing the social determinants of health that their clients face.
Maybury, Catherine (UMD SPH Behavioral and Community Health)
Horowitz, Alice M. (UMD SPH Behavioral and Community Health)
La Touche-Howard, Sylvette (UMD SPH Behavioral and Community Health)
Child, Wendy (Independent Consultant)
Battanni, Katy (Maryland Department of Health)
Wang, Min Qi (UMD SPH Behavioral and Community Health)
Background: Dental care is recommended during pregnancy. However, only 44% of US women (2004-2006) reported a dental visit during pregnancy, and only 26% women in Maryland (2016) reported having their teeth cleaned during pregnancy. Many low-income pregnant women do not know poor oral health affects their overall health and that of their baby. They do not know that prenatal dental care is available to them. They do not understand decay causing bacteria can be passed from mother to infant after birth.
Goal: The study examined why low-income pregnant women do not receive prenatal dental care.
Objectives: The study assessed low-income pregnant women’s knowledge, understanding and practices related to preventing dental caries (decay) and barriers and facilitators to prenatal dental care.
Approach: A mixed methods approach used a 56-item survey assessing knowledge, understanding, opinions and practices related to preventing dental caries; opinions of dental provider communication practices, and oral health literacy. One-on-one interviews/ focus groups examined awareness, attitudes and beliefs about the importance and safety of prenatal dental care; and awareness of Maryland’s prenatal dental insurance program. Survey data was analyzed using SPSS (v24) descriptive statistics and Chi Square test of independence (alpha level .05); the interview/focus group data was analyzed using Atlas.ti (v7.5). The study was approved by University of Maryland and Maryland Department of Health IRBs.
Results/Conclusions: Most women were unaware of the Maryland Medicaid dental benefits for pregnant women. Many could not find a Medicaid dental provider and/or had difficulty navigating the Medicaid dental program. Most women could not afford dental care if they had to pay. Most women lacked understanding about the importance of prenatal dental care; some believed dental care was unsafe during pregnancy. To decrease caries rates, policies and programs must be implemented to increase the oral health literacy of low-income pregnant women so they are aware of Medicaid dental benefits for pregnant women; understand the importance of and need for prenatal dental care; and gain the knowledge and understanding to prevent caries in themselves and their children.
Importance to public health: Results will be used to inform policies and programs to increase awareness of the importance of and need for prenatal dental care among low-income women.
McLain, Pat. (UMB)
Allen, Laura (UMB)
Background: The Community and Public Health Environmental Initiative (CPHEI) will assist 51 Head Start (HS) centers to obtain Eco-Healthy Childcare (EHCC) certification. My capstone project was developed to evaluate a new approach to work with staff from seven HS centers interested in EHCC certification.
Goal: The purpose is evaluation of Eco-Healthy Child Care (EHCC) program in helping child care facilities improve their environmental health.
Objectives: Describe at least 3 categories of environmental health practice being assessed by the Eco-Healthy Childcare (EHCC) Program. Identify two areas where Head Start Centers in Baltimore initially had difficulty meeting environmental standards using the EHCC checklist. Discuss the effectiveness of EHCC classroom education for child care professionals using pre- and post-knowledge tests and the success of EHCC certification of the centers.
Approach: At our initial visit, we conducted an assessment using the EHCC checklist. The Center Director independently completed the checklist and submitted it to us. Two to three weeks later, we shared our initial results with Center staff and provided two one-hour education programs for staff on environmental health and safety practices lacking in the Center. HS staff members completed pre- and post-knowledge tests to assess their learning. We revisited the center four weeks later to re-evaluate environmental health practices to determine if changes by center staff would enable the Center to meet the requirements for EHCC certification
Results/Conclusions: Initial environmental concerns were similar in all HS centers and included the use of toxic cleaning chemicals, aerosols, and lack of administrative policies for third party cleaning and maintenance. Most center’s self-reported checklist score was lower than our score, primarily due to staff uncertainty about checklist items. Following classroom education, the average post-test score for HS staff was 45% higher than the pre-test score. At the 4-week re-assessment, six out of seven HS Centers met certification criteria.
Importance to public health: This evaluation will guide implementation of the EHCC program in Baltimore HS centers and will advise future implementation nationally.
How To Roast Legumes At Home
Importance to public health: Sover
Carter-Pokras, Olivia (UMD Department of Epidemiology and Biostatistics)
Payne-Sturges, Devon (UMD Applied Environmental Health)
Ogungbesan, Toluwanimi (UMD Department of Epidemiology and Biostatistics)
Background: Hypertension is a chronic condition that affects about one-third of all Americans and more than 40% of the African-American population. There is a large amount of research regarding hypertension in the African-American community; however, most of this research does not make any distinction between U.S. born African Americans and African immigrants. Thus, the prevalence of hypertension among African immigrant populations to the United States remains underexplored.
Goal: The overall purpose of this project is to review the epidemiologic literature regarding hypertension prevalence among African immigrants to the United States by country/region of origin.
Objectives: 1) To use prevalence data from literature published from 2000-2018 to estimate the prevalence of hypertension among African immigrant adults to the United States currently 2) To estimate and qualitatively compare the prevalence of hypertension among African immigrants to the US by African region of origin (North, South, East, West, and Central Africa)
Approach: Using 3 different literature databases – PubMed, EBSCO, and Google Scholar – this literature review examined the existing epidemiologic literature published from 2000-2018 to estimate the hypertension prevalence data among adult African immigrants as a whole and by region of origin.
Results/Conclusions: Results of this literature review indicate that the prevalence of hypertension among African immigrants as a whole is lower than that of the US population (22.1% vs 33.2%). Results also indicate that West African immigrants have a higher hypertension prevalence than East African immigrants (14.8% vs 10.5%), and there are indications that younger African immigrants have worse hypertension rates compared to their young American-born counterparts. Lack of data from Northern, Southern, and Central African immigrants suggests that more research regarding among these populations need to be undertaken.
Importance to public health: The compiled literature indicates that future research should consider region of origin for African immigrants when examining hypertension, particularly among immigrants specifically from the northern, southern, and central regions of Africa. Results also indicate that approaches to controlling hypertension among African immigrants from Western and Eastern regions of Africa should be tailored to account for differences in prevalence between the groups and underlying causes.
Payne Sturges, Devon (UMD)
Background: Neonicotinoids are widely used as insecticides worldwide. The related toxicity effects on humans and pollinators are a growing cause of concern. The Maryland Pollinator Protection Act (MPPA), enacted in response to these concerns, prohibits all retail sales and consumer use of neonicotinoids in the state of Maryland. The MPPA went into effect on January 1, 2018.
Goal: The goal of this research project was to evaluate retail store compliance with the MPPA within the first year of the law’s implementation.
Objectives: Our specific objective was to assess if neonicotinoid products were available in retail stores in Maryland post-January 1, 2018 when the MPPA went into effect. We hypothesized that the presence of these products would differ by store type.
Approach: We visited over 50 large home and garden stores, small independent hardware stores and nurseries across Maryland from May-Oct 2018. We surveyed their home, garden, and lawn care product shelves to identify any neonicotinoid products for sale. We looked for the chemical names of neonicotinoids on the ingredients list: acetamiprid, clothianidin, dinotefuran, imidacloprid, thiacloprid, thiamethoxam, nitenpyram or nithiazine. We used χ2 tests and multivariate logistic regression to assess the association between the presence of neonicotinoid products and store type (α=0.05).
Results/Conclusions: Twenty-five percent of the 52 stores surveyed had neonicotinoid products. The most common product was Bayer 2 in 1 Rose & Flower Care, which contained imidacloprid. Small independent stores were statistically significantly more likely (AOR=7.00, 95%CI=1.4-36.2, P-value=0.017) to have neonicotinoid products on their shelves than big chain stores, controlling for days since the MPPA went into effect.
Importance to public health: Our results demonstrates that the MPPA is effective in reducing the availability of neonicotinoids, insecticides that are harmful to beneficial insects and public health. However, compliance with MPPA appears to be mainly among the big retail chain stores. In order to ensure full compliance, The Maryland Department of Agriculture, the state agency responsible for enforcement of MPPA, will need to conduct targeted outreach among smaller and independent hardware and garden stores.
Fong, Allan (MedStar Health Research Institute)
Wesley, Deliya (MedStar Health Research Institute)
Background: The prevalence of Type 2 diabetes (T2D) is estimated to increase by 21% between 2013-2025 with racial/ethnic minorities disproportionately impacted. Care teams need to understand patients’ individual context including the role of different social determinants of health such as social support (SS). Novel methods to characterize patients’ complex medical needs are required.
Goal: The goal of this study was to identify how patients use their social networks for diabetes self-management (DSM).
Objectives: The purpose of this study was to co-develop and pilot a web-based application to characterize social support among patients with T2D.
Approach: Thirty-five participants were recruited from two inner-city endocrinology clinics in Baltimore. Participants were primarily female (86%), self-identified as Black or African American (97%). Mean age was 62. Participants were administered a digital, tablet-based diabetes adapted Colored Eco-Genetic Relationship Map (D-CEGRM) which focuses on different types of DSM support patients receive from their social network. The D-CEGRM was conducted as a collaborative activity between the patient and research coordinator.
Results/Conclusions: After completing the D-CEGRM participants discussed feasibility and utility of the tool. The majority of participants indicated they enjoyed the activity and the visualization of their social network and supports. Several participants emphasized that the just talking about their social network related to their T2D was calming, and therapeutic.The D-CEGRM allows for the capture of additional dimensions of SS compared with standard tools.
Importance to public health: Further development is needed to enable our digital D-CEGRM to capture more complex social networks and to optimize the collection of social support and social determinants of health data.
Panthi, Suraj (UMD SPH Maryland Institute of Applied Environmental Health)
Sapkota, Amir (UMD SPH Maryland Institute of Applied Environmental Health)
Background: The finite source of freshwater for agricultural use has already become an increasingly scarce resource due to several competing factors such as rising demand for food, urbanization, and climate change. Hence there is an urgency to identify additional sources of water for agricultural use including nontraditional water sources such as reclaimed wastewater, return flows, produced and brackish waters.
Goal: Such nontraditional agricultural water sources may have high level of contaminants compromising the quality, and it is very critical to characterize and evaluate these agricultural water sources for microbial and chemical contaminants prior to agricultural use so they don’t pose health threats to public.
Objectives: Historically there has been concerted effort for safety guidelines on wastewater derived pathogens, but emerging chemical contaminants have been overlooked, and our study aims to characterize five different nontraditional water types for herbicides, antibiotics, stimulants, and disinfectants.
Approach: Water samples were collected from five different nontraditional water sources for agricultural use and they are extracted using solid phase extraction and analyzed to quantitate targeted emerging chemicals using ultra-high pressure liquid chromatography tandem mass spectrometry (UPLC-MS/MS).
Results/Conclusions: Trace level of contaminants were detected across all water types, and the highest level of herbicides (atrazine) was detected in untreated pond water (median concentration 135.9 ng/L). Reclaimed water had the highest levels of antibiotics and stimulants including azithromycin (215 ng/L), sulfamethoxazole (232.1 ng/L), and caffeine (89.4 ng/L). Produce processing plant water also tended to have higher levels of atrazine (102.7 ng/L) and ciprofloxacin ( 80.1 ng/L). ). In addition, we observed seasonal variability across water types, with the highest atrazine concentration observed during summer months while maximum azithromycin concentrations observed during spring season.
Importance to public health: As our research demonstrates the presence of trace level of such emerging chemicals across all non traditional irrigational water sources, it is of great public health concern if these contaminants are accumulated by crops leading to unintentional exposure through the ingestion of crops irrigated by such water sources. Hence further studies are needed to evaluate the effectiveness of feasible on farm treatment technologies that could remove emerging chemicals from water sources so they could be safely used for irrigation.
Parada, Franklin (UMD SPH Public Health Science)
Borzekowski, Dina (UMD SPH Behavioral and Community Health)
Background: I conducted the project in order to get a better understanding of the research/progress that has been made on a particular disease of interest that was affecting countries that some of my family live in. Also to shed a bit of light on this epidemic that has been going on for more than a decade now with no definite causality established yet.
Goal: The goal was to analyze research being done on the disease for the past ten years to create a research review paper, exposing potential conflicts of interest.
Objectives: 1. Find possible developments in the field of research regarding CKDu from the past 10 years. 2. Get first-person experiences/information from researchers in the field, at least one from each major hypothesis. 3. Uncover any major conflicts of interest, or other things that might affect the validity of a hypothesis 4. Find evidence with backup sources confirming possible causes to the CKD in patients. 5. Find information regarding what local health organizations, governments, and industries have done to address this issue among the various communities affected by the epidemic.
Approach: Papers were chosen starting from 2009 to the end of January of 2019. All of these reports were then compiled into a 10-page analysis. I also collected first-person experience/information was then gathered from researchers from each hypothesis (at least one from each) via email/phone interviews and were asked general questions about the epidemic.
Results/Conclusions: I found potential conflicts of interests with one of the main hypotheses, with regards to where they got their research funding from as well as their answers which didn't support the evidence found in the countries affected. I also found out that most of these countries have banned most pesticides in agricultural use, but some companies continue to get their supply from companies such as Monsanto in the U.S. who give these companies the least refined, and cheapest type which is even more harmful to workers, and now even mothers and children living downstream from these plantations.
Importance to public health: I was able to uncover and learn what progress has been made on finding a cause to the disease from both political and research sources, as well as uncovering potential conflicts of interests that might affect the validity of the hypothesis being proposed.
Casadesus, Damian (Jackson Memorial Hospital)
Perez, Giselle (Ross University School of Medicine)
Nunez, Tatiana (Ross University School of Medicine)
Danny, Russell (Ross University School of Medicine)
Perez, Jennifer (St George's University)
Ashraf, Jahanzeb (American University of the Caribbean)
Background: Amongst all drug users, marijuana is the most commonly used illicit drug in the United States today, thus making this a common behavior on the rise. This project was conducted to raise awareness of the pulmonary complications that can arise from smoking marijuana in the adolescent and young adult population.
Goal: The project goal is to demonstrate how marijuana use can have adverse pulmonary consequences such as subcutaneous emphysema and pneumomediastinum in the adolescent and young adult population.
Objectives: Our objective is to bring awareness to the possible adverse effects of marijuana smoking in the young population. In this study, we present two clinical cases that presented to the Emergency Department with subcutaneous emphysema and pneumomediastinum.
Approach: This project studied two similar cases of young habitual marijuana users suffering from uncommon pulmonary complications.
Results/Conclusions: This project compared two cases of young marijuana users who suffered uncommon pulmonary complications. Case 1 is an 18-year-old male with a history of alcohol and daily marijuana abuse who presented with neck pain and swelling. Chest x-ray and CT chest showed extensive pneumomediastinum with diffuse subcutaneous emphysema of the bilateral neck and soft tissues of the chest. Patient was admitted and treated with 100% oxygen non-rebreather mask and supportive care. Repeat chest x-rays two days later showed improved pneumomediastinum and soft tissue emphysema. The second case is of a 21 year old who presented with acute dyspnea, without pain, cough or recent infection. He reported smoking marijuana frequently. On physical exam, he had palpable crepitus. Chest x-ray and CT chest also found pneumomediastinum and extensive subcutaneous emphysema. He received similar treatment as the previous case and symptoms two days later. As the prevalence of marijuana use continues to rise it is important to keep pulmonary complications such as subcutaneous emphysema and pneumomediastinum on the differential when a young patient presents with dyspnea, chest pain, or neck pain. Therefore it is important to counsel adolescents and young adults about the adverse effects of the use of marijuana including these complications.
Importance to public health: The presented cases reiterate that marijuana has more documented harms than benefits in the adolescent and young adult population.
Pietro, Kyle (UMD - SPH - Kinesiology)
Hatfield, Bradley (UMD - SPH - Kinesiology)
Background: In today’s world of sport, it is not unusual for an athlete to receive one day of rest. Overtraining Syndrome arises from the lack of rest and concurrent increase in training volume. Remarkably, there is a paucity of data corroborating stress and overtraining.
Goal: The purpose of this commentary is to highlight the etiology of Overtraining Syndrome and various data linking overtraining, stress and performance.
Approach: The commentary will focus on studies by Mackinnon et al. (1997), Shields et al. (2017) and Meeusen et al. (2010). A review was conducted. The databases examined were: Web of Science, PubMed, Scopus, and CLIO.
Results/Conclusions: A review of the literature revealed a scarcity of literature featuring human subjects with reliable biomarker data to diagnose overtraining. The articles in this commentary did utilize human participants, with varying results. A major theme that these articles share is that stress biomarkers alone are not the most reliable sources to determine if an athlete is overtrained. Meeusen et al. (2010) propose a “Two-Bout Exercise Protocol” be implemented to determine if athletes are underperforming. This may be a valid marker to determine future overtrained athletes. Shields et al. (2017) highlight that although student-athletes are exhibit unique psychological responses, they do not differ from non student-athlete controls in terms of the stress hormone cortisol or in cognitive performance.
Importance to public health: The implications of these studies not only help to expand the existing body of research, but also present new methods for the testing of overtraining syndrome. Based on the literature, there does not seem to be one single unambiguous marker to determine overtraining.Therefore, future research should focus on the collection of a family of physiological and psychological data in an attempt to classify (eg. machine learning approach) athletes who are or will be overtrained. This may in turn may shed light on how best to train populations like student-athletes, first responders and military personnel.
Pope, Elle (UMD SPH)
Sehgal, Neil (UMD SPH)
Background: Individuals with serious mental illness (SMI), including schizophrenia, bipolar disorder, and major depressive disorder, with a risk factor for cardiovascular disease (CVD) are a vulnerable population with diminished quality of life, complicated treatment plans, and mortality rates two to three times higher than the overall US population, mostly due to CVD.
Goal: Since individuals with SMI are known to be a high-risk vulnerable patient population, the goal of this project was to estimate and quantify the magnitude of overall direct health care expenditures among individuals with these dual diagnoses. This information could help motivate decision-makers to screen SMI patients early, inform disease management plans, and mitigate downstream health care expenditures.
Objectives: To determine if significant direct healthcare costs exist between patients with SMI and a CVD risk factor compared to those who only have a single diagnosis of SMI or a CVD risk factor.
Approach: Using the 2010-2015 Medical Expenditure Panel Survey (MEPS) data, a two-part model (logit/GLM) was used to estimate total direct health care expenditures among patients with SMI and a CVD risk factor. Patients for primary analyses were identified as those 18 years of age or older who had either or both a diagnosis of any SMI or a risk factor for CVD.
Results/Conclusions: Among patients with SMI and at least one risk factor for CVD, 61% were found to have public insurance and the majority (39%) had incomes less than 100% of the federal poverty level. Unadjusted total health care expenditures were $14,590 (CI 95%13,274-15,906) for patients with both a SMI and CVD risk factor, compared to $9,863 (CI 95% $6,872-$12,854) for patients with SMI and no CVD risk factor and $13,307 for patients with only a CVD risk factor ($13,216-$13,398). Emergency Department and prescription medication costs were found to be highest among those with both SMI and a CVD risk factor ($90 and $5,311, respectively). Patients with both SMI and a CVD risk factor were 32% (p<0.0001) more likely to incur higher annual direct health care expenses compared to those with either a single diagnosis of SMI.
Importance to public health: The economic burden of SMI and a comorbid CVD risk factor accounts for a disproportionate share of expenditures compared to patients without these risk factors. Given the large prevalence of CVD risk factors among patients with SMI, screening for these conditions should be prioritized for timely diagnosis, appropriate disease management, and to mitigate downstream health care expenditures.
Remigio, Richard (UMD SPH Maryland Institute for Applied Environmental Health)
Jiang, Chengsheng (UMD SPH Maryland Institute for Applied Environmental Health)
Raimann, Jochen (Renal Research Institute)
Kotanko, Peter (Renal Research Institute)
Maddux, Franklin (Renal Research Institute)
Usvyat, Len (Renal Research Institute)
Kinney, Patrick (Boston University)
Sapkota, Amir (UMD SPH Maryland Institute for Applied Environmental Health)
Background: Extreme heat events (EHE) are projected to increase in frequency, duration, and intensity in response to a changing climate. Many studies have linked exposure to EHE with an increased risk of morbidity and mortality among the general population, but there is a paucity of data regarding EHE impacts to a vulnerable population such as end-stage renal disease (ESRD) patients.
Goal: Characterize EHE-related risk of hospitalization and mortality among ESRD patients across race/ethnicity and co-morbidities.
Objectives: Our objective is to characterize EHE-related risk of hospitalization and mortality among ESRD patients across race/ethnicity and co-morbidities.
Approach: Daily hospitalization and mortality counts were obtained from Fresenius Medical Care (FMC) in-center hemodialysis patients treated in Boston, MA; Philadelphia, PA; and New York City, NY between in 2001 and 2012 (N=7212). EHE were identified using 95th percentile threshold values derived from location- and calendar day-specific long-term baselines (1960-1989). We used time-stratified case-crossover analysis to estimate all-cause hospitalization and all-cause mortality risks associated with EHE. Maximum daily air temperature compared to county-wide 30-year baselines (1960-1989) and its respective extreme temperature thresholds (95th percentile) across selected northeastern counties. Extreme heat event (EHE) metric based on two-day (same day and one day-lag) cumulative, and unconstrained same-day and one-day lagged exposures. We further stratified the analysis by race/ethnicity (Asian, Hispanic, Non-Hispanic (NH) Black, and NH-White) and co-morbidities (congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes).
Results/Conclusions: NH-Black and NH-White patients demonstrated consistent increased EHE-related hospitalization and mortality risk across same-day, one-day, and cumulative lag periods. Patients living with any co-morbidity responded with increased hospitalization risk across estimated lag-responses. Notably, diabetics had the highest hospitalization risk (RR: 1.32, 95% CI: 1.14-1.53). CHF and COPD exhibited substantially higher mortality risk. Same-day EHE exposure yielded the highest mortality risk (RR: 2.61, 95% CI: 1.67-4.10) for patients with COPD. Effect modification analysis between EHE and air pollution is ongoing and will be presented.
Importance to public health: Our data suggest that EHE-related risk increases in hospitalization and mortality may vary across race/ethnicity as well as co-morbidity status. In light of projected increased frequency of extreme heat events, future studies with national-outlook are needed to quantify geographic and demographic variability in risk and inform ESRD management guidelines under a changing climate.
Saksvig, Brit (UMD SPH Epidemiology and Biostatistics)
Phillips, Colin (UMD ARHU Linguistics)
Zukowski, Andrea (UMD ARHU Linguistics)
Background: “parkrun” is a global community-based, free, weekly, timed 5K event organized by volunteers in 20 countries, with over 1,400 events and 250,000 participants every Saturday. A distinctive feature of parkrun is that it is entirely led by local volunteers, with a focus on community engagement and inclusiveness. Globally, engagement is high, with 25% of the 3 million participants having attended 10+ times. In the US there are 24 events nationally and around 1,200 participants weekly, with considerable variability in participation and engagement across events. The College Park parkrun is thriving, growing from 50 participants/week to 150 participants/week over 2 years. While the potential for scalable impact in the US is high, it is poorly understood why some events grow while others remain small.
Objectives: The aim of this exploratory study was to describe the participants of College Park (CP) parkrun and identify characteristics potentially associated with participation and engagement.
Approach: Two data sources were used: 1) 11,000 weekly participant event records from CP parkrun were summarized to compare with national data; and 2) an online survey was developed by KNES602 MPH students for a class assignment. It was designed to understand CP parkrun participants’ involvement and motivation in the event. The University of Maryland’s Institutional Review Board approved the survey and participant permission was obtained.
Results/Conclusions: CP parkrun event records show that 12% of all participants have attended 10+ times (double the US average), and 22% finish in 40+ minutes indicating both walkers and runners. The 110 survey participants were primarily CP parkrun regulars: 70% had attended ≥8 events, 52% were female, 83% were white, and 63% were ≥45 years old. The top 4 reported reasons for initial attendance were “it’s a free 5k”, “sounded fun”, “to challenge myself”, “to lose weight/improve my health”. Top 4 reasons for returning were “it’s a free 5K”, “to get some exercise”, “it’s a fun activity”, and “I look forward to seeing other parkrunners. The top 3 qualities that participants reported as being very/extremely important to the parkrun experience were the “5k course”, “the face-face-interaction with other parkrunners”, and “encouragement and support from other parkrunners”. Two-thirds of respondents attended with friends/family, 96% had recommended the event to others, and 90% reported that they strongly/somewhat agree that the CP parkrun group is a close-knit community. Half of the respondents reported volunteering ≥1 time, with 20% volunteering for ≥8 events. Three-quarters live within 20 minutes of the course.
Importance to public health: Increasing physical activity is an important health objective for Healthy People 2020. Replicating the CP parkrun success, and creating the kind of impact seen in other countries could have a significant impact on the physical activity behavior and community engagement in U.S. communities.
Shah, Veeraj (UMD SPH Family Science)
Solow, June (UMD SPH Family Science)
Lewis, Jonathan (UMD SPH Family Science)
Mulloor, Anjali (UMD SPH Family Science)
Singh, Sunmeet (UMD SPH Family Science)
Talarico, Kelsey (UMD SPH Family Science)
Soltani, Darya (UMD SPH Family Science)
Parikh, Zill (UMD SPH Family Science)
Pekosz, Maddy (UMD SPH Family Science)
Vahanan, Manasvinee (UMD SPH Family Science)
Parekh, Nina (UMD SPH Family Science)
Holmes, Katie (UMD SPH Family Science)
Background: Public Health Without Borders (PHWB) is a service-learning student organization that aims to reduce global health disparities while educating University of Maryland (UMD) students about sustainable interventions, health literacy, and cultural competency in global health work.
Goal: Through our intervention and needs assessment models, our organization aims to provide a global health education platform for undergraduates across the country to gain invaluable experience and make tangible changes in the lives of others by improving health.
Objectives: The primary objective of Public Health without Borders is to provide experiences in global health and international development to undergraduates. With this, we aim to deliver sustainable and culturally competent health interventions in our partner communities. We ultimately aim to share this approach with other universities in the US and grow our organization beyond UMD.
Approach: Since its creation in 2014, PHWB has conducted international health with a team of more than 200 undergraduates, graduate students, and faculty advisors on three active projects: Compone (Peru), Calaba Town (Sierra Leone), and Varanasi (India). Through initial needs assessments, our teams identify the pressing health disparities in a community. The underlying concept behind our interventions is a train-the-trainer model, in which our members have the opportunity to deliver interventions which can then be repeated by members of our partner communities.
Results/Conclusions: Over the past four years, our health intervention and needs assessment model have allowed us to reach over 2,000 students and community members. Our Sierra Leone team found that the community faces burdens from tropical diseases due to lack of resources and health education. They subsequently delivered workshops to more than 300 students, 10 faculty members, and approximately 50 community members focusing on handwashing, oral hygiene, and malaria prevention. In Peru, our team found that this community faced issues involving mental health and anemia. In response, our team conducted workshops on nutrition and road safety, and held stress relief and yoga programs. In India, our team recently found that a concern of both students and parents in the community was nutrition and water potability. Our team is currently planning an intervention for January 2019 where we will deliver nutrition education workshops to both students and parents, as well as build water treatment systems.
Importance to public health: The model our organization follows has shown success in multiple countries and over a variety of health interventions. It has significant potential for application at universities around the world, allowing students to see health disparities first-hand and gain experience in designing effective and sustainable solutions in a culturally conscious manner.
Shaw, Emma P. (UMD)
Rietschel, Jeremy C. (Veteran's Health Administration)
Hendershot, Brad D. (DoD-VA Extremity Trauma and Amputation Center of Excellence)
Pruziner, Alison L. (DoD-VA Extremity Trauma and Amputation Center of Excellence)
Wolf, Erik J. (DoD-VA Extremity Trauma and Amputation Center of Excellence)
Dearth, Christopher L. (DoD-VA Extremity Trauma and Amputation Center of Excellence)
Miller, Matthew W. (Auburn University)
Hatfield, Bradley D. (UMD)
Gentili, Rodolphe J. (UMD)
Background: Although few studies have evaluated the cognitive demand of walking with a prosthetic device using behavioral measures, only one has provided a direct assessment of the underlying brain dynamics. Furthermore, these prior efforts have not directly compared the differences in cognitive workload between individuals with varying levels of lower-limb loss (LL).
Goal: This study aimed to evaluate cognitive workload through a combined assessment of gait and cortical dynamics in individuals with unilateral lower-LL during dual-task walking.
Objectives: We hypothesized that individuals with transfemoral (TF) compared to transtibial (TT) LL would reveal a more prominent alteration of temporal-spatial features of gait, along with a more pronounced increase in mental effort during dual-task walking.
Approach: Biomechanics and EEG were simultaneously recorded as 12 individuals with TT LL and 8 with TF LL performed a task of varying cognitive demand while being seated or walking on a treadmill within a Computer Assisted Rehabilitation Environment.
Results/Conclusions: Though the results revealed both groups exhibited similarities (increased gait stability and theta synchrony) as cognitive-motor demands increased, notable differences emerged. Individuals with TF compared to TT LL lacked an adaptive cortical response within the low- and high-alpha bandwidths while walking, which corresponded with performance decrements on the cognitive task along with further gait deviations. The results as a whole suggest that while both groups were able to recruit neural mechanisms (e.g., attentional control, working memory) critical for the maintenance of cognitive-motor performance, dual-task walking with a prosthesis may impose additional cognitive and biomechanical demands in individuals with more proximal levels of amputation.
Importance to public health: The present study provides support for the utility of EEG as an objective real-time assessment of cognitive workload during dual-task walking within an ecologically valid environment. This work was supported by the DoD Defense Health Program (NF90UG) and the DoD-VA Extremity Trauma & Amputation Center of Excellence. Views expressed in this abstract are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
Liu, Hongjie (UMD SPH Epidemiology and Biostatistics)
Slopen, Natalie (UMD SPH Epidemiology and Biostatistics)
Background: Young children’s attitudes, beliefs, behaviors, and general health are greatly influenced by their adult caregivers. As half of all mental disorders develop by the middle teenage years, it is important to understand how the context of the family and home life is related to the development of depression and anxiety.
Goal: The purpose of my project is to gain a better understanding of the current associations between various characteristics of parents/guardians and depression and anxiety in adolescents ages 12-17 in the United States in order to better identify and provide services for youth at risk for mental health disorders.
Objectives: I hypothesize that children with caregivers who: 1. are biological or adoptive parents, 2. are between the ages of 35 and 54, 3. have a college degree, 4. are married, 5. are employed, 6. are in good physical health, and 7. are in good mental health will have lower prevalence of depression and/or anxiety as compared to those who do not.
Approach: The project consists of an analysis and a report on data collected by the National Survey of Children’s Health (NSCH) during 2016 and 2017. Randomly selected U.S. addresses receive mailed invitations to take the survey online. Adult participants provide information about children in the household and one child per household is selected to be included in the sample. Participants then complete an age-appropriate questionnaire. This is a cross-sectional design as the data is collected at one point in time and there is no follow up or temporality. Analysis is being conducted in SAS Studio 3.8. Relative risk, correlations, and logistic regression are being employed to test study hypotheses.
Results/Conclusions: Analysis of data collected on a sample 23,751 children ages 12-17 in the U.S. each having two primary caregivers (one male and one female) produced the following results: -children living with biological/adoptive parents exhibit reduced prevalence of depression and anxiety -having a caregiver who is married is protective against depression, but not anxiety -having a caregiver in good mental health is strongly associated with reduced risk for ever having had depression and anxiety -children with relatively young male caregivers appear to have reduced odds of ever having depression as compared to children with more typically aged parents, but this is not true for female caregivers
Importance to public health: These findings provide a basis for further research on how caregivers impact adolescent depression and anxiety which will allow public health practitioners to identify adolescents at greater risk for these mental health conditions and implement programs to help them.
Shuggi, Isabelle (UMD)
Shaw, Emma (UMD)
Wu, Helena (UMD)
Moreno, Arianna (UMD)
Oh, Hyuk (UMD)
Shewokis, Patricia (Drexel)
Gentili, Rodolphe (UMD)
Background: Numerous studies have assessed mental workload to understand the allocation of attentional resources throughout performance of a cognitive-motor task. However, only a limited number of studies have investigated mental workload in the context of motor learning throughout longitudinal training. Although the examination of mental workload during motor learning is critical to understanding the underpinnings of cognitive-motor mechanisms, psychological factors such as the notion of self-efficacy are also crucial.
Goal: Therefore, this work aimed to examine the concomitant changes in performance, mental workload, and self-efficacy throughout practice of a novel reaching task.
Objectives: 1. It was hypothesized that throughout practice motor performance would improve, while mental workload decreased and self-efficacy increased. 2. Additionally, it was expected that motor performance would improve at a faster rate than the decrease of mental workload and both would change at a faster rate than self-efficacy.
Approach: By employing limited head movements, participants learned via a human-machine interface to control a virtual robotic arm within a two dimensional workspace. Participants could move their heads in eight directions (i.e., up, down, left, right, and diagonally) to reach the targets, which appeared randomly throughout the workspace. Kinematic performance, mental workload, and self-efficacy were assessed on each of the eight training days.
Results/Conclusions: Overall, as individuals progressed through training, the results revealed that: i) motor performance and self-efficacy improved while mental workload decreased and ii) the dynamics of motor performance, mental workload, and self-efficacy tended to differ throughout training. Namely, although additional analyses are needed to further examine these dynamics, with respect to the first day of training, performance improved faster than the decrease in mental workload, while self-efficacy seemed to be the slowest to exhibit improvement.
Importance to public health: This work is presently being extended through the use of electroencephalography (EEG) to assess attentional reserve and cortical effort, which combined can index changes in mental workload throughout motor practice and learning. As a whole, this work contributes to inform cognitive-motor mechanisms as well as the design and training of assistive technologies and prostheses.
Sifat, Munjireen (UMD SPH Behavioral and Community Health)
Green, Kerry (UMD SPH Behavioral and Community Health)
Holder, Sharifah (UMD SPH Behavioral and Community Health)
Background: Suicide is a serious public health problem and a leading cause of death in the U.S. Rates of suicide are particularly problematic in older adults. Research suggests that suicide manifests itself differently in African Americans compared to Whites, though research among African Americans is scant. Thus, it is imperative to learn more about suicidal ideation in African American older adults. Family factors such as maternal attachment and family bonding are known protective factors with regards to physical and psychological well being, including suicide, yet few studies have examined this factor for suicide prevention among African Americans.
Goal: The aim of the study is to examine multiple components of family factors across the lifespan as predictors of suicidal ideation in a cohort of African American adults.
Objectives: The objective of this research is to learn more about what family factors in African American's from childhood, adolescence and young adulthood, may influence mid-life suicidal ideation. We will determine both who is at risk of mid-life suicidal ideation, as well as discover where to intervene in their life course.
Approach: This study uses data from the Woodlawn Study, a longitudinal study that followed an African American cohort in Chicago from 1st grade into midlife (age 42, n=1,242), with data collected at ages 6 (childhood), 16 (adolescence), 32 (young adulthood), and 42 (midlife). We controlled for substance use, mother’s substance use and education, and depression. We examine the role of multiple family factors measured in adulthood as predictors of suicidal ideation at midlife: children living with you, marriage, attachment to mother, family communication, warmth, and parental rule setting.
Results/Conclusions: Adjusting for sociodemographic confounders, an association was found between one childhood factor, whether the participant was raised by just a mother, or if the mother was absent, and midlife suicidal ideation. Those who were raised in a family in which the mother was absent had 3.24 the odds of having suicidal ideation in midlife than those who grew up with just their mothers. No associations were found between adolescent factors. In young adulthood, no family factors were associated with suicidal ideation. Other family factors did not predict ideation in the final model. Follow up analyses will explore additional early life factors and gender interactions, as males and females may have different pathways toward suicide. Findings show that certain components of family factors in childhood are associated with suicidal ideation among middle-aged African Americans. Evidence demonstrates that being raised by a mother (when compared to having an absent mother) serves as protective factors toward suicidal ideation in this vulnerable population.
Importance to public health: Future research should continue to examine the relationship between childhood family factors and suicide among African Americans to inform the development of suicide prevention interventions. Learning about the pathways to suicide for these populations is a high priority, warranting further research.
Talarico, Kelsey (UMD CMNS Biology)
Soltani, Darya (UMD SPH Public Health Science)
Hurtado, Ali (UMD SPH Family Science)
Maring, Elisabeth (UMD SPH Family Science)
Background: Adolescent development is a subject that is influenced by both societal and cultural norms. In school’s of western society, such as the United States, youth are free to discuss physical and emotional changes that occur during development. However, in areas such as rural Compone, Peru, the topic is rarely discussed due to cultural values, family traditions, and religious beliefs that play into their societal practices. Additionally, a lack of educational resources may also hinder the adults’ ability to teach children about adolescent development. In 2017, Public Health Without Borders (PHWB) conducted a health strengths and needs assessment for the community of Compone and learned that adolescent development was a topic the community was interested in learning more about.
Goal: The primary goal of this intervention was to make the topic of adolescent development a natural and easy subject to talk about among peers and family members through the utilization of culturally relevant examples and relatable advice.
Objectives: The primary goal of this intervention was to make the topic of adolescent development a natural and easy subject to talk about among peers and family members through the utilization of culturally relevant examples and relatable advice.
Approach: Conducted literature review to determine culturally sensitive approaches to address topics of adolescent development Implemented programs in community primary and secondary school classrooms Approximately 200 secondary school students participated in the intervention Focused on adolescent’s changing mind and attitudes Developed a cross the line game to show similarities among classmate’s feelings and attitudes about their adolescent experiences Used anecdotes to structure discussions and get the students comfortable discussing their changes during adolescent years Used a question and answer session to directly target what the participants wanted to learn
Results/Conclusions: 36 total participants over three classes 22 participants aged 16-17 years old 14 participants aged 13-14 years old In total, 42% of students aged between 13-17 years old reported feeling frustrated 16-17 year olds tended to feel more frustrated than 13-14 year olds (64% vs 7%) Almost all students stated that they noticed their body is changing 92% of students aged between 13-17 reported experiencing mood swings Younger students were more dissatisfied with their appearance than older students
Importance to public health: The stages of adolescent development are key in the maturation process as young adults. They are learning to manage their emotions and relationships as well as acquiring skills that are essential for taking on adult roles. Understanding this process is vital for making the transition from childhood to adulthood and helps to relieve the subsequent mental and emotional stress. The PHWB adolescent development workshops aim to show children how to maintain a healthy body and mind, as well as how to face emotional challenges during this vulnerable time in development.
Talarico, Kelsey (UMD CMNS Biology)
Soltani, Darya (UMD SPH Public Health Science)
Hurtado, Ali (UMD SPH Family Science)
Maring, Elisabeth (UMD SPH Family Science)
Background: Various health concerns such as hypertension, diabetes, and anemia are prevalent in the community of Compone, Peru due to unhealthy habits, including unbalanced diet and inaccessibility to essential food items. It is estimated by The World Food Programme that 13.1% of Peruvian children (33.4% in rural areas such as Compone) suffer from malnourishment. The limited access to foods high in crucial vitamins and minerals contributes greatly to the prevalence of obesity and anemia amongst these populations. Public Health Without Borders (PHWB) traveled to the community of Compone during July 2018 to address these issues and promote healthy nutritional habits.
Goal: Collaborate with the local health clinic and primary and secondary schools to deliver a nutritional intervention in a culturally appropriate manner Address the positive effects of a healthy diet and highlight specific health conditions, such as hypertension, diabetes, and anemia, that can occur as a consequence of an unhealthy diet Show portion sizes by illustrating fat, sugar, and salt content in common foods Promote healthy nutritional habits through accessible, local foods and physical exercise
Objectives: Collaborate with the local health clinic and primary and secondary schools to deliver a nutritional intervention in a culturally appropriate manner Address the positive effects of a healthy diet and highlight specific health conditions, such as hypertension, diabetes, and anemia, that can occur as a consequence of an unhealthy diet Show portion sizes by illustrating fat, sugar, and salt content in common foods Promote healthy nutritional habits through accessible, local foods and physical exercise
Approach: Conducted literature reviews to gain insight on the nutritional resources and foods that the people of Compone had access to Interventions targeted both adults and adolescents and discussed the content of sugar, salt, and fat in their diet Used the drink Inca Cola to form an interactive activity and stimulate discussion about the sugar content Discussed ways to create more balanced meal options into their diet Used hands on games to explore healthy plate options with the primary school children Implemented interventions at the community center for adults and school classrooms for adolescents Approximately 400 people participated in the various nutrition workshops that were held Used discussions and question and answer seminars to articulate information and address common questions about nutrition Gave out pamphlets to reinforce ideas discussed in the seminars
Results/Conclusions: Tailor evaluations to participant literacy level and improve clarity of questions Work to find better ways to inform community of workshops that will be taking place Expand social network to partner with local organizations and complement existing efforts to inform about public health concerns Plan future workshops using these workshops as a model Assist in strategizing the best ways to continue implementation while gone
Importance to public health: Continue to collaborate with the community to promote healthy practices with regards to nutrition Develop new community-informed health interventions: Dental Hygiene Nutrition Bullying
Ketterman, Jesse (UMD Extension)
Pippidis, Maria (University of Delaware Cooperative Extension)
McCoy, Lisa (UMD Extension)
Braun, Bonnie (UMD)
Brown, Virginia (UMD Extension)
Little, Lynn (UMD Extension)
Background: Consumers are confused about health insurance and its costs. Only about 20% of people are able to calculate what they may owe after a routine doctor visit. A review of literature has shown that being confused by terms, not building health costs into spending plans, and not tracking use of health care can keep people from being effective users of their health insurance.The Smart Choice Health Insurance™/ Smart Use Health Insurance™ programs were created to help consumers to reduce confusion, increase capability and increase confidence so they become smart users of health insurance.
Goal: The goal of this project was to create a module entitled the Smart Use Health Insurance - Understanding and Estimating Health Care Costs focusing on helping consumers understand and estimate their own health care costs.
Objectives: The participant objectives are to: Increase their confidence that they understand health insurance cost terms Increase their confidence that they could estimate their total health care costs Increase the likelihood that they would determine how much they would need to save in order to cover their health care expenses
Approach: In order to achieve the objectives, educators taught workshops using the Understanding and Estimating Cost module. The module included practice identifying health insurance terms, practice estimating health care expenses for a family, and a discussion of ways to reduce health care spending. Participants in the workshops completed surveys before and after the program.
Results/Conclusions: Results from 16 workshops with 186 participants showed that workshop participants increased their confidence in their understanding of health insurance cost terms and their ability to estimate total health care costs. Participants also showed increased likelihood in determining how much they would need to save to cover their health care expenses. For all three increases, results were statistically significant.
Importance to public health: The results show that this program can help health insurance users feel more confident in their ability to understand and plan for health insurance costs. This increased confidence and planning could help participants avoid costly health care mistakes in the future.
VanDyke MPH, Erika (UMB)
Lane Ph.D, Hannah (UMB)
Deitch MS, Rachel (UMB)
Hager Ph.D, Erin (UMB)
Henley Ph.D, Shauna (UMD)
Background: The project was conducted to further investigate the provision of Technical Assistance (TA) in a pilot intervention (Wellness Champions for Change, WCC), which aimed to support the development of school-level wellness teams to enhance wellness policy implementation in schools. In WCC, two intervention approaches (teacher trainings and teacher trainings + TA) were both effective at enhancing wellness policy implementation via formation of active school wellness teams compared to controls (Hager et al., 2018). This finding led researchers to question why TA did not further bolster wellness policy implementation as there was no significant difference between schools who received TA versus schools who did not receive TA.
Goal: The goal of the project was to examine the perception of the provision of TA from both the perspective of the TA provider (“wellness specialists”, extension agents or local health department employees trained to lead teacher training and provide TA) and the TA recipients (“wellness champions”, teachers trained to oversee wellness teams) in order to understand what strategies/methods were perceived to be most and least effective.
Objectives: 1. What are the wellness specialists’ (TA providers) perceptions of the TA they provided to the wellness champions (TA recipients) during the pilot study intervention? 2. What are the wellness champions’ (TA recipients) perceptions of the TA provided by the wellness specialists (TA providers) during the pilot study intervention? 3. How did the perceived interactions with the wellness specialists differ among wellness champions who received only training versus training and TA?
Approach: Semi-structured interviews were conducted in the summer following the intervention year. Five wellness champions in each group (training only and training +TA) participated in interviews (50% of those randomly selected). All wellness champions (n=5) participate in interviews (100%). Interviews were conducted by phone. A qualitative analysis framework and coding guide were developed based on the Social Cognitive Theory (SCT). Interviews were transcribed verbatim and analyzed using MAXQDA software.
Results/Conclusions: The analysis revealed the TA providers were unsure of what TA to provide, faced barriers to facilitating TA, and provided passive TA. The TA recipients expressed facing barriers to receiving TA, but when TA was appropriately provided, felt supported. When comparing schools that received TA vs. schools that did not receive TA, interactions with the TA provider was described similarly; which may explain why the provision of TA had no further impact on pilot study intervention. Recommendations for future TA provision, which reflect the current literature, include clearly defining role of TA to both provider and recipient, providing proactive TA, and possibly constituting a new, broadly used term for “Technical Assistance” to avoid confusion.
Importance to public health: The results of this project provide insight to the potentials barriers for providing effective TA and provide useful recommendations for future applications of TA within the field of public health.
Wandy, Tiffany (LifeBridge Health Clinically Integrated Network)
Gray, Sommer (LifeBridge Health)
Durand, Daniel (LifeBridge Health)
Background: Studies show that lesbian, gay, bisexual, and transgender populations, in addition to having the same basic health needs as the general population, experience health disparities and barriers related to sexual orientation and/or gender identity expression. Many avoid or delay care or receive inappropriate or inferior care because of perceived or real homophobia, biphobia, transphobia, and discrimination by health care providers and institutions.
Goal: To improve awareness and provide strategies for interactions with LGBTQ patients.
Objectives: By the end of the first training, participants will be able to identify at least three risk factors that contribute to LGBTQ disparities By the end of the second training, participants will be able to enact at least two ways to affirm gender
Approach: Conduct an initial mandatory one-hour training with at least 80% of the Radiology Department (both staff and providers) by the end of 2018 Conduct an initial optional one-hour training with at least 50% of the Radiology Department (both staff and providers) by the end of Q2 2019 Improve the Radiology Department’s ability to provide high-quality care for LGBTQ patients by: 1. Increasing knowledge about LGBTQ health/social service needs 2. Increasing LGBTQ-affirming attitudes 3. Increasing LGBTQ-affirming behaviors Develop and refine strategies that enable the Radiology Department to collect and utilize sexual orientation and gender identity data to improve health services and patient outcomes
Results/Conclusions: In order to have a quantifiable way to measure the impact of the training sessions, we implemented a pre/post assessment. The assessments were identical and included a total of five questions, one of which was true/false and four that were open-ended. In the pre-assessment, participants correctly answered an average of 2.5 questions, incorrectly answered an average of 0.5 questions, and left blank an average of 2.0 questions. In the post-assessment, participants correctly answered an average of 4.1 questions (64% increase), incorrectly answered an average of 0.5 questions (no change), and left blank an average of 0.5 questions (75% decrease). Interestingly, the open-ended questions elicited much more comprehensive responses on the post-assessment; the average number of words used to answer the pre-assessment was 12, while the average number of words used to answer the post-assessment was 29 (142% increase).
Importance to public health: Health care providers can take positive steps to promote the health of their LGBTQ patients by examining their practices, offices, policies, and staff training for ways to improve access to quality health care for LGBT people. Participating in provider and staff training programs can give teams the tools necessary to create a welcoming environment for every patient who walks through the door.
Wandy, Tiffany (LifeBridge Health Clinically Integrated Network)
Kiritsy, Michael (LifeBridge Health Clinically Integrated Network)
Background: The LifeBridge Health (LBH) Accountable Care Organization (ACO) serves approximately 18,000 Medicare beneficiaries, many of whom have Type I or Type II diabetes. Like other ACOs across the nation, LBH struggled with low compliance rates for diabetic retinopathy eye exams, with adherence typically hovering around 50%. Primary care providers were diligent with providing patients with referrals to ophthalmologists, but many patients were simply not following through. This lack of follow through was due to a number of challenges and barriers, including education patients about risk, the burdens involved in additional doctor visits for patients who were already under the care of multiple physicians, the costs associated with specialty care, obstacles to access care, and the confusing nature of today’s insurance environment. This care gap is both clinically and financially detrimental. Clinically, patients had pathologies that were undiagnosed, preventing our system from providing interventional care. Nationwide, diabetic retinopathy is the leading cause of blindness in working age adults. Financially, LifeBridge is hurt by not maximizing quality scores across various pay for pay for performance programs, including the Medicare Shared Savings Program.
Goal: Understanding that diagnosed diabetic retinopathy provides primary care physicians with a new level of information to help manage and treat patients with diabetes, and knowing that easy access to this diagnostic exam is best for patient care, LifeBridge sought a solution that was easy for our physicians and clinic teams to use. IRIS (Intelligent Retinal Imaging Systems) was identified as the vendor of choice.
Objectives: To measure whether implementation of this tool effectively enabled providers to better meet the diabetic retinopathy screening measure, we performed two analyses, one comparing practices with IRIS to those without IRIS from the time it was implemented until 11/18, and another comparing the IRIS practices before and after the pilot program was initiated. Manual chart abstraction of patients seen in the previous 4/6 weeks who were eligible for the measure was done to determine the proportion of patients who met the measure. This was done in every Primary Care practice throughout the organization on an approximately quarterly basis. In addition to this analysis, we also report our volume of patients screened as of 3/20/2019.
Approach: A pilot was initiated at three large primary care practice locations in the last quarter of 2017. Two of the locations received table top cameras, while the other location received a more mobile, hand held unit. Working with a dedicated LBH IRIS team, the practices created and implemented workflows, documented processes, and instilled best practices.
Results/Conclusions: Across the three sites, 796 patients have been screened for diabetic retinopathy. Of these 796 patients, 32.9% (274 patients) were diagnosed with pathology. Approximately 15.1% (126 patients) were diagnosed with diabetic retinopathy. We have also identified 83 patients who are considered “IRIS saves,” patients who had pathology identified that was serious enough to put them at imminent risk of losing their sight. For all patients requiring follow up, direct referrals were made to our in-network ophthalmologists at Krieger Eye Institute for treatment that these patients would not have otherwise received. Comparison of practices using IRIS to those who were not showed means of 47.2% and 33.3%, respectively, a 13.9% improvement in screening. Pre-Post comparison of the IRIS Pilot sites showed means of 38.5% and 47.2%, respectively, an 8.7% improvement.
Importance to public health: The introduction of the IRIS screenings at these three offices allowed our primary care providers to provide more comprehensive care to their patients with diabetes, eliminating the need for multiple appointments and office visits. It also was able to demonstrably improve performance in the diabetic retinopathy screening measure, and identify serious retinal pathology that would greatly impact patients’ lives. As a result, PCPs, with IRIS, helped facilitate access to care, thus making it easier for patients to do the right thing for their health.
Wandy, Tiffany (LifeBridge Health Clinically Integrated Network)
Kiritsy, Michael (LifeBridge Health Clinically Integrated Network)
Background: In Maryland, as in many other parts of the country, health care providers are wrestling with the challenge of combating the opioid epidemic. LifeBridge Health is taking a unique, population-based and systems-focused approach to address the issue.
Goal: As part of it’s overarching strategy, the organization is focusing on both provider and patient engagement as a way to change the narrative and perception of with treating those with opioid-related substance use disorder.
Objectives: Decrease opioid prescription use Decrease high-risk opioid use Decrease opioid overdoses Increase treatment for opioid-related substance use disorder
Approach: Our provider engagement program, launched in 2017, centers around sharing high-quality population health data and providing enhanced education to support appropriate referral patterns. We shared population health data directly with providers regarding their prescribing patterns for opioids. These reports identified prescriptions that are deemed suboptimal based off best practice research from Advisory Board and other national organizations. This data has the dual benefit of identifying any providers with suboptimal prescribing patterns, such as patients receiving prescriptions for more than 90 morphine milligram equivalents (MME) per day, patients prescribed 3+ doses of 30mg oxycodone, and patients with four or more opioid prescribers in the past year. Our provider education was structured to convey specific information about various opioid alternatives programs available in our system that may benefit patients with chronic pain. The organization offers minimally invasive procedures which relieve pain without the risks of surgery, general anesthesia, hospital stays or prolonged recovery periods. The goals of these interventions are to help decrease the level of pain and suffering, return patients to their maximum level of functioning and independence, help restore quality of life, and reduce reliance on opioids for pain management. The patient engagement efforts, launched between 2017 and 2018, center around offering Narcan prescriptions and providing care coordination to patients presenting to the Emergency Department (ED) with in opioid overdose. All patients presenting with an opioid overdose are offered a Narcan prescription upon discharge. Furthermore, these patients are screened by a dedicated care coordination team using a validated tool and are offered counseling and referral to treatment.
Results/Conclusions: Since the start of our provider engagement programs, our system has improved opioid prescribing for our patients. In our Medicare ACO population, we reduced those receiving prescriptions of 90 MME by 16% from 2017 to 2018. We also reduced the number of patients who received over three doses of 30mg of oxycodone daily by 11%, and the number of patients receiving opioids from four or more providers during the past year by 10% over the same period. Moreover, we have reduced the number of opioids given in the ED at one of our system hospitals by 20% from 2017 to 2018. Our patient engagement outcomes have also been positive. From 2017 to 2018 we increased the number of patients receiving Narcan prescriptions after an overdose by 38% (130 to 180) in one of our system EDs. Our care coordination efforts, launched in 2018 have also yielded great results. Since initiation we have screened 40,662 patients, 3,988 of whom have screened positive. 1,861 (46.6%) of these patients have received counseling, and 187 (10% of those who received counseling) have been referred to treatment.
Importance to public health: LifeBridge has successfully improved it’s opioid prescribing practices and begun to help those at-risk or already opioid dependent to decrease their use. However, we still have a long way to go to combat this epidemic.
Chu, Jun (UMD SPH Health Services Administration)
Liu, Ying (ETSU College of Public Health Biostatistics and Epidemiology)
Xie, Xin (ETSU College of Business and Technology Economics and Finance)
Background: Alcohol and drug use may influence the unmet need for mental health services; in addition, most of these alcohol and drug use variables might also be inter-correlated. This project studied the inter-relationship among alcohol and drug variables through an oblique principal component cluster analysis (OPCCA).
Goal: The goal of this study was to classify the variables pertaining to alcohol and drug use in the past year and investigate the selected variables of past year alcohol and drug use with the unmet need for mental health services.
Objectives: Our objective was to examine the factor structure of 37 variables pertaining to alcohol and drug use in the past year which may influence the unmet need for mental health services. Our hypothesis was that alcohol and drug use variables might be highly inter-correlated.
Approach: This data was collected on 43,373 adults (ages 18 and above) from the 2015 National Survey on Drug Use and Health (NSDUH). Oblique principal component cluster analysis (OPCCA) was used to classify 37 variables on alcohol and drug use in the past year into disjoint clusters. Weighted multiple logistic regression analysis was used to examine the associations of selected variables with the unmet need of mental health services. The odds ratios and 95% confidence intervals were estimated.
Results/Conclusions: 37 alcohol and drug use variables were divided into 7 clusters. Multiple logistic regression analysis showed that pain reliever use (OR=1.33, 95% CI=1.17-1.50), tranquilizer use (OR=2.49, 95% CI=2.16-2.86), stimulant use (OR=1.22, 95% CI=1.01-1.47), and illicit drug and alcohol use (OR=1.54, 95% CI=1.34-1.77) revealed positive associations with the unmet need for mental health services.
Importance to public health: This project highlights the relationship between drug and alcohol use and provides evidence that there is an unmet need for mental health services for both alcohol and drug users. This is additionally important for public health education as medical professionals dealing with alcohol and substance abuse should also be trained to recognize unmet mental health needs within their patients.
Barrington, Debbie (Georgetown University Department of Human Science)
West, Delia (Georgetown University Department of Human Science)
Background: Obesity prevalence among young adults has increased globally over the last two decades. The impact of education on weight status deserves further investigation in this population.
Goal: To determine the association between education and overweight/obesity in young adults.
Objectives: 1. To assess the distribution of weight status among young adults. 2. To evaluate the relationship between education and overweight/obesity by sex, race/ethnicity, and SES.
Approach: We analyzed 1999-2016 data from the National Health and Nutrition Examination Survey (NHANES) on 9,109 adults aged 18-30. Education categories included college graduate, attending college, some college experience, and high school graduate only (HS-Grad). Overweight/obesity was defined as a body mass index, BMI (kg/m2), of > 25. SES was defined by categories of poverty-to-income ratios (POV): low-income (<1.30), middle-income (1.31-1.85), and high-income (>1.85). Chi-square tests and associated p-values <0.05 determined statistical significance between education and weight status. Logistic regression models were used for age-adjusted associations. Statistical analyses were performed in SAS version 9.4.
Results/Conclusions: Educational status and overweight/obesity prevalence differed by race/ethnicity, sex, and POV. Associations between education and overweight/obesity were found in Non-Hispanic (NH) White (p=0.0016) and NH black (p<0.0001) men, and among Mexican-American (p=0.0030), Hispanic (p=0.0092), White (p=0.0001), and Black (p=0.0002) women. Among low-income White men, those who were in college had lower odds of overweight/obesity compared to HS-Grad (OR=0.42; 95% CI: 0.18,0.98). High-income Black men who were college graduates had an increased odds of overweight/obesity compared to HS-Grad (OR=2.64; 95% CI: 1.22,5.75). Among low income Hispanic women, those who had some college experience had an increased odds of overweight/obesity compared to HS-Grad (OR=2.59; 95% CI: 1.02,6.55). High-income White women who were college graduates had an increased odds of overweight/obesity compared to HS-Grad (OR=0.49; 95% CI: 0.32,0.73).
Importance to public health: Our findings indicate that intersections between race/ethnicity, sex, and SES influence the cardiometabolic health of young adults.
Williams, Natasha D. (UMD SPH Family Science)
Fish, Jessica N. (UMD SPH Family Science)
Background: Compared to heterosexual and cisgender people, lesbian, gay, bisexual, and transgender (LGBT) people indicate poorer physical, mental, and behavioral health, and these disparities vary by race/ethnicity. LGBTQ community-based organizations (CBOs) have provided important access to support and healthcare for the LGBTQ community. Documenting the ways in which LGBTQ CBOs address the unique needs of queer people of color (QPOC) is a crucial step in understanding how these programs help improve LGBTQ population health.
Goal: To document the characteristics and correlates of LGBTQ CBOs offering specific services for QPOC.
Objectives: 1. What LGBTQ CBO characteristics (e.g., size, resources) are associated with offering QPOC-specific services? 2. Are LGBTQ CBOs with QPOC leadership (i.e., board membership, management) more likely to offer specific services for QPOC?
Approach: Data are from a 2018 national survey of LGBTQ CBOs coordinated by CenterLink and the Movement Advancement Project (n = 128). Data analysis is largely descriptive and include measures of central tendency (i.e., frequencies, medians, modes). Logistic regression was utilized to test whether specific traits are associated with offering QPOC-specific services. Models testing RQ2 adjust for geographic region, capacity, and the racial/ethnic makeup of center patrons.
Results/Conclusions: Approximately 50% of all CBOs surveyed reported services that are specifically designed to meet the unique needs of QPOC. Larger centers appear to be better equipped to provide specialized services, although findings suggest that budget does not play a role in whether CBOs offer QPOC-specific services. Perhaps these larger centers are able to accommodate demand regardless of their financial circumstances. This demand may be coming from Black and Other-race LGBTQ patrons in particular, although we cannot determine the impact of the racial/ethnic makeup of the CBO service area on this relationship. Notably, we find preliminary evidence that having people of color in leadership is associated with offering QPOC services, emphasizing the importance of representation in leadership for these organizations.
Importance to public health: Findings offer an initial investigation into the factors that influence whether LGBTQ-serving CBOs offer QPOC-specific services in their communities. These services likely play an important role in improving the population health of QPOC and warrant additional study.
Wilson, Micayla (UMD SPH Behavioral and Community Health)
Howard, Donna (UMD SPH Behavioral and Community Health)
Background: Electronic forms of communication are increasingly reshaping how teenagers socialize, providing new ways to form dating relationships, but also new ways to engage in Teen Dating Violence (TDV). The role electronic communication technologies play in healthy dating relationship formation is a pressing, yet understudied, public health issue.
Goal: The goal of this research is to explore how electronic communication technologies including, but not limited to, social networking sites and text messaging, are used in teen dating relationships and may be used to perpetrate TDV.
Objectives: The research objective is to explore how social networking sites are used specifically in the initiation phase of teen dating relationships among African-American adolescent girls.
Approach: In-depth interviews were conducted with 10 African-American high school females in greater Baltimore, Maryland using methodology consisting of focused probing to explore the role electronic communication technologies play in teen dating relationships. The analytic approach was Qualitative Description, which aimed to describe participants’ perceptions and experiences in the world they navigate. We began with open coding, and progressed through data sorting, resorting, and aggregation, and generation of distinctive themes and sub-themes.
Results/Conclusions: Three themes related to the use of electronic communication technologies and the initiation of teen dating relationships emerged from the analysis: Theme 1: Initial attraction to potential partner based on self-representation online; Sub-theme 1: attraction based on photos posted by potential partner; Sub-theme 2: attraction based on traits perceived through comments and text-based posts; and Sub-theme 3: attraction based on social media biographies; Theme 2: Potential partner compatibility is determined online indirectly without actual communication between potential partners; and Theme 3: Potential partner compatibility is determined online directly through active communication between potential partners
Importance to public health: Current literature on online teen dating relationships focuses on TDV or the use of online dating relationship apps for sexual identity development, less so on elucidating the general nature of online teen dating relationship dynamics. This research aims to better understand how electronic communication technologies influence the formation of online dating relationships among adolescents, and thus its influence on the health and wellbeing of teens involved in these online dating relationship dynamics.
Won, Junyeon (UMD SPH Kinesiology)
Alfini, Alfonso (John's Hopkins University SPH Mental Health)
Weiss, Lauren (UMD NACS and SPH Kinesiology)
Leitner, Brooks (NIH Neurobiology of Fear and Anxiety)
Hagberg, James (UMD SPH Kinesiology)
Smith, J. Carson (UMD NACS and SPH Kinesiology)
Background: Despite the robust body of literature demonstrating the salutary effects of exercise on brain health, there is currently no consensus on the effect of exercise cessation on the aging brain in general, memory function in particular.
Goal: The aim of this study is to examine the effect of 10-day exercise cessation on semantic memory-related functional activation using task-activated fMRI in master athletes.
Objectives: 1.To examine if the FNT performance significantly changes after 10-day detraining compared to baseline. 2.To assess if the fMRI semantic memory activation during the FNT significantly changes after 10-day detraining compared to baseline.
Approach: Twelve older adults athletes (62.6±7.0 years) with long-term endurance training histories (29.0±6.3 years), were recruited from Washington D.C. running clubs. During the 10-day exercise cessation period, participants were asked to remain sedentary, performing only the low-intensity activities of daily living required by a sedentary life style. Before and immediately after the exercise cessation period, fMRI semantic memory activation was measured using the Famous Name Task.
Results/Conclusions: A voxel-wise analysis revealed greater semantic memory activation in eight out of nineteen semantic memory-related regions derived from disjunction maps (FWE p < 0.005). The greater activations during engagement in semantic memory task may suggest decreased neural efficiency as a result of attenuation of training-induced improvement in neural capacity and efficiency.
Importance to public health: The present results provide evidence that even relatively short period of exercise deprivation brings about impactful changes in neural network that may have been strengthened by decades of training-induced effects. This study also indirectly indicates potentially detrimental effects of sedentary lifestyle in the aging brain and sheds light on the significance of sustained and regular participation of physical activity based on one of the most widely-accepted neuroplasticity theories, “use it or lose it”.
Woodard, Nathaniel (UMD SPH Behavioral and Community Health)
Williams, Randi (UMD SPH Behavioral and Community Health)
Fryer, Craig (UMD SPH Behavioral and Community Health)
Wang, Min Qi (UMD SPH Behavioral and Community Health)
Knott, Cheryl (UMD SPH Behavioral and Community Health)
Background: The church has played a large and stable role in African American communities for decades. In addition to offering religious services and resources, in recent years, African American churches have increasingly offered a variety of health programming as part of their ministry. While many churches have instituted these important health initiatives, there is a dearth of empirical literature on the types and quantity of services offered.
Goal: This project seeks to address gaps in the scientific literature by examining health programming implemented by African American churches.
Objectives: 1) Quantify the amount of health areas and programs addressed by a sample of African American churches. 2) identify the range in types of health areas and programs addressed by these churches. 3) Investigate church characteristics, such as church size, building ownership and pastor education, that may predict greater amounts of programs offered.
Approach: Leaders of African American churches (N=119) were recruited through Facebook ads, faith-based magazine advertising, and networks of community partners. Leaders were asked to complete a paper or digital questionnaire assessing general church characteristics and health promotion activities conducted. Analyses include Pearson’s bivariate correlation and independent sample t-tests.
Results/Conclusions: Within the past 12 months, churches offered an average of 6.08 health programs (SD = 2.15), the most common being food assistance, shelter/clothing assistance, mentioning health in sermons, and distributing health information. An average of 4.66 different health areas (SD = 3.63) were prioritized, the most common being cancer, heart disease, and diet. The quantity of programs was correlated with the number of adult members (r = .223, p = .016), part time staff (r = .280, p = .013), and health areas addressed (r = .622. p < .001). Churches with a health ministry offered 1.66 more programs (p < .001) and addressed 3.46 more areas (p < .001) than churches without a health ministry.
Importance to public health: Understanding the scope and predictors of these services allows practitioners to better assist churches in their health promotion activities through improving and evaluating programming that already exists and introducing interventions to address the gaps in health issues adopted by the church.
Barrington, Debbie (Georgetown University NHS Department of Human Science)
Yang, Henry (Georgetown University NHS Department of Human Science)
Background: Acculturation has been linked to worsening cardiovascular health among US immigrants. However, the relationship between acculturation and hypertension in a nationally representative sample of Asian Americans remains largely unexplored.
Goal: To determine the association between acculturation and hypertension in Asian Americans.
Objectives: To describe the relationship between hypertension and three measures of acculturation: citizenship status, length of residency, and language spoken at home.
Approach: We analyzed 2011-2016 data from the National Health and Nutrition Examination Survey (NHANES) on 1,973 non-Hispanic (NH) Asians aged ≥ 20 years. Measures of acculturation were citizenship status, years of US residency, and language spoken at home. Hypertension was defined based on the 2017 American Heart Association (AHA) guidelines: systolic blood pressure (mSBP) ≥ 130 mmHg and/or mean diastolic blood pressure (mDBP) ≥ 80 mmHg and/or taking antihypertensive medication. Chi-Square tests and associated p-values <0.05 determined statistical significance of the independent relationship between acculturation measures and hypertension. Multivariable logistic regression models were used to determine the age-adjusted association between acculturative status and hypertension. All statistical analyses were performed in SAS version 9.4.
Results/Conclusions: The prevalence of hypertension was 43.6% for men and 35.2% for women. US-born Asians had a higher prevalence of hypertension compared to foreign-born Asians (44.6% vs 30.2%; p<0.0001). Those who spoke both English and their native language equally at home had the lowest prevalence of hypertension (30.3%). Hypertension increased with longer US residency (<10 years: 25.0%, ≥ 10 years: 47.2%). After age-adjustment, foreign-born had lower odds of hypertension compared to US-born Asians (OR=0.78; 95% CI: 0.63,0.98); women who spoke more of their native language at home had lower odds of hypertension compared to those who only spoke English (OR=0.56; 95% CI: 0.34,0.92); and, among women, longer length of residency increased risk for hypertension (OR <10 years vs. ≥ 10 years=1.70; 95% CI: 1.23,2.35).
Importance to public health: With the increased influx of Asian immigrants, further investigation is needed into how their cardiovascular health changes with increased assimilation into the US.
Yee, Eileen (Georgetown University Human Science)
Barrington, Debbie (Georgetown University Human Science)
Background: Racial/ethnic differences have been found in the prevalence of diagnosed and undiagnosed diabetes. The nationwide prevalence of uncontrolled diabetes in Asian Americans relative to other racial/ethnic groups remains unexplored.
Goal: To investigate the prevalence of uncontrolled diabetes in the US.
Objectives: 1. To state the racial/ethnic and sex differences in the prevalence of diabetes. 2. To describe the racial/ethnic and sex differences in uncontrolled diabetes before and after controlling for confounders.
Approach: We analyzed 2011-2016 data from the National Health and Nutrition Examination Survey (NHANES) on 14872 adults ages ≥20 years. A sub-sample of 1985 individuals diagnosed with diabetes was used to estimate the prevalence of uncontrolled diabetes. Race/ethnicity, age, sex, and diabetes status were self-reported. Uncontrolled diabetes was defined as a measured glycohemoglobin level of ≥7% as per American Diabetes Association (ADA) 2018 recommendations. Chi square tests and associated p-values <0.05 determined statistical significance of racial/ethnic and sex differences in uncontrolled diabetes. Sex-stratified multivariable logistic regression models adjusting for confounders were used to describe the independent associations between race/ethnicity and uncontrolled diabetes. All statistical analyses were performed in SAS version 9.4.
Results/Conclusions: The prevalence of diabetes was 8.9% for Non-Hispanic (NH) Whites, 13.1% for NH Blacks, 11.7% for Mexican Americans, 9.5% for Other Hispanics, and 9.3% for NH Asians (p<0.0001). Among men, the prevalence of uncontrolled diabetes was 49.3% for NH Whites, 54.0% for NH Blacks, 65.9% for Mexican Americans, 44.6% for Other Hispanics, and 53.6% for NH Asians (p=0.0025). Among women, the prevalence of uncontrolled diabetes was 42.9% for NH Whites, 48.1% for NH Blacks, 56.4% for Mexican Americans, 62.5% for Other Hispanics, and 48.8% for NH Asians (p=0.0047). Age-adjusted logistic regression models reveal racial/ethnic differences in uncontrolled diabetes relative to NH Whites: NH Blacks (OR=1.23, 95% CI: 0.82,1.86), Mexican Americans (OR=1.72; 95%CI: 1.06,2.79), Other Hispanic (OR=2.22, 95% CI: 0.990,1.01), NH Asians (OR=1.27, 95% CI: 0.73,2.22). Racial/ethnic differences remained after adjusting for confounders.
Importance to public health: Racial/ethnic differences in uncontrolled diabetes suggest that certain groups will be disproportionately impacted by long-term consequences such as neuropathy, nephropathy, and premature mortality.
Zhu, Qianyu (UMD COE CHSE School Psychology)
Wang, Cixin (UMD COE CHSE School Psychology)
Background: Academic stress is common among high school students (APA, 2014; Cadime et al., 2016; Compas, Orosan, & Grant, 1993; Shih, 2015), as high school students are often involved in many demanding academic activities every day (Cadime et al., 2016). High school years are more stressful for Chinese students because of the cultural emphasis on academic success, intense competition for college entrance exam, and attending a good university is regarded as the primary way to pursue upward mobility (Hu & Schaufeli, 2009; Shih, 2015).
Goal: To examine the relationship between parental involvement, parenting style, students’ academic burnout, and engagement over time among Chinese students.
Objectives: 1.To examine whether parental involvement and parenting style at T1 will predict students’ academic burnout and engagement at T3. 2.To examine whether students’ insecure attachment at T2 will mediate the relationship between parental involvement and parenting style at T1 and students’ academic burnout and engagement at T3.
Approach: A total of 238 Chinese high school students (32.8% 10th graders, 40.3% 11th graders, and 26.9% 12th graders, 55% boys) and their parents participated in this study. First, fathers and mothers completed the parental involvement and parenting style questionnaires. Then students completed attachment and perceived parental support questionnaires a month later (T2). And two weeks after that, students completed academic burnout and engagement questionnaires (T3).
Results/Conclusions: Results supported three mediation pathways linking parental behavior to adolescents’ academic burnout or engagement. Fathers’ authoritative parenting style predicted less insecure attachment among adolescents, which then resulted in less academic burnout. On the other hand, mothers’ authoritarian parenting style predicted more insecure attachment among adolescents, which then results in more academic burnout. Fathers’ involvement in education predicted more perceived support, which then resulted in greater academic engagement for their adolescents.
Importance to public health: It is important to promote authoritative parenting (instead of authoritarian parenting) and parental involvement to prevent adolescents’ academic burnout and foster academic engagement among high school students in China.