2015 Master of Public Health Graduates

Capstone Abstracts & Presentations

2015 MPH Graduates

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  Kyle Adams - The Relationship Between Shift Work Schedule and Worker Health

kadams@printpack.com
Advisor: Robert Goldberg, MD

Abstract:

This paper seeks to summarize the current state of research into the health effects of shift work and make recommendations for the design of a shift schedule least detrimental to worker health. A PubMed search was conducted with occupational, health, schedule, shift, and effects selected as keywords. The resulting articles were assessed for sufficient quality and relevance before being included in this review.  The effects of shift work on Circadian rhythm and sleep disorders, cardiometabolic and endocrine health, and psychosocial health were explored. The impact on health of workers due to variables in shift design such as shift duration, shift rotation direction, and shift start time was also reviewed.

Overall, shift work schedules appear to contribute to increased chronic health issues in workers, but those results vary greatly in prevalence and severity. Shift schedule design variables were found to have minimal impact on the health of workers.  The most important aspect of schedule design was found to be worker acceptance and support of the schedule being implemented.  A common theme throughout the literature reviewed was a theory that some individual workers are more likely to successfully adapt to shift work without detriment to health than the average worker.  Future research should increase focus on this topic in order to gain a better understanding of what makes some individuals more adaptable to shift work schedules.

PowerPoint Presentation (PDF)

 

  Jessica Bell - The Impact of the HPV Vaccine on Boys and Young Men

bell.jessica721@gmail.com
Advisor: Andrew Petroll, MD, MS

Abstract:

Objective: To understand how HPV vaccination rates can be increased in boys and young men.

Methods: A review of literature was done to learn the possible reasons for low vaccination rates among boys and young men as well as how effective the vaccine has been in this population. Media campaigns were reviewed to determine how much influence such campaigns have over rates of vaccination.

Results: Barriers to vaccination were found to be stigma and level of awareness. Stigma towards vaccination due to lack of perceived need, age of potential vaccination of boys and fear of side effects were described. Knowledge of HPV and the HPV vaccination were found to be limited.

Conclusion: There is a need for increased awareness and more education on the HPV vaccine. A national HPV vaccination program and campaign could increase knowledge and awareness of the vaccination and thus increase vaccination rates. 

PowerPoint Presentation (PDF)

  Christa Cupp - The Landscape of Wisconsin's Voluntary Public Health Accreditation

10.cmarie@gmail.com
Kusuma Madamala, PhD, MPH

Abstract:

Wisconsin was one of the first states to have a PHAB accredited health department and is currently one of the leading states with the most accredited health departments. Lack of perspective of accreditation experiences from local health departments in Wisconsin prompted semi- structured interviews with representatives, both health department directors and/or accreditation coordinators, from Wisconsin's six accredited health departments. Facilitators, barriers and the impact of accreditation were explored. Maintaining accreditation status was also examined. Strong leadership engagement was identified as a facilitator to accreditation. Competing priorities, funding and insufficient staff time were noted as barriers to the accreditation process. Respondents indicated the impact of accreditation has been an increased visibility and credibility for their organizations. For example, health departments have seen an increase in media attention as well as an increase in community partner involvement. While accreditation has had a positive impact on Wisconsin health departments, continued research should be conducted to further evaluate the impact of accreditation.

PowerPoint Presentation (PDF) 
 

  Abby Demler - Suicide Behaviors Among Individuals With Intellectual Disabilities: A Literature Review

abby.dem27@gmail.com
Advisor: Zeno Franco, PhD

Abstract:

The purpose of this paper is to review available literature regarding suicide behavior among adults, children, and adolescents clinically diagnosed with intellectual disabilities.  Suicide is a public health concern that causes injury and death in populations worldwide. Efforts to address this concern have been attempted among the general population, but limited research is available to explore how suicide impacts intellectuals with disabilities.  About 1-3% of the total United States population has been clinically diagnosed with an intellectual disability. The PubMed database available through The Medical College of Wisconsin was used to retrieve articles to review how suicide behaviors impact individuals with intellectual disabilities.   Majors trends found while conducting this literature review include: 1) As age increases, the likelihood of suicide behavior also increases; 2) The likelihood of suicide behavior was found to be more evident in the female gender as age increased; 3) Suicide behaviors were found more prevalent in patients with higher IQ scores (within the range of intellectual disability); and 4) Presence of mood disorders and schizophrenia contributed to increased rate of suicide behaviors among both adults and children and adolescent age groups. Public health efforts to address the lack of research include an ongoing collection of data to support public action. Surveillance efforts are applied to support these efforts in development of methods for prevention, screening, and for better understanding of how disability evolves over time.

PowerPoint Presentation (PDF)

 

  Kelsey Dietrich - Using SNAP to incentivize fruit and vegetable purchases: A review of pilot programs and recommendations

kelsey.a.dietrich@gmail.com
Advisor: David Nelson, PhD, MS

Abstract:

Background: A primary goal of the Supplemental Nutrition Assistance Program (SNAP) is to promote nutritionally adequate diets. Despite recent education initiatives to improve dietary quality among SNAP participants, this population continues to fall short of federal recommendations for fruit and vegetable consumption. Programs that provide a financial incentive for fruit and vegetable purchases have been tested as a method for improving diet and health among this population. The objective of this paper was to review the evidence for incorporating a financial incentive into national SNAP policy.

Methods: A search was conducted using Scopus, Ovid, and PubMed to identify SNAP-based financial incentive programs (SBFIP). The USDA Economic Research Service website and references from relevant studies were also reviewed. Studies or reports that evaluated at least one of the following were included in the review: fruit and/or vegetable consumption; fruit and/or vegetable purchase patterns; types of fruits and/or vegetables purchased; or percentage of food purchased using SBFIP benefits that was consumed.

Results: These programs are well utilized, and participants generally report increasing their purchase and/or consumption of fruits and vegetables. Many studies identified in this review did not provide sampling or analysis methods, had small sample size, or used convenience samples, and the findings may not be generalizable to the broad SNAP population. These programs may be most effective for participants who have difficulty accessing fresh produce outside of farmers’ markets, those who have lower levels of education, and those who do not consume fruits and vegetables frequently.

Conclusion: Studies reported an increase in self-reported fruit and vegetable intake among surveyed program participants, but there is insufficient evidence that these programs improve long-term diet and health. More rigorous and long-term studies are needed prior to incorporating this incentive into national SNAP policy.  

PowerPoint Presentation (PDF)
 

  Jon-Christopher Ecker - Lyme Disease, Prevention Methods and Program Planning

Advisor: Jenifer Coburn, PhD

 

 

  Cynthia Esparza - Childhood Obesity: Literature Review of Best Practices of Meal Programs Nationwide

cynthia_esparza17@live.com
Advisor: Eric Gass, PhD

Abstract:

Background: Childhood obesity has become a serious public health concern across the United States. According to the Centers for Disease Control and Prevention data, childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. It has both immediate and long-term effects on health and well-being. Overweight and obesity are associated with increased risk for heart disease, diabetes, stroke, several types of cancer, osteoarthritis, etc. The objective is to evaluate the evidence in existing literature, examining successful meal programs that have addressed the issue of childhood obesity within schools.

Methods: A literature review regarding the elimination of competitive foods, promotion of nutrition education services, and pricing and availability of fruits and vegetables at schools was conducted.

Results: Creating rigorous new competitive food nutrition standards improved meal program standards by removing unhealthy alternatives from school environments. Nutrition and food choice promotion resulted as an accessible and effective tool in developing healthy nutrition-related practice and dietary habits in youth. Availability of fruits and vegetables appeared to have an inconsistent effect on food choices; however, lower prices for fruits and vegetables were consistently associated with higher consumption of these items. 

Conclusion: While childhood obesity may not be overcome by efforts of school systems alone, the need to promote healthy eating among youth has intensified as a result of the growing national epidemic of obesity. Schools provide an important opportunity for childhood obesity prevention. Overall, more efforts and resources should be devoted to policy and implementation efforts at the federal, state, and local levels.

 PowerPoint Presentation (PDF)

 

  Childhood Diabetes in the United States - A 14-Year Review of the National Health and Nutrition Examination Survey (NHANES) Data (1999-2012)

Abstract:

Background: Childhood diabetes is becoming increasingly recognized as an important public health issue in the United States (U.S.). The Centers for Disease Control (CDC) National Health and Nutrition Examination Survey (NHANES) database is a national survey of the U.S. population since 1999. The purpose of this study is to examine prevalence and trends of childhood diabetes among U.S. participants to the (NHANES) during survey years 1999-2012, with additional information on the sub-populations.

Methods: A cross-sectional secondary analysis of integrated 1999-2012 NHANES datasets pertaining to information from the diabetes questionnaires as well as related data of demographics, physical examination, and laboratory values was conducted. Prevalence and trends of each of the seven biannual periods for participants <20 years of age were computed and compared. Subgroup analyses based on race, gender, age, family income, and type of diabetes were conducted. Glycosylated hemoglobin (HgB-A1C) was used to examine disease control and body mass index (BMI) was used to ascertain the association between childhood obesity diabetes prevalence. Multivariate logistic regression modeling was used to assess risk factors. SAS procedure ‘PROC SURVEYLOGISTIC’ was employed to examine the data including testing of any trends as appropriate.

Results: Ninety cases of childhood diabetes (Type 1 and Type 2) were identified from a total of 33,892 pediatric participants from 1999-2012. The overall prevalence was 304 per 100,000 (0.3% of the population) with no obvious upward or downward trend, despite some variations. Applying the ~85 million people <20 of age 2010 U.S. Census population data, this was translated into a population estimate of ~250,000 children with diabetes. U.S. Prevalence of Type 1 vs. Type 2 childhood diabetes estimates was 217 and 87 per 100,000, respectively. Subgroup analyses showed higher prevalence among older age groups (>10 years of age) but no significant difference was found in gender or family income. Moreover, despite numerically slightly higher prevalence among non-Hispanic Black, there was no statistical significance demonstrated among any racial groups. Disease control among the subjects was moderate (median HgB-A1C=7.6) although it should be noted that about one-third of the participants had this data missing. There were no obvious obesity trend (defined as ≥ 95 percentile of BMI for specific age/gender) demonstrated among the 33,892 pediatric participants along with no correlation with Type 2 diabetes prevalence observed. Statistical analyses using multivariate regression model showed age (p = 0.0215) and BMI (p = 0.0048) as the only risk factors for diabetes, but not other parameters.

Conclusions: Despite no observed upward trend in prevalence from this study, childhood diabetes remains an important public health issue. Further research into issues such as etiology, medication compliance and diabetes-related complications would aid policy makers in designing optimal policies to ensure proper health access, education, and preventive efforts for patients to better manage this important disease.

Keywords: Childhood Diabetes, Epidemiology, Prevalence, Risk Factors, National Health and Nutrition Examination Survey (NHANES)


 

 

  Leanne Fusco - Parent Engagement in School Health Programs, Best Practices of Parent Engagement in the Development and Sustainability of School Health Programs

leafusco@gmail.com
Advisor: David Nelson, PhD

Abstract:

Objective: To analyze data, research and articles on the effect of parent engagement in school health programs.

Methods: Ovid Medline, ERIC, Education Research Complete and the Educational Administration Abstract files were used to combine the terms “Health Promotion”, “Health Education with Schools” and “Parent Engagement “ to retrieve relevant articles. Articles were kept or discarded based on the level of discussion and analysis on parent engagement in school health programs. Forty-four articles found were directly related to parent engagement in school health programs.

Results: Research suggests that parent engagement enhances the effect of school health programs and improves the health of children and families. There are recommendations to engage parents in school health programs. Barriers on reasons why parents do not engage in school programs are discussed. Recommendations to increase parent engagement in school health programs are made.

Conclusion: Parent engagement in school health programs enhances the effectiveness of the program and reduces health risks in school aged children.

PowerPoint Presentation (PDF)

  Erin Hammelev - Childhood asthma: a literature review evaluating risk factors, barriers to care, and the health programs available to mitigate these issues.

ehammelev@gmail.com
Advisor: Mitchell Grayson, MD

Abstract:

Asthma is a chronic disease characterized by inflammation of the lungs and narrowing of air passages that result in shortness of breath, wheezing, chest tightness, and coughing. Asthma involves a combination of genetic predispositions and environmental exposures.  These exposures include indoor and outdoor allergens, tobacco smoke, chemical irritants, and air pollution. Socioeconomic and ethnic disparities also exist, with African American and Puerto Rican children being at a higher risk of developing asthma.  This literature review discusses these risk factors and barriers to care in more detail.  In addition, health programs are identified that mainly focus on parental education as well as environmental inspections.  

PowerPoint Presentation (PDF)

  Patrick McCarty, MD - Cardiovascular Deaths in Firefighters

patrick_mccarty@inova.org
Advisor: Charles Cady, MD

Abstract:

Firefighters suffer on duty cardiac deaths and non-fatal cardiac events while responding to fires. This rate has not been declining in spite of a reduced number of structural fires and improvements in equipment and technique. Current standards in place to monitor and improve firefighters’ health have not been implemented universally, and these standards leave much to the discretion of individual departments. Current standards for monitoring cardiac risk factors may not be consistent with clinical preventive medicine best practices, and may need to be updated. Screening for cardiac disease in this high risk group has not been standardized and implementation is variable. Further research regarding screening is clearly needed. Firefighters have high rates of obesity and low fitness which may be amenable to changes in lifestyle. Design of firefighter wellness programs to improve diet and exercise has not been standardized and implementation is incomplete at best. Standardization and implementation of a firefighter wellness program should be a priority for national authorities and fire departments alike.  

PowerPoint Presentation (PDF)

  Andrea Moosreiner - The Agricultural Act, Food Environments and Food Insecurity

amoosreiner@mcw.edu
Advisor: Eric Gass, PhD

Abstract:

The Agricultural Act of 2014 and previous Farm Bills are as much of a health policy as they are a regulatory agricultural policy. The Act encourages certain types of commodity crops to be planted which then influences the cost and nutrient content of America’s food supplies. The gap between food supplies and the Dietary Guidelines have been researched and documented. The Agricultural Act also regulates federal nutrition assistance programs that aid food insecurity which has been at an all-time high since 2008. A greater understanding of how the Agricultural Act impacts food environments and food insecurity is needed due to the current statues of diet related illnesses and food insecurity levels. This summary will articulate questions for researchers and consumers on provisions of the latest bill and potentially guide a movement that supports a food system high in nutrient-dense foods and increase dietary intakes of those who are food insecure.   

PowerPoint Presentation (PDF)     

  Cody Pearce - Is Racine's Public Health Emergency Preparedness Plan Ready for Project Public Health Ready? A Gap Analysis and Improvement Plan

cpearce06@yahoo.com
Advisor: Zeno Franco, PhD

Abstract:

Introduction: Inadequacies identified within the U.S. public health workforce for responding appropriately to emergencies prompted increased funding to provide training for these workers, and also called for greater accountability for ensuring preparedness in the future. Project Public Health Ready (PPHR) is a national program that evaluates emergency preparedness levels of health departments, with a goal of ensuring these programs meet best practices. The City of Racine Health Department (RHD) maintains a Public Health Emergency Plan (PHEP), with guidelines and resources for responding to public health emergencies. The objective of this project is to compare the PHEP to the PPHR program’s guidelines, performing a gap analysis and creating an improvement plan for the PHEP.

Methods: PPHR documents were reviewed in conjunction with the PHEP. Areas where the PHEP does not meet guidelines were noted, as were opportunities for improvement of the PHEP overall. A literature review was performed to research the effectiveness of performance improvement programs aimed at emergency preparedness.
Results. The vast majority of topic areas in the PPHR Criteria were satisfied by the PHEP; however, a small number of deficiencies were identified in the plan. Two entire topics are not included in the PHEP and several smaller individual measures, under various topic areas, are missing as well.

Discussion: Many identified gaps can be resolved by including the requested information in the applicable sections of the PHEP. The missing topic areas are fulfilled by the Racine County Comprehensive Emergency Management Plan, which assigned those duties to other agencies. Opportunities for improving the PHEP in other ways include more frequent updates of staff and agency contact lists. Personal experience with RHD and the PHEP points out further opportunities for improving preparedness in Racine.

Conclusion: Further studies to prove the effectiveness of programs like PPHR are important, and although participation in PPHR is beneficial for health departments and their communities, there are definite obstacles to the process. Overall, RHD appears to be well on its way to a successful PPHR application, should the decision be made to seek recognition.

PowerPoint Presentation (PDF)
 

  Maria Pechacek - A Child Care Walkthrough Program Plan

mapech07@smumn.edu
Advisor: Mitchell Grayson, MD

Abstract:

The child care walkthrough program serves as a tool for child care centers to reduce asthma triggers within their environments. These changes will improve the air quality in the environment and therefore decreases asthma exacerbations in the children and staff. This program plan serves as a guide for other communities to implement a child care walkthrough as it includes the defined outcomes, organizational plan, budget and performance management sections. The information provides sufficient detail to create, organize and evaluate for the child care walkthrough program.

PowerPoint Presentation (PDF)

 

  Megan Rozman - The Impact of the Affordable Care Act on Emergency Department Utilization

megrozman@gmail.com
Advisor: Eric Gass, PhD

Abstract:

Objective: To use data to determine how Emergency Department (ED) utilization at Froedtert Hospital has changed between the years 2013 and 2014, corresponding to the introduction of new health insurance laws after the enactment of the Patient Protection and Affordable Care Act (ACA). 

Methods: ED data was analyzed for each year across a variety of demographic and clinical variables. Chi-square tests were calculated comparing admission rates according to age, gender, race, zip code, type of payment, time of admission, acuity of presenting symptoms, and Ambulatory Care Sensitive Condition (ACSC) status. Logical regression tests were also calculated for each year on both admission time and ACSC status using race, income-based zip code category, and group as predictors.

Results: We identified three major themes across the ED data: 1) a greater proportion of patients used the ED for more appropriate reasons in terms of both admission time and reason for visit in 2014, 2) there was a shift to higher proportions of people presenting Medicaid insurance and less who self-paid for treatment in 2014, and 3) the payer dynamics shifted in both the low income and high income zip codes.

Conclusion: It is proposed that the expansion of Medicaid and more affordable private insurance to those not eligible for government programs has led to fewer people using ED resources for non-critical reasons and for conditions that could have been prevented by access to a medical home, as well as people using the medical home resources in their community.

PowerPoint Presentation (PDF)

  Erich Stauder - Cadavers as Educators: Planning an Approach to Utilizing Body Donors to Deliver Health Behavior and Preventable Disease Education

erich.stauder@gmail.com
Advisor: Todd Hoagland, PhD

Abstract:

Background/Purpose: Respect for medical school body donors (cadavers) can be demonstrated by maximizing their educational value.  Therefore, a program plan was developed and the Cadavers as Educators (CAE) program was formed to use body donors to teach high school students about health behaviors and preventable disease, and this study documents the CAE program planning process.

Literature Review: Health education best practices were determined, including: using a wide variety of active learning strategies that let students learn in a practical manner, addressing multiple risk behaviors concurrently, stressing the need for engagement in multiple positive health behaviors as only the combined approach will be effective, and finally taking advantage of an existing area of interest can improve intervention success.   Also, the current health behavior status of high school student regarding alcohol and tobacco use, unhealthy diet/obesity, inadequate physical activity, and sexual behaviors leading to STD was investigated.

Curriculum: After development of Logic Model and program plan, curriculum was developed using health education best practices and focused on current health behavior problems found in literature review.  The M1 lead CAE curriculum covers the Thorax, Abdomen, and Extremities.  Anatomy and physiology are introduced and briefly explained, and then healthy and diseased organs will be demonstrated and compared as participants hold them.  Health behaviors which caused the pathology are discussed as well as disease prevention. 

PowerPoint Presentation (PDF)

  Le'erin Voss - Literature Review: Improving the Health of Injection Drug Users by Harm Reduction Methods and Education to Reduce Transmission of Viral Infections

vossleerin@gmail.com
Advisor: Janaki Shah, DO

Abstract:

Illicit drug use presents a problem not only within the confines of the U.S., but across the globe.  Injecting illicit drugs into one’s body presents additional confounders beyond the mere concern of the drug problem itself, but also in that it increases individuals risk for injected-related, blood borne diseases, such as the Human Immunodeficiency Virus and Hepatitis C Virus.  Harm reduction and education are considered potential means to possibly reduce transmission of such blood borne disease.  However, harm reduction programs that provide needle exchange materials and safer injection facilities are controversial, as some feel these programs promote injection drug use, rather than avert disease transmission.  The aim of the literature review is to determine the effectiveness of needle exchange programs based on reduction viral transmission, specifically, Hepatitis C Virus Transmission, and Human Immunodeficiency Virus Transmission.  Articles were collected from an array of databases.  The effectiveness of harm reduction and educational programs was measured in terms of diminishing disease and economic outcomes.   Harm reduction programs, specifically needle exchange programs, were determined both effective in reducing disease and economic burden on society.

PowerPoint Presentation (PDF)

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