2016 Master of Public Health Graduates

Capstone Abstracts & Presentations

2016 Master of Public Health Graduates

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  Anupama Aryal Khanal - Early Detection and Prevention of Pulmonary Tuberculosis in Rural Nepal

anupama_aryal@yahoo.com
Advisor: Alan Wells, PhD

Abstract:

Pulmonary Tuberculosis (TB) is a major health problem of Nepal that significantly contributes to increasing morbidity and mortality rates of rural populations. According to the Global Health Delivery Project at Harvard University, nearly half (45 percent) of the country’s total population of 28 million in 2013 was infected with TB (Banstola, 2012).  Each year 40,000 people get the active disease of whom 5,000 to 7,000 die due to the lack of basic detection and treatment (GHDonline, 2012). TB mortality is tragic given that the deaths are preventable if there is reasonable access to health care facilities for timely diagnosis and treatment. The lack of infrastructure, financial resources, equipment, supplies, a surveillance system and trained staff continue to hinder the development, expansion, and implementation of early detection and prevention programs in rural Nepal. Multidrug–resistant TB (MDR-TB) is yet another threat, which is a result of poor and inefficient TB-control programs in this region (National TB Center, 2014).  The condition has worsened after the earthquake in April 25, 2015, put thousands of people living in temporary shelter at risk for getting this disease.

The purpose of this paper is to review the current programs and efforts undertaken for the early diagnosis and treatment of pulmonary TB in rural Nepal. The circumstances contributing to the higher incidence and prevalence of TB, as well as the challenges, the role of the public health sector in addressing this issue, and possible approaches for addressing the problems will be discussed.

PowerPoint Presentation  (PDF)

 

  Elizabeth Beck - A Comprehensive Review of Current Initiatives and Policies in Portage County that Work to Prevent Alcohol Abuse

elizabeth.beck01@yahoo.com
Advisor: Eric Gass, PhD

Abstract:

Background

Alcohol abuse in Portage County has been consistently high over the years and has created a number of health concerns. Research conducted by The Community Guide among other sources has provided a foundation of recommendations that may prove useful for Portage County to adopt to prevent alcohol abuse.

Methods

A literature review, which examined potential initiatives to prevent alcohol abuse in addition to the Portage County Alcohol and Other Drug Abuse (AODA) Coalition board member survey, was conducted. These two research approaches provided the baseline for this study.

Results

Outcomes of the literature review and AODA Coalition board member survey indicate there are several different policies and initiatives that Portage County could adopt to prevent alcohol abuse. Next steps for the county would be to assess what resources are currently available and then create a plan of what changes should be implemented to prevent alcohol abuse.

Conclusion

There are a number of comprehensive, evidence-based practices that may be a good fit to help Portage County prevent alcohol abuse. Initiatives to raise the price of alcohol in particular have shown a decrease in alcohol consumption and availability. The adoption of new policies and initiatives is crucial for Portage County to aid in the reduction of alcohol abuse.

PowerPoint Presentation (PDF)

 

  Carsen Bentley - Integrating Oral Health into Social Marketing Campaigns: Program Development and Description for San Francisco's Children's Oral Health Strategic Plan

carsenbentley@gmail.com
Advisor: Jennifer Peterson, PhD

Abstract:

Integrating oral health into an existing San Francisco Department of Public Health (SFDPH) social marketing campaign was a specific goal of the San Francisco Children’s Oral Health Strategic Plan 2014-2017 with the purpose to more fully integrate oral health promotion into the City’s overall health promotion efforts. In the winter of 2015, utilizing a collaborative approach, oral health was successfully integrated in the Open Truth campaign, promoting decreased consumption of sugar sweetened beverages in order to improve health outcomes, including decreasing tooth decay.

PowerPoint Presentation (PDF)

 

  Heather Blum - Point of Dispensing at Northeast Wisconsin Technical College

Advisor: Nancy Kreuser, PhD

 

 

 

  Pa Nhia Chang - A Literature Review, The Relationship Between Maternal Adverse Childhood Experiences (ACES) and Infant Mortality

pchang@mcw.edu
Advisor: Eric Gass, PhD

Abstract:

Background: Infant mortality is defined as the death of a baby before his or her first birthday. Infant mortality rate is used as an indicator to measure the health and wellbeing of a nation since it is often associated with multiple risk factors such as maternal health, access to medical care, and socioeconomic status. ACEs are traumatic experiences that a child experienced before turning 18 years old. ACEs are separated into three main categories: abuse, neglect, and household dysfunction. The intent of this paper is to conduct a literature review to better understand the relationship between ACEs and infant mortality.

Methods: PubMed and Academic Search Premier were used to identify studies and secondary data sources for the literature review. The search term used was “Adverse Childhood Experiences” which resulted in 416 PubMed articles and 499 Academic Search Premier articles. A total of 17 articles will be reviewed.

Results: Certain ACEs such as sexual abuse, substance abuse, domestic violence, incarceration, and emotional neglect have more of an impact on infant mortality. Household dysfunction seemed to have a greater impact on the contributing risk factors for preterm birth, SIDS, maternal complications, and injuries compared to other types of ACEs.

Conclusions: The literature review demonstrated that there is a dose response relationship between ACEs and risk factors which increases the risks of infant mortality.

PowerPoint Presentation (PDF)

  Charlotte Herzele - Developing a Measure to Evaluate Changes in Eating Behaviors in Households of Youth Who Participate in the Urban Roots Internship Program

herzele@utexas.edu
Advisor: Alan Wells, PhD

Abstract:

Obesity among children has become an epidemic. Efforts to combat childhood obesity have turned to multifactorial interventions like urban gardening programs that focus on building skills and knowledge around healthy eating. The evaluation literature generally focuses on self-efficacy of participants to initiate changes in attitudes and behaviors surrounding attitudes toward foods and nutrition.

This project grew out of desire to learn if there was a behavioral and/or a psychosocial impact on the household members of youth who participate in a gardening intervention, Urban Roots Youth Internship program, in Austin, Texas.   The Urban Roots (UR) Youth Internships offers twenty-four youth, aged 14 to 17 years an opportunity to intern on a 3.5 acre urban farm and learn to cultivate the land, plant and grow fruits and vegetables, harvest the produce, and donate approximately 40% of the 30,000 pound harvest to food pantries and soup kitchens and market the remaining 60% through Farmers Markets and a Community Supported Agriculture (CSA) program. A search of recent literature, using the online search engines Google Scholar and PubMed.gov. with the search terms, youth gardening interventions, impact on family members (of gardening interventions), eating behaviors, family meals, fruit and vegetable consumption, and child-to-parent learning yielded evidence of positive effects of paid youth internships, child-child learning, value of fruit and vegetable consumption and the value of family meals. There was no literature found regarding child-to-parent learning.

Increasing fruit and vegetable consumption is positively associated with health benefits including decreased risk of cardiovascular disease, diabetes, and cancer. The USDA, American Cancer Society, and American Heart Association recommend that people consume five or more servings per day of fruits and vegetables; yet, a report by the Continuing Survey of Food Intakes by Individuals showed that children aged 2 to 19, averaged 1.3 servings/day and 2.6 servings/day of fruit and vegetables, respectively. Fewer than 26% met the recommendations for fruit and fewer than 36% met the recommendations for vegetables.

Youth who participate in the UR internships bring home fresh produce. In addition to learning to grow and market the produce, they learn ways to prepare what they grow in healthy ways.  The UR Internship program holds potential to enhance parental modeling by bringing home fresh fruits and vegetables and sharing their newly acquired knowledge of nutrition and methods of preparation.

The purpose of this Capstone project is to develop an evaluation plan to create measures to assess the potential of the UR youth internships to influence behaviors, consuming more fruits and vegetables, consuming more family meals, together in addition to increasing knowledge, interest, and motivation in obtaining, preparing, and consuming more fruits and vegetables among household members of the interns.

An additional online search was conducted for existing evidence-based research methods and measures, using the search terms pre- post- test, internal validity, focus groups, food scanners, and survey questionnaires.

The primary outcomes explored include family fruit and vegetable consumption, preparation and consumption of family meals together, increased accessibility and availability of fruits and vegetables, and general knowledge regarding intake of fruits and vegetables.

 Intermediary or psychosocial outcomes include knowledge, interest, and motivation.  Particular attention will be paid to changes in amounts of fruits and vegetables consumed, awareness of health benefits of consuming more fruits and vegetables, and preparation and consumption of family meals.

The study population will consist of primary caretakers of the interns who may be parents or other family members such as aunts, uncles, and/or grandparents, if applicable. Primary caretakers of applicants (one or two/family) on the waiting list for internships, or applicants who have not yet begun an internship, will serve as controls, or as a comparison group.       

Small focus groups consisting of family members of youth who have already participated in the internships will help determine if the survey questions are appropriate for gathering the desired information and provide internal validity and will allow family members to provide additional insights into the measures and perhaps provide additional ideas about key aspects of the program that might be measured.

Survey questions regarding consumption of fruits and vegetables, family preparation of fruits and vegetables and family meals together will be developed from existing fruit and vegetable screeners that have evidence of reliability and validity in measuring fruit and vegetable consumption.

Content analysis will be used to code transcripts of the focus groups and identify key themes that emerge from the focus group discussions. For the pre- post- test, responses from each survey period will be compared. The survey instrument will be developed from the focus group and pre- post- test responses.

 It is hoped that the responses to the resulting survey questionnaire will reveal important changes in eating behaviors, particularly, an increase in consumption of fresh fruits and vegetables, and an increase in family preparation and consumption of meals as a result of the youth’s participation in the Internship. Additionally, it is hoped that this line of research will be pursued. It would be valuable to learn if there is a “ripple” effect from the youth internships that carries their newly acquired eating behaviors and attitudes home to their families and potentially extend into the community.

Keywords: childhood obesity, youth gardening interventions, eating behaviors, fruit and vegetable screeners, child-to-parent learning

PowerPoint Presentation (PDF)

 

  Marques Hogans Sr. - Father Involvement: Impactful in Childhood Development and Maternal Stress

mhogans@mcw.edu
Advisor: Eric Gass, PhD

Abstract:

For centuries, child development has been an issue of continuous research and theory development; thus programs and interventions have been developed to measure, learn, and promote advancement in the field.  Programs and interventions have usually focused on one relationship, mother-child, and nothing beyond.  The attachment theory suggests that close relationships are internally represented throughout life as a relationship schema or map from early parent-child relationship (Alleyne-Green, Grinnell-Davis, Clark, Quinn, & Cryer-Coupet, 2014).  While empirical evidence suggests the necessity as well as successes for such programs and interventions; one intrinsic piece of child development was absent, the father.  By nature, mothers are said to provide love and nurturing, while fathers bring to the table structure and discipline.  Together these attributes collectively intertwine and ultimately result in an atmosphere which should be conducive for proper child development.  In addition to playing a vital role in child development, the father also has an indirect role in the psychological state of the mother.  Pregnancy and child rearing bring along stressors that affects mothers physically, emotionally, and mentally.  Having the support and presence of an involved father before, during, and after pregnancy has been shown to also have a positive impact on maternal stress.  This report will highlight and support the positive impact fathers have on maternal stress and child development.

Keywords: Father Involvement, Fatherhood Interventions, Child Development, Maternal Stress, Child-Rearing, Early Childhood, Adolescent Risk Factors, Fathers and Children

PowerPoint Presentation (PDF)

  Carissa Hoium - Housing as a Contributor to Health: A Review of Healthy Homes Programs

crssnrhf@yahoo.com
Advisor: Mitchell Grayson, MD

Abstract:

Physical, chemical and biological hazards in the home can result in serious health issues.  To address the public health impact of unhealthy housing, Healthy Homes programs have been developed and implemented across the United States (U.S.).  These programs include education about health hazards found in the home and the remediation of these hazards, which has shown to be a comprehensive, effective means of creating housing that is conducive to good occupant health.  This paper is a review of Healthy Homes programs that were recently implemented in multiple U.S. cities, with a focus on Milwaukee, WI.  The methods used to implement the programs and the results of these programs are compared.  Multiple similarities and differences between the programs are then discussed.  Despite the use of various cities in this review and their use of various methods to implement the interventions, the low-cost, holistic Healthy Homes programs all led to significant improvements in participants’ health (physical and mental) and significant cost savings.

PowerPoint Presentation (PDF)

  Heidi Keating - Ethical Implications of Legalizing Recreational Marijuana

h2keating@gmail.com
Advisor: Tom May, PhD

Abstract:

Objective: To use a public health ethics framework to examine the issue of legalizing recreational marijuana. The public health ethical framework is based on contemporary ethics influenced by the work of Beauchamp and Childress. The framework has three sections to guide decision-making and consider public health issues from viewpoints in order to reach the best possible solutions and outcomes. 1) Analysis—which focuses on harm related to the issue, the public health goals, legal scope, stakeholders and professional code of ethics. 2) Evaluation—using ethic standards of utility, rights, justice, common good, and virtue. 3) Justification—using effectiveness, proportionality, necessity, and least infringement to determine a public health action.

Results: The public health goals are to prevent negative health and social consequences with a special focus on youth, eliminate disparities related to use, and support policies that result in the greatest benefit to society. The ethical standards use philosophical ideas to contemplate the greatest balance of good over harm, individual happiness, and harm to others. Competent individuals should be able to make their own decisions according to the rights approach while justice determines if a policy is fair to all. The common good and virtue standards consider the community and what is best for all. 

Conclusion: Independent research shows marijuana is less harmful than many other drugs including alcohol and tobacco. Marijuana is not harmless, especially for adolescents; however, the greatest harm comes from prohibition not use. Laws should be the least restrictive on a population and the most effective. Prohibition is neither. If done correctly, legalization can reduce harm caused by prohibition and achieve public health goals.

PowerPoint Presentation (PDF)

  Sean Marquis - Methodology Proposal for the Assessment of Change in Outcomes of Trauma Patients with the Implementation of Community EMS Physician Field Response Program

smarquis@mhsjvl.org
Advisor: Riccardo Colella DO, MPH

Abstract:

Introduction:  Traumatic injury death is a major and often preventable public health problem for which the entire population is susceptible.  There is little existing evidence that physician-level prehospital treatment improves outcomes in any selected prehospital patient population.  The purpose of this project is to develop a methodology to assess the change in outcomes of trauma patients with the implementation of a community EMS physician field response program: the Mercy Health System EMS Physician Field Response (MD-1) Program.

Methods:  A five-year retrospective cohort research study is proposed to review approximately 1,600 severe trauma patients of all ages who presented initially to Mercy Hospital and Trauma Center (MHTC) in Janesville, Wisconsin as a full or modified trauma activation via any EMS agency from a scene for 30 months before and 30 months after the March 2013 implementation of the MD-1 Program.  The primary outcome of the study is survival to hospital discharge; secondary outcomes are Cerebral Performance Category (CPC) scale, inpatient length of stay (IPLOS), time from ED arrival to hospital admission, and physician procedures performed.  Participants will be assigned into groups according to the timing of their acute injury encounter before or after the implementation of the MD-1 Program and whether or not they received direct patient care from an MD-1 physician prehospital.

Analysis:  The Trauma Score-Injury Severity Score (TRISS) methodology is useful in such studies to provide an accurate indication of injury severity and probability of survival (PS).  By comparing the actual versus predicted chance of survival between groups one can adjust for the benefits participants received from the MD-1 Program and MD-1 direct patient care.  Results will be presented using odds ratios and descriptive characteristics.

Conclusion:  Results from this study will provide important information about the association between the implementation of a regional EMS physician field response program and trauma outcomes in the community with implications for other similar programs around the United States.  EMS and public health partners around the country are encouraged to conduct regular evaluation of their regional trauma and EMS systems with consideration towards advancing and refining their medical direction practices and EMS physician field response program capability. 

PowerPoint Presentation (PDF)

  Kavitha Muthuramalingam - A Review of Nutrition Education as an Element of Local School Wellness Policies

kmuthuramal@mcw.edu
Advisor: David Nelson, PhD

Abstract:

Background

Preventing childhood obesity is a pivotal issue for the United States that requires priority attention from policy makers at all levels of government. The epidemic is even more pronounced for children, whose development is being adversely impacted, not only physically and mentally, but also academically. Schools have a rich opportunity to prevent this epidemic through local school wellness policies that include a nutrition education component. As part of these policies, nutrition education may be integrated into the core curriculum, linked with the school food environment, such as school meal programs, school smart snacks and school gardens, and incorporated into other coordinated school health initiatives, such as after school programs to ensure that the children are educated about healthy habits from very young age.  However, there are barriers and challenges in implementing these policy elements in schools.

Methods

A mixed methods approach has been used in developing this paper by: 1) interviewing a member of the local school wellness policy committee; and, 2) conducting a literature search review to study the importance of nutrition education as a policy element, the public health impact of wellness policies in schools, barriers faced in policy implementation, and ways to overcome these barriers.

Results

Studies indicate that nutrition education cannot be confined to any particular class or time of day in schools, however, can be very effective in imparting knowledge, since children spend almost seven-eight hours each day in school. Nutrition education has been shown to be effective when programs are conducted in different venues of the schools, by having extended time for nutrition education, and by involving teachers, parents, and school officials. Some of the barriers identified by the interviewer are indicated in the studies as well. These barriers include lack of training for the educators, lack of time and duration to implement the programs, financial constraints, lack of marketing the programs, and, finally, lack of reinforcement of the policy.

Conclusion

Studies show that schools have been making some progress in improving the school food environment, and nutrition education has played a major role. However, additional work is needed. Stronger policies are needed to incorporate nutrition education using multiple interventions with greater intensity and duration. Also, staff training, financial aid from government and other sources, and improved and innovative marketing strategies can help overcome barriers. In addition, improved monitoring, assessment, and follow up to determine the effectiveness of the nutrition education components of local school wellness policies would be beneficial.

PowerPoint Presentation (PDF)

  Bridget Nelson - A Comprehensive Assessment of Health Care Systems in Kenya, Africa: A Theoretical Plan for the Improvement of Public Health within the Country

benelson3@gmail.com
Advisor: Eric Gass, PhD

PowerPoint Presentation (PDF)

 

 

  Hillary Petska - Legal Barriers that Affect the Medical Response to Suspected Child Maltreatment in Wisconsin

Advisor: Lynn Sheets, MD

Abstract:

Child maltreatment is a significant public health concern with short- and long-term health consequences for children. There are several well-recognized barriers to prevention that compromise the safety of children. These include inadequate medical response to suspected abuse and neglect due to uncertainty in diagnosis and the negative implications of mandated reporting. Laws addressing child maltreatment are complex and vary by state. This leads to confusion, which represents another potential barrier to appropriate response. Better understanding of the legal definitions of mandated reporting as well as child neglect, physical abuse, and sexual abuse may improve this response. Appropriate response is also dependent on clear public health policy. Following extensive literature review, an in-depth analysis of Wisconsin legal code was performed to clarify these statutes and the implications for healthcare providers. Gaps in Wisconsin law were then identified as an opportunity to better protect the health and safety of children.

PowerPoint Presentation (PDF)

 

  Julie Poludniak - Impact of Medical Cannabis: Role of Occupational Medicine Providers with Employers in the State of Maryland

jpoludniak@uhcc.com
Advisor: Eric Gass, PhD

Abstract:

Background: Cannabis is illegal federally but many states have enacted legislation allowing medical and recreational cannabis in recent years. Legalization of Cannabis within the United States contradicts the public health approach to drug policy and is not supported federally. The impact of medical Cannabis legalization in Maryland on employers and occupational medicine providers will require them to become familiar with both federal and state laws in order to adequately provide employer requested evaluations of fitness for duty on employees that may be using medical Cannabis. Increased knowledge of the signs and symptoms of Cannabis impairment will aid employers and occupational medicine providers in their efforts to evaluate employees using medical Cannabis. 

Methods: A literature review and analysis of applicable policies, procedures, and regulations currently in place at other locations, including but not limited to, federal, state, and local laws, as well as law enforcement, organization, and coalition documents were identified and utilized in formulating recommendations for this study.

Results: Currently, federal law prohibits Cannabis use and the Controlled Substance Act of 1970 still has Cannabis as a Schedule I Controlled Substance. In contrast, state legislation within the state of Maryland has a provision allowing Cannabis to be recommended by a physician for certain medical conditions. Additionally, the Federal Drug-Free Workplace Act of 1988 prohibits certain Maryland employers that receive federal funding to allow Cannabis regardless of current state regulations. Lastly, employers have a duty to prevent foreseeable injury and provide a safe workplace environment, free from substance misuse.

Conclusion: Both employer and OM provider will need to keep current with the rapidly changing regulations in the state of Maryland regarding Cannabis and continue to contrast these regulations with the federal laws. Employers and providers will need to increase their knowledge on the physical effects of the use of Cannabis as well as symptoms of Cannabis impairment in order to provide a safe working environment. Employers will need to update their drug-free workplace policies to reflect the new medical Cannabis option. Finally, the state of Maryland will need to enact legislation establishing an impairment level of five nanograms of active tetrahydrocannabinol (THC) per milliliter of whole blood.

PowerPoint Presentation (PDF)

  Greg Wise - Vaccination Policy: A Review of the Public Health Response to the Anti-Vaccination Movement

gswiseph@gmail.com
Advisor: Eric Gass, PhD

Abstract:

Purpose: The purpose of this policy and literature review was to attempt to determine the most effective vaccination exemption policies and practices through the filter of each anti-vaccination faction.

Methods: Data was collected from government websites and online medical and public health journals and publications. Centers for Disease Control (CDC) data was also gathered and compared to policy data.

Results: The results indicate that, currently, nineteen states allow for philosophical exemptions. All but Mississippi and West Virginia allow for vaccination waivers based on religious beliefs. Those two states reported no measles cases in 2015 and no Disneyland measles outbreak associated cases. Nineteen states reported an increase in pertussis cases from 2013 to 2014. Seven of those states allow philosophical exemptions.

Discussion: It is suggested that data collection methods for some states are inadequate and philosophical and religious waivers should be reported separately. Additionally, further studies should be carried out to determine whether policies and practices that do not allow religious or philosophical exemptions are most effective like this review seems to suggest.

PowerPoint Presentation (PDF)

 

 

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