2012 Master of Public Health Graduates

Capstone Abstracts & Presentations

2012 graduates

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  Erica K. Bergstrom, MPH | Sport Related Injuries in Competitive Swimmers: A Review of the Epidemiology of Swimming Related Injuries

bergstro.eric@gmail.com
Advisor: E. Brooke Lerner, PhD, Associate Professor and Research Director, Department of Emergency Medicine


Abstract:

Competitive swimming is a popular physical activity in the United States with over 300,000 swimmers registered with USA-Swimming in 2011. This report examined the epidemiology of swimming injury and the current status of sports injury surveillance systems active in the United States through a comprehensive English language literature review of swimming injury related publications. Articles were identified using Google Scholar, Pub Med, and multiple swimming specific resources. Injuries were found to occur in roughly 70% of swimmers, with shoulder injury occurring the most commonly at an estimated rate of up to 91%. Spine, and hip and knee injuries occurred at maximum estimates of 68% and 28% respectively. Three injury surveillance systems were examined including USA-Swimming, High School RIO, and NCAA Injury Surveillance System. The report concluded that competitive swimming - related injury, despite its apparently high incidence, is not adequately captured by current sports surveillance systems, and a sport specific injury surveillance system will be needed if the true incidence and mechanisms of swimming injury are to be understood. USA-Swimming is suggested as a prime organization with already established resources to collect injury data and conduct this much needed research.

PowerPoint Presentation (PDF)

  Laura (Fadrowski) Conklin, MPH | Web 2.0 – Social Media Marketing: Taking Local Public Health Departments to the Next Level

lfadrows@hotmail.com
Advisor: Julie Willems Van Dijk, PhD, RN, Assistant Professor, Institute for Health and Society


Abstract:

Social media has quickly become one of the most effective ways to communicate with the general public about a wide variety of issues, including public health matters. The need for public health officials to understand and become proficient in the use of social media to advance their objectives is evidenced by the sheer number of individuals who subscribe to social media sites. The number of people looking to social media as their sole source of information grows every day. How does a local health department (LHD) effectively utilize Facebook, Twitter, and other social media tools to market public health ideas, programs and initiatives? What are some examples of how social media has aided public health initiatives? What are some barriers reported by LHD’s in utilizing social media? How can these be addressed to move forward with social media marketing? This paper addressed these questions through a comprehensive literature review, as well as interviews conducted with local and national public health officials. The results of this research show it is now more important than ever for public health departments to join the social media revolution.

PowerPoint Presentation (PDF)

  Shereen Elbaz, MD, MPH | Impact of Prenatal Health Care, Prenatal Smoking and Alcohol Drinking on Infant Mortality

shereen_elbaz8@hotmail.com
Advisor: Jason Jarzembowski, MD, PhD, Assistant Professor, Department of Pathology


Abstract:

Introduction: Infant mortality is one of the important indicators of a nation’s health. It is greatly affected by maternal health and behavior during pregnancy. Our focus in this study was prenatal smoking and alcohol drinking as determinants of infant mortality. We also addressed the prevalence of these behaviors in Wisconsin to help enable policy makers to set preventive programs to improve health outcomes over the long term.

Background: The infant mortality rate has not declined significantly in the US since 2000. A literature review supports a strong correlation between each of smoking and alcohol consumption during pregnancy and infant mortality. The prevalence of smoking during pregnancy in the U.S. was 40% in 1967 and has gradually declined to 13% in 2006. The prevalence of alcohol use during pregnancy was 20% in 2001. It has also declined to 15% for moderate drinking and 4% for frequent drinking in 2005.

Methods: We conducted a retrospective study based on data collected from the Infant Death Center of Wisconsin (IDCW) survey from 1991 to 2000. It was offered to the family of every infant who died in Wisconsin during that time period excluding in-hospital deaths. A subset of the survey questions addressed smoking and alcohol drinking during pregnancy and prenatal health care. A descriptive analysis was used in this study showing the prevalence of each behavior within this cohort. We compared these results with the national averages to explore the magnitude of the problem and examine if infant mortality in our study was attributable to these negative behaviors.

Results: The proportion of women who smoked during pregnancy in the IDCW study is significantly higher than in the overall population (50% vs. 20%, p < 0.05). However, the proportion of women who drank during pregnancy in our study is no different than that in the population (20% vs. 20%, p > 0.05).

Conclusion: We concluded from literature and our study data that there is a relationship between smoking and alcohol use during pregnancy and infant mortality. We recommend establishing more well-constructed preventive services that focus on modifying negative health behaviors during pregnancy. 

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  Jennifer L. Hanke, MPH | Refugees in Colorado: A Review of Colorado’s Refugee Preventive Health Program and the Health Status of a Community

jlhanke@comcast.net
Advisor: James Sanders, MD, MPH, Associate Professor, Department of Family and Community Medicine


Abstract:

Objective: Refugees resettled in new countries often arrive with abnormal health conditions. While various studies have provided information regarding the scope and rates of common ailments, an in-depth review of the health services provided to this population has not been undertaken. This review serves to detail the duties and purposes of Colorado’s Refugee Health Services Program, and determine the health status of Colorado’s refugee population.

Methods: A literature review was conducted regarding refugee health on both a national and global scale. William Stauffer and Michelle Weinberg’s article “Emerging Clinical Issues in Refugees,” published in Current Opinion in Infectious Disease in 2009 provides the basis for this study. Personal interviews were conducted with administrators of Colorado’s Refugee Resettlement Program and Colorado Refugee Health Services Program, along with employees of a non-profit agency serving Colorado’s refugee population.

Results: Refugees enter the state with a variety of health concerns, which include a high rate of communicable illnesses (e.g. Hepatitis B, parasitic infections, tuberculosis). As many refugees find employment in “high-risk” areas such as food service industries and child care centers, risk for transmission becomes a concern.

Conclusion: While many refugees are found to have abnormal health conditions at their domestic health screening, the resulting treatment, and follow up care has proven effective, as there have been no known outbreaks of communicable illness associated with the refugee population in Colorado.

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  Christy L. Kiekenbush, MPH | The Human Papillomavirus Vaccine: A Systematic Review Elucidating the Dynamics of Ethical Concerns and Public Health Policies

ckiekenbush@gmail.com
Advisor: Thomas May, PhD, Associate Professor of Bioethics and Medical Humanities, Institute for Health and Society


Abstract:

This report employs a systematic literature review to explore factors impacting HPV vaccination acceptance and compliance with recommended vaccination guidelines, as well as strategies which may guide future approaches to increase attainment of vaccination goals. A systematic search for articles published from 2004 to April 2012 related to the HPV vaccine was performed. Extracted articles provided quantitative and qualitative information on the HPV epidemic and factors influencing vaccination compliance. Several factors were identified, including related public health policies, ethical considerations, and expressed public opinions concerning HPV vaccination.

The results of the research reveal that moral and ethical beliefs, social influences, public health policies, interaction with the health care system, and cost are associated with parental and young adult perceptions of the HPV vaccine and intent to vaccinate. This systematic review also elucidates potential strategies to increase HPV vaccination rates. The information supplied by this systematic review may have implications for future novel vaccines, in particular, those for sexually-transmitted infections, which may encounter similar barriers to vaccination as those experienced by the HPV vaccine.

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  Jennifer L. Leonard, MPH | Identification of the Need for Inclusion of Alcohol / Substance Use into Comprehensive Sexual Education Courses in Public Schools

jen-leonard@hotmail.com
Advisor: Andrew Petroll, MD, MS, Assistant Professor of Infectious Diseases, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine


Abstract:

Academic and public health researchers have examined the sexual behaviors as well as alcohol and substance use among teens, but rarely the complex relationship between the two. To further explore these topics and their relationship, I conducted a review of published data pertaining to (a) teen sexual activity and risk of sexually transmitted infections, (b) alcohol and substance use among teenagers, (c) current sexual education curricula, and (d) examples of change to sexual education curricula. Two programs were effective at reaching their target population and reducing the rate of HIV when incorporating alcohol and substance use with sexual education curricula. This paper outlines this data and highlights the need to incorporate alcohol and substance use into comprehensive sexual education.

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  Peigang Li, MPH | Racial and Social-economic Evaluations of Community Health Disparities: The Association between Health Outcomes and Local Retail Food Environment in the City of Milwaukee

Advisor: Alan Wells, PhD, MPH, Assistant Professor, Institute for Health and Society


Abstract:

Background: Studies have shown that increased access to healthy foods is linked to positive health outcomes in children and adults. The project aims to study associations between local retail food environments and health outcomes, specifically the relationship between density of food stores and infant birth outcomes such as morbidity, low birth weight (LBW), and mortality.

Methods: A multilevel and ecological approach was taken to explore the associations and to help inform public health policies that aim to eliminate health disparities. Both a modified retail food environment index (RFEI) and a local disparity value (LDV) were derived as risk factors from the multiple data sources. Geographical Information System (GIS) software was used to overlay health outcome and risk factors by zip codes in the Greater Milwaukee area.

Results: Individual-level health determinants were associated with birth outcomes confirmed in other epidemiological investigations. The area-level (neighborhood) risk factors were marginally associated with birth outcomes, determined by the variation at the area-level factors (types and density of food stores in zip code area).

Conclusion: The current study demonstrates the utility of both multilevel analysis and applied GIS in examining the link between local retail food environments and birth outcomes. The main outcome of this project is the relationship between area-level factors (food stores in zip code areas) and birth outcomes. Variation in the area-level data suggests that birth outcomes are associated with RFEI and zip code.

PowerPoint Presentation (PDF)

  Katharine E. Lohse, MPH | How does the rate of cesarean section rates affect rural areas? A systematic literature review

lohs0021@gmail.com
Advisor: Kirsten Beyer, PhD, MPH, Assistant Professor, Institute for Health and Society


Abstract:

The purpose of this paper is to examine how the rise of cesarean section rates in the United States affects rural areas. The way in which this increase in cesarean section rates affects rural women in the United States is not well understood. It is likely that unique health and medical challenges face pregnant women living in rural areas of the United States, as it is known that rural populations face particular health related challenges associated with rural environments. While there is information available on different aspects of the topic, we know of no published review of cesarean section rates and their effects in rural settings. To address this gap in knowledge, we performed a systematic review of the published literature to understand how the rise in cesarean section rates affects rural areas. In total, 226 articles were identified and seven were included in the final review. We focus on the following domains that emerged while conducting the review: cesarean section rates in rural versus urban areas; access to healthcare in rural areas; socioeconomic status, healthcare payments and insurance; and cesarean sections as linked to other birth and health outcomes. We found that a small amount of research has been conducted comparing cesarean section rates in rural and urban areas, showing a slightly higher rate in rural areas versus urban. Given the rise of cesarean section rates, more research is needed to determine whether rural-urban differences in cesarean sections rates occur across the United States and what factors influence these differences. To truly understand and correct any disadvantages facing rural pregnant women, more studies should include primary data collection from rural women making birth choices and seeking pregnancy related services.

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  Alexandra M. Ostromecki, MPH | A Program Plan for Childhood Obesity Prevention in a Local Community

alexandra.ostromecki@gmail.com
Advisor: James Wallace, MD, PhD, Professor, Department of Surgery


Abstract:

Childhood obesity is a rapidly progressing issue in the United States that continues to grow. It is a salient public health, medical, economic, and social issue, and federal policy related to childhood obesity as it currently exists does not adequately reach the grassroots level in many local communities. This paper describes a community health program plan designed to implement national childhood obesity-related policies at the local level, as executed by a local public health department. The program is targeted at childhood obesity prevention in school-age children, with beneficial secondary effects for family and the surrounding community members and stakeholders. Prevention components include, but are not limited to, increased physical activity, proper nutrition and healthy lifestyle education, school compliance with federal policies, and stakeholder involvement and support. The program utilizes various state and federal programs aimed at combating obesity, including the Farm to School Program and Let’s Move! Campaign championed by First Lady Michelle Obama, and this paper illustrates what a $70,000 budget can achieve for a local community in terms of childhood obesity prevention in a one-year time period. Overall, it is a promising program that is designed to be easily modified for almost any local organization to implement, be it public or private, and it moves this country one step closer towards subduing the childhood obesity epidemic, one community at a time.

PowerPoint Presentation (PDF)

  Esha Pillai, MPH | The Mobile Markets Project: Nutrition Education with Healthy, Affordable Food at the Neighborhood Level

esha.pillai@gmail.com
Advisor: Paul Hunter, MD, Volunteer Clinical Professor, Department of Family and Community Medicine


Abstract:

An obesity epidemic is sweeping the nation, and the most vulnerable individuals are those living in “food deserts,” or locations where the existing food environment has multiple barriers to healthy food access (Cannuscio, Weiss, & Asch, 2010, p. 388). Health interventions have been conducted in urban disadvantaged neighborhoods all over the country to address this issue. One such intervention is the evidence-based, community-informed Mobile Market (MM) Nutrition Education Project.

The MM Project was created through collaboration between various community and academic groups to provide a nutrition education adjunct to the existing Mobile Markets provided by SHARE Wisconsin at five culturally diverse sites. The nutrition education project presented a different nutrition topic at each session, accompanied by interactive components such as games and food demonstrations. The sessions were specifically tailored based on the cultural backgrounds of the populations at each site. Surveys presented at each session provided a means to measure the success of and interest in the programming. This paper serves to provide the process evaluation for the project.

Participants at all five of the sites enjoyed the sessions overall, especially the interactive components and incentives; however, attendance was not optimal. Possible reasons for absences included lack of transportation, sick children, or school holiday. The relationship of the target population to the site was a key factor in the likelihood of sustained attendance. Future implementation of similar programming could follow the session framework presented here, but further studies should consider/identify additional recruitment strategies to increase attendance.

PowerPoint Presentation (PDF)

  Elma Racquel Racadio, MPH | Barriers to Emergency Contraception Access in Rural Wisconsin Communities: A Qualitative Analysis of Public Health Officer Interviews

eracadio@hotmail.com
Advisor: Alan Wells, PhD, MPH, Assistant Professor, Institute for Health and Society


PowerPoint Presentation (PDF)

  Brianne N. Runyan, MPH | The Future of Public Health: National Public Health Department Accreditation versus the Current Wisconsin DHS 140 Review: Requirements of Local Health Departments

briannerunyan@gmail.com
Advisor: Nancy Kreuser, PhD, MSN, Assistant Professor, Institute for Health and Society

Abstract:

Background: The purpose of this paper is to examine the new national accreditation process and the influence it may have on the Wisconsin Department of Health Services 140: Required Services of Local Health Departments Review (DHS 140 Review). This paper will aim to understand why some local health departments (LHD) are motivated to pursue accreditation while others are not. Since the accreditation program is relatively new to the world of public health, and to many it may seem daunting, this report will be significant in that it will help others to better understand accreditation and how it relates to the current practice. Accreditation is currently voluntary; however, there is a chance that it may be mandatory in the future. The big question is, “What does this mean for the DHS 140 Review?”

Methods: A literature search was conducted to determine if accreditation is appropriate in public health. Accreditation programs have been developed for a variety of other settings, including healthcare, and reports on the lessons learned from these other settings will be reviewed and discussed. A survey was also designed and conducted among Wisconsin public health officers about their knowledge and opinion of the voluntary, national public health department accreditation process and the current DHS 140 review. With this information, the paper intends to evaluate different factors related to local health departments, such as level, size, resources, etc. and how that might affect their decision to apply for accreditation. Lastly, an interview was conducted with a former Health Commissioner for the City of West Allis/West Milwaukee. Information from all sources is used throughout the paper to illustrate the key findings.

Results: When examining the public health workforce demographics of Wisconsin and the entire nation, the 2011 Wisconsin Local Health Department Accreditation Survey and the 2010 National Profile Local Public Health Departments provided information on the size of populations served, the types of jurisdictions, the annual expenditures, the number of full-time equivalents(FTEs), the overall distribution of the LHD workforce, if departments participated in any quality improvement activities and how all of these characteristics relate to an agency’s familiarity with the national accreditation program and their intentions on applying. After extensive research regarding information on local public health agencies, there is a correlation with the size of the jurisdiction served by departments and these departments’ eagerness to apply for accreditation. Even though the responses to questions about intent to seek voluntary national accreditation suggest a high level of interest among LHDs in the national accreditation program, the literature indicates some departments in Wisconsin and across the US are not going to have the resources to apply for the program. This may have to do with the fact that accreditation readiness relies on numerous factors which can be very limited in many health departments. These factors include financial resources, dedicated staff available to work on accreditation activities, etc. In addition, health departments also need to have the three pre-requisites in place before they can consider applying for accreditation.

Conclusion: There is much to be learned from accreditation programs in other service industries as well as from current public health quality improvement efforts. While results from key studies related to accreditation program may not be entirely applicable to public health, it has been argued that if these programs have been successful in strengthening the delivery systems for other health and social services, a similar program may hold promise for the field of public health. It would behoove every LHD, whether they are the early adopters, the majority who will wait a few years to seek accreditation, or the late followers, to work together towards the same vision that every LHD in America will someday be accredited and every individual in this nation can receive the same care regardless of where they live and which department serves them.

PowerPoint Presentation (PDF)

  Devyne L. Schmidt, MPH, CHES | The Role that Incentives Plan in the Improvement of Population Health at Worksites: A Systematic Review

strand.devy@gmail.com
Advisor: Robert Goldberg, MD, Assistant Professor, Institute for Health and Society


Abstract:

Introduction/Purpose: As the presence of chronic diseases related to modifiable risk factors continues to cause an increase in health care costs, employers have taken a recent interest in improving their employees’ health. One way to accomplish this goal is by offering worksite health programs (WHPs) and encouraging employees to participate through different means, including offering incentives. The purpose of this paper is to determine the role that incentives have in the improvement of population health at worksites.

Methods: A two-part systematic review was conducted on studies of efficacy of WHPs where 28 articles met the inclusion criteria and participation rates in WHPs where 23 articles met the inclusion criteria.

Results: 25 of the 28 studies proved effective where the participants had better outcomes than the control group. Participation rates varied from 3.5% to 90% depending on the type of incentive offered.

Discussion: WHPs which were determined effective had variations in program length, topic, and modality of delivery, making it difficult to draw concrete conclusions. Readiness to change was identified as a variable to consider, along with effectiveness. In addition, gender was identified as a confounding variable when exploring participation rates. The variation in participation rates is an important factor, but the limited number of mutually exclusive incentives produced inconclusive results. A more relevant study to address the impact of incentives would be to review participation rates for programs already deemed effective, to allow for more control of the variables also impacting participation rates.

Conclusion: Offering an incentive is just one of the many variables employers need to consider while aiming to improve the health of their employee population. Additional variables to consider include the type of incentive and intervention, communications, and worksite culture. Addressing each of these variables is likely to provide a recipe for success for WHPs.

PowerPoint Presentation (PDF)

  Michelle Thate, MPH | Nutrition Education at Mobile Markets: A Community Needs Assessment to Guide Nutrition Programming Development and Implementation at Mobile Market Sites

michellethate@gmail.com
Advisor: Paul Hunter, MD, Volunteer Clinical Professor, Department of Family and Community Medicine


Abstract:

Many residents of low-income neighborhoods live in ‘food deserts’ – areas that have limited access to affordable and nutritious foods. Current research suggests that these residents have higher rates of obesity and chronic diseases, possibly due to their socioeconomic status and environment (Whitacre et al., 2009). The evidence-base is growing to show that increasing healthy food access paired with nutrition education is a promising intervention combination to improve both the health of these residents and communities.

One current program is SHARE Wisconsin’s Mobile Markets (MM), which bring healthy, affordable foods into Milwaukee’s low-income neighborhoods. In addition to increased access to good nutritional options, community and academic groups have partnered to develop and provide nutritional education programs to be held at the MM sites. The current project seeks to develop nutrition education to promote consumption of nutritious food and increase knowledge of healthy food preparation methods and food selection. A consumer survey was administered to 261 consumers to identify interests in nutrition education and determine population specific pre-education attitudes, beliefs, and self-reported fruit and vegetable consumption. After frequency and percent analysis, this needs assessment report utilizes the survey data to provide recommendations for the project team to utilize in developing nutrition education programming.

The typical MM customer is approximately 50 years old, generally healthy, and a recipient of federal food assistance. Healthy food access does not appear to be an issue, but cost is. The majority understand that fruits and vegetables are important for good health and are confident in meeting USDA recommendations. Yet, most also think it is necessary to eat more fruits and vegetables than they currently do, and interest in nutrition education is high. Thus, results may have been subjected to self-reporting bias. This report is strengthened by the survey development process.

Further studies should explore community-specific food desert dynamics prior to program planning, and develop surveys with more knowledge specific questions to thoroughly measure change in comprehension and behaviors. Nevertheless, providing education and nutritious food resources will aid food desert residents in making healthy life choices.

PowerPoint Presentation (PDF)

  Sylvia Torres, MPH | The Teen Perception of Unhealthy Sexual Behaviors: The Development of Items for a Teen Survey

sylvia_torres2000@yahoo.com

Advisor: Eric Gass, PhD, Assistant Professor, Institute for Health and Society


Abstract:

Objective: The purpose of this project is to determine the types of questions that will be used in a survey that will capture the understanding behind the engagement of unhealthy sexual behaviors by teens.

Methods: A list of 83 developed items regarding sexual health and education were given to teens from the University of Wisconsin-Milwaukee Upward Bound Program. These teens were instructed not to answer any of the items and only cross out the item the teen did not feel was a good question to ask other teens for a future survey. A factor analysis was conducted to find correlations among the items the teens did not discard.

Results: A total of 21 teens ages 15-18 reviewed the list of items. Out of the 83 list of items, 5 items were kept by all of the teens that participated. The list was further reduced to 55 items after the analysis was performed.

Conclusion: Allowing teens the opportunity to judge a list of items that will be used in a future survey is important to gain the teen perception on the importance of the item. This process allows us to gather appropriate items that today’s teen is currently experiencing. By developing these items with a teen’s perception, it allows us to ask the questions that are pertinent and that will give us an insight into the mind of their peers. Once this type of tool is developed, it can be incorporated into model programs that contribute to reducing teen pregnancy rates, increasing high school graduation rates and post-secondary education.

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