2013 Master of Public Health Graduates

Capstone Abstracts & Presentations

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  Allison Beilke, MPH | Literature Review to Demonstrate the Relation of Health Effects Due to Obesity and Motor Vehicle Crashes in Truck Drivers

Advisor: E. Brooke Lerner, PhD, Associate Professor and Research Director, Department of Emergency Medicine


Rates of obesity in the United States have monumentally risen in the past 20 years with recent rates finding over one-third of adults (35.7%) are obese (Ogden et al., 2012). As a major public health issue, obesity supported the modernization of public health efforts, compelling a shift from infectious diseases towards chronic diseases. Obesity raises the risk of numerous chronic diseases and raises the overall risk of mortality by all-causes (National Heart Lung and Blood Institute, 1998). More specifically obesity raises the risk of morbidity from conditions such as hypertension, type 2 diabetes, coronary heart disease, as well as sleep apnea and respiratory problems. The ability to perform personal and occupational tasks may be hindered by chronic disease and physical disability. Due to the health conditions associated with obesity a person may be less able to perform tasks requiring vigilance, such as driving (Anderson et al., 2012). For example, sleep apnea may cause excessive daytime sleepiness (ESD) as well as fatigue, which can lead to dangerously reduced driving abilities. This presents a public safety concern. Due to the associated monetary, social, and physical costs, the obesity epidemic, as it has been deemed, not only affects people who are obese, but the entire country.

PowerPoint Presentation (PDF)

  Kavita Bhat, MD, MPH | What are the top health concerns in the City of Milwaukee and how do we manage them? An examination of Key Informant Interviews from Milwaukee's 2013 Community Health Assessment

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


Background and Objective: The city of Milwaukee is currently one of the least healthy cities in Wisconsin. It has an overwhelming amount of health issues and concerns. These health issues are currently being addressed by the city of Milwaukee Health Department through a community health assessment. The purpose of this paper is to gain perspective on the top health concerns for the city of Milwaukee and examine the methods to take on these issues through a qualitative analysis of key informant interviews.

Methods: Fifteen key informant interviews were conducted and the data regarding “top health concerns” was thoroughly analyzed using a coding process.

Results: The top health issues and concerns stated by the key informants in order of priority were: Mental Health, Access to Health Care, Overweight/Obesity, and Nutrition. The informants expanded on each of these issues stating: existing strategies, barriers, additional strategies, and potential partners.

Discussion: The benefits of the key informant interviews were that they provided rich, insightful information and awareness regarding the health issues of the community and how to manage them. The limitations of the interviews were that they did not represent the entire community’s views and there may have been inadvertent biases. Expanding further on the results of the key informant interviews provides a deeper understanding of what is currently being done about the health issues of concern.

Conclusion: Key informant interviews provide important information and help to build the foundation of the community health assessment, but are only a small piece of the overall picture of the community. Next steps in the process are: completing the four assessments, strategies and goal formation, and finally the action cycle. Hopefully upon completion, the assessment will lead to a healthier Milwaukee.

  Gayathri Chelvakumar, MD, MPH | LGBT Healthcare Experiences in Milwaukee

Advisor: Andrew Petroll, MD, MS, Assistant Professor of Infectious Diseases, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine


Background: LGBT individuals are disproportionately at risk for many medical and mental illnesses. Bias and discrimination from health care professionals and perception of such bias have been identified as one of the barriers to care that contributes to these disparities.

Objectives: Gather information on Milwaukee LGBT individuals’ healthcare experiences, identify characteristics of non-judgmental, LGBT friendly care, and identify patient expectations at healthcare visits.

Methods: A mixed method study design utilizing a quantitative written survey and qualitative structured interview was used to gather information on healthcare experiences.

Results: The majority of study participants (5/7) reported that their sexual orientation or gender identity had negatively affected the quality of healthcare they received. Qualities that were repeatedly identified as characteristics of LGBT friendly care were respect, provider knowledge of LGBT specific issues, provider comfort in caring for LGBT patients, efficient care, and a safe clinic environment.

Conclusions: The majority of individuals recruited reported that discrimination based on sexual orientation or gender identity had at some point affected the quality healthcare they received. Participants reported that a safe, respectful and welcoming environment in a clinic that provided timely, efficient, LGBT sensitive care were aspects of an LGBT friendly clinic.

PowerPoint Presentation (PDF)

  Paula Cody, MD, MPH | Parental Knowledge and Beliefs Regarding Childhood Immunizations

Advisor: Paul Hunter, MD, Volunteer Clinical Professor, Department of Family and Community Medicine


Objective: To determine barriers to vaccination of children, including parental knowledge, beliefs, and perceived vaccination status of the child.

Design: A survey was administered asking questions about knowledge and beliefs about vaccines and vaccine-preventable diseases, preferred sources of health information, and perceived vaccination status of the participant’s children.  This perceived vaccination status was compared to vaccination status of the children as documented in the Wisconsin Immunization Registry (WIR).

Setting: Women, Infants, and Children (WIC) clinics in urban Milwaukee.

Participants: Parents/guardians of children 19-35 months of age.
Main Outcome Measures: Parents’ perceived vaccination status of the child (up to date, not up to date, on time, not on time) compared to recorded vaccination status.

Results: 36 parents/guardians completed the survey representing 76 children whose vaccines were recorded in WIR. 95% believed their children were up to date (UTD), while only 66% were UTD in WIR. 84% of the parents believed their children got all their vaccinations on time, however only 32% of the children received their vaccinations in accordance with the Advisory Committee on Immunization Practices (ACIP) schedule. The majority of parents were familiar with WIR, but only 19% have ever used WIR to look up their child’s immunizations. All the parents stated that immunizations were important to the health of their children and 92% thought that vaccinations were safe The parent’s preferred source of health information was a health care provider.

Conclusions: One-third of the children whose parents/guardians report as up to date with their vaccinations when they are not up to date in WIR. This misperception might result in missed opportunities to vaccinate when parents/guardians do not ask for vaccinations to be updated during clinical visits. Educating and motivating parents/guardians to access WIR and encouraging parents to keep track of their child’s immunizations may reduce the misperceptions of vaccination status and thereby reduce missed opportunities.

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  Gerard Coly, MPH | Characteristics of African American Study Participants in Milwaukee

Advisor: Theodore A. Kotchen, MD, Professor, Department of Medicine - Endocrinology


Background: Researchers continue to voice concerns about the relatively low African American participation in medical research studies which prevents them from generalizing their findings and reducing health disparities.

Objectives: To examine characteristics of African Americans study participants and to determine to what extent the awareness of Tuskegee Syphilis Study, the financial incentives, the consenting process, and the trust of the researchers affect their willingness to participate in medical research.

Methods: Ninety African Americans enrolled in the Insulin Resistance and Gender Differences Study were invited to participate in a survey. The survey was either mailed to all participants who already completed the above mentioned research study or administered to other participants who came to Froedtert Hospital for the screening visit.

Results: All 38 respondents were non-smoking, healthy African Americans between the ages of 18 and 45; 50% were females, 79% had graduated or attended college, and 50% of the respondents had never been involved in medical research. Ninety two percent reported their trust level will not change based on the race of the researcher or staff. Nearly 52% of the respondents knew about the Tuskegee Syphilis Study and among those who were aware of the TSS, 63% felt that this historical event did not play a role in their decision to take part in the study.

Eighty-nine percent reported the consent form length was correct and 71% of the study participants read the consent form all the time. Nearly 41% would not participate in the research study if they did not receive a financial incentive.

Conclusions: Although Tuskegee syphilis study awareness is high among this young African American sample with college educational level, this historic event has less influence in their trust and decision to participate in medical research. However, the financial incentive aspect deserves our full attention to appropriately set the payment s and avoid coercive actions toward minorities involved in research.

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  Kevin Culbert, MD, MPH | Considerations for Legislation to Raise the Minimum Legal Sales Age for Tobacco in the Commonwealth of Virginia

Advisor: Nancy Kreuser, PhD, MSN, Assistant Professor, Institute for Health and Society


Background: Tobacco use and cigarette smoking in particular among youth provide the basis for a lifelong addiction. Another 3,800 Americans under 18 years of age start smoking each day. Policymakers have advanced both demand reduction and youth access strategies to prevent tobacco use among adolescents and young adults. Unsuccessful legislative efforts have sought to increase the age limit to 19 in two states and to 21 in twelve states. The purpose of this paper is to evaluate the effectiveness of access limits in reducing youth tobacco use.

Methods: A literature search was conducted using CINAHL, MEDLINE, PsycINFO, and the Cochrane Database for studies and reviews published in English between 1987 and 2012 that report outcomes from interventions intended to reduce youth tobacco access and use.

Results: The evidence obtained from the review indicates that tobacco minimum age of sales restrictions have yielded mixed results when retailer compliance has been marginal. Local interventions with strong enforcement and community support, as well as nationwide access limits have resulted in reductions in youth smoking prevalence.

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  Melissa Enriquez, MPH | A Nutrition Assessment of the Uninsured Hispanic Population Living in Wisconsin and Accultration's Role on Health

Advisor: Zeno Franco, PhD, Assistant Professor, Department of Family Medicine


The goal of this study was to determine the nutritional status of an uninsured, Spanish-speaking, Hispanic population and to determine if acculturation decreases healthy nutrition practices compared to a native Hispanic population. Nutrition questionnaires were used to determine the consumption frequency of food and drink items. Additional questions were asked concerning length of time living in the United States, country of origin, and self-reported disease status. 98 questionnaires were completed by adult participants and analyzed to determine the nutritional status of the population of interest. Multiple variables were also analyzed in order to establish a correlation between acculturation, measured as length of time living in the United States, and a decrease in healthy nutrition habits or food frequencies. Four predictors of variance were identified that accounted for 19.8% of the variance including: aguas frescas, soda, cream, and salsa. A limitation to the study is the relatively small sample size. One of the most unique native traditions of the Hispanic diet is the consumption of corn tortillas instead of flour tortillas. This behavior was reflected across all subsets, regardless of years of immigration. The consumption frequency was higher across all groups, ranging from nearly 47% to over 94%. In conclusion, a similar result was found in this study as in other studies regarding Hispanic participants not meeting dietary recommendations.  Extraneous factors such as being uninsured and not speaking the native language prove to be barriers to achieving good health and nutrition, but future interventions and research still need to be done to identify the most effective way to improve the nutrition status of the population under study.

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  Lisa Forsch, MPH | The Influence of Social Business on Public Health

Advisor: David Nelson, PhD, Assistant Professor, Department of Family Medicine


A variety of evidence-based solutions exist to improve the burden of global malnutrition, yet the statistics still impair both developing and developed nations. New, emerging and innovative practices are evolving, but need further research and support in order to make vast improvements in malnutrition rates and break the poor health cycle. The relationship between social business and public health is an example of a not commonly investigated solution option; though the relationship provides promising creative and reasonable insight into the development of multidimensional public health solutions. The premise of this relationship builds upon the idea that a social business, created by social entrepreneurs, is an organization that utilizes the strategies, technologies and processes to maximize a social impact through a profitable business model while engaging all the individuals of its ecosystem. The profitable social activism idea demonstrates that social entrepreneurship and social business alike have the opportunity to actively build creative ways to solve pressing social issues. Due to the nature of the malnutrition, this social business-public health relationship presents a valid resolution proposition.

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  Nicholas Hevey, MPH | Analysis of the Public Health Fund Provision of the Patient Protection and Affordable Care Act: How We Can Direct the Funds to Maximize Public Health Impact in Wisconsin

Advisor: C. Oren Renick, JD, MPH, FACHE, Associate Adjunct Professor, Institute for Health and Society


Objective: To analyze the usage of funds directed from the Patient Protection and Affordable Care Act by means of the Public Health Fund Provision of the law in the State of Wisconsin. Also, provide insight and analysis on how the funds can be best used within the State in the future and explain how the State would need to effectively do so.

Methods: The author searched public health governmental and non-governmental organizations’ websites to determine how the public health funds were being used in the State of Wisconsin and conducted an internet search to determine how obesity prevention can best maximize public health goals for the State of Wisconsin by usage of funds from the Public Health Fund. The author conducted personal interviews via telephone with important public health department leaders and personnel to learn more about the status and usage of the public health fund as well.

Results: The author identified that the Public Health Fund has made $18.3mil available to the State of Wisconsin, but only $683,000 of these funds have been mandated for anti-obesity campaigns. Obesity has been linked to 75% of the nation’s overall health care expenditures each year because obesity is linked to higher rates of chronic diseases. 

Conclusion: The majority of the investment of the Public Health Fund in Wisconsin should be directed solely towards anti-obesity campaigns. Obesity is the largest looming epidemic in the State of Wisconsin today and can be reduced through public health anti-obesity campaigns, school anti-obesity initiatives and increasing the access to affordable and fresh produce in underserved areas of Wisconsin. The political climate towards the public health fund from both sides of the political aisle makes the availability of these Public Health Funds from year-to-year tenuous. The State of Wisconsin and local municipalities should act quickly to create a plan to use the Public Health Fund to combat obesity in Wisconsin. 

PowerPoint Presentation (PDF)

  Kerri Holden, MPH | Effectiveness of Motivational Interviewing on Health Outcomes in Patients with Diabetes: A Review of the Literature

Advisor: Julie Willems Van Dijk, PhD, RN, Assistant Professor, Institute for Health and Society


The global prevalence of diabetes has increased rapidly during the last two decades, becoming one of the most common non-communicable diseases of the 21st century. Prevention of diabetes related complications is essential for reducing the morbidity and mortality associated with the disease. However, individuals with diabetes may be ambivalent about making these necessary lifestyle changes. Motivational interviewing (MI) is a patient centered counseling technique, which focuses on allowing patients to explore their ambivalence to lifestyle changes. This systematic review evaluates the effectiveness of MI as a basis for improving health outcomes among patients with diabetes. A search of the literature restricted to randomized controlled trials (RCTs) identified 10 applicable studies. Six studies demonstrated significant differences in behavior, psychosocial, or clinical outcomes between treatment and control groups. Since diabetes management involves daily engagement in self-care behaviors, it is imperative that healthcare providers understand the patient's individual needs and work collaboratively to overcome barriers unique to their everyday situations. Part of this care could involve motivational interventions, as the present review offers some preliminary evidence that MI may improve perceived competence in several diabetes management behaviors.

PowerPoint Presentation (PDF)

  Mandy H.W. Kastner, MPH | Review of the Quality of Hypertension Care at the Lake Area Free Clinic in Oconomowoc, Wisconsin

Advisor: James Sanders, MD, MPH, Associate Professor, Department of Family and Community Medicine


Background: Hypertension is a causal factor in cardiovascular disease and death and is present in about one-third of the US population. Like many chronic conditions, it is more prevalent among patients accessing safety net clinics. Improving the quality of hypertension care at the Lake Area Free Clinic has the potential to improve health outcomes and decrease health care costs. The first step to making improvements in care is to measure aspects of that care.

Methods: A ten-step performance measurement process was followed to establish how to measure the performance of hypertension care at LAFC. First, treatment guidelines, health plans and quality reports were reviewed to select appropriate quality indicators. Those included blood pressure control, annual lipid and creatinine monitoring and body mass index. The indicators and sample population were clearly defined. Data were extracted and analyzed to illustrate baseline performance. Based on the results, recommendations were made for short term and long term process improvements at LAFC.

Results: The results of the chart review revealed that 74% of patients with hypertension had their blood pressure controlled at last measurement. Seventy-five percent had creatinine measured during the measurement period, while 68% of patients had lipids drawn. Eleven percent of patients had a healthy BMI, with 31% being overweight and nearly 58% obese. 

Conclusion: Though there are limitations to the review, it illustrates the capacity for a free clinic to provide high quality hypertension care. Several recommendations have been made to build the foundation of tracking hypertension quality indicators at LAFC. Once the foundation for performance measurement of the quality of hypertension care has been laid, changes can be implemented to improve upon that care. Being able to track and improve performance will better position LAFC to be competitive in funding requests and will also illustrate to donors that their contributions have made an impact.

PowerPoint Presentation (PDF)

  Sharon Kolbe, MPH | Chagas Disease: A Systematic Review of Prevention Efforts in Latin America

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


Chagas disease is a potentially deadly, infectious vector-borne parasitic disease. Identified as “the most serious parasite disease in Latin America” by PAHO and WHO, it is the fourth leading cause of disability and death in at-risk populations. With over 55,000 new infections occurring each year in the region, prevention is the key to halting this devastating disease. This paper provides in-depth background of Chagas disease, and includes a systematic review of the effectiveness of primary prevention strategies employed to prevent transmission. Successful strategies employ multiple prevention methods simultaneously; take into consideration the contextual political, cultural, and socioeconomic factors; and call on entire communities, including individuals at risk, to take action.

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  Carrie Madormo, MPH | A Comprehensive Evaluation of the Wisconsin Seal-A-Smile Program

Advisor: John Meurer, MD, MBA, Director and Professor, Institute for Health and Society


The purpose of this paper is to evaluate the effectiveness of school-based dental sealant programs using existing literature and local data from Children’s Health Alliance of Wisconsin (Alliance) Seal-A-Smile (SAS) program. Oral health is a concern for children across the country. Nationally, dental decay is the most common pediatric chronic illness. It is four times more common than asthma in children. By age 17, 80% of young people have had a cavity. According to 2010 National Oral Health Surveillance System (NOHSS) data, 33% of Head Start children and 55% of third-grade children have experienced dental caries. In Wisconsin, 25% of Head Start children and 20% of third-grade children had untreated decay.

PowerPoint Presentation (PDF)

  Jessica (Arndt) Olbrot, MPH | Barriers and Facilitators for Hmong Seeking Mental Health Counseling: Implications for Community-Based Organizations and Public Health

Advisor: David Nelson, PhD, Assistant Professor, Department of Family Medicine


The purpose of this paper is three-fold: to (1) describe how cultural brokers are utilized within the context of mental health, (2) describe the facilitators and barrier to seeking mental health services impacting the Hmong community, and (3) describe the public health implications.

The Academic Search Premier search for “Hmong Cultural Broker” resulted in 1 full text article. Searches for full text articles using the search term “cultural broker refugees” resulted in 6 articles, and the search term “Asian cultural broker” resulted in 14 articles. The search term “cultural broker” resulted in 423 full text articles. The 423 articles were further narrowed down by filtering only peer reviewed articles, and revising the term to “cultural broker mental health”. This narrowed the results to 23 articles. Only 13 of these articles from the Academic Search Premier were pertinent to the subject matter. Ten articles were not used because there subject matter did not relate to the topic of this paper. The topics of these articles included measuring masculinity in men of color, caregiving for cancer patients, and dementia and aging in India. The PsycINFO search found no articles and a search in PubMed resulted in three additional articles. This paper is a review of those sixteen articles.

Conclusion: Reaching culturally diverse groups of people like the Hmong, is a difficult task for healthcare providers, yet one that is viewed as a top public health priority to eliminate health disparities and increase access to care. A community-driven program is needed in the Milwaukee area to reach out to the Hmong community and increase their awareness of mental health issues and services. Although there is no current program using cultural brokers within the Hmong community, many existing groups could n partner and provide cultural brokers. Resources also exist at the State and Federal level to guide community driven programs aimed at reducing health disparities among minority populations like the Hmong.

PowerPoint Presentation (PDF)

  Cathlyn Smith, MPH | First Steps to Mitigate Opioid Abuse in a Local Community

Advisor: Mark Kostic, MD, Associate Professor, Pediatrics and Emergency Medicine


In recent years, there have been numerous journal articles, white papers and editorials written regarding the growing problem of prescription drug abuse. According to the Centers for Disease Control, this abuse is the fastest growing drug challenge in the US. In 2007, an average of one person died every 19 minutes involving unintentional drug overdoses. Data from the National Center for Health Statistics for 2007 states unintentional poisoning was the leading cause of unintentional injury death involving adults 35-54 years of age and the second leading cause of injury death for adults aged 25-34 and 55-62.

Further, in 2009, 16 million Americans ages 12 and older took prescription pain relievers, tranquilizers, stimulants, or sedatives for strictly nonmedical purposes at least once in the previous year. The National Institute on Drug Abuse (NIDA)-funded 2010 Monitoring the Future Study showed that 2.7% of 8th graders, 7.7% of 10th graders, and 8.0% of 12th graders had abused the opioid pain medication Vicodin and 2.1% of 8th graders, 4.6% of 10th graders, and 5.1% of 12th graders had abused the opioid OxyContin, for nonmedical purposes at least once in the previous year. The focus of this report is to examine the prescription drug abuse epidemic: its contributing factors, increasing frequency, and impact on society.

PowerPoint Presentation (PDF)

  Ema Uko-Abasi, MPH | Developing an Expanded Tobacco Use Vital Sign Program Through Research Evidence of Effectiveness

Advisor: John Meurer, MD, MBA, Director and Professor, Institute for Health and Society


Background: The battle against tobacco use has been a long one over the years, particularly following the first Surgeon General's report on its health hazards. Happily, the yield of this enduring effort is the declining level of tobacco use in the United States. Various public health strategies have resulted in this positive outcome, including the recommendation of the United States Surgeon General to include tobacco use status with the traditional clinical vital signs to increase the identification and consequent management of tobacco use during every clinic visit. Following the inception of this intervention in 1991, it is important to determine how effective the tool is at a clinical level. This project aimed to search for evidence of its effectiveness and use this evidence to design a program that could further promote its use and effectiveness in primary care settings.

Methods: I performed a review of evidence of the effectiveness of the tobacco vital sign in published research work. Evidence in the form of study results and author recommendations provided the basis for the design of an expanded Tobacco Vital Sign using a guiding logic model.

Results: Evidence demonstrated that the Tobacco Vital Sign is effective in increasing identification and documentation of tobacco use status, but besides facilitating moderate increase in simple quit advice, it is largely ineffective in moving the tobacco user towards long-term abstinence and cessation as a single intervention. 

PowerPoint Presentation (PDF)

  Joseph Welter, MD, MPH | The Amish of Central Wisconsin: Preparing for an Outbreak of Vaccine-Preventable Disease

Advisor: Nancy Kreuser, PhD, MSN, Assistant Professor, Institute for Health and Society


Numerous outbreaks of vaccine-preventable disease have occurred within Amish communities. Wisconsin has the fourth highest state Amish population in the U.S., and central Wisconsin is home to approximately 17% of the state’s Amish population; yet, this population has not been well-defined and its immunization level has not be well-determined. This study describes Amish history in practical terms, and through the use of Amish sources, better defines the Amish population of central Wisconsin. Through studying state-mandated school immunization records, less than 12% of Amish schoolchildren were found to have received any vaccinations, placing this and surrounding populations at significant risk for vaccine-preventable disease. Recommendations are made for accessing this local, and often reclusive, Amish population for the purpose of increasing the vaccination rate and, ultimately, lowering the area risk of vaccine-preventable disease.

PowerPoint Presentation (PDF)

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