An Evaluation of Parkview Health system’s School-Based Physical Activity and Nutrition Program: Planting Healthy Seeds
cball84@gmail.com
Advisor: Julie Willems Van Dijk, PhD

Abstract:
Background
Childhood obesity continues to be of great concern for today’s school children. School-based physical activity and nutrition programming have been implemented in schools across the nation in an attempt to curb the growing problem and enhance the health and wellbeing of youth. An evaluation of Parkview Health’s school-based physical activity and nutrition program, Planting Healthy Seeds (PHS), was conducted to evaluate the effectiveness of the program in increasing children’s knowledge in the areas of physical activity, nutrition, and behavior change.

Methods
A retrospective, one-group, pre-post-test design was conducted to evaluate the impact PHS had on third and fourth grade students in the areas of physical activity and nutrition knowledge and behavior change. Pre-and post-test questionnaire results for third and fourth grade students who completed PHS during the 2015/2016 and 2016/2017 school year were analyzed for changes in knowledge and behavior from the beginning of the program to completion. Success was determined as any percentage of positive change noted from pre-to post-test questionnaire results.

Results
A major limitation of the evaluation was that while the program was delivered in 11 schools in 2015/2016 and 14 schools in 2016/2017, numerous students were missing full sets of pre- and post-test results, so many students were excluded from the evaluation. Results for those students who met inclusion criteria revealed that 60% to 88% of students demonstrated positive knowledge gains in nutrition, 58% to 87% of students demonstrated positive knowledge gains in physical activity, and 45% to 57% of students demonstrated positive behavior changes when post-test results were compared to pre-test results.

Conclusion
Results are consistent with previous study findings from programs with similar duration, curriculum, and incorporation into the classroom setting. Further study is needed to determine the long-term effectiveness of the program in reducing childhood obesity rates locally, regionally, and nationally.

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Program Planning and Evaluation of a Diabetes Incentive Program as a Population Health Management Intervention for Diabetic Employees of a Multispecialty Medical Group
Advisor: Eric Gass, PhD

Abstract
In 2014, over 29 million people in the United States carried a diagnosis of diabetes. Many employers are looking to improve the health of employees for production and cost reasons. The aim of this project was to evaluate the effect of a program featuring health education and co-pay reduction on health care utilization and disease control. In a pre/post study, diabetic employees and spouses (members) covered under the company health plan received reduced out of pocket co-pays for insulin, in exchange for attending two sessions with a diabetic educator. De-identified electronic health record data were assessed quarterly. The diabetics who participated were compared to those who did not participate. There were 1717 diabetic members. 343 members met the requirements to receive the incentive benefit and 273 members were included for analysis. From 2015 to 2016 there was a 75% increase in the number of members who attended diabetic education. Mean HbA1C in the recipient group decreased by 0.15. Compared to the diabetics who did not participate, this was a significant change (p=0.025). The effect was seen in males, ages 50-60, and in members with an endocrinology encounter (p=0.01). There were no significant changes to the number of ER or hospital visits and related costs in the groups. After one year, this diabetic incentive program had the desired effect of increasing utilization of health education and outpatient services with a modest reduction in mean HbA1C. Efforts to determine if the trend will continue and any impact on total health care costs related to diabetes are underway. A value-based benefit design combined with health education may be an effective strategy for population health management of diabetes in the workplace.

Translating Trauma-Informed Care from The Community to The Clinician: A Community-Informed, Strengths-Based Approach to Asking About Trauma
kceelee@yahoo.com
Advisor: Hillary Petska, MD, MPH

Abstract
Background/Hypothesis/Objective(s)
Exposure to adverse childhood experiences (ACEs) is a major public health problem. ACEs can lead to childhood toxic stress and negatively impact health and well-being. National organizations have advised that providers discuss childhood adversity and its impact with children and families. However, little is known regarding patients’ perspectives on ACEs, or their preferences on discussing these topics in the medical setting. This study addresses these gaps by adding the voices of adults from a community with a heavy burden of ACEs.

Methods
Design: Descriptive qualitative study.

Setting: Three Federally Qualified Health Centers (FQHC) in Milwaukee, WI.

Recruitment: English- or Spanish-speaking adults were recruited from health center waiting rooms and interviewed. Participants: 37.5% African-American, 50% Hispanic, 12.5% Caucasian, 55% female, ages 18-35 (mean 43), 70% parents, and 75% from poorest zip codes.

Data Collection: Interview elicited responses about the impact of stress on individuals and families; preferences and recommendations for discussing adults and their children’s ACEs; and barriers and facilitators of disclosing ACEs. 31 interviews were audio-recorded and transcribed. 9 interviewees declined recording; those interview notes were transcribed after the interview.

Data Analysis: Transcriptions were analyzed with an iterative coding process and thematic analysis.

Results
Five themes emerged.

1. Stress adversely affects parenting and children.
2. Benefits include getting help for themselves and their children, receipt of resources and feeling less alone.
3. Barriers to disclosure include judgment and mistrust.
4. Providers should ask patients about ACEs and strengths and can overcome barriers by establishing rapport and building trust.
5. Providers should frame discussions of ACEs, utilize a variety of approaches for starting conversations, and be transparent about reporting responsibilities.

Discussion
Providers whose practices reflect patients’ preferences may facilitate disclosure of adversity, identify strengths, and prevent negative health consequences and promote resilience.

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The Importance and Challenges Associated with Recruiting African American Donors for Blood Donation in the United States
Advisor: Kim Gearin, PhD

Abstract
Objective
The purpose of this paper is to enhance understanding of the importance, challenges, and strategies associated with recruiting African American donors for blood donation in the United States.

Methods 
This literature review analyzed 14 studies related to African American blood donation conducted within the last 30 years.
Results: From these studies, it was determined that several barriers prevent African Americans from donating blood. Notable barriers include lower donation eligibility rates and increased rate of deferrals, different motivators and deterrents to donating, and lower hemoglobin levels as compared to Caucasian donors. This paper also discusses strategies to increase African American blood donation, such as new marketing strategies, and hemoglobin education programs aimed specifically at African American donors.

Conclusions
These findings demonstrate the need to further explore what prevents African Americans from donating blood and explore various strategies that may increase donation rates.

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Multi-domain Evaluation of Concussion Management, Practice Patterns, and Resource Utilization Among Wisconsin Athletic Trainers
dhuber@mcw.edu
Advisor: Michael McCrea, PhD

Abstract
Background
Sport-related concussion (SRC) is a significant public health concern which effects as many as 1.6–3.8 million people each year.  Athletic trainers (ATs) are uniquely suited to address the challenges associated with SRC and may help reduce or prevent its impact.  Current guidelines recommend a multifaceted (i.e., more than two) approach to assessment at baseline, acute assessment, and return-to-play (RTP).  Previous national and state-level investigations do not adequately reflect regional differences in practice patterns due to variations in legislation and policy.

Purpose
The purpose of this project is to evaluate the current awareness and utilization of resources and practice patterns related to SRC management and education among Wisconsin ATs.

Methods
A 55-item questionnaire was disseminated through email and social media to over 900 Wisconsin ATs in early 2018.  Survey questions were intended to assess respondent clinical and educational practice patterns, and demographics and professional experience.

Results
A total of fifty-two (n = 52) survey responses were collected from Wisconsin Athletic Trainers’ Association (WATA) members for an estimated response rate of 7.6% (52/680 certified members).  Respondents were typically between the ages of 35 to 44 with 11 to 15 years of experience.  ATs in Wisconsin indicated using multiple guidelines (84%) for SRC management and generally employed a multifaceted approach to concussion assessment (94%) and RTP (82%), but not at baseline (22%).  A minority (12%) of ATs indicated that they conducted no baseline assessments.  Computerized neuropsychological testing was the most common assessment at baseline (86%) with a symptom checklist most frequently used acutely (96%) and at RTP (92%).  Resource access was considered adequate by most ATs (92%), but a significant minority reported by feeling overwhelmed by number available (34%).  A sizeable proportion of ATs also felt that improvements could be made to athlete (46%), coach (51%), and parent (51%) education.  Although the sample size was relatively limited, practice patterns were not found to significantly vary based on gender, practice setting, or years of experience.

Conclusion
Wisconsin ATs have largely complied with current SRC guidelines for injury assessment and management but may not have the necessary resources (i.e., time, personnel, or funding) to provide multifaceted assessment at baseline.  Additionally, ATs generally feel well informed but indicate that there may be significant gaps in athlete, parent, and coach education. 

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Infant and Early Childhood Risks and Services Assessment of Wisconsin Counties
t.kohlman@gmail.com
Advisor: Kaija Zusevics, PhD

Abstract
This report is a statewide, county-level needs assessment of select risks to healthy development facing children under the age of five across Wisconsin. This assessment identifies the counties whose children are at the greatest and lowest risk of negative developmental outcomes based on eleven health, safety, and economic indicators. An overall risk score is calculated by combining the results from these risk indicators. Eight counties are identified as being at the highest risk level, and eleven counties are found to be at the lowest risk, but vulnerabilities and strengths exist within each county. Additionally, the current availability and utilization of five programs aimed at improving outcomes for this age group are examined in relation to the overall level of risk faced by children in each county. This information is meant to inform conversations regarding how to best meet the developmental needs of Wisconsin’s youngest and most vulnerable population.

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Social Stigma and Substance Use Patterns Among Women: A Review
skrechel3@gmail.com
Advisor: Kim Gearin, PhD

Abstract
Objective
Stigma is a product of social interaction and identity management. It is found to have profound effects on health outcomes, particularly for women who use illegal drugs. This paper will draw on Goffman’s theory of stigma to examine how stigmatization frames social perceptions of substance abuse, addiction and treatment in scientific literature and mainstream media.

Methods
Sixteen journal articles and 30 magazine articles were selected and examined to identify and analyze references to women, stigma and opioids. A summary of findings from the literature review is organized into three categories: stigma and addiction, stigma and treatment and stigma, and the criminal justice system.

Results
This qualitative review found differing attitudes toward women who use opioids. The mainstream media tends to have a more understanding perspective, acknowledging opioid addiction as a mental health condition deserving of fair treatment. Whereas the most common protocols in the criminal justice system bar women from receiving referrals to appropriate treatment programs, thereby perpetuating stigma.

Conclusion
Despite recent changes to how opioid use and addiction are understood, the history of opioid use as inherently criminal continues within the criminal justice system. The differing opinions of how opioid use should be addressed in the United States creates inconsistency in treatment approach and continues to perpetuate stigma. To reduce the burden of stigma on women who use, the United States’ criminal justice system and drug treatment courts should adopt policies that promote best-practice treatment standards and recognize opioid use/addiction as a mental health concern.

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Quality Improvement Project Using Assessment Feedback Incentives Exchange to Increase Human Papillomavirus Immunization Rates
kailynn.mitchell@dhs.wisconsin.gov
Advisor: Kim Gearin, PhD

Abstract
Background
The Assessment, Feedback, Incentives, and eXchange (AFIX) Program applies quality improvement (QI) to increase vaccination rates in the Vaccines for Children (VFC) program. To improve adolescent human papillomavirus (HPV) vaccination rates, AFIX site visits were conducted at VFC clinics in Wisconsin in 2015.

Objective
To assess effectiveness of an HPV AFIX project by examining whether 1) participating clinics implemented their QI strategies, 2) providers strengthened their HPV vaccine recommendations, 3) clinic immunization staff engaged in QI, 4) participating clinics wanted additional support, and 5) HPV vaccination rates and missed opportunities changed more at participating clinics compared to control clinics.

Methods
HPV AFIX site visits (187) were conducted at self-selected VFC clinics during 2015 and 2016. At these visits immunization rates, practices and strategies to improve HPV immunization rates were evaluated. The Wisconsin Immunization Registry (WIR) was used to provide data for 11-18 years olds, for one dose of tetanus, diphtheria, acellular pertussis vaccine (Tdap), one dose of meningococcal vaccine (MCV4), and one (HPV1) and three doses (HPV3) vaccines. Missed opportunities (any contact a patient has with a health service that did not result in an eligible child receiving recommended vaccines) were also assessed. Control clinics were chosen based on population size and geographical proximity to participating clinics.

Results 
For both age groups, HPV1 and HPV3 rates increased at control clinics and AFIX clinics. Compared to control clinics, the increase at participating clinics was not statistically significant. Compared to control clinics, there was a statistically significant reduction in missed opportunities at AFIX for both age groups at six months. Findings suggest that many clinics engaged staff and completed QI projects, and some clinics wanted additional support.

Conclusion
AFIX should be used by all clinics to increase uptake and awareness of the HPV vaccine in adolescents.

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Assisted Living in Wisconsin: An Analysis of the Relationship Between Enforcement Data and Client Groups Served
spica@mcw.edu
Advisor: Kim Gearin, PhD

Abstract
Background
Wisconsin leaders have described assisted living homes in Wisconsin as operating as “mini-nursing homes” but with far less resources. This is not surprising, given the substantial increase in the number of assisted living facilities and equal decrease in skilled nursing facilities. The Wisconsin Department of Health Services reports an increase in serious regulatory concerns, especially within Community Based Residential Facilities. These facilities may serve residents from one to ten client groups. Given the rapid growth, increased needs of residents, and serious quality issues, the relationship between client groups served and regulatory measures recorded should be examined.

Methods
A literature review for existing data on serving different client groups in one facility and regulatory best practices in assisted living. Then, enforcement data provided by the Wisconsin Department of Health Services on Community Based Residential Facilities to examine the relationship between client groups served and enforcements.

Results
Facilities that serve residents with irreversible dementia/Alzheimer’s and advanced age accounted for a disproportionate share of enforcements. They also had the highest percentage of facilities with key code enforcements. An unexpected finding of this study was the lack of data collected and reported by the state, as well we the significant backlog of surveys not conducted by the departments target.

Conclusion
These findings raise important issues and point to an alarming pattern of increased enforcement citations at CBRFs that serve specific client groups, especially irreversible dementia/Alzheimer’s. Urgent action and additional research is needed, which would be best initiated through an external legislative audit.

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Cancer Disparities Among Asian-Americans
alramoski@me.com
Advisor: Kaija Zusevics, PhD

Abstract
Background
Cancer is the leading cause of death among Asian Americans compared to heart disease for other racial groups. Several barriers exist that preclude this racial group to cancer screening and early detection. This study aimed to describe the cancer disparities among the different subgroups of Asian Americans and the evidence-based and culturally-tailored interventions to reduce their cancer burden.

Methods
Literature review was performed to analyze the trend of cancer among Asian Americans. Physicians in the Inland Empire region of Southern California were recruited to participate in individual interviews (n=8) to assess their opinions about cancer in this racial group. The medical providers from various specialties belong to medical groups, public, and private practice.

Results
Literature review: Four articles described cancer trends among Asian Americans. The data revealed the extent of heterogeneity and variation of cancer morbidity and mortality among the U.S. Asian subgroups. The most common malignancies include prostate, breast, colorectal, and lung.  There is also a higher incidence of infection-related cancers including liver, nasopharyngeal, and stomach malignancies compared to other racial groups.

Physician interviews: Lifestyle patterns including poor diet, obesity, and smoking were the most commonly identified risk factors for the heavier cancer burden in this group. Several barriers to care including lack of access to health insurance and language and cultural barriers were reported. Physicians’ time limitation during clinic visits was an unexpected response. Most physicians agreed that collaboration between health care and public health must occur to improve cancer awareness and screening.

Conclusion
Promotion of cancer awareness, screening, and early detection among Asian Americans is of utmost priority to decrease disease cancer rates. Addressing the multiple barriers will reduce cancer disparities in this racial group. Further research is needed to investigate the impact of cancer on underrepresented subgroups and the cultural determinants of cancer among young Asian Americans.

Reducing Childhood Asthma Exacerbations
Advisor: Kristen Volkman, MD

Abstract
Background
Childhood asthma is the most common chronic illness in the pediatric population, affecting thousands of children across the nation. Asthma triggers found in a variety of locations increase asthma exacerbations, hospitalizations, and mortality and morbidity. Prevention techniques should be utilized to reduce and/or eliminate asthma triggers and improve the quality of children’s lives.

Objective
To describe common asthma triggers found in a variety of environments and prevention techniques to reduce and/or eliminate their presence.

Methods
Five scientific articles were reviewed to determine the most common asthma triggers found in homes, child care centers, and schools. Prevention techniques were also identified from these articles as well as other sources.

Results 
Asthma triggers that can be found in homes, child care centers, and schools include tobacco smoke, dust mites, outdoor air pollution, pests, pets, mold, and strong odors. Many prevention methods were identified, such as removal of carpeting, smoking cessation, effective cleaning methods, and repairing water incursion.

Conclusion
If prevention techniques of common asthma triggers were utilized, positive outcomes, such as decreased asthma exacerbations, decreased missed school days, decreased hospitalizations, and decreased mortality and morbidity of children can be achieved.

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The Opiate Impact on Southeastern Wisconsin Communities
awiess1987@yahoo.com
Advisor: Eric Gass, PhD

Abstract
Background
Opioid related deaths have become a growing epidemic in Wisconsin. A steady increase has been documented throughout the state from 2000 to 2016, increasing from 111 deaths in 2000 to 827 deaths in 2016. While the entire state has seen an overall increase, no county has been hit harder than Milwaukee County. Between the years of 2003 and 2013, opioid overdose increased in Milwaukee by 600%. Between the years of 2012 and 2016, Milwaukee County had a documented total of 967 opioid related deaths.  One of the biggest contributors to the increase of opioid related overdoses and deaths is the drastic increase in prescriptions for pain killers that are being written and dispensed to patients. In 2013, nearly 207 million prescriptions were written for opioids, and in 2016, prescribing rates were so high that in a quarter of U.S. counties, there were enough prescription opioids prescribed for each person to have one.

Objective
To establish the best evidence-based practices of lessening the burden of opioid related overdoses and death.

Methods
A literature review and analysis was conducted through an online search of databases and government websites including: Google Scholar, PubMed, National Institute of Health and Centers for Disease Control and Prevention. The database searches were completed using the following search terms: prescription drug monitoring, PDMP success, naloxone, opioid prevention, medication-assisted therapies, drug take back, opioid epidemic state success and opioid policies.

Results
 Studies suggest that the most successful programs included improving and requiring the use of prescription drug monitoring programs, development of medication assisted therapies, creating new state policies, and establishing drug take back programs are proven ways to create the highest level of success. In addition, states with success have also begun requiring opioid prevention programs into school curriculum to promote awareness.

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Racial and Ethnic Disparities in HIV/AIDS in the United States
vbhavna92@gmail.com
Advisor: Eric Gass, PhD

Abstract
Background
According to the Centers for Disease Control and Prevention (CDC) surveillance data, 1.2 million people are living with the human immunodeficiency virus (HIV) in the United States, with one fifth unaware of their status. In 2010, 47,500 new cases of HIV were diagnosed and 71 percent of these cases were among adults and adolescents of different racial and ethnic minority groups. In recent years, use of antiretroviral therapy has slowed the progression of HIV in many infected individuals; however, a similar decline is not observed in ethnic and minority populations. The paper analyzes various articles and highlights the reasons for such disparities.

Methods
An online search of databases including PubMed, NIH and Medscape was conducted to look for published studies. Only full text articles were retrieved for reviewing and extracting information. The following search terms were used: HIV/AIDS, racial/ethnic disparities, high risk sexual behavior, HIV stigma and access/barriers to healthcare. Articles selected provided HIV/AIDS related information, HIV/AIDS surveillance and analytical data, socio-economic determinants, HIV related risk behaviors, access and barriers to care and treatment about ethnic and racial population groups in United States. A total of 30 articles were chosen for review.

Results
The study found that racial/ethnic population groups in the United States continue to bear the disproportionate burden of HIV/AIDS. African Americans account for 12% of the U.S. population, but represent 45% of the HIV diagnoses. Hispanics/Latinos represent 18% of the U.S. population, but account for 24% of the HIV diagnoses. Such disparities stem from a lack of health insurance, poor access to quality health care, lack of education, poverty, and societal stigmatization. Future HIV prevention programs and strategies should focus more on addressing behavioral and sociocultural causes and optimize healthcare delivery in such communities.

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Climate Change, Climate Action, and Public Health: The Relationship Between Green Infrastructure and Health
ames010827@gmail.com
Advisor: Kirsten Beyer, PhD

Abstract
Background
Anthropogenic driven climate change has been characterized as the defining challenge of our time. Environmental alterations induced by excessive greenhouse gas emissions threaten essential ecosystems and ecosystem services, economic development, global security, human development, and ultimately population health and well-being. As a result of these significant challenges, addressing climate change through climate action has become a leading global priority. Among emerging mitigation and adaption strategies is the use of green infrastructure (GI) as a common component of climate action. GI has the ability to not only mitigate and adapt to climate change, but also to protect and promote health and well-being.

Objective
To document the potential pathways through which GI can impact health and well-being.

Methods
A literature review of peer-reviewed journals and grey literature was conducted to document the evidence-based pathways through which GI can impact health and well-being.

Results
GI has the ability to impact health through three primary pathways: (1) provisional ecosystem services; (2) regulatory ecosystem services; and (3) cultural ecosystem services. Through the provision of services such as food, freshwater, carbon sequestration, air quality regulation, climate regulation, runoff regulation, water purification, recreation, aesthetic values, and the stimulation of social relations, GI provides life-supporting and health promoting services.

Conclusion
Emerging evidence suggests that GI provides multiple beneficial services that can assist in addressing climate change and its impacts, and ensuring health and well-being. While additional research is necessary, current research supports the place-based incorporation of GI into climate action, public health, and land use plans. The collective challenges of climate change require a multidisciplinary, multifaceted, and multiphase response. GI has the opportunity to be an effective component of climate and public health action.

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Hospital-Community Analysis and Plan to Reduce Neonatal Intensive Care Utilization and Cost
tcawthra@hotmail.com
Advisor: Kim Gearin, MS, PhD

Abstract
Background
Hospitals are encountering changing reimbursement structures including through the Patient Protection and Affordable Care 30-day readmission penalties, Medicare and Medicaid capitated systems, and others. As part of an analysis of de-identified data of births in 2014 and 2015 at Unity Point Health- Meriter (Meriter), I identified several social factors which may be influencing neonatal intensive care unit (NICU) use. By identifying high-risk patients early in pregnancy, hospitals can provide programs and services to address identified social factors, ultimately reducing NICU utilization and reducing hospital costs.

Methods
A literature review of interventions to address NICU use for infants born to women who smoked, live with a smoker, experience prenatal depression and use illicit drugs provided the framework for potential program development. Discussions with internal hospital leaders and external community-based non-profit organizations formed the basis for a high-level cost-benefit analysis for programs that may address social factors influencing NICU utilization.

Results
Prenatal yoga has been shown to reduce preterm births in pregnant women as well as in women with depression. Using data from Meriter’s birthing center, an analysis of projected savings was conducted. A program plan, performance management plan, and budget plan was proposed for a drop-in yoga program for pregnant women with depression. The program would provide simple yoga instruction for women on a drop-in basis, to accommodate complex schedules, and would offer child-care services and transportation support to address anticipated barriers to participation. The total cost for a full-time yoga instructor, two part-time child care staff, space for yoga and childcare, and supplies is less than the projected savings resulting from reduced NICU utilization, resulting in a positive return on investment for Meriter.

Conclusion
Prenatal yoga offered for depressed women may result in cost savings for a health system able to identify high-risk patients during their pregnancy. Programs such as prenatal yoga can help address social factors affecting birth outcomes. This project used a narrow parameter for determining a financial benefit to a health system. By taking a wider view and considering factor than influence a child’s health beyond the NICU, there are many other programs which can help reduce unnecessary medical costs. As health systems experience pressures on reimbursement and other financial measures, it will be worthwhile to investigate potential savings through programs that address factors outside of the hospital which influence health.

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Staff Time Allocations in Local Health Departments: Implementation of a Time and Cost Allocation System in a Local Health Department
mary.dorn@outagamie.org
Advisor: Nancy Kreuser, MSN, PhD

Abstract
Background
The evolution of services provided by local health departments (LHD) has vacillated between clinical and population services over time. The variation of services and structure in LHDs contributes to the challenge of determining the cost to provide basic public health services in a community. To determine a return on investment for the services provided to the community, public health leaders need the ability to perform financial management and analysis (Honore & Costich, 2009).

Methods
A comprehensive review of the literature on public health staffing in LHDs was completed with a focus on systems or methods utilized to monitor the time that staff spend on various areas of their work and determining the investment made from a staffing perspective to provide public health services at the local level.

Results
The grey literature supports the need for consistent concurrent methodologies to be implemented in LHDs. A staff time allocation framework was developed for implementation in LHDs that allows public health leaders the ability to monitor, track, and evaluate the time that staff members from various job classifications dedicate to services and program areas.

Conclusion
Limited research is available to assist local public health leaders in workforce management. Implementation of methodologies established by national public health organization’s research, further research as the implementation occurs, and publication of the research, will assist in providing rationale and support for funding of public health services at the local level. In addition, research will assist public health leaders in determining the current and future workforce needs.

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Increasing Condom Availability Around Selected High Schools in High Impact Areas of Miami-Dade County, Florida
ddurleyjr@gmail.com
Advisor: Alan Wells, PhD, MPH

Abstract
Objective(s)
To explore lo

1. To explore local factors and reasons related to sexual behaviors contributing to increasing STI rates.
2. To increase condom availability to high school students by recruiting businesses in nearby high schools in high impact areas.

Methods
Data was collected at the Healthy Teen Expos through generated surveys. Healthy Teens Expos provide students with the opportunity to receive free, confidential HIV and STI testing as well as health care information, counseling, and education to promote health awareness. Teen friendly businesses were recruited within a one to three mile radius of five priority high schools. Evaluations were used to document the number of condoms distributed at recruited businesses approximately four weeks from the initial condom distribution date. In addition, evaluations were used to gather feedback from businesses such as potential increases in customers, age range of customers, inquiries regarding additional condoms pickup locations or STI/HIV materials.

Results
A total of 99 surveys were collected from the Healthy Teens Expos. Survey data collected from Healthy Teens Expo revealed that many students were unaware of a location where they can pick up free condoms, and some students were opposed to picking up condoms due to social stigmas. A total of 13 businesses were recruited and 3,250 condoms were distributed. A total of 68%, or 2,222 of the condoms provided to the businesses were distributed to the public after a four-week period.

Conclusion
Although project aims were met, future outreach efforts are crucial to reducing STI’s in high priority Miami-Dade County high schools. Future recommendations include: tailoring prevention programs towards STI/HIV education as well as collaborating with additional local businesses to provide condoms for high school students.

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Mental Health's Impact on the Greendale Community: A Review of Hospital Admissions Data
fuadkhoury@gmail.com
Advisor: Kaija Zusevics, PhD. MPH, CHES

Abstract
Background
The Village of Greendale Health Department (GHD) is continually tasked in performing a Community Health Assessment (CHA) as prescribed by the Public Health Accreditation Board (PHAB) in order to maintain accreditation. The GHD will use hospital admissions data to determine mental health’s impact on the community as well as compare rates with Milwaukee County. There is also a special focus on dementia-related diagnoses among the admissions.

Methods
The GHD has obtained hospital admissions data for residents from 2010 – 2014 in order to gain insight on community health using admission diagnoses. Diagnoses used are classified by the International Classification of Disease (ICD). The data was compiled by the Wisconsin Department of Health Services Office of Health Informatics in a Microsoft Excel workbook. Filtering for mental health and dementia-related diagnoses was done using Excel functions. Calculation of rates was done using population estimates from the U.S. Census Bureau.

Results
There were 9,521 total hospital admissions of Greendale residents between 2010 – 2014 and 422 or 4.4% had a principal diagnosis classified under ICD’s mental illness. Data indicates that mental health’s impact on the Greendale community, using hospital admissions, disproportionately affects the population aged 65 and older. This demographic is the only group within Greendale that had rates higher than those of Milwaukee County. Dementia’s effect on the community is demonstrated by 298 individuals aged 65 and over admitted with a dementia diagnosis, accounting for 9.3% of the over 65 population.

Conclusion
The Greendale Health Department can utilize the results of this project in order to prioritize resources for community mental health initiatives. The GHD has already implemented some dementia-friendly community initiatives to help create better experiences for those suffering from dementia within the community. The findings of this project will be presented to the Village of Greendale Board of Health to potentially influence the Board to advocate for community mental health initiatives.

Managing the Public Health Workforce: An Examination of Employee Performance Review Processes in Local Public Health Departments
martalenore@gmail.com
Advisor: Seth Foldy MD, MPH, FAAFP

Abstract
Purpose
This investigation identified best practices for employee performance evaluations through a literature review. Next, it determined prevalent employee performance evaluation practices in Public Health Accreditation Board (PHAB) accredited local health departments through the use of a survey. Lastly, based on the identified list of best practices and prevalent practices, the investigation provides recommendations on employee performance evaluations and the supporting process for local health departments.

Literature Review
The literature search demonstrated that previous research on the specific topic of employee performance evaluations in public health is very limited. Literature was identified, however, that focused on the evidence base supporting the use of employee performance evaluations in public health, the assurance of an accurate tool and rating system, competencies and skills to be assessed, the use of motivational tools and incentives, and evaluating supervisors or using a 360 degree review process.

Methods
Accredited health departments were identified through the Centers for Disease Control and Prevention State, Tribal, Local & Territorial Public Health Professionals Gateway. Agencies were sent a standard set of questions via email during the week of September 12, 2016. Branching logic was used to ask different questions of agencies currently with and without an employee performance evaluation process in place. Questions focused on key components of an evaluation process, how long the process has been in place, benefits, successes, barriers, and challenges, reasons why a process is not in place, what information is needed to put a process in place, and what barriers may need to be overcome.

Results
Eighteen (95%) of the respondents do have some sort of formal employee performance process in place. Only one respondent reported having a formal evaluation of all supervisors by subordinates in place, two, however, utilized it as an optional process, but it was not implemented universally within the department. Twelve (67%) of the 18 respondents who had a formal employee evaluation process in place reported that the evaluation was somehow tied to a monetary increase. Eleven (61%) respondents reported an evaluation process that included the public health core competencies.

Conclusion
Although the literature supports the use of such processes, little is published about the specific implementation of an evaluation process in local public health departments. Through broad research of public health practices and practices of other types of organizations, and outreach to several PHAB accredited local health departments, several ideas and recommendations have been identified for evaluation process implementation. Recommendations include the use of an assessment tool which utilizes standard ratings, yet allows staff to provide input in the form of a self-assessment and targeted questions; assessment of staff based on specific duties, job descriptions, and needs and goals of the agency; 360 degree reviews of supervisors; and goal setting for all staff. Additional research should be conducted following the implementation of such a process, however, it is expected that implementation of specific employee evaluation recommendations outlined would lead to greater staff motivation, satisfaction, accountability, professional development, facilitate open communication, and ultimately enhance department operations and impact.

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Occupational Noise Induced Hearing Loss (NIHL): Resounding Effects throughout the Department of Defense (DoD)
tracylee@mcw.edu
Advisor: Seth Foldy, MD, MPH, FAAFP

Abstract
Noise-induced hearing loss (NIHL) is a major occupational health hazard within the Department of Defense (DoD) negatively affecting personnel in the United States (US) as well as DoD installations around the world. The effects of NIHL are not only an occupational hazard within the DoD but also span various private enterprises. Negative effects of NIHL include not only personnel health and well-being comprised of both physical and mental health but also workforce longevity and productivity, significant economic costs, and ultimately the national security of the US.

Hearing conservation is a top DoD health priority especially considering the higher risk of occupational noise exposures of DoD personnel working in unique environments. However, NIHL continues to occur with persistent increases in veteran disability claims attributable to NIHL. NIHL is completely preventable if proper precautions are taken. The current DoD hearing conservation program (HCP) sets forth guidelines for multimodal approaches to prevent NIHL involving multiple professionals, such as audiologists, safety officers, industrial hygienists, and occupational health professionals. Improving upon the DoD HCP by incorporating evidence-based methods is imperative in order to improve NIHL prevention. Thus, recommendations for developing a local HCP are proposed for commands onboard Naval Air Station North Island (NASNI), which, if successful, may serve as a model for future DoD HCP policy worldwide.

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Home Hospice Discharge Prevention - A New Approach to Reducing Hospice Discharge
tilenz@mcw.edu
Advisor: Riccardo Collella DO, MPH, FACEP

Abstract
Background
Community paramedics play a unique role in extending primary care into the patient’s home and prehospital community setting. By targeting at-risk populations and those who inappropriately utilize emergency services, community paramedics offer a unique solution to fill the void in lack of primary care providers and other healthcare services, while improving access to primary care and reducing health care costs. The overall goal of Mobile Integrated Healthcare (MIH) is the integration of emergency medical services (EMS) and community paramedics into the current and future healthcare system. Community paramedicine is a model of community-based health in which paramedics function outside of their typical role of emergency response and transport, and enhance access to care for underserved populations and those who inappropriately use the emergency response system. Community paramedics may provide services to those with limited access to primary care, have recently been discharged from the hospital, have multiple comorbid conditions, and over-utilize the emergency system due to non-compliance with medication regimens or lack of education about their particular disease. One vulnerable population is hospice patients, who may be discharged from hospice care if they seek care related to their terminal illness in the emergency department. Unfortunately, transport to an emergency department is not always best for the patient and does not achieve the overall goals of hospice. Community paramedics could play a pivotal role in preventing unnecessary transport and subsequent discharge of hospice patients.

Objectives
The intent of this project is to determine if a fire-based EMS system could be effective in reducing the number of preventable home hospice discharges. Through developing a partnership between Greenfield Fire Department and VITAS Home Hospice, we began shaping the program, creating metrics, and determining efficacy. A two-tiered approach was taken, ascertaining awareness of hospice programs and the comfort level of patients pre- and post-initiation of home hospice and analysis of whether a reduction of unnecessary home hospice discharges occurred in the target population.

Methods
Design: Surveys were developed to be sent to families of deceased hospice patients, home hospice nurses, and EMS personnel involved in the care of the hospice patient in order to establish satisfaction and success of the program. Greenfield Fire Department enrolls those identified at-risk for hospice discharge and enters them into their Computer Aided Dispatch so EMS responders have pre-arrival information about the patient’s hospice status and family contact information. Thirty days following the death of the patient, surveys will be mailed to families so program successes and failures can be assessed. Additionally, home hospice nurses will be surveyed to gain their input on program satisfaction. Finally, EMS personnel will be asked about their interactions with the patient, patient’s family, and hospice nurse, and if they felt as though they and the program were advocates for the patient. Data: Surveys will be entered into a secured database and results analyzed. Descriptive analysis will be utilized to determine significance.

Anticipated Outcome
Positive feedback from EMS and the home hospice nurse is anticipated. We hypothesize a reduction in home hospice discharge due to transport to emergency departments and subsequent hospital admissions. We decided not to survey the patient, as many will likely be too ill to respond or even comprehend the survey. That said, depending on family involvement in care and the hospice discharge prevention program, feedback could be mixed. This is a new concept nationally, so there is no gold standard and little data for comparison.

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Retrospective Analysis of Advancing Healthier Wisconsin Endowment-Funded Projects
jeolson@mcw.edu
Advisor: Cheryl Maurana, PhD

Abstract
Background
Since 2004, the Advancing a Healthier Wisconsin (AHW) Endowment has invested approximately $200 million to improve the health of Wisconsin residents through research, education, and community-based initiatives. In that time, no calculation on the collective, transformative value of those investments has been completed.

Methods
A comprehensive literature review was conducted to inform the evaluation strategy. A three-phase protocol of identifying research questions and resources, creating and coding measures of value, and conducting interviews and completing calculations was outlined.

Results
Phases 1 and 2 of this protocol were completed in a format that allows for modifications to be made in response to stakeholder needs. Products produced include a Transformative Value Framework for Coding Analysis, A Framework for Interviewing, A Framework for Calculating Transformative Value, and a Comprehensive Protocol for future use.

Conclusion
Exploring the value of the first ten years of AHW funding will demonstrate the lasting impact of investing in research, education, and community initiatives. It may also result in the creation of calculations to communicate Transformative Value for other grantmaking organizations, and improve future AHW investment practices.

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Identifying Multidimensional Causes of Obesity and Solutions in the United States
jotterholt218@gmailcom
Advisor: Kaija Zusevics, PhD, MPH, CHES

Abstract
The topic chosen focuses on obesity and the multidimensional causes that are intertwined to produce the epidemic that the United States is facing. Obesity is one of the most common preventable chronic diseases that is costing the United States billions of dollars. The purpose of this paper is to display how obesity is a disease that has multidimensional causes and why prevention should be a priority in the United States. The importance of multivariate causes are summarized through a literature review on related causes of obesity and two interviews completed by front-runners for obesity prevention in Oneida County, Wisconsin. Results indicate that in order to make improvements to current health outcomes, resources must be streamlined and coordinated together to promote prevention and education among all populations and early in life.

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Mental Health Treatment Gap Analysis of Washington and Ozaukee Counties
maxwellroy26@gmail.com
Advisor: David Nelson, PhD, MS

Abstract
Mental health is a prioritized issue in the United States (U.S.). A portion of the U.S. adult and child population are impacted by mental illness. Despite being a priority, research shows that many adults and children with mental illness do not receive treatment. The purpose of this paper is to calculate and understand the mental health treatment gap in Washington and Ozaukee Counties in Wisconsin. This paper calculates and identifies themes associated with the mental health treatment gap using mixed methods. A difference was calculated between the any mental illness (AMI) prevalence in both adult and child populations and the unique patient count (received from the Wisconsin Health Information Organization – WHIO) for adults and children who accessed mental health services, which produced an estimate of the mental health treatment gap in both Washington and Ozaukee Counties. Additionally, health and human service professionals were interviewed to provide insight into themes that act as associated factors to the treatment gap. Open coding of the interview notes and recorded conversations highlighted reoccurring themes to help understand the mental health treatment gap in both counties. The mental health treatment gap for children and adults in Washington and Ozaukee were higher than state averages. Lack of providers, long wait times, lack of education, and financial/insurance factors were major themes addressed by interviewees. Further efforts to increase providers, treatment options, educational efforts for adults and youth, and improving transportation systems may help improve the mental health condition and reduce the treatment gap in both counties.

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Evaluation Plan for the Enhanced Care Program: Designing a Chronic Disease Medical Home's Health Program Evaluation
gstadter@mcw.edu
Advisor: Julie Mitchell MD, MS

Abstract
Given the increasing expenditures on health care spending and an aging population, the United States health system is currently facing an imperative to improve outcomes while reducing the cost of care. This is especially true for patients with chronic conditions, who currently account for over 85% of the nation’s health care expenditures3. One strategy that has recently been deployed to reduce costs and improve outcomes for patients with chronic conditions is the Medical Home health care delivery model. Medical Homes offer comprehensive, patient-centered care and stress care coordination, accessibility and quality. Through these methods, the Medical Home aims to reduce the cost of patient care for individuals with chronic diseases by encouraging patients to utilize primary care with enhanced services and extended access, rather than emergency department care, while also engaging and empowering these patients to manage their own care. These approaches have been proven to lead to improved health outcomes. This paper will seek to describe and analyze available literature on the Medical Home care model, design a program evaluation for a soon to be established Medical Home at the Medical College of Wisconsin (MCW), and to inform any real evaluation plan that is subsequently developed. The Medical Home model is still a relatively new concept. Therefore, a strong health program evaluation for this newly established program will be essential for the initiative’s success and can inform both internal and external stakeholders moving forward.

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Applications of Infrared Spectroscopy in Clinical Medicine and Production Animal Agriculture
aestanton@wisc.edu
David McClure, PhD

Abstract
Introduction
The implementation of infrared (IR) spectroscopy in human medicine and agricultural fields has provided opportunities to sample various tissues and bodily fluid samples for the purpose of diagnosing diseases and conditions through identifying sample composition. Biological specimens are regarded as the ideal sample for this technology, in human medicine as well as in agriculture. Of particular interest is the use of this technology to predict antibiotic residues in milk at both the herd and individual cow level, since the growing concern of antibiotic over-use and antibiotic resistance greatly affects producers, consumers, and has implications in various aspects of public health.

Purpose
The purpose of this literature review is to provide background information on the past and current diagnostic capabilities of IR-spectroscopy and the potential value of this method in detection of antibiotics and antibiotic residues in milk.

Methods
Papers were chosen for this critical review from the biomedical databases PubMed and OVID by searching with the keywords “infrared spectroscopy in veterinary medicine”; “infrared spectroscopy AND milk quality”; “infrared spectroscopy AND mastitis”; “infrared spectroscopy AND clinical medicine”; “infrared spectroscopy AND veterinary”; “infrared spectroscopy AND antibiotic*”. Abstracts were reviewed for relevance, and those remaining were critically reviewed.

Results
Clinical medicine commonly uses IR-spectroscopy to analyze serum, whole blood, and urine. Less commonly assayed bodily fluids include saliva, amniotic, joint and cerebrospinal fluid. Within serum samples, mid-infrared spectroscopy (MIR) and near-infrared spectroscopy (NIR) can determine concentrations of glucose, total protein, albumin, triglycerides, urea and cholesterol. However, while analysis of these metabolites is possible, accuracy has yet to be established for some of these for use in clinical medicine. This is also true for urinalysis, analysis of amniotic fluid, and evaluation of joint fluid. In agriculture, IR-spectroscopy has proven useful for identification of various nutritional components, meat and cheese quality, and milk quality. Within milk quality, components being critically analyzed for use in predictive models may reflect ability to discern aspects of cow health beyond simple monitoring of production components of milk. These may include antibiotic residue detection, identification of organisms causing mastitis, pregnancy status, detection of embryo loss, ketosis, acidosis, methane as an environmental impact, and cow energy balance. In order for these advances in application of IR-spectroscopy to be realized in the agricultural setting, it is recognized that further research is needed for the purpose of standardization of spectrometers; development of a transnational database; building of predictive equations from associations between phenotypes and milk MIR spectra to predict health status, nutritional status, environmental impact of individual cows; and development of web tools to make the service readily available.

Conclusion
The use of IR-spectroscopy as a predictive tool in production animal agriculture has the potential to be invaluable. The technology is non-invasive, rapid, reliable, and cost-effective. However, future research is necessary and should be made a priority as producers, consumers, researchers and public health officials continue to strive towards methods to ensure a safe food supply and reduce the effects of overuse of antibiotics in multiple settings.

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Antibiotic Overuse in Agriculture: Implications for Animal and Human Health, A Literature Review
svollmer@mcw.edu
Advisor: Jennifer Peterson, PhD, MA

Abstract
Antibiotic fortified feed and water help contribute to antibiotic resistance in food animals, which has impacted both human and environmental health through excreted veterinary and feed antimicrobials, occupational exposures, and contaminated animal products. The purpose of this literature review is to add new perspectives on the health relationships that exist between animals, humans and the environment with antibiotic resistance stemming from antibiotic overuse in agriculture. This literature review discusses the animal, environmental and human health impacts that result from overuse of antibiotics in agriculture. Peer-reviewed research articles published within the last five years were collected using Google Scholar, PubMed and the National Institutes of Health. Articles were selected based on their relevance to key words such as ‘agriculture’, ‘food animal’, ‘manure runoff’, ‘ecological effect’, ‘transmission’ and ‘antibiotic misuse,’ in combination with antibiotic resistance. Articles were not selected if they were not published within the last five years, were not translated to English, were review articles, the free-full text was not available, or the titles and/or abstracts did not relate to the purpose of this review. This review identified health relationships that exist between animals and people in shared environments through the overuse of antibiotic fortified feed. Antibiotic feed impacted animal health directly through altering the microflora of food animals, impacted both soil and aquatic environments indirectly through excreted antibiotic residues and antibiotic resistance genes, and ultimately impacted community health through occupational hazards and contaminated animal products. The trickle down effects that were identified with overusing fortified feed can drastically impact community health by limiting treatment options for both humans and animals as well as providing additional avenues for people to become infected with antibiotic resistant infections. Furthermore, the health relationships that were identified in this review illustrate an additional argument to investigate policy changes in order to decrease the amount of antibiotics used in agriculture in order to improve overall community health.

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Including and Engaging People with Disabilities: A Guide for Local Health Departments
williamsmer@gmail.com
Advisor: Nancy Kreuser, MSN, PhD

Abstract
Background
When compared with the general population, people with disabilities have traditionally been underserved and experience significant health inequities, receive fewer preventive and primary care services, develop more preventable secondary health conditions, and report poorer health and quality of life. Including people with disabilities in all public health efforts has been widely recommended to address these health inequities. Local health departments (LHDs), however, face multiple barriers to including people with disabilities in their programs and activities, such as resource constraints, competing priorities, and low awareness of and access to disability inclusion strategies.

Methods
A literature search was conducted to identify promising practices and recommendations for disability inclusion from non-profit organizations, government agencies, businesses, and educational institutions. Because much of the work on disability inclusion has been conducted outside the field of public health, making recommendations from other sectors relevant to LHDs was a priority.

Self-assessment and recommendations
This guide provides a self-assessment tool and recommendations that LHDs can use to (1) better understand the needs of people who have disabilities, (2) assess their LHD’s current level of disability inclusion, (3) plan for making practical, sustainable, and low-cost improvements over time. To make the biggest impact for their efforts, LHDs can begin by improving communication accessibility and reaching out to disability organizations.

Conclusion
LHDs are uniquely positioned to improve health outcomes for people with disabilities and promote disability inclusion throughout their communities. Including and engaging people with disabilities can help LHDs improve the health of the general population, meet their goals, fulfill the ten essential public health services and professional competencies, and design policies, programs, and activities that are more effective for everyone. By sharing what they learn while working to increase disability inclusion, LHDs can become leaders in the emerging field of disability and public health.

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Efficacy of Home-Based Interventions in Adults with Asthma, A Literature Review and Analysis of a Local Project
azane@mcw.edu
Advisor: Joshua Steinberg, MD

Abstract
Background and purpose
Asthma self-management skills are essential to asthma control. Self-management education can be delivered in inpatient and outpatient clinical settings or individuals’ homes. This paper reviews existing home-based adult asthma interventions and offers suggestions for future research, including the ongoing work of Fight Asthma Milwaukee Allies.

Literature review
Methods
A PubMed literature search identified eight peer-reviewed papers assessing home-based educational or educational and environmental interventions for asthma control in adults.

Results
Research to date has evaluated the impact of home-based interventions on the home environment and health outcomes of adult participants. Limited data showed modest but non-significant decreases in home allergen levels as a result of environmental remediation. With respect to health outcomes, interventions improved asthma control and quality of life. Health care utilization improved in some cases, but home-based interventions had little effect on lung function and asthma management behaviors.

Discussion
Improvements in quality of life measures support the use of home-based asthma management interventions. Future studies should better evaluate the lone vs. combined effects of asthma self-management education vs. environmental interventions on health outcomes and reconsider how lung function measurements are used in evaluating asthma control.

Project analysis
FAM Allies Home Visiting Program

Methods
FAM CARES is a 6-visit home-based asthma education and environmental intervention program led by community health workers.

Results and discussion
Eight adults are currently enrolled in the program. Enrollment and data collection is ongoing. Asthma Control Test scores have improved and quick relief medication use decreased over 4 weeks among participants for whom data is available. Experience continues to inform improved implementation and data collection.

Conclusion
Existing research shows support for continued use of home-based asthma interventions for adults. Programs like FAM CARES will continue to inform the body of evidence supporting the use of community-based health care initiatives. Future research should consider appropriate measures of success for interventions and which activities improve health outcomes the most.

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