Thesis (M.A.)--Georgia State University, 2006. / Title from title screen. Stuart Galishoff, committee chair; Clifford M. Kuhn, J. Lyle Conrad, committee members. Electronic text (157 p. : col. ill.) : digital, PDF file. Description based on contents viewed Aug. 17, 2007. Includes bibliographical references (p. 152-157).

Thesis (M.P.H.)--University of Wisconsin--La Crosse, 2002. / Includes bibliographical references (leaves 50-52).

This qualitative analysis of the framing of health issues by the Centers for Disease Control and Prevention, one of the world’s premier health organizations, and by major U.S. newspapers analyzes the frames present in a sample of the CDC’s press releases, and the frames present in the contemporaneous (and often resulting) press coverage. This study focuses on communication surrounding public health events that occurred in the six-year period 2002–2007.

This research uses data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) to determine dietary and other factors associated with serum 25(OH)-Vitamin D concentration for 5,474 adults age 20 years and older. After multivariate adjustment, we found that serum 25(OH)-Vitamin D concentration was positively associated with diets high in fruits, vegetables, and lean meats, while diets high in processed foods and high-fat meats were inversely associated with vitamin D level. Serum 25(OH)-Vitamin D concentration was also signifi-cantly associated with age, gender, race/ethnicity, BMI, physical activity, supplementation, and the season of survey administration. Self-reported cardiovascular and kidney disease were significantly associated with serum 25 (OH)-Vitamin D concentration after adjustment for significant confounders.

Thesis (M.A.)--Georgia State University, 2008. / Title from file title page. Leonard Teel, committee chair; Kathryn Fuller-Seeley, Holley Wilkin, committee members. Electronic text (158 p.) : digital, PDF file. Description based on contents viewed Nov. 18, 2008. Includes bibliographical references (p. 130-158).

Class of 2014 Abstract / Specific Aims: The purpose of this study was to assess pharmacists’, pharmacy technicians’, and pharmacy interns’ knowledge of current Centers for Disease Control and Prevention (CDC) immunization guidelines for pregnant women. Methods: Questionnaires administered to volunteers during the Arizona Pharmacy Association (AzPA) 2013 Annual Convention and Trade Show collected data showing the volunteers’ level of knowledge about current immunization guidelines; data on professional roles (pharmacist, pharmacy intern, or pharmacy technician), years in practice, current immunization certification status and activity, and practice setting were also collected. Main Results: Questionnaires were completed by 112 volunteers, including 48 pharmacists, 25 pharmacy technicians, and 39 pharmacy interns. The overall percentage of correct answers from all participants was 33%. Pharmacists, pharmacy technicians, and pharmacy interns had correct answer percentages of 41%, 16%, and 34%, respectively. Pharmacy practitioners who were state certified to perform immunizations performed statistically significantly better than the non-certified group (44.2% correct versus 33% correct, P=0.012). Practitioners who work at a practice site that provides immunizations were compared with practitioners who do not, with results trending toward statistical significance, but falling just short (45.7% correct versus 36% correct, P=0.054). Conclusion: The general level of knowledge about CDC immunization guidelines appears to be inadequate among the volunteer group of pharmacy practitioners, possibly leading to missed opportunities for needed immunizations.

Background: At a primary care center in Brooklyn, New York, approximately 27% of diabetic patients with abnormal Hgb A1C fail to return for follow-up appointments, as recommended by the Centers for Disease Control and Prevention (CDC). According to electronic medical records (EMR), healthcare providers demonstrated inconsistency in ordering and monitoring Hgb A1C and clinic follow-up appointments for patients. Purpose: The purpose of this quality improvement project was to determine retrospectively the healthcare providers’ ordering, monitoring, and follow-up appointments for adult diabetic patients with abnormal Hgb A1Cs; to develop and implement astandardized process for healthcare providers to monitor and follow these patients, especially those with possible nonclinic follow-up compliance and abnormal Hgb A1C; to determine prospectively healthcare providers’ ordering, monitoring, and follow-up appointments; and to evaluate the prospective charts to determine if Hgb AIC results changed from abnormal to normal or elevation over time until the next follow-up appointment.

A groundbreaking narrative, which would come to be known as the theory of “deaths of despair”, emerged in 2015 from a study by Case and Deaton analyzing mortality rates in the United States between 1999 and 2013. They found an increasing trend in all-cause mortality rates due to drug poisonings, alcohol-related liver disease, and suicides, which they called “deaths of despair”, among non-Hispanic (NH) white Americans aged 45 to 54—this age group was called the midlife. Case and Deaton’s findings and their narrative about the hypothetical causes of their findings garnered significant attention. The authors of this narrative hypothesized that the observed increases in mortality rates were due to white individuals in midlife increasingly suffering from “despair” and proposed a causal link between increasing “despair” rates and increased mortality rates only among white Americans in midlife. Case and Deaton did not provide a clear definition of “despair”; they presumed that white Americans in midlife were hopeless about their prospects for the future compared to what their parents had attained. This provocative narrative persisted and gained momentum because it functioned as an explanation of recent events like the 2016 U.S. presidential election, rise in white nationalism, and far right extremism. These white-related events were thought to be expressions of an agonizing, poor, under-educated generation of white Americans increasingly suffering from hypothetical feelings of "despair”, which have led them to self-destructive behaviors and premature death. However, no study has investigated the central claim of this theory: whether there is evidence of an association between increased “despair” rates and increased mortality rates only among white individuals in midlife, particularly for those with low education. Moreover, there is little evidence of their hypothesis of an increasing epidemic of “despair” affecting only white Americans in midlife, particularly those with low education. The theory of “deaths of despair” can be understood through Geoffrey Rose’s framework of causes of incidence and causes of cases, which highlights the difference between between-population and inter-individual causes of disease. Rose’s argues that causes of incidence explain the changes in outcome rates between populations, and may be uniform and imperceptible within populations. On the other hand, the causes of cases explain why some individuals within a population are susceptible or at high risk of the outcome. Like Rose’s causes of incidence, the authors of the theory of “deaths of despair” argue that “despair” increased between the midlife white American population in 1999 and in 2014, which led to increased mortality rates. Conversely, this theory does not claim that some individuals are at higher risk of death due to “despair”, which would be analogous to causes of cases. Therefore, the contrast of interest to test the central claim of Case and Deaton’s theory of “deaths of despair” is a between-population contrast (causes of incidence). As such, this dissertation aims to test the claims of the theory of “deaths of despair” proposed by Case and Deaton at the right level (causes of incidence). I began by conducting a scoping review of the current literature providing empirical support to the different elements of this theory: 1) socioeconomic causes as causes of “despair”, “diseases of despair”, “deaths of despair”, and all-cause mortality, and 2) “despair” as the cause of “diseases of despair”, “deaths of despair”, and all-cause mortality. I found 43 studies that I organized and displayed in two graphs according to Rose’s causes of cases (individual-level causes of “deaths of despair”) and causes of incidence (between-population level causes of “deaths of despair” rates). In each graph, I showed the number of studies that provided evidence for the individual- or population-level elements of the theory of “deaths of despair”. Of these 43 studies, I found that only 13 studies explicitly stated that they tested this theory. Three studies provided different definitions of “despair”, which did not align with the previous vague definition provided by Case and Deaton about white individuals’ hopeless about their prospects for the future. Most studies provided individual-level evidence for “despair” increasing the likelihood of death and despair-related outcomes, which is analogous to a type III error—a mismatch between the research question and the level at which the studies’ design and analyses were conducted to answer that question. Further, no study addressed at the right level—between populations—the central claim of the theory of “deaths of despair”. This led me to review the literature around concepts similar to “despair” and propose a suitable indicator to test the claims of the theory of “deaths of despair”. I leveraged data from the National Health Interview Survey and the Centers for Disease Control mortality data to test whether increases in the prevalence of “despair” were associated with increases in all-cause mortality rates only among white individuals in midlife and whether this effect was bigger among low educated white individuals. To obtain a valid estimate of this association, I adapted econometric methods to develop a valid estimator of the association between increasing “despair” prevalence and increased all-cause mortality rates. After adjusting for potential confounders at the between-population level, I found that the trends in the prevalence of “despair” were negligible across all race and ethnic groups and that an increasing trend could not be identified. Further, I found no evidence that increasing prevalences of “despair” were associated with increased all-cause mortality rates among NH white individuals in midlife, or that this association was more pronounced for those with low education. Lastly, I conducted a similar analysis looking at the association between increased prevalences of “despair” and increased rates of “deaths of despair”. I replicated Case and Deaton’s observed increased rates of “deaths of despair” among white individuals in midlife. However, I found no evidence that increased prevalences of “despair” were associated with increased “deaths of despair” rates among white individuals in midlife or that this association was higher for those with low education. Together, these findings suggest that the claims about the causes of increased mortality rates among white Americans in midlife are at best, questionable, and at worst, false. My aim with this work is to challenge and provide a critical examination of the theory of "deaths of despair", which has fueled the narrative of a suffering white generation and justified recent problematic events as white individuals lashing out for being forgotten to despair and die. While Case and Deaton’s observed rise in mortality rates among whites is a reproducible fact, their narrative ignores other evidence of white racial resentment as the cause of rise in mortality among white individuals. With this work, I intend to help stopping the perpetuation of narratives that favor structural whiteness by promoting an unsubstantiated narrative of psychosocial harm experienced by white Americans. Ultimately, I hope this work helps shift the focus in public health away from Case and Deaton's findings, which may overshadow and detract from the stark reality that mortality rates for Black individuals significantly exceed those for white individuals.

Autism is the fastest-growing developmental disability in the United States. Proactive adult behaviors leading to early intervention are a child’s best hope to reach their full potential. The Centers for Disease Control and Prevention partnered with Porter Novelli to develop a public health campaign called “Learn the Signs. Act Early.” The goal of this campaign was to increase awareness about the early warning signs of autism to help invoke positive behaviors in parents so that children receive services at the youngest age possible. HealthStyles survey data were analyzed to assess the difference in level of autism awareness of those surveyed before the campaign launch and of those surveyed two years post-campaign launch. Association between awareness of autism and early intervention behavior was also examined. Results of the study show improvements in awareness of autism issues; however, the results indicate minimal association between awareness and early intervention behavior. Further research efforts are essential to modify the campaign and target the issues necessary to instigate early intervention behavior.

The purpose of this capstone project was to develop the content for an online training module entitled Promoting Older Adults’ Health through Policy. The Centers for Disease Control and Prevention (CDC) Aging and Health Work Group was interested in complementing their workshop, Promoting Older Adults’ Health: Opportunities and Resources for CDC Professionals with an online training module on aging and policy. This project highlights significant pieces of U.S. legislation that promotes older adults’ health and draws attention to emerging policy, systems, and environmental changes on the horizon. An anticipated short-term outcome is a demonstrated sensitivity to population aging in all CDC centers, divisions, programs, and initiatives. Similarly, an anticipated long-term outcome is growth in the number, quality, and scope of collaborative efforts across CDC centers, divisions, programs, and initiatives that focus on older adults’ health. Two perspectives, “Healthy Aging” and “Successful Aging,” provide the foundation for a discussion of legislation and policies oriented towards older adults’ health. Various policy frameworks, i.e., cost-benefit, problem, political, vision, and a futures policy approach frame the discussion of policy development. Significant legislation that promotes older adults’ health, i.e., Social Security, Medicare, Medicaid, and the Older Americans Act of 1965 provide a historical context for a discussion of emerging policy, systems, and environmental changes that promise even greater advances. The mobility challenge for older adults as a population group in the U.S. provides the thematic thrust of this section of the module. Examples of CDC’s work exploring the link between older adults’ health and mobility, the built environment, and emergency preparedness are highlighted based on several criteria: burden of the problem, preventability, relationship to other CDC initiatives, and usefulness to practitioners are critical considerations. The module also discusses how legislation and policies designed to promote health aging also improve the quality of life for all population groups. Policies focused on healthy aging lay the groundwork for an integration of a “health in all policies” approach (World Health Organization/ WHO, 2006), working in tandem with the “health for all” framework (WHO, 1998) and the “society for all ages” construct (United Nations, 1999).