Oral health in rural children is in need of significant improvement. The combination of a high prevalence of poverty, limitations of employment benefits, depressed population and economic growth, and decreased preventive care in rural regions all contribute to the problems in oral healthcare in rural areas. Current literature and programs show that community involvement is crucial in reducing the outcomes of poor oral health despite economic disadvantages. In this study, three Head Start offices of rural Pennsylvania are used as the community model to determine the extent of awareness and any additional need to change the behaviors of those who participate in the program. Results showed that in these three areas, Head Start staff needs to increase communication about oral health to parents and guardians. The implications of the studys findings indicate the need to allow communications to be based upon components of community building. The findings from this study are significant in public health since it enables a governmental backed program to be able to be spotlighted upon this pressing issue, which could allow for increased support to address this problem through larger studies representing the entire nation and further legislative actions. The multidimensional attributes of Head Start programs enables the key structures that make community assessments efficacious to be utilized while maintaining general regulations that are accommodating to a multitude of groups. Future actions could even successfully create a nation wide mandate for dental health to be a part of a pre screening regimen for children who are planning on enrolling into schools or daycares.

During an internship at Magee-Womens Hospital, I had the opportunity to work with the teen centered prenatal care program. Through my interactions with the teens, I found that it is very beneficial to them to have access to a prenatal care program that is teen-focused. I wondered if access the same type of program would be beneficial to pregnant teens in rural areas. Although rates have declined, teen pregnancy continues to be a health issue with significant social and economic implications. Pregnant teens are a vulnerable population at higher risk for poor prenatal and post-partum outcomes. Pregnant teens have unique circumstances that require a different approach than that provided to pregnant adults. Teen parents lack parenting skills and are at a higher risk for child abuse and neglect. Teen mothers are less likely to finish high school and more likely to have poor long-term outcomes. Teen pregnancy in rural settings is as much of an issue as teen pregnancy in urban settings, however, the availability of teen-focused prenatal services in rural areas are disproportionately low. Pregnant teens in rural areas are limited to seeking care in adult-focused clinics or traveling to neighboring urban counties for teen-focused services. Pregnant teens would benefit from comprehensive teen-focused prenatal care programs. Providing care in a teen-focused setting allows teens to learn needed skills in a supportive atmosphere. A teen-focused program addresses issues such as increasing the use of contraception to prevent subsequent pregnancies; it also provides nutritional counseling, teaches parenting skills, encourages continued education, and identifies available resources. Teen Outreach is an example of a comprehensive teen centered education program located in Washington County, PA. The program provides prenatal, post-partum, and parenting education for pregnant teens in a rural setting. The purpose of this thesis is to address the need for comprehensive teen-focused prenatal programs in rural areas.

Background: In 2005, 63% of the US population was employed, representing over 142 million people over the age of 16 in the United States. Because so many Americans spend so much time at work, the workplace has become a natural setting for public health interventions. The field of worksite health promotion (WHP) offers many opportunities to improve the health of the US population and achieve Healthy People 2010 objectives. WHP programs often contain a participatory component in the form of worksite wellness committees (WWC). Despite their popularity, little is known about how wellness committees organize, assess, plan, implement and evaluate programs. This project sought to understand how WWCs functioned at PPG Industries, a Fortune 500 manufacturing company, Methods: To evaluate the WWCs, two survey tools were developed. The first gathered information about WHP program offerings; the second assessed the organizational processes by which the committees operated. The tools were deployed by email to approximately 100 worksites. The data were analyzed, along with pre-existing HRA data, to see if worksite demographics or organizational functioning were significantly related to the health of employees and if there was a relationship between the processes by which the WWCs operated and the quality of the WHP offered. Results: Larger, US-based, and older worksites did have significantly more resources and activities in the areas of blood pressure, lipid, and overweight/obesity control, and cancer and depression screenings. In general, worksites in the US had slightly more mature organizational processes than those internationally. However, there were no significant differences were found in the location, size, or age of employees on organizational maturity. Higher functioning worksites did also have significantly higher scores on the Program Inventory in all areas except nutrition and physical activity categories. HRA data revealed that many preventative health behaviors were significantly associated. However, few significant relationships were found between organizational functioning and employee health. Public Health Significance: WWC need increased attention from researchers and evaluators. Organizational maturity is related to program outcomes, but not necessarily to employee health. Improving organizational functioning may lead to improved WHP programming.

Nursing homes are considered lagging behind in adopting health information technology (HIT). Many studies have highlighted the use of HIT as a means of improving health care quality. However, these studies overwhelmingly do not provide empirical information proving that HIT can actually achieve these improvements. The main research goal of this dissertation is to review the current development of HIT in nursing homes, to determine the nursing homes use of HIT features in MDS software, and to examine whether these uses result in better quality of care as measured by Nursing Home Compare (NHC) quality measures. This dissertation includes three parts and each part has its own emphasis and methodology centered on the main topic of the use of HIT in nursing homes. The first paper reviews the background and definitions of HIT as well as the most important applications and several standards that are currently used or under development. The second paper examines the use of commercial Minimum Data Set (MDS) software in nursing homes and identifies the HIT features that are available in the most commonly used software package. The frequency of use of each HIT feature in MDS software is also reported. The third paper evaluated whether the use of such HIT features is associated with better quality of care as measured by NHC. This dissertation reviews the HIT, summarizes a list of top 12 advanced HIT features in commercial MDS software used by the surveyed nursing homes. The study also evaluates the frequency of use of each feature. It concluded that although nursing homes were often viewed as technologically impaired, many of them had used quite advanced HIT in commercial MDS software. The findings are helpful in prioritizing the importance of future HIT development in nursing homes. Understanding the highlighted issues and the evidence of HIT use for promoting quality of care in nursing homes is a top research and public health concern. Future research should extend the list of HIT features in the current commercial MDS software and interconnect such features with available EHR systems in the continuum of health care.

There is a gap between the growing presence of fathers in the lives of their children and their inclusion within the prenatal process. The healthcare system fails to acknowledge fathers by not addressing their needs, issues or concerns programmatically or within the clinical setting. This topic is of public health relevance because a fathers contribution to the health of his child may optimize the childs overall health and well-being. The presence of fathers during labor and delivery is common place in todays society, however little is known about their birthing expectations and needs. Furthermore, the literature on this topic is sparse. Maternal child health is the phrase used for the study of women and children, interestingly, paternal child health is invisible, and the phrase is non-existent. This research study seeks to address this gap by looking at programs that engage fathers in order to make recommendations in the prenatal health care sector. Interviews were conducted with fathers to assess their experiences throughout the prenatal process. The mother-baby dyad has a historical context, but as the dynamics of our society has changed, the healthcare system cannot afford to remain stagnant. The dyad must evolve to include fathers in-order to provide the services and information they need to parent their children as well as support mothers in the process.

Undiagnosed and untreated child mental health problems create a public health emergency in the United States (US). In the US the human suffering, burden of disability, and economic costs associated with mental illness are immense. Mental illness is the second leading cause of disease burden, directly resulting in substantial lost productivity. Behavioral health and prevention research highlight the effectiveness of interventions that reduce risk factors and enhance protective factors associated with mental illness. This focus on prevention and resilience reflects the relatively recent public health approach to mental health. The emphasis on promotion, prevention, and early intervention in a public health approach is especially relevant for young children. Likewise, the social-ecological perspective often used in public health interventions mirrors the multi-tiered influences on young childrens social and emotional wellbeing. Finally, child development research shows young children can recover from early detection and early intervention for a mental health problem. One in five children and youth is estimated to experience symptoms of psychiatric disorder each year. Many of the mental health problems diagnosed in school aged children and teenagers originate in early childhood, but there are long delays before diagnosis and treatment are received. Approximately 10% of children experience mental problems to the point of impairment, yet less than 20% of those in need receive treatment. This unmet need in the population most likely to benefit from prevention and early treatment creates a problem of public health significance. Currently, there is little research linking public health approaches to mental health services for children birth to age five. This paper discusses the need for, and relevance of, a public health approach to young childrens mental health, and makes recommendations for implementation of that approach.

HIV/AIDS has become a major public health concern in the United States over the past 35 years and when paired with substance abuse, specifically intravenous drug use, the co-occurrence can have a significant impact on the risk of HIV infection. Health issues related to HIV and substance abuse do not exclusively affect one specific demographic; however, evidence shows that the concurrence and spread are more prevalent in the economically and socially deprived, mainly low-income black communities, than in areas with higher incomes and a lower minority population. Programs, such as the PATF in Allegheny County, developed the Partnership for Intervention and Empowerment (PIE) for populations at risk for the co-occurrence of HIV infections and substance abuse. The purpose of this paper is to evaluate the strengths and weaknesses of PIE during the first year of implementation into the target communities. Conclusions from this paper were drawn to determine that incorporating best practice factors into the study design of behavioral interventions would greatly enhance the applicability of an intervention program in specific communities. The public health significance of this thesis is to identify program planning strategies that would provide information and/or access to appropriate clinical care for individuals who test positive for HIV/AIDS. Developing strategies to counteract the disparity in access to care is paramount in addressing the plight of black populations living in low-income housing

Previous studies have shown that women exposed to certain air pollutants are at an increased risk for preterm delivery and/or delivering a low birth weight newborn. Preterm delivery and low birth weight are associated with an increased risk for morbidity and mortality. In an effort to better understand the impact of local environmental factors on pregnancy health, duration and outcomes, this study investigated the relationship of hazardous air pollutant chemicals released by local industries and the adverse pregnancy outcomes of preterm delivery and term low birth weight in Allegheny County, PA. This study included 2,798 singleton birth records for deliveries that occurred in Allegheny County in January through March of 2004. The Toxic Release Inventory provided data for 2003 fugitive and stack air releases of all facilities in Allegheny County reporting air releases of lead and toluene. This data was used for determining proxy maternal exposure measurements. ArcGIS software was used to calculate the distance from each maternal residence to each TRI facility. The distances and reported total pounds of release from each facility were then used to calculate a total lead and toluene exposure value for every birth record. Binary logistic regression was used to assess maternal characteristics effects on birth outcomes. Chi square tests were used to assess maternal characteristics and levels of exposure to lead and toluene. Chi square tests and binary logistic regression were then used to assess pregnancy outcomes in relation to quartiles of exposure. This study found that mothers with certain age, race, education, and marital characteristics were significantly associated with lower exposure levels of lead and toluene. However, exposure to higher levels of lead or toluene, as measured in this study, was not significantly associated with an increased risk for preterm delivery or term low birth weight. Adverse pregnancy outcomes negatively impact an individuals immediate and lifelong health. Decreasing the incidence of preterm delivery and low birth weight are of great importance to public health. Research that helps to identify environmental determinants of adverse pregnancy outcomes is of vital public health significance.

Depression is the most common mood disorder after traumatic brain injury (TBI). This study evaluated how the presence and/or severity of depression post-TBI affect a persons cognitive status and quality of life (QOL). Demographic variables, injury severity, and pre-morbid psychiatric histories were documented from patient interview and medical records. Persons with TBI were assessed at 6 and 12 months post-injury for posttraumatic depression using the Patient Health Questionnaire (PHQ-9). They were also evaluated for cognitive status and QOL at the same time points. Results indicate that persons with moderate/severe TBI exhibit worse cognitive status and report lower QOL post-injury than persons with no depression. Persons with mild depression report lower QOL than persons with no depression, but do not display worse cognitive functioning. The severity of posttraumatic depression, not just the presence of depression, affects a persons cognitive status and QOL after injury. TBI and posttraumatic depression are chronic conditions. The Chronic Care Model is a framework for identifying and improving care at multiple levels within the health care system including delivery system design, decision support, clinical information systems, self-management support, and within the community. The current health care delivery for persons with TBI suffering from posttraumatic depression and treated in southwestern Pennsylvania is discussed and areas for improvement within the system are identified. The public health significance of this research is important for understanding the relationship of depression, cognition and QOL after TBI and effectively targeting persons with posttraumatic depression to formulate interventions which allow for better outcome and QOL post-injury.

Latina immigrants living in the United States face many challenges when trying to access prenatal care, including lack of insurance, lack of citizenship, language barriers, and financial limitations. There has been little research conducted on prenatal care for Latinas from the clinical perspective. Bridging this research gap has the potential to significantly improve quality of care. Prenatal care providers in Allegheny County, PA, were interviewed on various topics regarding care for their Latina patients, focusing on challenges, protective factors, and opportunities for improvement. Providers included obstetrician/gynecologists, family medicine physicians, nurses and doulas. An interview guide was developed based on existing literature on prenatal care for Latinas and quality measurement theory, including Donabedians theoretical framework. Language, citizenship issues, lack of health insurance, and financial burdens were some of the primary barriers identified by the providers also specified in the literature. Inadequate domestic violence and family planning resources were among the interview responses that were not emphasized in the literature. Recommendations included the expansion of state sponsored health insurance to all women during pregnancy, increasing the number of Spanish-speaking prenatal care providers, and improvements to informed consent procedures in the hospital system. In terms of public health significance, this research is directly related to several Healthy People 2010 goals, including increasing the number of women who receive adequate prenatal care and improving infant mortality rates.