<p><em>Objectives: </em> (i) To determine the types and impact of uncertainty in the decision-making process of policy-makers regarding the implementation of the human papillomavirus (HPV) vaccine. (ii) To determine the relative strengths and limitations of qualitative and quantitative knowledge synthesis methodologies as well as their contributing role to the policy-making regarding the HPV vaccine.</p> <p><em>Methods</em>: A systematic review and a meta-ethnography were conducted concurrently. Four different search strategies, of nine different databases, were used to target all potential quantitative and qualitative literature published from 1990 to 2011. Studies were selected after abstract and full-text screening by two reviewers, with disagreements resolved by consensus. English language studies of any study design that addressed the HPV vaccine and policy were eligible for inclusion. Quality appraisal of included studies was undertaken using available criteria and tools according to study design. The criteria sets by Tong and colleagues and CASP were used for the qualitative literature while the economic evaluations were appraised with criteria set by Nujiten and colleagues. Quality of the cross-sectional study was not systematically appraised. Data extraction forms were designed for each study type. The data extracted included: study characteristics, types of uncertainty, number of types within each study, policy decision measured as the authors’ final recommendation, and perceptions of the confidence of these recommendations as rated by the reviewers. Chi-square tests were conducted to determine if presence or absence of uncertainty influenced decisions. Pearsons Correlations were conducted to determine the relationship between the amount of uncertainty and perceived certainty of the decision. The qualitative analysis was conducted using steps outlined by Noblit and Hare to determine how studies were related, to translate studies into one another, and to synthesize translations.</p> <p><em>Results:</em> Of the initial pool (n= 865), 21 studies met inclusion criteria and were considered; 17 quantitative and 4 qualititative. (i) The simulation cohorts of the decision analytic models did not vary by study appreciably. Chi square analyses failed to find evidence that policy decisions were influenced by presence or absence of uncertainty. Further, no statistically significant correlation was found between amount of uncertainty and perceived certainty with the funding decision. At least four types of uncertainties were identified in each qualitative study including but not exclusive to cost, public acceptance due to the sexually transmitted nature of HPV, as well as the health care system’s ability to implement and monitor the vaccine. After employing the Noblit and Hare translation process, four broad types were identified: uncertainties around managing different public acceptability viewpoints, the manufacturer’s role and input, the actual vaccine’s characteristics, and the system’s ability to implement a vaccination program. (ii) Specific and measurable outcomes could only be identified <em>a priori</em> for the quantitative studies due to the nature of questions asked. Locating relevant qualitative studies was more complex and time-consuming due to variation in the manner that each study’s defining features and information are catalogued and searched. A lack of reporting in both the qualitative and quantitative studies disabled a thorough assessment of methodological quality. Data extraction only varied in the manner that the data was recorded. The quantitative results consisted of specific types of data (numerical or categorical) while qualitative results were descriptive.Within data analysis, the types of uncertainty were determined through reciprocal translation while the impact of uncertainty was tested using two statistical techniques. These differences highlight the rigidity and flexibility of quantitative and qualitative literature, respectively.</p> <p><em>Conclusions:</em> Using both qualitative and quantitative methods enabled a more complete understanding of the role of uncertainty within the decision-making process. Regardless of the methodology used, each type of knowledge synthesis method provided relevant data in regards to the HPV vaccine; simply from different perspectives.</p> / Master of Science (MSc)

Since June of 2013, Plan B and its generics have been available over-the-counter without age restriction nationwide. Even so, pharmacy-based economic, physical, and staff-associated barriers still exist, potentially leading adolescent customers to fail to obtain emergency contraception (EC) in a sufficiently timely manner to prevent pregnancy. This study explores these pharmacy-based barriers to EC in the state of Kentucky focusing on comparisons of urban and non-urban pharmacies and chain and private pharmacies. Using a secret-shopper survey technique, the researcher called 220 Kentucky pharmacies acting as a 15-year-old girl seeking information about EC. Among other findings, a logistic regression analysis revealed that private pharmacies were 97% less likely to carry EC compared to chain pharmacies (OR= .027; p

The National Health Planning and Resources Development Act. Public Law 93-641, the last major step in the regulation of the health care system, created a network of health system agencies and state level health planning agencies. Subsequent legislation, the Health Planning and Resources Development Amendment 1929, Public Law 96-79, amended 1974 Law and changed the role and function of health systems agencies to include more regulatory activities. By 1981, the activities of Health System Agencies were being curtained by the action of the Reagan administration. The Health promotion/wellness movement which seeks to improve health has been developing as a compliment to medical medicine for several years. Previous research has determined that health systems agencies were active in health promotion and identified several planning and implementation activities related to this involvement. This is a survey of health systems agencies to determine their efforts in healthy promotions. Resources allocated to these activities, and opinions of the director relevant to agency involvement in health promotion. All active healthy system agencies listed in the 1980. Directory of Health System Agencies (DHSH) were surveyed by a mailed questionnaire. Reponses were receive from 112 agencies (57%) and the respondents were found to be representative of the population. The results revealed health systems agencies to be involved in health promotion. More than 90 percent of the responders listed some type of health promotion activity in their Healthy System Plans for the 1979-1980 planning year. Approximately half of the responders reported some community activity in health promotion. The majority of executive directors saw health systems agencies as being only moderately effective in controlling health care costs: considered healthy promotion as a viable means of controlling health care cost: and believed that modifications of individual life-styles had the greatest potential for improving health status. The survey revealed that Healthy System Agencies did not restrict the wellness/health promotion activities to traditional health facilities, but were defining health broadly and working with a variety of agencies to develop services.

Background/Objective: Overweight and obesity has been steadily on the rise in the United States for all groups. The prevalence of obesity for adolescents has tripled since 1980. The purpose of this study is to determine an association between the frequency of physical education classes and the prevalence of overweight/obesity in adolescents in the United States.Methods: This was a cross-sectional study that used the 2001 Youth Risk Behavior Survey (YRBS) of the Center for Disease Control. The outcome variable for the study was Body Mass Index (BMI). A BMI of 25 or greater was considered overweight or obese. The main independent variable was frequency of attending physical education classes. Other independent variables were included such as demographics, nutrition, physical activity, and drug use. Univariate and multivariate statistical analysis methods were used to calculate the odds ratios for frequency of physical education classes and other risk factors for overweight and obesity. Adjusted odds ratios and their 95% confidence intervals were calculated by using a multivariate logistic regression model. SPSS 11.0 and Epinfo 6.04 were the statistical software used for the statistical analysis. Results: The study indicates that about 26% of adolescents in the United States are either overweight or obese. It was found that about 50% of adolescents do not attend PE class at all during the week. No statistically significant relationship was found between enrollment in physical education classes and overweight/obesity in adolescents, adjusting for confounders (OR=0.95 CI=0.81-1.11). There was no statistically significant relationship between the frequency of physical education classes and the overweight/obesity of adolescents, adjusting for confounders (OR=1.01 CI=0.95-1.08).Conclusion: The data shows that there is no direct relationship between the frequency of physical education classes and the prevalence of overweight/obesity, although there is a direct correlation between physical activity and the prevalence of overweight/obesity, which is found in the literature. The content of physical education classes needs to be assessed as well as providing more classes that incorporate physical activity.

Objective: The Hayes E. Willis Health Center (HWHC) was opened in a neighborhood of South Richmond in October 1993 to remove the barriers that prevented South Richmond residents from accessing primary healthcare services. The major objective of this study was to determine the effectiveness of the HWHC in providing primary care to the South Richmond Community deemed to be in need. An additional objective was to describe the changes in characteristics of clinic users and illnesses seen over time.Methods: Patient data was compared from the HWHC�s first full year of operation in which patient data was collected (1995) to the most current year (2003) to determine if the targeted population of South Richmond had been serviced by the HWHC. A combined total of 20,190 visits occurred in 1995 and 2003 by a total of 7,552 patients. A Pearson chi-square analysis was performed to test whether the observed differences in proportions between the two study groups (1995 and 2003) were statistically different for the variable of patient residence location, as well as the variables of race, sex, age, type of insurance used, and clinic visited. Results: The patient population living in the original target area of South Richmond has declined from 82.6% in 1995 to 67.1% in 2003. The proportion of patients residing within the metropolitan Richmond area, but outside of South Richmond, has increased from 13.2% in 1995 to 21.1% in 2003. The proportion of clinic patients residing outside of Richmond completely has nearly tripled � from 4.2% to 11.8%.Conclusions: While the HWHC has gained popularity with non-South Richmond residents, it is clear that it has in fact been successful in offering primary care health services for the residents of South Richmond. The HWHC, and the public health policy that created it, should be viewed as an ideal model for other areas in Richmond, as well as other metropolitan areas across the United States to emulate and implement in their own communities.

Purpose. This study was conducted to identify factors that influence preventive dental behaviors and, from the results, target groups for intervention.Methods. Data were collected using the 1997 Behavioral Risk Factor Surveillance System (BRFSS) resulting in a probability sample of 399 dentate adults living in Richmond City, Henrico, Chesterfield and Hanover Counties in Virginia. All analyses were performed using the statistical software program STATA. Initial hypothesis testing was performed using univariate logistic regression models. Multivariate logistic regression models were used to test the significance of independent variables while controlling for other possible predictors of behavior.Results. Females were more likely than males to brush and floss their teeth at the recommended frequencies (OR 2.7, 95% CI 1.4-5.1; OR 2.8, 95% CI 1.5-5.1 respectively). Individuals with higher levels of education were more likely than those with lower levels of education to brush twice daily and have preventive dental visits (OR 4.2, 95% CI 1.3-13.2; OR 5.3, 95% CI 2.0-14.4 respectively). There was no racial difference in the three preventive dental behaviors.Conclusions. Findings suggest that sex and education are important considerations when planning dental health interventions. In the Richmond area, less educated males are in the greatest need of education and other interventions aimed at twice-daily toothbrushing and daily flossing. Further, men and women with lower levels of education are in need of interventions for increasing the utilization of preventive dental services.

Study Objectives: To examine demographic characteristics and contraceptive habits of young men.Methods: A descriptive study was conducted utilizing data analyzed from three waves of the National Survey of the Adolescent Male (NSAM) administered in 1988, 1991, and 1995. The first wave consisted of 1,880, never-married, noninstitutionalized 15-19 year old men living in the United States. The second wave consisted of 1,676 re-interviewed respondents who were 17-22 years old. The third wave consisted of 1,377 re-interviewed respondents who were 22-27 years old. Descriptive statistics were used to compare personal and demographic characteristics across each year group. Odds ratios, and their corresponding 95% confidence intervals were used to determine demographic risk factors; p-values, and chi-square tests were included in the demographic analysis.Results:The majority of the young men in waves 2 and 3 believed the male equally responsible if their partner became pregnant (92% vs. 96%). These young men also believed the male should ask their female partner about contraception before being intimate (71%, waves 2 and 3). Only 3% (wave 2), to 4% (wave 3), believed they would feel more like a man if his partner became pregnant. Almost 50% of males, ages 17-22 (wave 1), and 21-27 (wave 2), believed there was "a little chance" to a "50-50 chance" that they would feel embarrassed to put on a condom. The majority of young men in wave 2 (61%), and approximately half (48%) of young men in wave 3 felt there was "a little chance" to a "50-50 chance" that condom use reduced their sexual pleasure. Only 12% of waves 2 and 3 respondents, felt there was "no chance" a female would become pregnant, if a condom was used during intercourse. Indicating a lack of knowledge regarding the overall benefits of condom use. In addition, less than 50% of waves 2 and 3 felt they had a "pretty good chance" to avoid a STD/AIDS if a condom was used. Conclusions: Results indicated that although the cohort was more cognizant of reproductive responsibility as they matured, steps are still needed to address behavioral changes.

Diarrheal diseases are a global public health burden, killing 1.8 million people annually. Diarrhea disproportionately affects children and those in poverty. Most diarrheal cases can be prevented through safe drinking water, basic hygiene and/or sanitation measures, with drinking water interventions having the most impact on reducing diarrheal disease. A meta-evaluation was completed of studies evaluating a specific household water treatment method, the biosand water filter. Results from the meta-evaluation illustrate that biosand water filters improve drinking water quality and reduce diarrheal disease. However, there is no generally agreed upon field method for determining biosand water filter effectiveness that is useable in low-resource communities. A pilot study was conducted of potential field use indicators, including the Colilert coliform Presence/ Absence test, hydrogen sulfide, alkalinity, hardness, pH, and fluorescently-labeled latex microspheres. The study included both laboratory and field testing. The Colilert Presence/ Absence test had the highest correlation to the United States Environmental Protection Agency standard method (IDEXX Quantitrays), but more data is needed before making a recommendation. This study adds to understanding about evaluation of biosand water filters and provides preliminary data to address the need for a field use indicator for biosand water filters.

In an effort to bridge the gap between public health practice and academia, the Health Resources and Services Administration–funded Tennessee Public Health Training Center (LIFEPATH) has supported establishment of an academic health department (AHD) involving the East Tennessee State University College of Public Health (COPH) and the Sullivan County Regional Health Department (SCRHD). The SCRHD identified a need to increase internal capacity to conduct ongoing community health assessment and community-centered practice. Similarly, the COPH recognized the need to expand evidence-based practice implementation and evaluation opportunities for public health students. Personnel from the SCRHD, LIFEPATH, and the COPH developed a formal AHD agreement during the summer of 2012 and launched the program the subsequent fall semester. One aspect of the COPH/SCRHD/LIFEPATH model that addresses financial barriers experienced by other AHDs is the competitive awarding of the coordinator position to a doctor of public health student from the COPH, demonstrating investment in the model by the college. The doctor of public health student gains leadership experience through project management, coordination of the local health council, and day-to-day facilitation of undergraduate and master's student interns. The SCRHD benefits from the formal academic background of graduate-level interns dedicated to working in the community. This AHD framework offers an opportunity for doctoral-level students to develop practical leadership skills in a health department while enhancing the capacity of the SCRHD and the COPH to serve their community and stakeholders.

No description available.