Immigrant clinicians are vital to population healthcare delivery and therefore population health. One in four physicians in the USA is foreign-born and notably represented in family and pediatric medicine—specialties charged with administering childhood/adolescent vaccines, such as human papillomavirus vaccine (HPVV). Our examination suggests there may be unique cultural and socialization factors that influence clinician HPVV recommendation practice; however, immigrant clinicians have not been adequately engaged within the national HPVV agenda. Given the volume and significance of immigrant clinicians, engagement of these clinicians, in both community and nation-wide efforts to increase HPVV, is a necessary step for improving and achieving the national health goal of optimizing HPVV for cancer prevention.

Objective: Short interpregnancy interval (IPI), <18 months between pregnancies, is a potential cause of adverse delivery and birth outcomes, and may be a particular issue among those with other risks. Our goal was to examine IPI and delivery/infant complications in Tennessee. Methods: Birth certificate/vital records data included 101,912 women with a previous delivery. IPI groups (<6, 6-12, 12-18, 18-60 months) were compared on outcomes. Results: Thirty-nine percent of the deliveries had IPI <18 months, 9% were <6 months, rates 11% and 27% higher than nationally. Women with IPI <18 months were younger, lower educated with lower income, had higher BMIs, and were more likely to be unmarried, smokers, and have begun prenatal care later (p <.001). In adjusted analyses, IPI <18 months predicted elevated risk for precipitous labor, low-birth weight, preterm delivery, NICU admission, and infant mortality, with effects strongest for IPI <6 months. Finally, risks related to IPI <6 months were substantially higher for the lowest income women. Conclusions: Rates of less than optimal IPI were high in this population already experiencing significant maternal-child health disparities, with short IPI a particular risk factor for poor out-comes for the most disadvantaged women, suggesting yet another precursor for adverse birth outcomes in those already most at risk.

Immigrant clinicians are vital to population healthcare delivery and therefore population health. One in four physicians in the United States are foreign-born and notably represented in family and pediatric medicine–specialties charged with administering childhood/adolescent vaccines, such as Human Papillomavirus vaccine (HPVV). Our examination suggests there may be unique cultural and socialization factors that influence clinician HPVV recommendation practice; however, immigrant clinicians have not been adequately engaged within the national HPVV agenda. Given the volume and significance of immigrant clinicians, engagement of these clinicians, in both community and nation-wide efforts to increase HPVV, is a necessary step for improving and achieving the national health goal of optimizing HPVV for cancer prevention.

Breast cancer affects over three million women in the United States, but this disease burden is not shared equally across all races. Black women, in particular, are diagnosed with more advanced cancer at a younger age and experience a disproportionately high mortality rate compared to white women. Factors that contribute to such disparity include socioeconomic status, tumor biology, age, insurance status, comorbidities, obesity, patients’ reproductive history and barriers to quality care. These factors alone, however, do not account for all the racial differences in mortality and outcomes experienced by black women. There is a growing body of literature that indicates black women are not receiving the same treatment and care as white women. Black women are less likely to receive surgery, radiation therapy, hormone therapy and targeted therapy than white women. Black women are also more likely to experience delays in the initiation of treatment, early discontinuation of treatment and overall guideline non-concordant care. The current literature has presented widespread racial disparities in the treatment of black women with breast cancer. Future research needs to focus on tangible interventions such as physician bias training and patient navigators to mitigate the inequity of care in the treatment of breast cancer.

Despite advances in health, science, and technology, U.S. healthcare lags in providing access to care and quality care to racial and ethnic minorities. Cultural competence has been noted as a strategy to improve access and quality. The purpose of this project was to assess public health nurses' cultural competence before and after participating in cultural competence informational modules. Two conceptual models were used in this project for theoretical guidance: Leininger's cultural care diversity and universality theory and Campinha-Bacote's process of cultural competence. To assess the nurses' cultural competence, the Cultural Competence Self-Assessment Checklist questionnaire was e-mailed to 57 public health nurses at a local health department. Survey participants remained anonymous. Data were collected on demographics. A paired t test was conducted to compare the statistical significance of the results. A quantitative software tool was used to analyze the data. Study results showed a confidence interval of 95% at p = 0.15, indicating that cultural competence informational modules made a significant difference between the pretest and the posttest of the Cultural Competence Self-Assessment Checklist. Thus, cultural competence informational modules make a difference in public health nurses' awareness, knowledge, and skills, which can enhance their ability to provide culturally competent care to racial and ethnic minorities. The implications of this project for social change include supporting health care professionals' ability to promote and implement cultural competence practices for all populations to decrease health disparities

On June 11, 2009 the World Health Organization announced that a novel strain of H1N1 influenza was being classified a Phase 6 pandemic, the highest level of alarm indicating that the disease was present worldwide and its spread was inevitable. While seasonal influenza epidemics occur annually, the 2009 H1N1 strain was the first novel pandemic influenza since the 1968 Hong Kong flu. The 2009 H1N1 pandemic provides a case study of how the U.S. population responded to an emergent and potentially lethal infectious disease. The richness and variety of public health data presents an opportunity to examine predictors of vaccination among men and women from different racial/ethnic groups. Because vaccination is often the most effective way to prevent influenza, it is important to understand the predictors of low vaccination uptake during the H1N1 pandemic to better prepare for future novel outbreaks of influenza. Through a series of three research papers, my dissertation provides a comprehensive examination of the ways that race, ethnicity and gender affected H1N1 vaccination behavior. Paper 1 explores the diversity of the U.S. Hispanic population by estimating H1N1 vaccination uptake among U.S-born and foreign-born Hispanics. In Paper 2, I shift my focus to H1N1 vaccination disparities between non-Hispanic whites and non-Hispanic blacks in the U.S. This paper further explores racial disparities in vaccination by examining intersections with gender and analyzing the influence of attitudes and beliefs about the H1N1 vaccine. In Paper 3, I provide a more detailed account of the socioeconomic and attitudinal mechanisms through which race, ethnicity and gender influence H1N1 vaccination. My research confirms large racial/ethnic disparities in H1N1 vaccination and identifies mechanisms amenable to policy change that could reduce the disease burden of a future influenza pandemic.

It is widely accepted that sexual minority youth (SMY) are subjects of homophobic bullying and homophobic victimization, and they are at higher risk for psychological distress compared to their heterosexual counterparts. Meyer (2003) introduced the minority stress conceptual framework to explain this increased prevalence and its effects. The minority stress conceptual framework proposed that the lesbian, gay, and bisexual (LGB) population is subjected to additional stressors due to its minority status which results in increased psychological distress. The problem addressed in this study was the high incidence of bullying, harassment, social isolation, and violence against SMY, those questioning their sexual identity, and those perceived to be LGB in a large metropolitan school district in South Florida. The purpose of this comparative study was threefold: to compare risk factors for students in Grades 9-12 (a) who identified as LGB to those who identified as heterosexual (straight), (b) who identified as LGB to those who identified as questioning, and (c) who perceived that others identified them as LGB compared to those who did not perceive that others identified them as LGB at a large metropolitan school district in the southeastern United States. Data from the 2015 National Youth Risk Behavior Survey (YRBS) was used to further examine how these risk factors, including alcohol and other drug use and abuse, psychological distress, violence, and sexual behaviors, interacted to influence health disparities among youth in Grades 9 to 12 impacted by homophobic bullying. Mann-Whitney U analyses were conducted to detect the differences in health risk behaviors and outcomes among heterosexual and LGB students. Also, logistic regression models were used to examine any sexual identity effects involved in the association between being bullied and health risk behaviors. Findings indicated that students who identified as LGB or gender nonconforming, or who reported being teased because of their perceived sexual orientation (PSO) were at greater risk for negative health outcomes and negative health risk behaviors. More specifically, identification as LGB or gender expansive, or being teased because of PSO was predictive of psychological distress, suicidal ideation, and sexual, alcohol, and drug risk behaviors. This study extends research on risky behaviors among youth who were bullied due to PSO and provides a new perspective on how homophobic victimization may influence these youth’s risk-taking behaviors and health disparities.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Advancement of preconception and interconception health is a key element to improve women’s health as well as pregnancy outcomes. Little is known about the preconception and interconception health status of rural Midwestern populations in the United States. The primary objective of this study was to determine the preconception and interconception health status as well as behaviors of reproductive age women living in a rural Midwestern area. Secondary objectives were to quantify process measures of health care access and barriers to care, as well as determine disparities in preconception and interconception health status among women in this rural area as compared to statewide estimates. As existing national or state secondary data sources often have limitations in data derived from areas with low population densities or insufficient sample sizes to generate reliable estimates, a cross-sectional study was performed using a 34- item survey. Data were collected from February to May 2019 from 315 non-pregnant women ages 18-45 years in a rural county in northwestern Ohio. Nearly all women surveyed had at least one risk factor associated with poor pregnancy outcomes, many of which were modifiable. Nearly half of all respondents reported at least one barrier to receipt of health care services. Women in this rural county fared worse for several preconception and interconception health measures when compared to statewide estimates derived from Behavioral Risk Factor Surveillance System and Ohio Pregnancy Assessment Survey data. These findings illustrate the need for continued development of interventions to improve preconception and interconception health for rural women as well as improved methods to capture and analyze data on important subpopulations at risk. / 2021-03-09

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第18686号 / 社医博第62号 / 新制||社医||8(附属図書館) / 31619 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中原 俊隆, 教授 福原 俊一, 教授 古川 壽亮 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM