Browsing by Author "Nichols, Deborah"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Mapping the Urban Lead Exposome: A Detailed Analysis of Soil Metal Concentrations at the Household Scale Using Citizen Science
    (MDPI, 2018-07-19) Filippelli, Gabriel M.; Adamic, Jessica; Nichols, Deborah; Shukle, John; Frix, Emeline; Earth Sciences, School of Science
    An ambitious citizen science effort in the city of Indianapolis (IN, USA) led to the collection and analysis of a large number of samples at the property scale, facilitating the analysis of differences in soil metal concentrations as a function of property location (i.e., dripline, yard, and street) and location within the city. This effort indicated that dripline soils had substantially higher values of lead and zinc than other soil locations on a given property, and this pattern was heightened in properties nearer the urban core. Soil lead values typically exceeded the levels deemed safe for children’s play areas in the United States (<400 ppm), and almost always exceeded safe gardening guidelines (<200 ppm). As a whole, this study identified locations within properties and cities that exhibited the highest exposure risk to children, and also exhibited the power of citizen science to produce data at a spatial scale (i.e., within a property boundary), which is usually impossible to feasibly collect in a typical research study.
  • Thumbnail Image
    Item
    Prison Health is Community Health: The Indiana Peer Education Program
    (Research Square, 2022-07-06) Janota, Andrea D.; Hibbard, Patrick F.; Meadows, Meghan E.; Cocco, John P.; Carr, Abigail L.; Nichols, Deborah; Chapman, Erika; Maupomé, Gerardo; Duwve, Joan
    Background: Concerning health inequities have been found in incarcerated populations, which likely impact broader community health. This paper evaluates the Indiana Peer Education Program (INPEP ECHO), an initiative that aims to improve health knowledge using the Project ECHO (Extension for Community Healthcare Outcomes) model to train people incarcerated in Indiana prisons (USA) as peer health educators inside prisons. Peer educators undergo a 40-hour training and then facilitate 10-hour long health education workshops inside their facilities over several days. Methods: We assessed the changes observed in pre- and post-session survey responses to estimate the impact this program had on peer educators and those they teach via multivariate regression analysis. We also examined peer educator qualitative data for emergent themes and confirmation of survey findings. Results: Findings from the 10-hour workshops showed improved knowledge scores and post-release behavior intentions. Peer educator surveys indicated increases in knowledge, health attitudes, and self-efficacy scores. Qualitative analysis affirms the latter finding and points toward peer educators acquiring expertise in the content they teach and how to teach it and that positive results likely expand beyond participants to others in prison, their families, and the communities to which they return. Further, peer educators shared they felt new purpose and hope tied to their participation in INPEP ECHO. Although these survey results show positive change in the short term, such improvements have been shown in other research to lead to improved middle- and long-term outcomes. Conclusions: Though preliminary, results indicate this type of public health intervention, training incarcerated individuals as peer educators on health topics, appears to increase important health knowledge and behavior intentions, which will likely lead to improvements in personal and public health outcomes. Results also point toward specific improvements associated with peers providing the education, and not external sources. The skills participants attain, as well, seem to increase their sense of purpose and self-efficacy, which have been shown to precede desistance from crime. While more work is necessary, the high costs associated with treating diseases like hepatitis C point toward an urgent need for programs like INPEP.
  • Thumbnail Image
    Item
    Removal of medicaid restrictions were associated with increased hepatitis C virus treatment rates, but disparities persist
    (Wiley, 2022) Nephew, Lauren D.; Wang, Yumin; Mohamed, Kawthar; Nichols, Deborah; Rawl, Susan M.; Orman, Eric; Desai, Archita P.; Patidar, Kavish R.; Ghabril, Marwan; Chalasani, Naga; Kasting, Monica L.; Medicine, School of Medicine
    Despite the release of a growing number of direct-acting antivirals and evolving policy landscape, many of those diagnosed with hepatitis C virus (HCV) have not received treatment. Those from vulnerable populations are at particular risk of being unable to access treatment, threatening World Health Organization (WHO) HCV elimination goals. The aim of this study was to understand the association between direct-acting antivirals approvals, HCV-related policy changes and access to HCV virus treatment in Indiana, and to explore access to treatment by race, birth cohort and insurance type. We performed a retrospective cohort study of adults with HCV from 05/2011-03/2021, using statewide electronic health data. Nine policy and treatment changes were defined a priori. A Lowess curve evaluated treatment trends over time. Monthly screening and treatment rates were examined. Multivariable logistic regression explored predictors of treatment. The population (N = 10,336) was 13.4% Black, 51.8% was born after 1965 and 44.7% was Medicaid recipients. Inflections in the Lowess curve defined four periods: (1) Interferon + DAA, (2) early direct-acting antivirals, (3) Medicaid expansion/optimization and (4) Medicaid restrictions (fibrosis/prescriber) removed. The largest increase in monthly treatment rates was during period 4, when Medicaid prescriber and fibrosis restrictions were removed (2.4 persons per month [PPM] in period 1 to 72.3 PPM in period 4, p < 0.001; 78.0% change in slope). Multivariable logistic regression analysis showed being born after 1965 (vs. before 1945; OR 0.69; 95% 0.49-0.98) and having Medicaid (vs. private insurance; OR 0.47; 95% CI 0.42-0.53), but not race was associated with lower odds of being treated. In conclusion, DAAs had limited impact on HCV treatment rates until Medicaid restrictions were removed. Additional policies may be needed to address HCV treatment-related age and insurance disparities.