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Item The Impact of Social Determinants of Health and Poverty on Health Outcomes in America(2022) Ogunmola, BotiwuoluwaINTRODUCTION: Over the last decade, there has been a slow but steady decline in poverty rates in the United States (U.S). However, the burden of poverty is still very high among certain communities and groups in the U.S, and it poses a challenge not just to the health of those affected but to the health of the entire country. This owes majorly to socio-economic factors in the environment as well as other determinants of health. Poverty makes it more difficult for certain individuals to make healthy life choices, have access to health coverage, live in good neighborhoods, or gain the necessary skills needed through education and job security to contribute effectively to society. Understanding the various ways in which social determinants of health contextually drive health outcomes can help provide a better approach to improving health care and addressing the health gap it has created. CONCEPTUAL FRAMEWORK: A scoping review was done based on secondary data analysis. Research materials were retrieved from search engines such as PubMed, Google Scholar, and ProQuest Public Health databases, including articles, scholarly literature, and publications. The relevant keywords for literature search included ‘social determinants of health (SDOH)’, ‘negative effects of SDOH’, ‘education’, ‘housing’, ‘poverty’, ’socio-economic status’, ‘United States’, ‘America’. Inclusion criteria: Scholarly literature and articles related to the topic of interest and published between 2012 and 2022. Exclusion criteria: Scholarly literature and articles that were unrelated to SDOH, poverty and or health and those published before 2012. About 1000 articles were retrieved but only 32articles were reviewed based on the inclusion and exclusion criteria DISCUSSION: Poverty is a complex issue that impacts health outcomes because it can be viewed as both a “cause” and an “effect”. For instance, poverty can be caused by illnesses, climate change, crime, disasters, economic inequality, etc. Yet, these same issues can occur because of poverty. People faced with the multi-dimensional aspects of poverty are more prone to making poorer health choices, affecting their quality of life. Social determinants of health (SDOH) are “conditions in the social environment in which people are born, live, learn, work, and play that affect a wide range of health, functioning, and quality-of-life outcomes and risks”. (Healthy People 2030). The US Department of Health and human services (Healthy People, 2020) has grouped the social determinants of health into 5 domains which will be discussed further in this paper (See poster for SDOH determinants). Certain conditions in which individuals live their lives have an impact on health outcomes and can cause differences in health. Increased burden of disease which are more prominent in low income and impoverished communities include chronic diseases such as hypertension, diabetes, and heart disease. Mental health and substance use disorders are also common among individuals living in these communities. (Walker E.R, Druss B.G.,2017). Every individual must interact with their environment to function fully, optimally and meet their needs. However, the conditions in which people live their lives can be directly proportional to their health outcomes. CONCLUSION: Global health priorities are determined by key policymakers which means that whatever health issue they choose to tackle becomes a "global health issue". Unfortunately, the marginalized and disenfranchised who are most affected are left out of critical decision-making processes. We must all understand that no one is healthy until we are all healthy especially with the emergence of globalization, travel, trade, etc. With the direct link between health and wellness, policymakers must shift their focus and priorities to promoting wellness by tackling poverty and other determinants of health at the grassroot. Achieving zero hunger, just like solving any other health crisis, may seem like a herculean task, but it can be done if the right strategies and tactics are employed.Item Affordability, negative experiences, perceived racism, and health care system distrust among black American women aged 45 and over(AIMS Press, 2024-09-26) Wiltshire, Jacqueline; Sampson, Carla Jackie; Liu, Echu; DeBose, Myra Michelle; Musey, Paul I., Jr.; Elder, Keith; Community and Global Health, Richard M. Fairbanks School of Public HealthBlack Americans (AA) face a confluence of challenges when seeking care including unaffordable costs, negative experiences with providers, racism, and distrust in the healthcare system. This study utilized linear regressions and mediation analysis to explore the interconnectedness of these challenges within a community-based sample of 313 AA women aged 45 and older. Approximately 23% of participants reported affordability problems, while 44% had a negative experience with a provider. In the initial linear regression model excluding perceived racism, higher levels of distrust were observed among women reporting affordability problems (β = 2.66; p = 0.003) or negative experiences with a healthcare provider (β = 3.02; p = <0.001). However, upon including perceived racism in the model, it emerged as a significant predictor of distrust (β = 0.81; p = < 0.001), attenuating the relationships between affordability and distrust (β = 1.74; p = 0.030) and negative experience with a provider and distrust (β = 1.79; p = 0.009). Mediation analysis indicated that perceived racism mediated approximately 35% and 41% of the relationships between affordability and distrust and negative experience with a provider and distrust, respectively. These findings underscore the critical imperative of addressing racism in the efforts to mitigate racial disparities in healthcare. Future research should explore the applicability of these findings to other marginalized populations.Item Miss Ellie’s Story(Springer, 2021) Tierney, William M.; Community and Global Health, Richard M. Fairbanks School of Public HealthItem Organizational-Level Recruitment of Barbershops as Health Promotion Intervention Study Sites: Addressing Health Disparities Among Black Men(Sage, 2018) Hood, Sula; Hall, Marla; Dixon, Carrissa; Jolly, David; Linnan, Laura; Community and Global Health, Richard M. Fairbanks School of Public HealthThis article describes the process and results associated with the organizational-level recruitment of Black barbershops into Fitness in the Shop (FITShop), a 6-month barbershop-based intervention study designed to promote physical activity among Black men. Organizational-level recruitment activities included (1) a telephone call to prospective barbershop owners to assess their interest and eligibility for participation, (2) an organizational eligibility letter sent to all interested and eligible barbershops, (3) a visit to interested and eligible barbershops, where a culturally sensitive informational video was shown to barbershop owners to describe the study activities and share testimonies from trusted community stakeholders, and (4) a signed agreement with barbershop owners and barbers, which formalized the organizational partnership. Structured interviews were conducted with owners of a total of 14 enrolled barbershops, representing 30% of those determined to be eligible and interested. Most enrolled shops were located in urban settings and strip malls. Barbershop owners were motivated to enroll in the study based on commitment to their community, perceived client benefits, personal interest in physical activity, and a perception that the study had potential to make a positive impact on the barbershop and on reducing health disparities. Results offer important insights about recruiting barbershops into intervention trials.Item Association Between Preadmission Acid Suppressive Medication Exposure and Severity of Illness in Patients Hospitalized With COVID-19(Elsevier, 2021) Elmunzer, B. Joseph; Wolf, Bethany J.; Scheiman, James M.; Tierney, William M.; Taylor, Jason R.; North American Alliance for the Study of Digestive Manifestations of COVID-19; Community and Global Health, Richard M. Fairbanks School of Public HealthItem Low- and Middle-Income Country Perceptions of Global Health Engagements: A Scoping Review(Canadian Center of Science and Education (CCSE), 2024) Amick, Erick; Sharmin, Farzana; Bucher, Sherri; Henry, Beverly W.; Community and Global Health, Richard M. Fairbanks School of Public HealthMore than one million Americans are estimated to participate in global health engagements (GHEs) in low- and middle-income countries (LMICs) each year. A growing number of studies document perceptions of GHEs from the perspective of American and other high-income country (HIC) visitors traveling to LMICs, particularly regarding motivations and satisfaction relative to their participation in these activities. Far fewer studies examine perceptions of GHEs from the perspective of LMIC hosts and other local constituent groups. The purpose of this study was to identify and analyze studies that examined local stakeholder perspectives of global health engagements in LMICs around the world. We conducted a scoping review of PubMed and Google Scholar using the Population-Concept-Context (PCC) framework. Assessment and analysis of articles was conducted by a team of three reviewers (EA, FS, SB). A total of 31 relevant papers published between 2009 and 2021 provided local perspectives of GHEs, with participants falling into three stakeholder categories- providers of care, recipients of care, and community members. Analysis revealed that stakeholder groups often held complex and highly nuanced perspectives of GHEs, perceiving these activities as having both positive and negative implications in the host communities. Synthesis of the eligible studies’ findings resulted in three thematic categories- resources and perceived benefits derived from GHEs; perceived challenges associated with GHEs; and opportunities for improvement of GHEs. To our knowledge, this scoping review is among the first to identify and collectively analyze LMIC stakeholder perceptions of GHEs. Recommendations for future research are provided.Item Smoking Behavior and Prognosis After Colorectal Cancer Diagnosis: A Pooled Analysis of 11 Studies(Oxford University Press, 2021-08-31) Alwers, Elizabeth; Carr, Prudence R.; Banbury, Barbara; Walter, Viola; Chang-Claude, Jenny; Jansen, Lina; Drew, David A.; Giovannucci, Edward; Nan, Hongmei; Berndt, Sonja I.; Huang, Wen-Yi; Prizment, Anna; Hayes, Richard B.; Sakoda, Lori C.; White, Emily; Labadie, Julia; Slattery, Martha; Schoen, Robert E.; Diergaarde, Brenda; van Guelpen, Bethany; Campbell, Peter T.; Peters, Ulrike; Chan, Andrew T.; Newcomb, Polly A.; Hoffmeister, Michael; Brenner, Hermann; Community and Global Health, Richard M. Fairbanks School of Public HealthBackground: Smoking has been associated with colorectal cancer (CRC) incidence and mortality in previous studies, but current evidence on smoking in association with survival after CRC diagnosis is limited. Methods: We pooled data from 12 345 patients with stage I-IV CRC from 11 epidemiologic studies in the International Survival Analysis in Colorectal Cancer Consortium. Cox proportional hazards regression models were used to evaluate the associations of prediagnostic smoking behavior with overall, CRC-specific, and non-CRC-specific survival. Results: Among 12 345 patients with CRC, 4379 (35.5%) died (2515 from CRC) over a median follow-up time of 7.5 years. Smoking was strongly associated with worse survival in stage I-III patients, whereas no association was observed among stage IV patients. Among stage I-III patients, clear dose-response relationships with all survival outcomes were seen for current smokers. For example, current smokers with 40 or more pack-years had statistically significantly worse overall, CRC-specific, and non-CRC-specific survival compared with never smokers (hazard ratio [HR] =1.94, 95% confidence interval [CI] =1.68 to 2.25; HR = 1.41, 95% CI = 1.12 to 1.78; and HR = 2.67, 95% CI = 2.19 to 3.26, respectively). Similar associations with all survival outcomes were observed for former smokers who had quit for less than 10 years, but only a weak association with non-CRC-specific survival was seen among former smokers who had quit for more than 10 years. Conclusions: This large consortium of CRC patient studies provides compelling evidence that smoking is strongly associated with worse survival of stage I-III CRC patients in a clear dose-response manner. The detrimental effect of smoking was primarily related to noncolorectal cancer events, but current heavy smoking also showed an association with CRC-specific survival.Item Feasibility and acceptability of a novel biomedical device to prevent neonatal hypothermia and augment Kangaroo Mother Care in Kenya: Qualitative analysis of focus group discussions and key Informant Interviews(Public Library of Science, 2024-04-16) Bhuiya, Nudar A.; Liu, Scott; Muyodi, David; Bucher, Sherri L.; Community and Global Health, Richard M. Fairbanks School of Public HealthHypothermia is a leading newborn complication, especially among premature and/or low birth weight infants. Within low/middle-income countries where incubators and radiant warmers are often in short supply, leading to gaps in the thermal care chain, neonatal hypothermia underlies high rates of newborn morbidity and mortality. Kangaroo Mother Care/Skin-to-skin care is an effective method for prevention of hypothermia in premature and low birthweight babies but can be very burdensome for families and healthcare providers. Our international multidisciplinary team has developed a prototype for a wearable biomedical device ("NeoWarm") to provide continuous thermal care and augment kangaroo mother care practices in low-resource settings. The objective of this study was to assess the feasibility and acceptability of NeoWarm and to obtain user design feedback for an early prototype from among adult end-users in Western Kenya. We performed key informant interviews (n = 17) among healthcare providers and 5 focus group discussions (FGDs) among 3 groups of adult stakeholders of premature babies, including: (1) parents/family members of premature babies aged 6 weeks or less (3 FGDs); (2) healthcare providers of newborns (e.g., nurses; physicians; 1 FGD); (3) community opinion leaders and stakeholders (e.g., traditional birth attendants; pastors; village elders; 1 FGD). Content and thematic analyses of transcripts indicate that NeoWarm is acceptable and feasible in promoting facility-based kangaroo mother care in the Kenyan setting. Novel findings derived from respondents include (1) the ability of the device to potentially overcome several barriers to traditional kangaroo mother care methods and (2) user-driven encouragement to expand the use case of the device to potentially include community-based kangaroo mother care and neonatal transport. User design feedback obtained during the interviews informed several key design iterations for subsequent prototypes of the device.Item Preclinical validation of NeoWarm, a low-cost infant warmer and carrier device, to ameliorate induced hypothermia in newborn piglets as models for human neonates(Frontiers Media, 2024-04-03) Bluhm, Nick D. P.; Tomlin, Grant M.; Hoilett, Orlando S.; Lehner, Elena A.; Walters, Benjamin D.; Pickering, Alyson S.; Bautista, Kevin Alessandro; Bucher, Sherri L.; Linnes, Jacqueline C.; Community and Global Health, Richard M. Fairbanks School of Public HealthIntroduction: Approximately 1.5 million neonatal deaths occur among premature and small (low birthweight or small-for gestational age) neonates annually, with a disproportionate amount of this mortality occurring in low- and middle-income countries (LMICs). Hypothermia, the inability of newborns to regulate their body temperature, is common among prematurely born and small babies, and often underlies high rates of mortality in this population. In high-resource settings, incubators and radiant warmers are the gold standard for hypothermia, but this equipment is often scarce in LMICs. Kangaroo Mother Care/Skin-to-skin care (KMC/STS) is an evidence-based intervention that has been targeted for scale-up among premature and small neonates. However, KMC/STS requires hours of daily contact between a neonate and an able adult caregiver, leaving little time for the caregiver to care for themselves. To address this, we created a novel self-warming biomedical device, NeoWarm, to augment KMC/STS. The present study aimed to validate the safety and efficacy of NeoWarm. Methods: Sixteen, 0-to-5-day-old piglets were used as an animal model due to similarities in their thermoregulatory capabilities, circulatory systems, and approximate skin composition to human neonates. The piglets were placed in an engineered cooling box to drop their core temperature below 36.5°C, the World Health Organizations definition of hypothermia for human neonates. The piglets were then warmed in NeoWarm (n = 6) or placed in the ambient 17.8°C ± 0.6°C lab environment (n = 5) as a control to assess the efficacy of NeoWarm in regulating their core body temperature. Results: All 6 piglets placed in NeoWarm recovered from hypothermia, while none of the 5 piglets in the ambient environment recovered. The piglets warmed in NeoWarm reached a significantly higher core body temperature (39.2°C ± 0.4°C, n = 6) than the piglets that were warmed in the ambient environment (37.9°C ± 0.4°C, n = 5) (p < 0.001). No piglet in the NeoWarm group suffered signs of burns or skin abrasions. Discussion: Our results in this pilot study indicate that NeoWarm can safely and effectively warm hypothermic piglets to a normal core body temperature and, with additional validation, shows promise for potential use among human premature and small neonates.Item Enhancing PBL authenticity by engaging STEM professional volunteers(Purdue University, 2021) Nicholas, Celeste; Scribner, J. Adam; Community and Global Health, Richard M. Fairbanks School of Public HealthThe article profiles a project addressing a central issue in reform-driven STEM education – the need to align educational experiences with real-world STEM. We profile an interdisciplinary project which aimed for authenticity by: 1) purposefully designing an authentic PBL project and 2) incorporating STEM professional volunteers as facilitators. Volunteers enhanced authentic elements of the project task (e.g., open-ended task, accountability) and context (e.g., autonomy, collaboration). Volunteers alleviated pedagogical barriers to PBL – their expertise allowed both volunteers and teachers to take up the facilitator roles foundational to PBL. Professional volunteers can play vital roles in STEM capacity-building initiatives, including those seeking to broaden participation. Further research is needed to understand how to best prepare and utilize volunteers in a variety of classroom roles, including as PBL facilitators.