School of Public Health
Permanent URI for this communityhttp://hdl.handle.net/1903/1633
The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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Item ADAPTING A BREAST CANCER CONTROL INTERVENTION FOR AFRICAN AMERICAN WOMEN BELOW SCREENING AGE: A CO-DESIGN APPROACH(2023) Huq, Maisha R; Knott, Cheryl L; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Despite African American women below screening age facing greater mortality from early onset breast cancer relative to similar aged peers of other races/ethnicities and African American women of screening age, little attention is given to this group of younger women. Evidence-based breast cancer educational interventions do not exist for this group of younger women. The purpose of the current work was to address the gap of evidence-based breast cancer educational interventions for African American women below screening age. Aims: The current study had two aims. Aim 1 was to adapt an evidence-based breast cancer educational intervention for African American women of screening age, to be targeted to younger African American women (i.e. those below screening age) using a systematic process guided by the seven-step adaptation framework by Card and colleagues, documented using an established implementation science model, the Framework for Reporting Adaptations and Modifications Enhanced Model (FRAME), and using a virtual co-design approach. Aim 2 was to assess the appropriateness of the adapted intervention for African American women below screening age through online surveys administered at the conclusion of Community Chat sessions. Methods: The adaptation process was guided by Card and colleagues’ seven-step framework. Five virtual co-design sessions with n=15 potential users and key stakeholders were conducted in step 7. Observational notes and FRAME Form data were collected from the co-design sessions and analyzed using five-step thematic and descriptive statistics analyses, respectively. Appropriateness data was collected through an online survey; quantitative data were analyzed using descriptive statistics and open-text survey responses were analyzed using five-step thematic analysis. Results: Application of Card and colleagues’ seven step framework was described. Six themes emerged from observing virtual co-design sessions: technological tools can encourage equal participation; personal relationships and stories enhance design; participants introduced content to promote equity; context of original intervention critical to adapt; challenges to virtual designing; and need for facilitator during co-design. Documentation of the adaptation process guided by FRAME found 14 adaptations led to “Black and Breasted (B&B)”, an Instagram and beauty brand partnership-based breast health education tool prototype. Motivations for adaptations were to promote fit (100%), reach (71%), and equity (29%). Adaptations were content (63%) and context-related (37%). All participants rated B&B as highly appropriate—selecting an average of 4.5 (SD=1.4) and 1.2 (SD=.75) reasons, respectively, B&B would and would not be a good fit. Thematic analysis of open-text responses on how to further enhance B&B identified four themes: increase strategies to improve health equity, use multiple social media, consider non-beauty brands, revise visuals/messages. Conclusions & Implications: While usage of the implementation science models led to a highly appropriate adapted intervention, initial testing identified the need for further strategies to improve equity of health outcomes through the intervention. Findings indicate implementation science frameworks may benefit from centering equity more. Co-design may also be an apt approach to promote health equity in public health interventions.Item Differential associations of homelessness with emergencydepartment visits and hospitalizations by race, ethnicity, andgender(Wiley, 2022-05-20) Yue, Dahai; Pourat, Nadereh; Essien, Elsie A.; Chen, Xiao; Zhou, Weihao; O'Masta, BrennaObjective To investigate the differential associations of homelessness with emergency department (ED) visits and hospitalizations by race, ethnicity, and gender. Data Sources California Medicaid enrollment and claims. Study Design We identified beneficiaries experiencing homelessness (BEH) and those who did not (NBEH) using diagnosis and place of service codes and residential addresses. Outcomes include four ED visit measures and four hospitalization measures. We compared the use of these services by BEH to NBEH overall and by race, ethnicity, and gender groups in regression models controlling for covariates. Data Collection We used a sample of Medicaid beneficiaries who met eligibility criteria for a California Medicaid demonstration program in 2017 and 2018 but were not enrolled in the program. We identified 473,069 BEH, and the rest (1,948,422) were considered NBEH. We used the 2018 data for utilization analyses and most covariates. We constructed lagged measures of health conditions using 2017 data. Principal Findings We found that homelessness was significantly associated with 0.34 more ED visits (p < 0.01) and a higher likelihood of frequent ED visits (2.77 percentage points [pp], p < 0.01), any ED visits due to mental health conditions (0.79 pp, p < 0.01), and any ED visits due to substance use disorders (1.47 pp, p < 0.01). Experiencing homelessness was also significantly associated with 0.03 more hospitalizations (p < 0.01), a higher likelihood of frequent hospitalizations (0.68 pp, p < 0.01) and high frequent hospitalizations (0.28 pp, p < 0.01), and a longer length of stay (0.53 days, p < 0.01). We found a larger association for American Indian and Alaska Native, Black, Native Hawaii or Pacific Islander, and White populations than that for Asian and Hispanic populations. The associations are larger for males than females. Conclusions Our findings identified distinct utilization patterns by race, ethnicity, and gender. They indicated the need for developing race, ethnicity, and gender-specific strategies to reduce ED visits and hospitalizations of BEH.Item EXAMINING NEIGHBORHOOD SOCIOECONOMIC CHARACTERISTICS AND ACCESS TO THE NATIONAL DIABETES PREVENTION PROGRAM: A MARYLAND PERSPECTIVE(2023) Buchongo, Portia; Franzini, Luisa; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Despite substantial federal and state investments made to promote the National Diabetes Prevention Program (NDPP) as a population health strategy for diabetes prevention it remains underutilized. Research has pointed to a variety of factors that have contributed to low uptake of this evidence-based lifestyle change program. However, the role neighborhood socioeconomic disadvantage plays in NDPP access and use has been underexplored. The state of Maryland is an ideal setting to investigate how neighborhood socioeconomic disadvantage impacts various dimensions of NDPP access due to the significant investments in primary care transformation and NDPP. This dissertation examines: (1) the relationship between neighborhood socioeconomic disadvantage and potential access to the NDPP using primary care providers geographic proximity to the NDPP sites in Maryland, (2) the relationship between neighborhood socioeconomic disadvantage and potential access to the NDPP based on geographic proximity of individuals with prediabetes to the nearest NDPP site in Maryland, and (3) the relationship between neighborhood socioeconomic disadvantage and utilization of diabetes prevention intervention such as NDPP, metformin, or both among individuals with prediabetes in Maryland. Findings from this work underscore how targeted statewide public health and health care initiatives can enhance NDPP access and utilization in neighborhoods with higher levels of socioeconomic disadvantage.