iDEA Collection: Health Sciences Theses and Dissertations

Theoretical Foundation of iPledge Campaign

Wed, 03 Apr 2013 20:27:07 GMT

Title: Theoretical Foundation of iPledge Campaign

Authors: Eluvathingal, Aju

Abstract: Background: The iPledge Campaign is a ‘Women Against Abuse’ initiative. This campaign originated in response to the rising incidence of domestic violence in Philadelphia. It embodies the mission of ‘Women Against Abuse’, by raising awareness of the prevalence and impact of abusive relationships, in order to prevent domestic violence. Objectives: Women Against Abuse wanted to provide a strong theoretical foundation for the iPledge campaign so that it could be studied by other organizations and replicated as per the requirement in different settings. Methods: Researched the existing health behavior theories used to influence the community to bring about the desired change in behavior, through literature review. A detailed understanding of the functioning of the iPledge campaign was taken into consideration to outline the theoretical foundation of this campaign. Results and Conclusion: The iPledge campaign has its concepts rooted in the different theories. This campaign integrates the concepts of Theory of Planned Behavior, Social Cognitive Theory, and Social Marketing Theory. The iPledge campaign attempts to bring about a change in the society by disseminating information, raising the awareness and getting the people actively involved in the cause for domestic violence victims.

Breast Cancer Screening Behaviors Among Women in Pennsylvania from 2000 – 2010

Wed, 03 Apr 2013 20:26:13 GMT

Title: Breast Cancer Screening Behaviors Among Women in Pennsylvania from 2000 – 2010

Authors: Hatia, Rikita

Abstract: BACKGROUND: Prevention is instrumental to decreasing the mortality and morbidity of cancer. Since 1991, the National Breast and Cervical Cancer Early Detection Program helps detect breast and cervical cancer early among uninsured and low income women. OBECTIVES: The study aims to examine how health insurance coverage and annual household income have impacted mammography utilization. Furthermore, temporal changes of late stage breast cancer rates in Pennsylvania will be analyzed to assess the impact of the statewide preventive initiatives. METHODS: A multivariate analysis was conducted of mammography screening rates in Pennsylvania from 2002 – 2010 for women aged 40 – 64. Multivariate analysis was also used to analyze breast cancer stage of diagnosis from 2000 – 2009 using Pennsylvania Cancer Registry to determine change over time. RESULTS: Compared to 2002, the rate of mammography utilization has steadily decreased. Mammography utilization is correlated significantly with health insurance and annual household income. Both individual and environmental factors appear associated with breast cancer diagnosis, with African American women having a higher odds of late stage cancer diagnosis, and the southeastern part of Pennsylvania having a higher rate. CONCLUSIONS: The study highlights the critical role of economic disadvantage on detection, and the importance of a program geared to low-income women, such as the HealthyWoman Project (HWP). The decreasing trend in late stage breast cancer diagnosis over time suggests a positive effect of HWP. Future studies should seek to better understand how factors influence the trajectory of breast cancer, and should investigate additional surveillance outcomes of the HWP.

Philadelphia Department of Public Health, Ambulatory Health Services Patient Satisfaction Survey 2012

Wed, 03 Apr 2013 20:25:15 GMT

Title: Philadelphia Department of Public Health, Ambulatory Health Services Patient Satisfaction Survey 2012

Authors: Crumlish, Cara Ann

Abstract: Patient satisfaction surveys have long been used as an evaluation tool to measure the quality of services delivered within health care settings. Surveys provide consumer insight to the effectiveness of programs that deliver health services to individuals. The importance of this feedback is pivotal to understanding the strengths and weaknesses of health care organizations and helps to identify areas of care that can be improved upon to ensure delivery of quality health services in an affordable and accessible ways. While these surveys have always served a valid purpose, their role in the health care realm will soon serve an even greater purpose and are likely to become a profound focus of administrative efforts in health care in the foreseeable future. The Philadelphia Department of Public Health has recognized this importance of patient satisfaction data, and has made a valiant effort to conduct surveys regularly. This report will examine the role of patient satisfaction in the City health Centers in Philadelphia to determine its role in the future of this public health setting.

Psychosocial factors influencing HPV vaccine uptake among female adolescents in Philadelphia, PA

Wed, 03 Apr 2013 18:28:55 GMT

Title: Psychosocial factors influencing HPV vaccine uptake among female adolescents in Philadelphia, PA

Authors: Wever, Stephanie E.

Abstract: Objective: To determine how psychosocial factors, including knowledge, self-efficacy, and communication, predict intention to receive the HPV vaccination and actual vaccination uptake. Methods: A secondary data analysis of African American adolescent females (n=200) aged 12 to 18 years in Philadelphia, PA who participated in an educational intervention program called ‘HPV Vaccination of Underserved Adolescents and Young Women in Pennsylvania.’ Baseline survey data was used to assess psychosocial factors and intention to receive vaccine. Uptake of HPV vaccination was assessed through linkage to the Philadelphia KIDS immunization registry. Results: In this population of urban adolescents, 44 % had high intention to vaccinate, 36.9% received the first HPV vaccination and 20.7% received both the first and second vaccination out of a three dose series. Self-efficacy and communication with parents and health care providers were associated with intention to vaccinate. Compared to those with low self-efficacy, participants with moderate or high efficacy scores had increased odds of intention to vaccinate (OR=5.01, 95% CI 1.84-13.64 and OR=28.20, 95% 9.48 – 83.86, respectively) and those with moderate to high communication scores have an increased odds for intention to vaccinate compared to those with low communication scores (OR= 3.48, 95% 1.52-7.97 and OR=9.62, 95% 4.04-22.93). Knowledge of the HPV virus and self-efficacy was significantly associated with receiving the first HPV vaccination, whereas only knowledge of the HPV virus was associated with receipt the first and second vaccination. Intention to receive HPV vaccine was not associated with receipt of vaccine. Conclusions: Future health educational interventions directed towards urban adolescents should focus on increasing participant’s self-efficacy to receive the HPV vaccination along with increasing their knowledge of the vaccine itself.

Social Support: A Predictor of Postpartum Depression among HIV-positive and HIV-negative Women

Wed, 03 Apr 2013 18:27:21 GMT

Title: Social Support: A Predictor of Postpartum Depression among HIV-positive and HIV-negative Women

Authors: Taylor, Amber Latrice

Abstract: Objective: The co-morbidity of depression among HIV-positive women has been associated with increased risk of preterm or low birth babies, increased disease progression, medication adherence and poor quality of life. We report findings from a prospective cohort study evaluating rates and predictors of postpartum depression among HIV-positive and HIV-negative women. Methods: We examined associations of social support as a predictor of elevated depressive symptoms using a Center for Epidemiological Studies-Depression (CES-D) scale score of ≥ 16 in 172 HIV-negative and 61 HIV-positive women (79% African-American women). Results: A total of 35 (15%) women were classified as depressed during the postpartum period. There was a significant difference in postpartum depression (PPD) by HIV serostatus (HIV-positive 26%, HIV-negative 74% p= 0.002). Overall, women with low prenatal social support had higher rates of PPD. Of women who reported no social support, HIV-negative women had significantly higher PPD symptoms than HIV-positive women, p <0.05. Significant potential social support predictors of PPD were emotional family and partner support, ability to confide in partner and instrumental partner support, p<0.05. Conclusion: Lack of social support is a risk factor of PPD. Social support as a predictor could serve as an indicator of PPD for prevention and treatment to decrease the exacerbation of mental health problems among pregnant women. Lower rates of PPD among HIV-positive women could be the result on increased access to care. This highlights the importance of early and ongoing assessment of mental health conditions for HIV-negative women to decrease the onset of PPD symptoms.

Associations of serum folate and B12 with cognitive function in children ages 6-16 years old

Wed, 03 Apr 2013 13:18:27 GMT

Title: Associations of serum folate and B12 with cognitive function in children ages 6-16 years old

Authors: Nguyen, Cathy T.; Gracely, Edward J.; Lee, Brian K.

Abstract: Background: Folate and B12 are important for nervous system functioning at all ages, with important roles in functions such as neurotransmitter synthesis. Although studies suggest a relation between folate and B12 and cognitive function in the elderly population, there is relatively less evidence regarding these vitamins and children’s cognitive function. Objective: The purpose of the study was to examine the associations of serum folate and B12 with cognitive performance in children ages 6-16 years old in the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994. Design: A cross-sectional analysis was conducted using data on 5,365 children ages 6-16 years old from NHANES III. Serum folate and B12 were measured, along with performance on the Wide Range Achievement Test-Revised (math and reading) and the Wechsler Intelligence Scale for Children-Revised (block design and digit span). Associations of B vitamins with cognitive performance were assessed using linear regression models adjusted for various covariates. Results: Higher serum concentrations of folate were associated with higher reading and block design scores after adjusting for various covariates. For example, compared with the lowest quartile of folate, children in the highest quartile scored on average 3.05 points higher on the reading test (p<0.001). B12 was not associated with any of the test scores. Conclusions: In the largest study to-date, higher folate concentrations were associated with better reading and block design scores. However, to determine the ideal concentrations of folate needed for optimal cognitive performance, more intervention studies with longitudinal follow-up are needed.

Developing and Implementing a “Hunger-Free Hospital” Model

Wed, 03 Apr 2013 13:16:55 GMT

Title: Developing and Implementing a “Hunger-Free Hospital” Model

Authors: Chen, Cynthia

Abstract: In 2010, approximately 14.5 % of households in the US were food insecure sometime during the year (Nord, Coleman-Jensen, Andrews, & Carlson, 2010). Children living in households that are food insecure are particularly vulnerable to developmental delays, physical illness and socio-emotional stress. Even marginal food insecurity can affect a young child’s development, learning potential and later life success. The “hunger-free hospital” is one way of addressing food insecurity and its associated problems. This new model was developed to address high levels of food insecurity among vulnerable families in the US. This model stresses the importance of food insecurity surveillance, and access to healthy food as a central resource in order to prevent illness and maintain health. Consequently, hospitals are considered a hub for tracing, treating and preventing illnesses associated with food insecurity. A medical institution may fulfill a number of criteria to become committed or designated as a “hunger-free hospital.” The basis of the model is to screen patients for food insecurity, and then connect positively screened patients with short and long term nutrition assistance. Furthermore, the information obtained through these food insecurity screenings may be recorded in the patient’s Electronic Medical Record for future reference and used to more comprehensively treat food insecure patients. Aggregate data may also be relayed to the city government to allow more accurate tracking and record keeping of food insecurity rates at a city-wide, and potentially state or nation-wide level. Implementation of this model relies on building relationships with key stakeholders, such as hospitals, government agencies, food providers, food pantries and city administrators. The contribution of hospitals interested in the “hunger-free hospital” project is dependent on their willingness to address and ability to achieve outlined objectives in the model. Each hospital, city and state has their own culture, beliefs and best interests in terms of addressing food insecurity in their own areas. Therefore, adjustments for the best-fit model are necessary for successful implementation. Reaching more medical institutions and branching out to nearby regions is recommended for the continual expansion of this project. The ongoing dissemination of the “hunger-free hospital” model may be used as an intervention for addressing food insecurity or used as a significant part of a larger plan for providing surveillance and alleviating food insecurity in the US.

Examining the Retention of HIV Positive Patients who attend the Drexel Partnership Comprehensive Care Practice

Wed, 03 Apr 2013 13:14:15 GMT

Title: Examining the Retention of HIV Positive Patients who attend the Drexel Partnership Comprehensive Care Practice

Authors: Fields, Darryl

Abstract: Introduction: HIV positive individuals who remain in care are shown to be healthier and live longer than those who do not (Christopoulos, Das, & Colfax, 2010; Janet M. Blair, 2011; Stephen D. Lawn, 2007). It is estimated 50% of known HIV-infected individuals in the United States are not engaged in regular HIV care (Gardner, McLees, Steiner, del Rio, & Burman, 2011). In order to effectively reduce the prevalence of HIV/AIDS in the United States, there is a need for the development of better retention methods. Purpose: The purpose of this study is to identify characteristics of patients, which attend the Partnership Comprehensive Care Practice, who are at a highest risk of being lost to care. Hypothesis: It is hypothesized those who are lost to care will have detectable viral loads, CD4 counts less than 500 cells/mm3, and not have private insurance. Method: Using SAS Version 9.2, univariate analyses were conducted to display the distribution of patient characteristics (independent variables) from 2010 - 2011. After a general distribution was assessed, the independent variables were stratified by retention status. The Mantel-Haenszel Chi-Square procedure was performed to test whether there is a significant linear association, on an ordinal scale, between the independent variables of interest and the three leveled retention measure. Variables were deemed to have a significant association with retention status if p-values were less than 0.05. Multiple logistic regressions were used to calculate the risk of patients not being retained in care in regards to patient demographics and HIV/AIDS indicator variables Results: Mantel-Haenszel Chi-Square statistics showed there were significant associations between viral loads and retention status (p<0.0001), as well as, between CD4 cell counts and retention status ((p<0.0001). There was not a significant association found between insurance type and retentions status (0.08). During 2010, women had a 52% increased risk not being optimally retained in care. In that same year women had a 65% increased risk of not being sub optimally retained in care. Injection drug users had a 91% increased risk of not being sub optimally retained in care and men who have sex with men (MSM) had a 68% increased risk of not being sub optimally retained in care. Patients whose primary insurance was classified as private had a 156% increased risk of not being optimally retained in care and 74% increased risk of not being sub optimally retained in care. The results of those privately insured was influenced by factors that was not due to privately insured patients missing medical visits, but due to the fact that the definition of retention used did not adequately assess this population. Hispanic patients were found to have a 60% decreased likelihood of being sub-optimally retained in care. Conclusion: Results from this study shows there are populations in the clinic who are in need of targeted inventions in order to enroll them back in to care. Further researcher should focus on the reasons why patients belonging to these populations are more likely not to be retained in care.

Deciphering Nutritional Labeling on Sit-Down Chain Restaurants: A Qualitative Analysis of Understanding and Readability

Wed, 03 Apr 2013 13:10:18 GMT

Title: Deciphering Nutritional Labeling on Sit-Down Chain Restaurants: A Qualitative Analysis of Understanding and Readability

Authors: Youngfert, Andrea

Abstract: BACKGROUND: In January 2010, Philadelphia County enacted a point-of-purchase menu labeling law that requires chain restaurants with 15 or more restaurants nationally to list nutrient values on all printed menus. This legislation provides an opportunity to examine the effectiveness of nutritional labeling in sit-down chain restaurants in Philadelphia. OBJECTIVES: Identify the factors that influence consumers' use of nutritional menu labeling at sit-down chain restaurants and highlight apparent barriers and facilitators to use. METHODS: Five consumer focus groups, totaling 36 participants, were conducted in August 2011. Focus group participants were predominantly female African Americans and had mean incomes <$60,000. Participant mean age was 36 years and mean education was 14.5 years. Two study team members independently conducted the coding analysis within NVivo qualitative software to identify the major themes. RESULTS: Two main themes emerged as facilitators or barriers to using the nutritional labeling: nutritional knowledge and menu design. Facilitators to use included higher prior nutrition knowledge, an increased awareness of nutrient content from seeing the labels, and displays that facilitated seeing healthier items and a nutritional anchor. Barriers to use included lower prior nutrition knowledge, confusion over the menu design, frustration with deciphering nutritional information, and a poor understanding of daily intake needs. CONCLUSION: While participants highlighted both facilitators and barriers to using nutrition information, the barriers to use served as stronger influences against using the listed nutritional information. Awareness of nutritional content did appear to increase from menu labeling which could influence healthier menu item selection in the future.

Assessing and Exploring the Attachment in Foster Children Through the Use of the Bird’s Nest Art Therapy Task and Narrative Story

Wed, 03 Apr 2013 13:09:19 GMT

Title: Assessing and Exploring the Attachment in Foster Children Through the Use of the Bird’s Nest Art Therapy Task and Narrative Story

Authors: Redtschitz, Veronika

Abstract: The purpose of this research study was to assess and explore attachment patterns in foster children between seven to eleven years of age using an art therapy assessment called the Bird’s Nest Drawing (BND). Three participants with a history of at least two foster home placements participated in this study. Two of the children were female and one child was male. All children were African-American. The results in a number of studies indicate that children in foster care are at elevated risk of developing behavior and mental health problems and insecure attachments (Finzi, et al., 2001; Klassen, 2000). A thorough understanding of this problem is essential to clinicians working with this population in order to plan and provide appropriate interventions and treatment. This pilot study, in which children were asked to draw a bird’s nest and tell a story about their drawing, was conducted in order to understand and assess attachment patterns in foster children. All children in this sample were assessed as insecurely attached and each one’s drawings and stories shared themes of isolation, vulnerability, fear, lack of protection, some type of a threat to the well-being of the birds living in the nest and loss of the bird’s nest. Despite the negative themes in the children’s artwork and narratives all participants ended their stories with positive endings, which suggests they may have wish-fulfillment fantasies or feel hopeful about their future. The findings of this study suggest that the children who participated were able to use the metaphor of the bird’s nest effectively, which provided valuable information concerning their attachment experiences. This suggests that the BND can be a valuable and effective tool to collect information about a child’s attachment experience and possibly assess attachment patterns within one 50-minute session. The findings suggest that information obtained during the BND assessment can be used by clinicians to track a client’s progress and plan treatment and interventions more efficiently during art therapy.