Megan Quinn

Prevalence and Correlates of Indoor Tanning and Sunless Tanning Product Use among Female Teens in the United States.

Background Indoor tanning (IT) before the age of 35 increases melanoma risk by 75%. Nevertheless, IT and sunless tanning product (STP) use have gained popularity among youth. However, there are limited data on the prevalence and sociodemographic correlates of both IT and STP use in a representative sample of American teens. Methods Teenage females (N = 778) aged 12–18 years were recruited as part of an on-going longitudinal study conducted between May 2011 and May 2013. Descriptive statistics explored IT and STP usage in teen females at baseline. Logistic regression was used to determine sociodemographic correlates of IT and STP use. Results Approximately 16% of female teens engaged in IT behavior and 25% engaged in using STPs. Female teens living in non-metropolitan areas were 82% more likely to indoor tan compared to those in metropolitan areas (OR = 1.82, 95% CI: 1.07–3.10). Age, geographic regions, and race increased the likelihood of IT and STP use. Conclusions Results indicate a significant proportion of teen females engage in IT and STP use. There was evidence that in teens that have never used IT before, STP use precedes IT initiation. Given the evidence for increased IT in rural populations, research focused on rural tanning bed use is needed.

Alcohol Consumption, Depression, Insomnia and Colorectal Cancer Screening: Racial Differences

Background: Mortality from colorectal cancer (CRC) can be reduced drastically by early detection and early treatment. However, uptake of CRC screening is relatively low, about 50% for those whom the test is highly recommended. Objectives: We examined the influence of and racial differences in depression, insomnia, alcohol use, and tobacco use on CRC screening uptake in the US. Patients and Methods: Analysis of the 2012 National Health Information Survey data was conducted. Both weighted univariate and multiple logistic regression analyses were performed in SAS to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs). A total of 21511 participants were included in the analysis. Results: Prevalence of CRC screening in the participants was 19%. Adjusting for all factors, insomnia (OR = 1.18, 95%CI = 1.06 - 1.32), moderate alcohol drinking (OR = 1.16, 95%CI = 1.01 - 1.30), past smoking (OR = 1.17, 95%CI = 1.04 - 1.32), depression (OR = 1.37, 95%CI = 1.18 - 1.58), African American (AA) race, and cancer history were positively associated with CRC screening. Females and Single were inversely associated with CRC screening prevalence. In stratified analysis by races (White and AA), depression was associated with CRC screening in both races. Marital status, smoking, cancer history and insomnia were associated with CRC screening in Whites only; while alcohol use was associated with CRC screening in AAs only. Conclusions: We have found significant associations between lifestyle factors (alcohol consumption and smoking) and mental health problems (depression and insomnia) and CRC screening uptake. To improve overall CRC screening uptake in the US, it is important to consider racial differences in predictors and tailor appropriate interventions to each racial/ethnic group.

The impact of trauma on the onset of mental health symptoms, aggression, and criminal behavior in an inpatient psychiatric sample

Experiences of trauma and maltreatment are frequent predictors of poor physical and mental health outcomes in adulthood. Existing literature also suggests an impact of developmental adversity on criminality and aggressive behavior, though little research exists describing the effects of cumulative adversity in forensic mental health samples. In the current study of 381 forensic mental health inpatients, rates of trauma, neglect, and parental substance abuse are reported in comparison with community norms. Cumulative adversity and the occurrence of foster care placement are examined via linear and logistic regression analyses in relation to age at first arrest, first psychiatric hospitalization, and onset of aggression, as well as history of suicide attempts and non-suicidal self-injury. Results revealed that experiences of developmental adversity were more common among participants than have been reported in community samples using the ACE survey, and that there were differential effects of gender on the prevalence of traumas experienced. Cumulative adversity scores were significantly associated with all outcomes, though the addition of foster care placement to the model significantly contributed to understanding outcomes, and in some cases, removed the effect of cumulative adversity. Implications and direction for future study are discussed.

Intentions to quit tobacco smoking in 14 low- and middle-income countries based on the transtheoretical model*

INTRODUCTION Over 80% of the worlds one billion tobacco smokers reside in low- and middle-income countries (LMICs); therefore, it is important to understand factors that promote intention to quit smoking in these countries. This study evaluated factors associated with three stages of intention to quit tobacco smoking among adults in LMICs. METHODS Data from 43,540 participants of the Global Adult Tobacco Survey in 14 LMICs were analyzed. Intentions to quit smoking were categorized into precontemplation (referent category), contemplation, and preparation stages based on the transtheoretical model. A multinomial logit model was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Approximately 82%, 14%, and 4% of the smokers were in precontemplation, contemplation, and preparation stages, respectively. Rural residents had increased odds of being in contemplation stage (OR=1.41, 95% CI=1.09-1.83) compared to urban residents. Compared to homes where smoking was allowed, smoke-free homes were associated with increased odds of contemplation (OR=1.77, 95% CI=1.41-2.23) and preparation (OR=2.18, 95% CI=1.78-2.66). Exposure to anti-smoking messages in more than one media channel was associated with increased odds of contemplation (OR=1.60, 95% CI=1.33-1.92) and preparation (OR=1.73, 95% CI=1.28-2.33) compared to no exposure to anti-smoking messages. CONCLUSION The results suggest that anti-smoking media campaigns and smoke-free policies may promote intention to quit smoking in LMICs. While these suggest the need for implementation of comprehensive anti-smoking campaigns and smoke-free policies, longitudinal studies are required to confirm these findings and to evaluate how intention to quit translates into quit attempts in LMICs.

Methods for understanding childhood trauma: modifying the adverse childhood experiences international questionnaire for cultural competency

Adverse childhood experiences (ACEs) research based in the United States demonstrated that traumatic stress in childhood can cause negative physical and mental health outcomes (Stumbo et al. 2015; Normal et al. 2012; Waldman et al. 2011). Many developing countries lack extensive research on ACEs and comprehensive data on exposure to childhood trauma (Anda 2009). The World Health Organization (WHO) ACE international questionnaire (ACEIQ) highlights multiple types of abuse, neglect, and violence while broadening the definition of traumatic stress to include more globally relevant concerns (WHO 2017). The ACE-IQ requires modifications to match the cultural context of the population. This is of high importance due to the need to develop and implement culturally relevant survey mechanisms specific to communities and interventions aligned with community needs. Cultural relevancy is formulated by addressing cultural and contextual differences between the priority population and other populations (Alegria et al. 2004; Kumas-Tan et al. 2007) and is depicted by a specific location, cultural mores, and terminology. The goal of this project was to modify the ACE-IQ for cultural context in a low-resource, underserved community in South Africa (SA). Munsieville, SA is an undeveloped township with reports of local children seeking assistance following acts of violence (Project Hope UK 2017). It is suspected that children living in townships are disproportionately affected by violence and family dysfunction (Ward et al. 2007). These circumstances made Munsieville an ideal community to examine ACE prevalence after modification of the ACE-IQ. Residents of Munsieville aged 18 and older were eligible to participate in the study and recruited through community leaders. Local facilitators were used to conduct three focus groups and one interview to gain insight into proper modification of the ACE-IQ. Groups included: females 18–29 (N = 6); females 30–50 (N = 5); males 18–29 (N = 5); and a male 30–50-year-old (N = 1). Discussion of the overall project and operational definitions of trauma, abuse, neglect, and violence for this setting were completed at the beginning of each session. For each question on the ACE-IQ, participants were asked:

Impact of adverse childhood experiences (ACEs) on adult alcohol consumption behaviors

BACKGROUND Long term negative physical and mental health problems occur from the lack of appropriate interventions targeting the adult population who experienced adverse childhood experiences (ACEs) and partake in risky alcohol consumption behaviors. OBJECTIVE This study aimed to identify the risk for alcohol consumption behaviors, specifically binge drinking (BD) and any drinking (AD), among adults with a history of adverse childhood experiences (ACEs). METHODS Behavioral Risk Factor Surveillance System (BRFSS) 2011-2012 data were used. Descriptive statistics were completed followed by simple and multiple logistic regression to determine the strength of association between ACEs and alcohol consumption, controlling for sociodemographic factors. RESULTS The final adjusted sample size was 69,793. Adults who experienced household abuse were 30% more likely to BD (Odds Ratio (OR): 1.30, 95% Confidence Interval (CI): 1.20-1.41) and 21% more likely for AD (OR: 1.21, 95% CI: 1.14-1.28) in the past month. Males were over two times more likely to BD (OR: 2.12, 95% CI: 1.96-2.29) and 60% more likely for AD (OR: 1.60, 95% CI: 1.51-1.69) in the past month compared to females. Individuals who completed some college were at higher risk of BD (OR: 1.51, 95% CI: 1.26-1.82), whereas those who graduated college were nearly two and a half times more likely to report AD in the past month (OR: 2.27, 95% CI: 1.99-2.59) compared to individuals with less than high school education. CONCLUSION Adults who experienced household abuse, are male, or possess at least some college education are at increased risk for BD and AD.

Review of biosand water filters

Diarrhoeal diseases are a global public health burden, killing 1.8 million people annually. Diarrhoea disproportionately affects children and those in poverty. Most diarrhoeal cases can be prevented through safe drinking water and basic hygiene and sanitation measures, with drinking water interventions having the most impact on reducing diarrhoeal disease. A meta-evaluation of studies assessing a specific household water treatment method, the biosand water filter, was completed. Results from the meta-evaluation illustrated that biosand water filters improve drinking water quality and reduce diarrhoeal disease. However, short follow-up times and inconsistent measures are a concern. Furthermore, there is no generally accepted field method for determining biosand water filter effectiveness that is useable in low-resource communities. This study adds to understanding of biosand water filters.

The Relationship between the Mean, Median, and Mode with Grouped Data

ABSTRACT It is widely believed that the median is “usually” between the mean and the mode for skewed unimodal distributions. However, this inequality is not always true, especially with grouped data. Unavailability of complete raw data further necessitates the importance of evaluating this characteristic in grouped data. There is a gap in the current statistical literature on assessing mean–median–mode inequality for grouped data. The study aims to evaluate the relationship between the mean, median, and mode with unimodal grouped data; derive conditions for their inequalities; and present their application.

Quantifying Collaboration Using Himmelman's Strategies for Working Together: Findings from the Tennessee Coordinated School Health Program.

Purpose – Coordinated school health programs (CSHPs), a type of health promoting school (HPS) program adopted by Canada and the USA, were developed to provide a comprehensive approach to school health in the USA. Community partnerships are central to CSHP and HPS efforts, yet the quality of collaboration efforts is rarely assessed. The purpose of this paper is to use Himmelman’s strategies for working together to assess the types of partnerships that are being formed by CSHPs and to explore the methodological usefulness of this framework. The Himmelman methodology describes four degrees of partnering interaction: networking, coordinating, cooperating, and collaborating, with each degree of interaction signifying a different level of partnership between organizations. Design/methodology/approach – Data were collected as part of the 2008-2009 and 2009-2010 CSHP annual Requests for Proposal from all 131 public school systems in Tennessee. Thematic analysis methods were used to assess partnerships in school s...

Alignment of Epidemiology Practice and Academic Competencies through Effective Collaboration

Background Online learning has recently garnered increased attention as technology use in the classroom grows. However, most of the published approaches regarding this topic in postgraduate education centers on clinical environments. Models of partnerships between applied public health agencies and academic centers to produce mutually beneficial online learning opportunities for graduate-level public health courses have not been explored in the literature. Methods East Tennessee State University (ETSU) and the Tennessee Department of Health (TDH) partnered to build three online, asynchronous epidemiology modules for an interdisciplinary audience of graduate students. The goals of the modules were to (1) introduce students to a public health issue, (2) provide students with hands-on learning about data and information available through TDH, and (3) allow students to connect theory to practice by having them create a product for use by TDH. TDH created topic-specific modules that would be used within the infectious disease, chronic disease, and cancer epidemiology courses, and piloted during the 2015–2016 academic term. Results Conference calls between the two institutions occurred in the spring and the summer of 2015. Two of the three epidemiology modules were presented to ETSU staff for critique and edits at an in-person meeting during the summer. The methods of delivery for each section within a module varied from recorded webinar format to self-guided instruction. One module utilized available learning tools provided by the Centers of Disease Control and Prevention, while the other module was constructed entirely using TDH data. Both modules included various exercises and assignments to be conducted in class and as homework and concluded with the student being asked to construct a learning product as a final project. The ETSU–TDH team decided that this learning product would be provided back to TDH for possible future use. Discussion The innovative partnership between a state government agency and an academic institution has demonstrated the need for such collaborations in public health. Understanding how applied public health practice would utilize what is learned in the classroom and preparing students for real-world application may be the missing link between theory and practice.