2024-03-28T14:06:56Zhttps://thescholarship.ecu.edu/oai/requestoai:TheScholarship.intra.ecu.edu:10342/123232023-02-15T08:16:28Zcom_10342_74com_10342_73col_10342_103
Pressure-Mediated Reflection Spectroscopy Criterion Validity as a Biomarker of Fruit and Vegetable Intake: A 2-Site Cross-Sectional Study of 4 Racial or Ethnic Groups
Jilcott Pitts, Stephanie B.
Johnson, Nevin
et al
skin carotenoids
biomarker
fruit and vegetable intake
2023-02-13T18:23:37Z
2023-02-13T18:23:37Z
2022
Article
0022-3166
http://hdl.handle.net/10342/12323
10.1093/jn/nxab349
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/122292023-02-11T08:16:15Zcom_10342_122com_10342_74com_10342_73col_10342_123col_10342_103
Evaluation of the use of Wastewater Based Epidemiology as a Surveillance Tool and the Potential effects of Vaccines and Students' Beliefs and Practices in Mitigating the Spread of COVID-19 Among Students at East Carolina University
White, Avian
Humphrey, Charles
Public Health
Wright, LaNika
Fallon, John
Iverson, Guy
Wastewater
Epidemiology
COVID-19
Wastewater-Based Epidemiology
Surveillance
Worldwide, newly emerging and re-emerging infectious diseases and pathogens have led to increases in the number and frequency of disease outbreaks. Although these disease outbreaks are not new, increases in outbreaks have led to the need for public health agencies to effectively monitor disease spread. It has been estimated that 25% of 60 million deaths occurring yearly are the result of infectious diseases (Fauci et al., 2005; Nii-Trebi, 2017). Thus, disease monitoring tools are of utmost importance. The outbreak and spread of a severe acute respiratory illness in China alerted the world to a potentially new or re-emerging pathogen. As the virus rapidly spread, it was named “Severe Acute Respiratory Syndrome 2� (SARS-CoV-2) by the World Health Organization (WHO). The SARS-CoV-2 virus was deemed a public health emergency and later declared a pandemic as people across the world contracted COVID-19. The rapid spread of the COVID-19 pandemic underscored the need for disease monitoring and surveillance to mitigate spread. SARS-CoV-2 causes fever, dry cough, shortness of breath and in some instances loss of taste and smell. However, some persons, particularly those with pre-existing conditions, may experience severe symptoms of high fever, severe cough pneumonia, and even death (WHO, 2020). In the United States alone, an estimated 88,044,073 cases have occurred since the start of the epidemic (Worldometer, 2022).
Early strategies to handle the epidemic included temporary sheltering in-place orders, and many institutions including schools and universities shifted to online strategies to ensure continuity in learning. As these entities later sought to fully re-open and regain a sense of normalcy, many were tasked with establishing monitoring systems to help detect potential outbreaks. The use of wastewater-based surveillance was evaluated as a tool in helping to identify when and where student polymerase chain reaction (PCR) testing should be conducted. Here, we utilized wastewater-based epidemiology by sampling dormitory wastewater thrice weekly during Spring and Fall 2021. Data obtained from this sampling was used to help identify potential cases of COVID-19 in dormitories. Additionally, as vaccines were developed and distributed, the relationship between vaccination rates and COVID-19 cases on campus was investigated. Lastly, students’ attitudes and behaviors toward the virus were also evaluated by administering an online survey tool designed through REDCAP systems. This survey utilized a Likert scale where possible to aid in analysis and comparison of student responses between Spring 2021 and Fall 2021 semesters.
Results from this study found significantly higher concentrations of SARS-CoV-2 in wastewater were observed during the Spring relative to the Fall semester. Dorms with higher numbers of COVID-19 cases also had higher concentrations of SARS-CoV-2 in their wastewater. A significant inverse relationship was observed between vaccine rates and student COVID-19 cases. As vaccinations rates increased within the dormitories, the number of student cases decreased. Students became more receptive to the vaccine in the Fall semester in comparison to the Spring. This change in attitudes may have helped the University’s vaccination rates in the Fall semester thus affecting student COVID-19 rates. Here, we saw students a significant difference in virus perception between Spring 2021 and Fall 2021 semesters. Specifically, a lower number of students having a negative perception of the virus. Additionally, students reported having less restrictive behavior (e.g., visitors, mask wearing) in Fall 2021 compared to Spring 2021. Overall, this study showed that universities may successfully use surveillance techniques such as wastewater-based epidemiology to help determine when swarm testing of students should be initiated. It also provided evidence that vaccination campaigns may have helped to reduce the incidence rate of COVID-19 on campus. Gaining an understanding of how students feel and behave regarding the threat of disease outbreaks, the implementation of various preventative measures, and the effects that changes in educational delivery platforms may have on learning and social interactions are also important for developing successful programs to mitigate the spread of diseases.
2023-02-10T18:20:01Z
2022-12
2022-12-01
December 2022
2023-01-31T21:14:32Z
Doctoral Dissertation
text
http://hdl.handle.net/10342/12229
en
application/pdf
application/pdf
East Carolina University
oai:TheScholarship.intra.ecu.edu:10342/58142021-03-03T21:10:32Zcom_10342_74com_10342_73col_10342_103
Forty-Year Trends in Tooth Loss Among American Adults With and Without Diabetes Mellitus: An Age-Period-Cohort Analysis
Luo, Huabin
Pan, Wei
Sloan, Frank
Feinglos, Mark
Wu, Bei
Abstract
Introduction
This study aimed to assess the trends in tooth loss among adults with and without diabetes mellitus in the United States and racial/ethnic disparities in tooth loss patterns, and to evaluate trends in tooth loss by age, birth cohorts, and survey periods.
Methods
Data came from 9 waves of the National Health and Nutrition Examination Survey (NHANES) from 1971 through 2012. The trends in the estimated tooth loss in people with and without diabetes were assessed by age groups, survey periods, and birth cohorts. The analytical sample was 37,609 dentate (ie, with at least 1 permanent tooth) adults aged 25 years or older. We applied hierarchical age-period-cohort cross-classified random-effects models for the trend analysis.
Results
The estimated number of teeth lost among non-Hispanic blacks with diabetes increased more with age than that among non-Hispanic whites with diabetes (z = 4.05, P < .001) or Mexican Americans with diabetes (z = 4.38, P < .001). During 1971–2012, there was a significant decreasing trend in the number of teeth lost among non-Hispanic whites with diabetes (slope = −0.20, P < .001) and non-Hispanic blacks with diabetes (slope = −0.37, P < .001). However, adults with diabetes had about twice the tooth loss as did those without diabetes.
Conclusion
Substantial differences in tooth loss between adults with and without diabetes and across racial/ethnic groups persisted over time. Appropriate dental care and tooth retention need to be further promoted among adults with diabetes.
2016-06-28T14:36:10Z
2016-06-28T14:36:10Z
2015
Article
Preventing Chronic Disease; 12:E211 p. 1-11
1545-1151
http://hdl.handle.net/10342/5814
pmc4674438
10.5888/pcd12.150309
https://www.cdc.gov/pcd/issues/2015/15_0309.htm
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/116612022-10-26T07:16:19Zcom_10342_74com_10342_73col_10342_103
Association of Patient Sex and Pregnancy Status With Naloxone Administration During Emergency Department Visits
Forbes, Lauren A.
Canner, Joseph K.
Milio, Lorraine
Halscott, Torre
Vaught, Arthur Jason
Naloxone
Emergency Department Visits
Patient Sex and Pregnancy Status
2022-10-25T14:48:05Z
2022-10-25T14:48:05Z
2021
Article
0029-7844
http://hdl.handle.net/10342/11661
10.1097/aog.0000000000004357
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/52562021-03-03T21:01:20Zcom_10342_7351com_10342_6421com_10342_1com_10342_74com_10342_73col_10342_7362col_10342_6408col_10342_7167col_10342_103
Associations between farmers market managers’ motivations and market-level Supplemental Nutrition Assistance Program Electronic Benefit Transfer (SNAP/EBT) availability and business vitality
Ward, Rachel
Slawson, Deborah
Wu, Qiang
Jilcott Pitts, Stephanie Bell
Electronic benefit transfer
Farmers market
Supplemental nutrition assistance program
SNAP/EBT
Ward, R., Slawson, D., Wu, Q., & Pitts, S. J. (2015). Associations between farmers market managers’ motivations and market-level Supplemental Nutrition Assistance Program Electronic Benefit Transfer (SNAP/EBT) availability and business vitality. Journal of Agriculture, Food Systems, and Community Development, 6(1), 121–130. http://dx.doi.org/10.5304/jafscd.2015.061.010. Licensed under a CC BY 4.0 license.
Farmers markets are promoted to improve access
to healthy food for low-income consumers by
providing affordable produce via Supplemental
Nutrition Assistance Program Electronic Benefit
Transfer (SNAP/EBT). Having SNAP/EBT at
markets also expands revenue opportunities for
participating farmers. Market managers play a key
role in implementing SNAP/EBT and promoting
business opportunities for farmers, yet they are not
motivated equally by public health and business
goals. There are few studies examining market
managers’ influence on food access for low-income
households and business opportunities for farmers.
We examined associations between managers’
motivations and (1) food access for low-income
households, measured by SNAP/EBT availability,
and (2) business vitality, measured by vendor
participation. A survey assessing manager motivation, SNAP/EBT availability, and vendor participation was sent to all market managers
(N=271) in North Carolina. Seventy (26%)
managers completed the survey. Multiple
regression models were used to examine the
association between managers’ motivations to (1)
improve access to healthful food and SNAP/EBT
availability, and to (2) support business
opportunities and total vendor count, weekly
vendor count, and the number of vendors who sell
only what they produce (“producer-only�). There
was no significant association between food access
motivation and SNAP/EBT availability, or
business motivation and total and weekly vendor
count. A high business motivation score was
positively associated with having 13 more
producer-only vendors at the market. Manager pay
was positively correlated with vendor participation,
including total vendor, weekly, and producer-only
vendor counts. Our results suggest that public
health interventions should emphasize the business
opportunities offered by SNAP/EBT at farmers’
markets, ultimately leveraging market managers’
business goals to encourage SNAP/EBT
implementation.
ECU Open Access Publishing Support Fund
2016-05-11T17:51:08Z
2016-05-11T17:51:08Z
2015-12-08
Article
http://hdl.handle.net/10342/5256
http://dx.doi.org/10.5304/jafscd.2015.061.010
en_US
http://www.agdevjournal.com/component/content/article/598-farmers-market-managers-motivations.html
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/120052023-01-11T08:16:22Zcom_10342_74com_10342_73col_10342_103
“Let’s Use This Mess to Our Advantage�: Calls to Action to Optimize School Nutrition Program beyond the Pandemic
Pitts, Stephanie Jilcott
Katz, Beth N.
school meal programs
child or adolescent
food insecurity
2023-01-10T15:19:29Z
2023-01-10T15:19:29Z
2022-06-22
Article
1660-4601
http://hdl.handle.net/10342/12005
10.3390/ijerph19137650
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58152021-03-03T21:10:50Zcom_10342_74com_10342_73col_10342_103
Food venue choice, consumer food environment, but not food venue availability within daily travel patterns are associated with dietary intake among adults, Lexington Kentucky 2011
Gustafson, Alison
Christian, Jay W
Lewis, Sarah
Moore, Kate
Jilcott Pitts, Stephanie Bell
Food store availability
Food environment
Dietary habits
Objective
The retail food environment may be one important determinant of dietary intake. However, limited research focuses on individuals’ food shopping behavior and activity within the retail food environment. This study’s aims were to determine the association between six various dietary indicators and 1) food venue availability; 2) food venue choice and frequency; and 3) availability of healthy food within food venue.
Methods
In Fall, 2011, a cross-sectional survey was conducted among adults (n=121) age 18 years and over in Lexington, Kentucky. Participants wore a global position system (GPS) data logger for 3-days (2 weekdays and 1 weekend day) to track their daily activity space, which was used to assess food activity space. They completed a survey to assess demographics, food shopping behaviors, and dietary outcomes. Food store audits were conducted using the Nutrition Environment Measurement Survey-Store Rudd (NEMS-S) in stores where respondents reported purchasing food (n=22). Multivariate logistic regression was used to examine associations between six dietary variables with food venue availability within activity space; food venue choice; frequency of shopping; and availability of food within food venue.
Results
1) Food venue availability within activity space – no significant associations. 2) Food Venue Choice – Shopping at farmers’ markets or specialty grocery stores reported higher odds of consuming fruits and vegetables (OR 1.60 95% CI [1.21, 2.79]). Frequency of shopping - Shopping at a farmers’ markets and specialty stores at least once a week reported higher odds of consumption of fruits and vegetables (OR 1.55 95% CI [1.08, 2.23]). Yet, shopping frequently at a super market had higher odds of consuming sugar-sweetened beverages (OR 1.39 95% CI [1.03, 1.86]). 3) Availability of food within store – those who shop in supermarkets with high availability of healthy food has lower odds of consuming sugar-sweetened beverages (OR 0.65 95% CI [0.14, 0.83]).
Conclusion
Interventions aimed at improving fruit and vegetable intake need to consider where individuals’ purchase food and the availability within stores as a behavioral and environmental strategy.
2016-06-28T14:38:38Z
2016-06-28T14:38:38Z
2013
Article
Nutrition Journal; 12: p. 17-17
1475-2891
http://hdl.handle.net/10342/5815
pmc3571876
10.1186/1475-2891-12-17
https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-12-17
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98022022-02-19T08:14:56Zcom_10342_74com_10342_73col_10342_103
Assessment of Occupational Noise Exposure among Groundskeepers in North Carolina Public Universities
Kearney, Gregory D.
Occupational Noise Exposure
Groundskeepers
North Carolina Public Universities
2022-02-18T15:12:07Z
2022-02-18T15:12:07Z
2016-01-01
Article
1178-6302
http://hdl.handle.net/10342/9802
10.4137/EHI.S39682
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/99422022-03-11T08:15:14Zcom_10342_74com_10342_73col_10342_103
Characteristics of Local Health Departments Associated with Implementation of Electronic Health Records and Other Informatics Systems
Luo, Huabin
Health Departments
Electronic Health Records
informatics
2022-03-10T17:55:55Z
2022-03-10T17:55:55Z
2016-03-01
Article
0033-3549
http://hdl.handle.net/10342/9942
10.1177/003335491613100211
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98222022-02-19T08:14:56Zcom_10342_74com_10342_73col_10342_103
Heat-Related Illness Among Latinx Child Farmworkers in North Carolina: A Mixed-Methods Study
Kearney, Gregory D.
Heat-Related Illness
Latinx Child Farmworkers
North Carolina
2022-02-18T15:16:33Z
2022-02-18T15:16:33Z
2020
Article
1048-2911
http://hdl.handle.net/10342/9822
10.1177/1048291120920571
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58392021-03-03T21:11:21Zcom_10342_74com_10342_73col_10342_103
Mapping the Future�Merging the Old with the New Across Disciplines
Efird, Jimmy T.
2016-07-28T17:36:48Z
2016-07-28T17:36:48Z
2012
Article
Cancer Informatics; 11: p. 191-192
1176-9351
http://hdl.handle.net/10342/5839
pmc3516043
10.4137/CIN.S11195
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516043/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/117362022-11-12T08:16:11Zcom_10342_74com_10342_73col_10342_103
Adaptation of a Modified Diet Quality Index to Quantify Healthfulness of Food-Related Toy Sets
Jilcott Pitts, Stephanie
Lazorick, Suzanne
Stage, Virginia C.
Poston, Jacqueline R.
Watkins, Rachel E.
child nutrition
diet quality
pretend play
2022-11-11T15:35:32Z
2022-11-11T15:35:32Z
2022
Article
2153-2168
http://hdl.handle.net/10342/11736
10.1089/chi.2021.0273
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58132021-03-03T21:10:30Zcom_10342_74com_10342_73col_10342_103
Measures of the Consumer Food Store Environment: A Systematic Review of the Evidence 2000–2011
Gustafson, Alison
Hankins, Scott
Jilcott Pitts, Stephanie Bell
Food environment
Community
Description of the consumer food environment has proliferated in publication. However, there has been a lack of systematic reviews focusing on how the consumer food environment is associated with the following: (1) neighborhood characteristics; (2) food prices; (3) dietary patterns; and (4) weight status. We conducted a systematic review of primary, quantitative, observational studies, published in English that conducted an audit of the consumer food environment. The literature search included electronic, hand searches, and peer-reviewed from 2000 to 2011. Fifty six papers met the inclusion criteria. Six studies reported stores in low income neighborhoods or high minority neighborhoods had less availability of healthy food. While, four studies found there was no difference in availability between neighborhoods. The results were also inconsistent for differences in food prices, dietary patterns, and weight status. This systematic review uncovered several key findings. (1) Systematic measurement of determining availability of food within stores and store types is needed; (2) Context is relevant for understanding the complexities of the consumer food environment; (3) Interventions and longitudinal studies addressing purchasing habits, diet, and obesity outcomes are needed; and (4) Influences of price and marketing that may be linked with why people purchase certain items.
2016-06-28T14:33:25Z
2016-06-28T14:33:25Z
2011-12
Article
Journal of Community Health; 37:4 p. 897-911
0094-5145
http://hdl.handle.net/10342/5813
pmc3386483
10.1007/s10900-011-9524-x
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3386483/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98852022-02-27T08:15:03Zcom_10342_74com_10342_73col_10342_103
Best Practices and Innovative Solutions to Overcome Barriers to Delivering Policy, Systems and Environmental Changes in Rural Communities
Pitts, Stephanie
rural populations
food assistance
low-income
2022-02-26T16:34:34Z
2022-02-26T16:34:34Z
2018-08-03
Article
2072-6643
http://hdl.handle.net/10342/9885
10.3390/nu10081012
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/95742022-02-01T08:15:41Zcom_10342_7351com_10342_6421com_10342_74com_10342_73col_10342_9479col_10342_103
Oral health, diabetes, and inflammation: Effects of oral hygiene behavior
Luo, Huabin
Wu, Bei
Kamer, Angela R.
Adhikari, Samrachana
Sloan, Frank
Plassman, Brenda L.
Tan, Chenxin
Qi, Xiang
Schwartz, Mark D.
Tooth loss
Periodontal disease
Diabetes
Inflammation
The aim of this research was to assess the association between inflammation and oral health and diabetes, as well as the mediating role of oral hygiene practice in this association. Data were from the 2009–2010 National Health and Nutrition Examination Survey. The analytical sample consisted of 2,191 respondents aged 50 and older. Poor oral health was clinically defined by significant tooth loss (STL) and periodontal disease (PD). Diabetes mellitus (DM) was determined by glycemic levels. The outcome variable was serum C-reactive protein (CRP) level, dichotomised as ?1 mg/dL (elevated CRP) vs <1 mg/dL (not elevated CRP). Two path models, one using STL and DM as the independent variable, the other using PD and DM as the independent variable, were estimated to assess the direct effects of having poor oral health and DM on elevated CRP and the mediating effects of dental flossing. In path model 1, individuals having both STL and DM (adjusted odds ratio [AOR], 1.92; 95% confidence interval [CI], 1.30–2.82) or having STL alone (AOR, 2.30; 95% CI, 1.68–3.15) were more likely to have elevated CRP than those with neither STL nor DM; dental flossing (AOR, 0.92, 95% CI, 0.88–0.96) was associated with lower risk of elevated CRP. In path model 2, no significant association was found between having both PD and DM and elevated CRP; dental flossing (AOR, 0.91; 95% CI:, 0.86–0.94) was associated with lower risk of elevated CRP. Findings from this study highlight the importance of improving oral health and oral hygiene practice to mitigate inflammation. Further research is needed to assess the longer-term effects of reducing inflammation.
ECU Open Access Publishing Support Fund
2022-01-31T16:24:39Z
2022-01-31T16:24:39Z
2021-11-29
Article
http://hdl.handle.net/10342/9574
10.1016/j.identj.2021.10.001
https://doi.org/10.1016/j.identj.2021.10.001
application/pdf
Elsevier
oai:TheScholarship.intra.ecu.edu:10342/123182023-02-15T08:16:26Zcom_10342_74com_10342_73col_10342_103
Co-Development of a Web Application (COVID-19 Social Site) for Long-Term Care Workers (“Something for Us�): User-Centered Design and Participatory Research Study
Little, Nancy Ruth
Saunders, Catherine H.
COVID-19
vaccine hesitancy
long-term care
2023-02-13T14:00:43Z
2023-02-13T14:00:43Z
2022
Article
1438-8871
http://hdl.handle.net/10342/12318
10.2196/38359
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/107792022-07-19T07:16:01Zcom_10342_74com_10342_73col_10342_103
Use of Oral Health Care Services in the United States: Unequal, Inequitable—a Cross-Sectional Study
Ju, Xiangqun
Mejia, Gloria C.
Wu, Qiang
Luo, Huabin
Jamieson, Lisa M.
Inequality
Indices of inequality
Concentration curves (CC)
2022-07-18T18:03:17Z
2022-07-18T18:03:17Z
2021-07-23
Article
1472-6831
http://hdl.handle.net/10342/10779
10.1186/s12903-021-01708-8
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58492021-03-03T21:11:16Zcom_10342_74com_10342_73col_10342_103
A Community-Driven Approach to Identifying “Winnable� Policies Using the Centers for Disease Control and Prevention’s Common Community Measures for Obesity Prevention
Jilcott Pitts, Stephanie Bell
Whetstone, Lauren M.
Wilkerson, Jean R.
Smith, Tosha W.
Ammerman, Alice S.
Federally funded, community-based participatory research initiatives encourage the development and implementation of obesity prevention policies. In 2009, the Centers for Disease Control and Prevention (CDC) published the Common Community Measures for Obesity Prevention (COCOMO), which include recommended strategies and measures to guide communities in identifying and evaluating environmental and policy strategies to prevent obesity. Agreeing on "winnable" policy issues can be challenging for community members. We used CDC's COCOMO to structure in-depth interviews and group discussions with local stakeholders (ie, planners, town managers, and a local community advisory council) to stimulate interest in and identify health-promoting policies for local policy and planning agendas. We first asked stakeholders to rank the COCOMO recommendations according to feasibility and likelihood of success given community culture, infrastructure, extent of leadership support, and likely funding support. Rankings were used to identify the most and least "winnable" COCOMO policy strategies. We then used questions from the evidence-based Community Readiness Handbook to aid discussion with stakeholders on the facilitators and barriers to enacting the most and least winnable policy options identified. Finally, we discuss potential adaptations to COCOMO for rural jurisdictions.
2016-07-28T18:00:58Z
2016-07-28T18:00:58Z
2012
Article
Preventing Chronic Disease; 9: p. 1-7
1545-1151
http://hdl.handle.net/10342/5849
pmc3392084
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392084/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/109002022-07-21T08:32:53Zcom_10342_74com_10342_73col_10342_103
Development and Implementation of Work Engagement Strategies in a Clinical Research Consortium During the Coronavirus Disease 2019 (COVID-19) Pandemic: A Reflective Inquiry
Johnson, Marcus R.
Asghar, Aliya
Velarde, Kandi
Donaire, Marti
Bratcher, Karen
Department of Veterans Affairs
Work Engagement
COVID-19
2022-07-20T14:07:57Z
2022-07-20T14:07:57Z
2021
Article
1539-1590
http://hdl.handle.net/10342/10900
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98572022-02-27T08:15:05Zcom_10342_74com_10342_73col_10342_103
Perceived Advantages and Disadvantages of Online Grocery Shopping Among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participants in Eastern North Carolina
Pitts, Stephanie
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
federal food-assistance programs
shopping practices
2022-02-26T16:31:02Z
2022-02-26T16:31:02Z
2020-04-16
Article
2475-2991
http://hdl.handle.net/10342/9857
10.1093/cdn/nzaa076
en_US
application/pdf
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98862022-02-27T08:14:51Zcom_10342_74com_10342_73com_10342_6421col_10342_103col_10342_6422
Gaps and Barriers Along the North Carolina Agri-Food Value Chain
Pitts, Stephanie
Value chain
Farm-to-market
Food systems
2022-02-26T16:34:42Z
2022-02-26T16:34:42Z
2016-02-01
Article
0007-070X
http://hdl.handle.net/10342/9886
10.1108/BFJ-06-2015-0223
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58332021-03-03T21:10:18Zcom_10342_74com_10342_73col_10342_103
Farmers’ market use is associated with fruit and vegetable consumption in diverse southern rural communities
Jilcott Pitts, Stephanie Bell
Gustafson, Alison
Wu, Qiang
Mayo, Mariel Leah
Ward, Rachel K.
McGuirt, Jared T.
Rafferty, Ann P.
Lancaster, Mandee F.
Evenson, Kelly R.
Keyserling, Thomas C.
Ammerman, Alice S.
Farmers’ market
Fruit and vegetable consumption
Rural communities
Obesity
Random digit dial
Background
While farmers’ markets are a potential strategy to increase access to fruits and vegetables in rural areas, more information is needed regarding use of farmers’ markets among rural residents. Thus, this study’s purpose was to examine (1) socio-demographic characteristics of participants; (2) barriers and facilitators to farmers’ market shopping in southern rural communities; and (3) associations between farmers’ market use with fruit and vegetable consumption and body mass index (BMI).
Methods
Cross-sectional surveys were conducted with a purposive sample of farmers’ market customers and a representative sample of primary household food shoppers in eastern North Carolina (NC) and the Appalachian region of Kentucky (KY). Customers were interviewed using an intercept survey instrument at farmers’ markets. Representative samples of primary food shoppers were identified via random digit dial (RDD) cellular phone and landline methods in counties that had at least one farmers’ market. All questionnaires assessed socio-demographic characteristics, food shopping patterns, barriers to and facilitators of farmers’ market shopping, fruit and vegetable consumption and self-reported height and weight. The main outcome measures were fruit and vegetable consumption and BMI. Descriptive statistics were used to examine socio-demographic characteristics, food shopping patterns, and barriers and facilitators to farmers’ market shopping. Linear regression analyses were used to examine associations between farmers’ market use with fruit and vegetable consumption and BMI, controlling for age, race, education, and gender.
Results
Among farmers’ market customers, 44% and 55% (NC and KY customers, respectively) reported shopping at a farmers’ market at least weekly, compared to 16% and 18% of NC and KY RDD respondents. Frequently reported barriers to farmers’ market shopping were market days and hours, “only come when I need something�, extreme weather, and market location. Among the KY farmers’ market customers and NC and KY RDD respondents, fruit and vegetable consumption was positively associated with use of farmers’ markets. There were no associations between use of farmers’ markets and BMI.
Conclusions
Fruit and vegetable consumption was associated with farmers’ market shopping. Thus, farmers’ markets may be a viable method to increase population-level produce consumption.
2016-07-28T17:24:12Z
2016-07-28T17:24:12Z
2014
Article
Nutrition Journal; 13: p. 1-1
1475-2891
http://hdl.handle.net/10342/5833
pmc3896848
10.1186/1475-2891-13-1
https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-13-1
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/30252021-03-03T20:55:22Zcom_10342_74com_10342_73col_10342_103
Perceptions of the Community Food Environment and Related Influences on Food Choice Among Midlife Women Residing in Rural and Urban Areas: A Qualitative Analysis
Jilcott Pitts, Stephanie Bell
Laraia, Barbara A.
Evenson, Kelly R.
Ammerman, Alice S.
Women's Health
Food choice
Women, Rural
Women, Urban
Women--North Carolina
Food environment
Introduction—Qualitative research on food choice has rarely focused on individuals’ perceptions of the community food environment. Women remain gatekeepers of the family diet and food purchasing. Therefore we assessed midlife, Southern women's perceptions of the food environment. Related influences on food choices at work and at home were also examined. Methods—We recruited 28 low- and moderate-income, midlife (37-67 years) women from rural and urban areas of southeastern North Carolina, using typical case and snowball sampling. They responded to questions about multilevel influences on food choice in semi-structured, in-depth interviews. Results—Women perceived differences between urban and rural food environments, with rural areas having fewer supermarkets and fast food restaurants compared to urban areas, which had fewer produce stands. Workplace food choices were affected by the social environment (co-workers), personal health concerns, and the surrounding food environment. Food chosen at home was primarily influenced by family members, health concerns, and convenient food sources. Discussion—While future studies should explore findings in more representative populations, potential intervention strategies can be inferred, including emphasizing healthful aspects of the food environment. Intervention and advocacy efforts are needed to improve aspects of the food environment that make healthy choices difficult. Originally published in Women & Health Vol. 49, No. 2-3, 2009.
2010-12-10T14:06:14Z
2011-05-17T01:05:47Z
2010-12-10T14:06:14Z
2011-05-17T01:05:47Z
2009
Article
Women & Health; 49:2-3 p. 164-180
http://hdl.handle.net/10342/3025
PMC2743920
en_US
http://www.informaworld.com/smpp/content~db=all?content=10.1080/03630240902915085
application/pdf
East Carolina University
oai:TheScholarship.intra.ecu.edu:10342/98562022-02-27T08:14:47Zcom_10342_74com_10342_73col_10342_103
Baseline Assessment of a Healthy Corner Store Initiative: Associations between Food Store Environments, Shopping Patterns, Customer Purchases, and Dietary Intake in Eastern North Carolina
Pitts, Stephanie
food availability
diet
convenience store
2022-02-26T16:30:56Z
2022-02-26T16:30:56Z
2017-10-07
Article
1660-4601
http://hdl.handle.net/10342/9856
10.3390/ijerph14101189
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/110002022-08-11T07:16:07Zcom_10342_74com_10342_73col_10342_103
Narrowing but Persisting Gender Pay Gap among Employees of the US Department of Health and Human Services During 2010–2018
Luo, Huabin
Chen, Zhuo
Zhang, Yihong
Zhang, Donglan
Rajbhandari‑Thapa, Janani
Yuheng Wang, Yuheng
Wang, Ruoxi
Bagwell‑Adams, Grace
Health workforce
Gender pay gap
Occupational segregation
2022-08-10T13:51:56Z
2022-08-10T13:51:56Z
2021
Article
1478-4491
http://hdl.handle.net/10342/11000
10.1186/s12960-021-00608-w
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/122852023-02-11T08:16:19Zcom_10342_122com_10342_74com_10342_73col_10342_123col_10342_103
Retrospective Risk Assessment of Forestry Workers in the United States: Injuries, Fatalities, and Hazards Impacting Occupational Health
Knecht, Heidi Yvonne
Richards, Stephanie
Public Health
Balanay, Jo Anne
Tutor Marcom, Robin
Langley, Ricky
Forestry
Logging
Occupational Safety
Occupational Health
Forestry (including logging) is one of the most hazardous occupations due to environmental, ergonomic, chemical, mechanical, mental, and physical components of the job. In the United States (US), workplace injuries account for one-third of all injuries and one-sixth of all fatal injuries among people ages 20-64 years of age. The fatal accident rate of forestry workers in the US is 19-times higher than other physically demanding industries such as construction and manufacturing. Forestry workers must deal with multiple workplace factors that range from moving heavy machinery and other job tasks while adapting to changes in terrain and weather. Forestry workers also may encounter wild animals, arachnids, insects, and snakes. Arboviruses (transmitted primarily by mosquitoes) and bacterial pathogens (transmitted primarily by ticks) are potential health threats to foresters. There are a limited number of studies that have retrospectively assessed work-related injuries/fatalities in forestry/logging industries and current literature is deficient on the additional health hazards associated with foresters. Consequently, the purpose of this study is to compile what is known about potential health and safety risks in foresters from the standpoint of biological (e.g., insects/arachnids, plants); chemical (e.g., pesticides); ergonomic (e.g., awkward postures, forceful motions); physical (extreme temperature, noise, vibrations, and radiation); psychosocial (e.g., workplace factors that cause stress, strain, or interpersonal problems for the worker); and safety (e.g., beetles and trucking) hazards that impact the overall health and injury status of workers. The aims of this study on forestry workers are to: 1) Analyze causes of injuries/fatalities to inform future intervention studies focused on risk mitigation, 2) Build the foundation for using multiple databases to analyze trends in injuries/fatalities, 3) Determine whether there are any trends/associations between work-related risk factors and workplace injuries/fatalities among foresters/loggers over a 16-year period (2003-2019), 4) Evaluate trends in injuries/fatalities to determine where intervention efforts are most needed, 5) Systematically review current knowledge on health hazards in the forestry industry, and 6) Identify knowledge gaps related to forestry and logging injuries, and fatalities for future studies to address. Our findings determined that, for the period of study (2003-2018 for fatalities; 2005-2019 for injuries), “contact with objects and equipment� was the primary cause of injuries and fatalities. “Transportation�-related incidents ranked second for the cause of fatalities, while “falls, slips, & trips� was the second leading cause of injuries. Our systematic review of recent literature showed that while many studies have focused on machinery related injuries and deaths, some areas of occupational health in the forestry industry have been understudied with in the US in the last ten years. Areas identified as needing additional study include chemical exposures from pesticides and diesel exhaust, cold and heat related illnesses, and exposure to ticks and mosquitoes. Our findings identified major gaps in knowledge for health and safety of US forestry/ logging workers and occupational health outcomes. Future research should focus on these areas with an emphasis on intervention strategies that eliminate or mitigate the deleterious health effects of occupational exposures. By identifying specific needs of the forestry industry, more appropriate interventions and aids can be designed and implemented to benefit worker health and safety. Here, we have identified several areas of research that need to be addressed in the future. The areas identified here should be addressed in a collaborative effort between researchers and the forestry industry to promote worker health and safety.
2023-02-10T19:07:33Z
2022-12
2022-12-02
December 2022
2023-01-31T21:14:35Z
Doctoral Dissertation
text
http://hdl.handle.net/10342/12285
en
application/pdf
application/pdf
East Carolina University
oai:TheScholarship.intra.ecu.edu:10342/68162021-03-03T21:18:06Zcom_10342_7351com_10342_6421com_10342_74com_10342_73col_10342_7360col_10342_103
Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study
Kim, Juhee
Mathews, Holly F.
Cortright, Lindsay M.
Zeng, Xiaoming
Newton, Edward
Patient portals
Digital divide
Pregnancy
Poverty
Health literacy
Copyright
©Juhee Kim, Holly Mathews, Lindsay M Cortright, Xiaoming Zeng, Edward Newton. Originally published in JMIR Formative Research (http://formative.jmir.org), 22.03.2018. Licensed under a Creative Commons CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).
Background: Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women.
Objective: This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women.
Methods: A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview.
Results: Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women.
Conclusions: The one-time verbal introduction of MyChart does not meet current patients’ needs. Data reveal the need for more consistent patient education and support programs, tailored to patients’ previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use.
ECU Open Access Publishing Support Fund
2018-07-02T16:16:25Z
2018-07-02T16:16:25Z
2018-03
Article
Kim J, Mathews H, Cortright LM, Zeng X, Newton E
Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study
JMIR Formativ Res 2018;2(1):e6
URL: http://formative.jmir.org/2018/1/e6
DOI: 10.2196/formative.5322
http://hdl.handle.net/10342/6816
10.2196/formative.5322
en_US
http://formative.jmir.org/2018/1/e6/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58432021-03-03T21:11:38Zcom_10342_74com_10342_73col_10342_103
Formative Evaluation for a Healthy Corner Store Initiative in Pitt County, North Carolina: Assessing the Rural Food Environment, Part 1
Pitts, Stephanie B. Jilcott
Bringolf, Karamie R.
Lawton, Katherine K.
McGuirt, Jared T.
Wall-Bassett, Elizabeth
Morgan, Jo
Laska, Melissa Nelson
Sharkey, Joseph R.
Introduction
Obesity prevalence in the rural United States is higher than in urban or suburban areas, perhaps as a result of the food environment. Because rural residents live farther from supermarkets than their urban- and suburban-dwelling counterparts, they may be more reliant on smaller corner stores that offer fewer healthful food items.
Methods
As part of a Communities Putting Prevention to Work (CPPW) healthy corner store initiative, we reviewed audit tools in the fall of 2010 to measure the consumer food environment in eastern North Carolina and chose the NEMS-S-Rev (Nutrition Environment Measures Survey-Stores-Revised) to assess 42 food stores. During the spring and summer of 2011, 2 trained graduate assistants audited stores, achieving interrater reliability of at least 80%. NEMS-S-Rev scores of stores in rural versus urban areas were compared.
Results
Overall, healthful foods were less available and of lower quality in rural areas than in urban areas. NEMS-S-Rev scores indicated that healthful foods were more likely to be available and had similar pricing and quality in rural corner stores than in urban corner stores.
Conclusion
Food store audit data provided a baseline to implement and evaluate a CPPW healthy corner store initiative in Pitt County. This work serves as a case study, providing lessons learned for engaging community partners when conducting rural food store audits.
2016-07-28T17:43:11Z
2016-07-28T17:43:11Z
2013
Article
Preventing Chronic Disease; 10: p. 1-7
1545-1151
http://hdl.handle.net/10342/5843
pmc3716336
10.5888/pcd10.120318
https://www.cdc.gov/pcd/issues/2013/12_0318.htm
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/99252022-03-11T08:15:13Zcom_10342_74com_10342_73col_10342_103
Dental Care Utilization among Caregivers Who Care for Older Adults
luo, Huabin
Dental Care
Caregivers
Older Adults
2022-03-10T17:49:23Z
2022-03-10T17:49:23Z
2015-05-29
Article
0164-0275
http://hdl.handle.net/10342/9925
10.1177/0164027514537082
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/107192022-06-23T07:16:06Zcom_10342_74com_10342_73col_10342_103
Rural, Suburban, and Urban Differences in Chronic Pain and Coping Among Adults in North Carolina: 2018 Behavioral Risk Factor Surveillance System
Rafferty, Ann P.
Luo, Huabin
Egan, Kathleen L.
Bell, Ronny A.
Little, N. Ruth Gaskins
Imai, Satomi
Urban Differences
Chronic Pain
North Carolina
2022-06-22T17:44:28Z
2022-06-22T17:44:28Z
2021-02
Article
1545-1151
http://hdl.handle.net/10342/10719
10.5888/ pcd18.200352
en
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/115662022-10-21T07:16:01Zcom_10342_74com_10342_73col_10342_103
Filtration Efficiency of Surgical Sterilization Fabric for Respiratory Protection During COVID-19 Pandemic
Sousan, Sinan
Garcia, Nicole
White, Avian
Balanay, Jo Anne
COVID-19
Respirator efficiency
Particle efficiency
2022-10-20T17:43:53Z
2022-10-20T17:43:53Z
2021
Article
0196-6553
http://hdl.handle.net/10342/11566
10.1016/j.ajic.2020.11.005
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98532022-02-27T08:14:48Zcom_10342_74com_10342_73col_10342_103
Direct Effects of the Home, School, and Consumer Food Environments on the Association between Food Purchasing Patterns and Dietary Intake among Rural Adolescents in Kentucky and North Carolina, 2017
Pitts, Stephanie
school food environment
home food availability
adolescent obesity
2022-02-26T16:30:36Z
2022-02-26T16:30:36Z
2017-10-21
Article
1660-4601
http://hdl.handle.net/10342/9853
10.3390/ijerph14101255
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98522022-02-27T08:14:50Zcom_10342_74com_10342_73col_10342_103
Associations Between Neighborhood-Level Factors Related to a Healthful Lifestyle and Dietary Intake, Physical Activity, and Support for Obesity Prevention Polices Among Rural Adults
Pitts, Stephanie
Rafferty, Ann P.
healthful lifestyle
dietary intake
obesity prevention
2022-02-26T16:30:30Z
2022-02-26T16:30:30Z
2015-08-06
Article
0094-5145
http://hdl.handle.net/10342/9852
10.1007/s10900-014-9927-6
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/116792022-11-02T07:16:22Zcom_10342_74com_10342_73col_10342_103
Laboratory Determination of Gravimetric Correction Factors for Real-Time Area Measurements of Electronic Cigarette Aerosols
Sousan, Sinan
Pender, Jack
Streuber, Dillon
Hale, Meaghan
Shingleton, Will
Soule, Eric
electronic cigarettes
particulate matter (PM)
indoor air quality
2022-11-01T18:05:43Z
2022-11-01T18:05:43Z
2022
Article
0278-6826
http://hdl.handle.net/10342/11679
10.1080/02786826.2022.2047152
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/99402022-03-11T08:15:12Zcom_10342_74com_10342_73col_10342_103
Gestational Diabetes and Health Behaviors Among Women: National Health and Nutrition Examination Survey, 2007-2014
Luo, Huabin
Gestational Diabetes
Health Behaviors
Women
2022-03-10T17:55:43Z
2022-03-10T17:55:43Z
2018-10-25
Article
1545-1151
http://hdl.handle.net/10342/9940
10.5888/pcd15.180094
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/30362021-03-03T20:55:27Zcom_10342_74com_10342_73col_10342_103
Differences in reproductive risk factors for breast cancer in middle-aged women in Marin County, California and a sociodemographically similar area of Northern California
Lea, C. Suzanne
Gordon, Nancy P.
Prebil, Lee Ann
Ereman, Rochelle
Uratsu, Connie S.
Powell, Mark
Breast--Cancer
Middle-aged women
Reproductive risk factors
Background: The Northern California county of Marin (MC) has historically had high breast cancer incidence rates. Because of MC's high socioeconomic status (SES) and racial homogeneity (non-Hispanic White), it has been difficult to assess whether these elevated rates result from a combination of established risk factors or other behavioral or environmental factors. This survey was designed to compare potential breast cancer risks and incidence rates for a sample of middle-aged MC women with those of a demographically similar population. Methods: A random sample of 1500 middle-aged female members of a large Northern California health plan, half from Marin County (MC) and half from a comparison area in East/Central Contra Costa County (ECCC), were mailed a survey covering family history, reproductive history, use of oral contraceptives (OC) and hormone replacement therapy (HRT), behavioral health risks, recency of breast screening, and demographic characteristics. Weighted data were used to compare prevalence of individual breast cancer risk factors and Gail scores. Ageadjusted cumulative breast cancer incidence rates (2000â 2004) were also calculated for female health plan members aged 40â 64 residing in the two geographic areas. Results: Survey response was 57.1% (n = 427) and 47.9% (n = 359) for MC and ECCC samples, respectively. Women in the two areas were similar in SES, race, obesity, exercise frequency, current smoking, ever use of OCs and HRT, age at onset of menarche, high mammography rates, family history of breast cancer, and Gail scores. However, MC women were significantly more likely than ECCC women to be former smokers (43.6% vs. 31.2%), have Ashkenazi Jewish heritage (12.8% vs. 7.1%), have no live births before age 30 (52.7% vs. 40.8%), and be nulliparous (29.2% vs. 15.4%), and less likely to never or rarely consume alcohol (34.4% vs. 41.9%). MC and ECCC women had comparable 2000â 2004 invasive breast cancer incidence rates. Conclusion: The effects of reproductive risks factors, Ashkenazi Jewish heritage, smoking history, and alcohol consumption with regard to breast cancer risk in Marin County should be further evaluated. When possible, future comparisons of breast cancer incidence rates between regions should adjust for differences in income and education in addition to age and race/ethnicity, preferably by using a sociodemographically similar comparison group. Originally published BMC Women's Health Vol. 9, No. 6 2009.
2011-01-06T21:55:27Z
2011-05-17T01:05:47Z
2011-01-06T21:55:27Z
2011-05-17T01:05:47Z
2009-03-25
Article
BMC Women's Health; 9:6 p. 1-9
http://hdl.handle.net/10342/3036
PMC2670264
10.1186/1472-6874-9-6
en_US
http://www.biomedcentral.com/1472-6874/9/6
application/pdf
East Carolina University
oai:TheScholarship.intra.ecu.edu:10342/98232022-02-19T08:15:01Zcom_10342_74com_10342_73col_10342_103
Health and Occupational Injury Experienced by Latinx Child Farmworkers in North Carolina, USA
Kearney, Gregory D.
child labor
migrant and seasonal farmworkers
health disparities
2022-02-18T15:16:46Z
2022-02-18T15:16:46Z
2019-12-30
Article
http://hdl.handle.net/10342/9823
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58452021-03-03T21:10:55Zcom_10342_74com_10342_73col_10342_103
Eastern Carolina Asthma Prevention Program (ECAPP): An Environmental Intervention Study Among Rural and Underserved Children with Asthma in Eastern North Carolina
Kearney, Gregory D.
Johnson, Lisa C.
Xu, Xiaohui
Balanay, Jo Anne
Lamm, Kevin M.
Allen, Daniel Landon
airway inflammation
environmental health
exhaled nitric oxide
OBJECTIVE:
Asthma is the most common chronic childhood condition affecting 6.3 million (US) children aged less than 18 years. Home-based, multi-component, environmental intervention studies among children with asthma have demonstrated to be effective in reducing asthma symptoms. In this study, a local hospital and university developed an environmental intervention research pilot project, Eastern Carolina Asthma Prevention Program (ECAPP), to evaluate self-reported asthma symptoms, breathing measurements, and number of asthma-related emergency department (ED) visits among low-income, minority children with asthma living in rural, eastern North Carolina. Our goal was to develop a conceptual model and demonstrate any asthma respiratory improvements in children associated with our home-based, environmental intervention.
METHODS:
This project used a single cohort, intervention design approach to compare self-reported asthma-related symptoms, breathing tests, and ED visits over a 6 month period between children with asthma in an intervention study group (n = 12) and children with asthma in a control study group (n = 7). The intervention study group received intense asthma education, three home visits, 2 week follow-up telephone calls, and environmental intervention products for reducing asthma triggers in the home. The control group received education at baseline and 2 week calls, but no intervention products.
RESULTS:
At the end of the study period, significant improvements were observed in the intervention group compared with the control group. Overall, the intervention group experienced a 58% (46 ± SD 26.9) reduction in self-reported asthma symptoms; 76% (34 ± SD 29.7) decrease in rescue medicine; 12% (145 ± SD 11.3) increase in controller medicine; 37% decrease in mean exhaled nitric oxide levels and 33% fewer ED asthma-related visits.
CONCLUSION:
As demonstrated, a combination of efforts appeared effective for improving asthma respiratory symptoms among children in the intervention group. ECAPP is a low cost pilot project that could readily be adapted and expanded into other communities throughout eastern North Carolina. Future efforts could include enhanced partnerships between environmental health professionals at local health departments and pediatric asthma programs at hospitals to carry out ECAPP.
2016-07-28T17:48:12Z
2016-07-28T17:48:12Z
2014
Article
Environmental Health Insights; 8: p. 27-37
1178-6302
http://hdl.handle.net/10342/5845
pmc4077872
10.4137/EHI.S16430
http://www.ncbi.nlm.nih.gov/pubmed/25057240
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58352022-12-14T17:24:22Zcom_10342_74com_10342_73col_10342_103
Maternal cadmium, iron and zinc levels, DNA methylation and birth weight
Vidal, Adriana C.
Semenova, Viktoriya
Darrah, Thomas
Vengosh, Avner
Huang, Zhiqing
King, Katherine
Nye, Monica D.
Fry, Rebecca C.
Skaar, David
Maguire, Rachel
Murtha, Amy
Schildkraut, Joellen
Murphy, Susan
Hoyo, Cathrine
Cadmium
Zinc
Genomic imprinting
Epigenetics
Pediatrics
Obesity
Background
Cadmium (Cd) is a ubiquitous and environmentally persistent toxic metal that has been implicated in neurotoxicity, carcinogenesis and obesity and essential metals including zinc (Zn) and iron (Fe) may alter these outcomes. However mechanisms underlying these relationships remain limited.
Methods
We examined whether maternal Cd levels during early pregnancy were associated with offspring DNA methylation at regulatory sequences of genomically imprinted genes and weight at birth, and whether Fe and Zn altered these associations. Cd, Fe and Zn were measured in maternal blood of 319 women ≤12 weeks gestation. Offspring umbilical cord blood leukocyte DNA methylation at regulatory differentially methylated regions (DMRs) of 8 imprinted genes was measured using bisulfite pyrosequencing. Regression models were used to examine the relationships among Cd, Fe, Zn, and DMR methylation and birth weight.
Results
Elevated maternal blood Cd levels were associated with lower birth weight (p = 0.03). Higher maternal blood Cd levels were also associated with lower offspring methylation at the PEG3 DMR in females (β = 0.55, se = 0.17, p = 0.05), and at the MEG3 DMR in males (β = 0.72, se = 0.3, p = 0.08), however the latter association was not statistically significant. Associations between Cd and PEG3 and PLAGL1 DNA methylation were stronger in infants born to women with low concentrations of Fe (p < 0.05).
Conclusions
Our data suggest the association between pre-natal Cd and offspring DNA methylation at regulatory sequences of imprinted genes may be sex- and gene-specific. Essential metals such as Zn may mitigate DNA methylation response to Cd exposure. Larger studies are required.
2016-07-28T17:27:34Z
2016-07-28T17:27:34Z
2015-07
Article
BMC Pharmacology & Toxicology; 16: p. 1-9
2050-6511
http://hdl.handle.net/10342/5835
pmc4502530
10.1186/s40360-015-0020-2
http://bmcpharmacoltoxicol.biomedcentral.com/articles/10.1186/s40360-015-0020-2
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98752022-02-27T08:15:02Zcom_10342_74com_10342_73col_10342_103
Nutrition-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002-2013
Pitts, Stephanie
Nutrition
Environmental Strategies
Obesity
2022-02-26T16:32:56Z
2022-02-26T16:32:56Z
2015-04-30
Article
1545-1151
http://hdl.handle.net/10342/9875
10.5888/pcd12.140540
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/110552022-09-09T07:16:18Zcom_10342_74com_10342_73col_10342_103
Temporal Changes in Mortality After Transcatheter and Surgical Aortic Valve Replacement: Retrospective Analysis of US Medicare Patients (2012–2019)
Irish, William
Lauck, Sandra B.
Baron, Suzanne J.
Borregaard, Britt
Moore, Kimberly A.
Gunnarsson, Candace L.
Clancy, Seth
Wood, David A.
Thourani, Vinod H.
Webb, John G.
Wijeysundera, Harindra C.
aortic stenosis
mortality
transcatheter aortic valve replacement
2022-09-08T17:26:06Z
2022-09-08T17:26:06Z
2021
Article
2047-9980
http://hdl.handle.net/10342/11055
10.1161/jaha.120.021748
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/99352022-03-11T08:15:14Zcom_10342_74com_10342_73col_10342_103
Health Literacy and Health Behaviors Among Adults With Prediabetes, 2016 Behavioral Risk Factor Surveillance System
Luo, Huabin
prediabetes
health behaviors
health literacy
2022-03-10T17:55:04Z
2022-03-10T17:55:04Z
2020-06-08
Article
0033-3549
http://hdl.handle.net/10342/9935
10.1177/0033354920927848
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/115052022-12-05T16:57:04Zcom_10342_74com_10342_73col_10342_103
Perceptions of Nutrition Education Classes Offered in Conjunction with a Community-Supported Agriculture Intervention Among Low-Income Families
Pitts, Stephanie B Jilcott
Lu, Isabel
Hanson, Karla L
Kolodinsky, Jane
Ammerman, Alice S.
Sitaker, Marilyn
Wang, Weiwei
Volpe, Leah C
Belarmino, Emily H.
Garner, Jennifer
Gonsalves, Liana
Seguin, Rebecca A
Community-Supported Agriculture
Nutrition education
Vegetable consumption
2022-10-13T15:40:04Z
2022-10-13T15:40:04Z
2021
Article
1368-9800
http://hdl.handle.net/10342/11505
10.1017/s1368980020002773
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/60642021-03-03T21:09:51Zcom_10342_7351com_10342_6421com_10342_1com_10342_74com_10342_73col_10342_7361col_10342_6408col_10342_7167col_10342_103
Applying Community-Based Participatory Research Partnership Principles to Public Health Practice-Based Research Networks
Winterbauer, Nancy L.
Bekemeier, Betty
VanRaemdonck, Lisa
Hoover, Anna G.
Practice-based research networks (PBRN)
Community-based participatory research (CBPR)
Academic-practice partnerships
Communities of practice
Knowledge co-production
With real-world relevance and translatability as important goals, applied methodological approaches have arisen along the
participatory continuum that value context and empower stakeholders to partner actively with academics throughout the
research process. Community-based participatory research (CBPR) provides the gold standard for equitable, partnered
research in traditional communities. Practice-based research networks (PBRNs) also have developed, coalescing communities
of practice and of academics to identify, study, and answer practice-relevant questions. To optimize PBRN potential for
expanding scientific knowledge, while bridging divides across knowledge production, dissemination, and implementation,
we elucidate how PBRN partnerships can be strengthened by applying CBPR principles to build and maintain research
collaboratives that empower practice partners. Examining the applicability of CBPR partnership principles to public health (PH)
PBRNs, we conclude that PH-PBRNs can serve as authentic, sustainable CBPR partnerships, ensuring the co-production of
new knowledge, while also improving and expanding the implementation and impact of research findings in real-world settings.
ECU Open Access Publishing Support Fund
2017-02-07T22:25:25Z
2017-02-07T22:25:25Z
2016
Article
http://hdl.handle.net/10342/6064
10.1177/2158244016679211
en_US
http://journals.sagepub.com/doi/abs/10.1177/2158244016679211
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98762022-02-27T08:14:51Zcom_10342_74com_10342_73col_10342_103
Development and Validation of a Farmers' Market Audit Tool in Rural and Urban Communities
Pitts, Stephanie
farmers’ market
food environment
nutrition
2022-02-26T16:33:01Z
2022-02-26T16:33:01Z
2015-07-31
Article
1524-8399
http://hdl.handle.net/10342/9876
10.1177/1524839915597899
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98632022-02-27T08:15:05Zcom_10342_74com_10342_73col_10342_103
A Mentor-Led Text-Messaging Intervention Increases Intake of Fruits and Vegetables and Goal Setting for Healthier Dietary Consumption among Rural Adolescents in Kentucky and North Carolina, 2017
Pitts, Stephanie
fruit and vegetable intake
adolescent
intervention
2022-02-26T16:31:39Z
2022-02-26T16:31:39Z
2019-03-11
Article
2072-6643
http://hdl.handle.net/10342/9863
10.3390/nu11030593
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58372021-03-03T21:10:28Zcom_10342_74com_10342_73col_10342_103
Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study
Johnson, Donna B.
Quinn, Emilee
Sitaker, Marilyn
Ammerman, Alice S.
Byker, Carmen
Dean, Wesley
Fleischhacker, Sheila
Kolodinsky, Jane
Pinard, Courtney
Jilcott Pitts, Stephanie Bell
Sharkey, Joseph
Rural populations
Nutrition
Food systems
Food access
Policy
Background
Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda.
Methods
This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations.
Results
Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other� (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access.
Conclusions
This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities.
2016-07-28T17:31:54Z
2016-07-28T17:31:54Z
2014
Article
BMC Public Health; 14: p. 592-592
1471-2458
http://hdl.handle.net/10342/5837
pmc4064519
10.1186/1471-2458-14-592
http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-592
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58502021-03-03T21:11:23Zcom_10342_74com_10342_73col_10342_103
Long-Term Mortality of 306,868 Patients with Multi-Vessel Coronary Artery Disease: CABG versus PCI
Efird, Jimmy T.
O'Neal, Wesley T.
Davies, Stephen W.
Kennedy, Whitney L.
Alger, Lada N.
O'Neal, Jason B.
Ferguson, T. Bruce
Kypson, Alan P.
CABG
PCI
survival
long-term
Background
Several randomized controlled trials (RCT) have reported no difference in long-term mortality between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The purpose of this pooled observational analysis was to compare recent retrospective studies examining long-term survival of patients with multi-vessel coronary artery disease undergoing CABG and PCI.
Methodology
We searched Medline for observational studies comparing long-term (>1 year) survival between CABG and PCI for the treatment of multi-vessel coronary artery disease over the past 10 years.
Results
Eight studies met inclusion criteria. A total of 306,868 patients (155,502 CABG; 151,366 PCI) were identified. Follow-up ranged from 1 to 8 years. Mantel-Haenszel combined hazard ratios (HR) for mortality demonstrated a protective benefit of CABG compared with PCI (HR=0.77, 95%CI=0.75–0.79).
Conclusion
These findings suggest a long-term survival advantage for CABG compared with PCI in patients with multi-vessel coronary artery disease.
2016-07-28T18:02:32Z
2016-07-28T18:02:32Z
2013-08
Article
British journal of medicine and medical research; 3:4 p. 1248-1257
2231-0614
http://hdl.handle.net/10342/5850
pmc3942885
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942885/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58362021-03-03T21:10:24Zcom_10342_74com_10342_73col_10342_103
Informational Odds Ratio: A Useful Measure of Epidemiologic Association in Environment Exposure Studies
Efird, Jimmy T.
Lea, C. Suzanne
Toland, Amanda
Phillips, Christopher J.
informational odds ratio
collapsibility
pre- and post-exposure odds
The informational odds ratio (IOR) measures the post-exposure odds divided by the pre-exposure odds (ie, information gained after knowing exposure status). A desirable property of an adjusted ratio estimate is collapsibility (ie, the combined crude ratio will not change after adjusting for a variable that is not a confounder). Adjusted traditional odds ratios (TORs) are not collapsible. In contrast, Mantel-Haenszel adjusted IORs generally are collapsible. IORs are a useful measure of disease association in environmental case-referent studies, especially when the disease is common in the exposed and/or unexposed groups.
2016-07-28T17:29:31Z
2016-07-28T17:29:31Z
2012
Article
Environmental Health Insights; 6: p. 17-25
1178-6302
http://hdl.handle.net/10342/5836
pmc3327557
10.4137/EHI.S9236
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327557/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98152022-02-19T08:15:01Zcom_10342_74com_10342_73col_10342_103
Roux-en-Y Gastric Bypass Surgery Restores Insulin-Mediated Glucose Partitioning and Mitochondrial Dynamics in Primary Myotubes from Severely Obese Humans
Houmard, Joseph A.
Glucose Metabolism
Mitochondrial Dynamics
Severe Obesity
2022-02-18T15:13:58Z
2022-02-18T15:13:58Z
2020
Article
0307-0565
http://hdl.handle.net/10342/9815
10.1038/s41366-019-0469-y
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/64392022-12-05T17:01:14Zcom_10342_7351com_10342_6421com_10342_74com_10342_73col_10342_7360col_10342_103
Baseline Assessment of a Healthy Corner Store Initiative: Associations between Food Store Environments, Shopping Patterns, Customer Purchases, and Dietary Intake in Eastern North Carolina
Jilcott Pitts, Stephanie Bell
Wu, Qiang
Laska, Melissa Nelson
Grinchak, Taras
McGuirt, Jared T.
Haynes-Maslow, Lindsey
Bell, Ronny A.
Ammerman, Alice S.
Truesdale, Kimberly P.
Food Environment
Diet
Food Availability
Food Store
Convenience Store
Open Access Funding
2017-11-21T17:38:42Z
2017-11-21T17:38:42Z
2017
Article
Jilcott Pitts, S.B.; Wu, Q.; Truesdale, K.P.; Laska, M.N.; Grinchak, T.; McGuirt, J.T.; Haynes-Maslow, L.; Bell, R.A.; Ammerman, A.S. Baseline Assessment of a Healthy Corner Store Initiative: Associations between Food Store Environments, Shopping Patterns, Customer Purchases, and Dietary Intake in Eastern North Carolina. Int. J. Environ. Res. Public Health 2017, 14, 1189.
http://hdl.handle.net/10342/6439
10.3390/ijerph14101189
http://www.mdpi.com/1660-4601/14/10/1189
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/118312022-12-09T08:16:48Zcom_10342_74com_10342_73col_10342_103
Oral Health, Diabetes, and Inflammation: Effects of Oral Hygiene Behaviour
Luo, Huabin
Tooth loss
Periodontal disease
Diabetes
2022-12-08T16:31:29Z
2022-12-08T16:31:29Z
2022
Article
0020-6539
http://hdl.handle.net/10342/11831
10.1016/j.identj.2021.10.001
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/117672022-11-22T08:16:39Zcom_10342_74com_10342_73col_10342_103
Understanding COVID-19 Situation in Nepal and Implications for SARS-CoV-2 Transmission and Management
Pokhrel, Lok R.
Dawadi, Prabin
COVID-19
wastewater surveillance
Nepal
2022-11-21T14:01:03Z
2022-11-21T14:01:03Z
2022
Article
1178-6302
http://hdl.handle.net/10342/11767
10.1177/11786302221104348
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/51562021-03-03T20:58:47Zcom_10342_7351com_10342_6421com_10342_2com_10342_1com_10342_74com_10342_73col_10342_7362col_10342_8858col_10342_6408col_10342_7167col_10342_103
Predictors for Using a HIV Self-Test Among Migrant and Seasonal Farmworkers in North Carolina
Kinney, Samantha
Lea, C. Suzanne
Kearney, Gregory D.
Kinsey, Anna
Amaya, Carlos
HIV Testing
seasonal and migrant farmworkers
behavioral factors
survey
North Carolina
Background: Approximately, two million migrant and seasonal farmworkers (MSF) work in the United States annually. Several factors, such as lack of access to healthcare services and health behaviors, contribute to risk of HIV transmission. Relatively few studies have explored MSF knowledge of HIV transmission and testing options. Methods: A 12-question, self-administered survey of farmworkers (n = 178) from 19 migrant camps was conducted. The survey assessed knowledge of factors related to HIV transmission, testing, and intention to use a HIV home-test kit. Results: Participants with knowledge of treatment for HIV (p = 0.03) and that condom use protects against HIV (p = 0.04) were more willing to express intent to use a home test kit than those with less knowledge. Concern among farmworkers that HIV was a very or somewhat serious problem in their community was associated with expressing intent to use a home test kit (OR = 2.3, 95% CI = 0.92–5.5). Respondents with less knowledge were less likely to use a home test kit. Conclusions: MSF were concerned about HIV in their community and would be willing to use to a home test kit. This pilot study provides a basis for additional research related to HIV testing within the MSF community.
ECU Open Access Publishing Support Fund
2016-01-28T19:50:10Z
2016-01-28T19:50:10Z
2015-07-17
Article
International Journal of Environmental Research and Public Health; 12:7 p. 8348-8358
http://hdl.handle.net/10342/5156
10.3390/ijerph120708348
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/115142022-10-14T07:16:00Zcom_10342_74com_10342_73col_10342_103
Masculinity, Resources, and Retention in Care: South African Men’s Behaviors and Experiences While Engaged in TB Care and Treatment
Kipp, Aaron
Daniels, Joseph
Medina-Marino, Andrew
Glockner, Katherine
Grew, Emily
Ngcelwane, Nondumiso
Masculinity
Tuberculosis
South Africa
2022-10-13T19:20:20Z
2022-10-13T19:20:20Z
2021-02
Article
0277-9536
http://hdl.handle.net/10342/11514
10.1016/j.socscimed.2020.113639
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98642022-02-27T08:15:03Zcom_10342_74com_10342_73col_10342_103
Fruit and Vegetable Preferences and Practices May Hinder Participation in Community-Supported Agriculture Among Low-Income Rural Families
Pitts, Stephanie
Fruit and Vegetable Preferences
Community Supported Agriculture
Low-income Rural Families
2022-02-26T16:31:45Z
2022-02-26T16:31:45Z
2019-01-01
Article
1499-4046
http://hdl.handle.net/10342/9864
10.1016/j.jneb.2018.08.006
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98552022-02-27T08:14:49Zcom_10342_74com_10342_73col_10342_103
Farm Fresh Foods for Healthy Kids (F3HK): An innovative Community Supported Agriculture Intervention to Prevent Childhood Obesity in Low-Income Families and Strengthen Local Agricultural Economies
Pitts, Stephanie
Childhood obesity
Diet
Local food system
2022-02-26T16:30:49Z
2022-02-26T16:30:49Z
2017-04-08
Article
1471-2458
http://hdl.handle.net/10342/9855
10.1186/s12889-017-4202-2
en_US
application/pdf
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58482021-03-03T21:11:11Zcom_10342_74com_10342_73col_10342_103
Telephone Surveys Underestimate Cigarette Smoking among African-Americans
Landrine, Hope
Corral, Irma
Simms, Denise Adams
Roesch, Scott C.
Pichon, Latrice C.
Ake, Diane
Villodas, Feion
smoking
blacks
telephone health surveys
methodology
Background: This study tested the hypothesis that data from random digit-dial telephone surveys underestimate the prevalence of cigarette smoking among African-American adults.
Method: A novel, community-sampling method was used to obtain a statewide, random sample of N = 2118 California (CA) African-American/Black adults, surveyed door-to-door. This Black community sample was compared to the Blacks in the CA Health Interview Survey (N = 2315), a statewide, random digit-dial telephone survey conducted simultaneously.
Results: Smoking prevalence was significantly higher among community (33%) than among telephone survey (19%) Blacks, even after controlling for sample differences in demographics.
Conclusion: Telephone surveys underestimate smoking among African-Americans and probably underestimate other health risk behaviors as well. Alternative methods are needed to obtain accurate data on African-American health behaviors and on the magnitude of racial disparities in them.
2016-07-28T17:56:05Z
2016-07-28T17:56:05Z
2013-09
Article
Frontiers in Public Health; 1: p. 1-8
2296-2565
http://hdl.handle.net/10342/5848
pmc3859986
10.3389/fpubh.2013.00036
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859986/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/107882022-07-19T07:16:02Zcom_10342_74com_10342_73col_10342_103
Qualitative Perspectives of the North Carolina Healthy Food Small Retailer Program Among Customers in Participating Stores Located in Food Deserts
Haynes-Maslow, Lindsey
Jilcott-Pitts, Stephanie B.
Boys, Kathryn A.
McGuirt, Jared T.
Fleischhacker, Sheila
Ammerman, Alice S.
Johnson, Nevin
Kelley, Casey
Donadio, Victoria E.
Bell, Ronny A.
Laska, Melissa N.
Nutrition legislation
Qualitative data collection and analysis
Customer perspectives
2022-07-18T18:15:27Z
2022-07-18T18:15:27Z
2021-07-27
Article
1471-2458
http://hdl.handle.net/10342/10788
10.1186/s12889-021-11509-x
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/124672023-04-12T18:18:39Zcom_10342_74com_10342_73col_10342_103
The Key Driver Implementation Scale (KDIS) for Practice Facilitators: Psychometric Testing in the “Southeastern Collaboration to Improve Blood Pressure Control� Trial
Cummings, Doyle M.
Peaden, Shannon
Key Driver Implementation Scale
blood pressure control
Psychometric Testing
2023-04-12T18:18:39Z
2023-04-12T18:18:39Z
2022-08-24
Article
1932-6203
http://hdl.handle.net/10342/12467
10.1371/journal.pone.0272816
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/122742024-02-09T09:01:58Zcom_10342_122com_10342_74com_10342_73col_10342_123col_10342_103
Accuracy of Wet Bulb Globe Temperature (WBGT) Obtained from Regional Weather Station Data for Agricultural Settings in Eastern North Carolina as Proxy for WBGT Obtained from Local Heat Stress Monitors
Dillane, Danielle Nicole
Balanay, Jo Anne G
Public Health
DeWitt, Jamie
Vos, Paul
Kearney, Greg
heat stress
WBGT
outdoor agricultural workers
OSHA WBGT outdoor calculator
worker safety
occupational exposure
exposure assessment
Introduction:
Agricultural workers are at high risk of suffering from heat stress and subsequently developing heat-related illnesses (HRIs) due to the outdoor nature of their work. This risk can be exacerbated in hot, humid temperatures such as those that define the climate found in Eastern North Carolina (ENC). It is critical for employers to monitor worker safety and assess occupational heat exposure on a daily basis so that preventative measures can be taken as needed to reduce the risk of HRIs. The Wet Bulb Globe Temperature (WBGT) Index is considered the ‘gold standard’ for assessing occupational heat stress among outdoor workers. However, traditional WBGT instrumentation may not always be readily available. Alternatively, WBGT can be calculated through models utilizing weather station data that is routinely collected and therefore readily available. Previous models have estimated WBGT based solely on standard meteorological data using heat stress data obtained from military settings. The main purpose of this study was to assess the accuracy of calculating WBGT indices from weather station data compared to instrumentation-based data obtained from locally stationed heat stress monitors in an agricultural setting. The specific aims of this study are to: 1) assess the accuracy of utilizing WBGT indices obtained from weather station data as a proxy for those obtained from instrumentation (primary aim), and 2) determine how farmers across ENC evaluate daily heat stress risk and handle/report HRI symptoms and cases among their farmworkers (secondary aim).
Methods:
QUESTemp°34 heat stress monitors were set up daily, weather permitting, from 8AM to 5 PM at two agricultural sites in Bertie County during the period of April-July 2021. Weather station data were collected from Weather Underground (Weather Underground, 2020) using the zip code for both study sites. The OSHA Outdoor WBGT Calculator was utilized to calculate the outdoor WBGT index for each site using the collected daily weather station data. Solar irradiance was estimated using two methods: 1) estimated solar irradiance calculated by OSHA Outdoor WBGT Calculator [weather data-based method 1/WeatherCalc1] and 2) Estimated Irradiance Based on Cloud Cover table from the heat stress chapter (Chapter 4) of OSHA’s Technical Manual (Table 1) (OSHA, 2017) [weather data-based method 2/WeatherCalc2]. The hourly average of the measured (instrumentation-obtained) WBGT index was determined and compared to the hourly calculated WBGT index using weather station data. Additionally, a survey was developed and distributed via Qualtrics to farmers across 27 counties in ENC to assess how HRI symptoms are addressed through training and how HRIs are handled and reported once they arise. The survey contained original questions developed to address the research questions of this study. At least one cooperative extension agent from each of the 41 counties in ENC were asked to provide farmer contact information as a method of recruiting participants for the survey. The study was approved by East Carolina University’s (ECU) University and Medical Center Institutional Review Board (UMC-IRB#21-000428). Line graphs and scatter plots were created to visualize the data. Bland-Altman plots were also created to assess whether the approximation behaved the same at high versus low temperatures throughout the study period. Pearson correlations were calculated to assess the strength of association between the weather station data-based and instrumentation-based WBGT indices. Statistical analysis software R (R Core Team, 2021) was used to create Bland-Altman plots and correlations.
Results:
Line graphs and scatter plots showed the weather data-based WBGT indices (WeatherCalc1 and WeatherCalc2) tended to be higher than instrumentation-based WBGT indices (MonitorSite1 and MonitorSite2), and that the method for calculating solar irradiance impacted WBGT indices as WeatherCalc2 WBGT indices tended to be higher than WeatherCalc1 WBGT indices.
All correlations were greater than 0.91. Despite a strong correlation, Bland-Altman plots suggest that utilizing zip code level weather data to calculate WBGT cannot be done accurately within ±1°C at least 90% of the time as a large portion of the data points fall outside of the limits of agreement set at ±1°C across all temperature ranges. This criterion was developed from the primary research article used for this study (Liljegren et al, 2008) which concluded accurate findings of WBGT predictions within ±1°C of the measured value 91-100% of the time, depending on location and functionality of instrumentation utilized. An overall response rate of 8.2% (147/1,788) was recorded for the survey. Survey results indicated that more widespread heat stress training is needed among agricultural workers, rest breaks with provided water need to be mandatory, a system needs to be in place for reporting and handling HRIs on individual farms, and more farmers need to assess risk of HRIs daily by checking either the heat index or WBGT index.
Conclusion:
Overall, utilizing zip code level weather data to accurately calculate WBGT indices that are within ±1°C of local instrument-measured WBGT indices cannot be accomplished at least 90% of the time, for either method used to calculate solar irradiance, using the model developed by Liljegren et al. (2008), thus answering the first primary research question for this study. For monitoring site 1, methods 1 and 2 of calculating weather data-based WBGT indices were accurate within ±1°C of instrumentation-based WBGT indices 45.0% and 30.5% of the time (respectively) for the entire study period. For monitoring site 2, methods 1 and 2 of calculating weather data-based WBGT indices were accurate within ±1°C of instrumentation-based WBGT indices 33.7% and 23.6% of the time (respectively) for the entire study period. This combined information answers the second primary research question for this study. However, the weather data-based WBGT indices were higher than instrumentation-based WBGT indices, indicating that their use may result in an overestimation of the risk of heat stress to workers. From a public health standpoint, the conservative and protective nature of overestimating WBGT indices utilizing weather data could be lifesaving. It is strongly recommended that all farmers across ENC provide annual heat stress training to their employees, implement a system for reporting and handling HRIs on their farm, provide water and mandatory rest breaks to employees, and check the heat index or WBGT index daily to assess heat exposure risks. These changes will directly provide a safer work environment for outdoor agricultural workers and could ultimately impact public health by lowering incidences of HRIs across ENC.
2023-02-10T19:05:13Z
2024-02-09T09:01:58Z
2022-12
2022-12-01
December 2022
2023-01-31T21:14:34Z
Doctoral Dissertation
text
http://hdl.handle.net/10342/12274
en
application/pdf
application/pdf
East Carolina University
oai:TheScholarship.intra.ecu.edu:10342/106122022-06-07T07:15:59Zcom_10342_74com_10342_73col_10342_103
A Neo-Searlean Theory of Intentionality
Georgalis, Nicholas
Searle
intentionality
intentional object
Crane
thought
thought-token
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
I present Searle’s theory of intentionality and defend it against some objections. I then significantly extend his theory by exposing and incorporating an ambiguity in the question as to what an intentional state is about as between a subjective and an objective reading of the question. Searle implicitly relies on this ambiguity while applying his theory to a solution to the problem of substitution in propositional attitudes, but his failure to explicitly accommodate the ambiguity undermines his solution. My extension of his theory succeeds. I also indicate how the new theory can be deployed to resolve other outstanding problems.
ECU/Cambridge open access publishing agreement
2022-06-06T12:14:13Z
2022-06-06T12:14:13Z
2022-03-14
Article
Georgalis, N. (2021). A Neo-Searlean Theory of Intentionality. Canadian Journal of Philosophy, 51(7), 475-495. doi:10.1017/can.2022.8
http://hdl.handle.net/10342/10612
10.1017/can.2022.8
https://www.cambridge.org/core/journals/canadian-journal-of-philosophy/article/neosearlean-theory-of-intentionality/1A12F39DC8E102923D0B5133B7AB322E
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98212022-02-19T08:14:56Zcom_10342_74com_10342_73col_10342_103
Respiratory Health and Suspected Asthma among Hired Latinx Child Farmworkers in Rural North Carolina
Kearney, Gregory D.
Respiratory Health
Asthma
Latinx Child Farmworkers
2022-02-18T15:16:22Z
2022-02-18T15:16:22Z
2020-10-29
Article
1660-4601
http://hdl.handle.net/10342/9821
10.3390/ijerph17217939
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/117692022-11-22T08:16:40Zcom_10342_74com_10342_73col_10342_103
Drinking Water–Associated PFAS and Fluoroethers and Lipid Outcomes in the GenX Exposure Study
Lea, C. Suzanne
Collier, David N.
Drinking Water
Per- and polyfluoroalkyl substances (PFAS)
perfluorooctanoic acid (PFOA)
2022-11-21T14:28:49Z
2022-11-21T14:28:49Z
2022-09-07
Article
0091-6765
http://hdl.handle.net/10342/11769
10.1289/EHP11033
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98782022-02-27T08:15:03Zcom_10342_74com_10342_73col_10342_103
Knowledge, Attitudes, Beliefs and Behaviors Regarding Fruits and Vegetables among Cost-Offset Community-Supported Agriculture (CSA) Applicants, Purchasers, and a Comparison Sample
Pitts, Stephanie
fruits and vegetables
community-supported agriculture
dietary quality
2022-02-26T16:33:13Z
2022-02-26T16:33:13Z
2019-06-12
Article
2072-6643
http://hdl.handle.net/10342/9878
10.3390/nu11061320
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/109962022-08-11T07:16:06Zcom_10342_74com_10342_73col_10342_103
A Four-Year Observational Study to Examine the Dietary Impact of the North Carolina Healthy Food Small Retailer Program, 2017–2020
Jilcott Pitts, Stephanie B.
Rafferty, Ann P.
Johnson, Nevin
Kaur, Archana P.
Wu, Qiang
Truesdale, Kimberly P.
Haynes-Maslow, Lindsey
Boys, Kathryn A.
McGuirt, Jared T.
Fleischhacker, Sheila
Bell, Ronny A.
Ammerman, Alice S.
Laska, Melissa N.
2022-08-10T13:46:44Z
2022-08-10T13:46:44Z
2021
Article
1479-5868
http://hdl.handle.net/10342/10996
10.1186/s12966-021-01109-8
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98042022-02-19T08:15:00Zcom_10342_74com_10342_73com_10342_6421col_10342_103col_10342_6422
A Decade of Environmental Public Health Tracking (2002-2012): Progress and Challenges
Kearney, Gregory D.
Environmental Public Health Tracking
epidemiology
exposure
2022-02-18T15:12:21Z
2022-02-18T15:12:21Z
2015-03-01
Article
1078-4659
http://hdl.handle.net/10342/9804
10.1097/PHH.0000000000000181
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98542022-02-27T08:15:02Zcom_10342_74com_10342_73col_10342_103
A Possible Dose-Response Association Between Distance to Farmers' Markets and Roadside Produce Stands, Frequency of Shopping, Fruit and Vegetable Consumption, and Body Mass Index Among Customers in the Southern United States
fruit and vegetable consumption
body mass index
Consumer behavior
2022-02-26T16:30:42Z
2022-02-26T16:30:42Z
2017-01-11
Article
1471-2458
http://hdl.handle.net/10342/9854
10.1186/s12889-016-3943-7
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/99262022-03-11T08:15:06Zcom_10342_74com_10342_73col_10342_103
Factors Driving the Adoption of Quality Improvement Initiatives in Local Health Departments: Results from the 2010 Profile Study
Luo, Huabin
determinants
local health departments
quality improvement
2022-03-10T17:49:29Z
2022-03-10T17:49:29Z
2015-03-01
Article
1078-4659
http://hdl.handle.net/10342/9926
10.1097/PHH.0000000000000113
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58402021-03-03T21:11:23Zcom_10342_74com_10342_73col_10342_103
Sinusoidal Cox Regression�A Rare Cancer Example
Efird, Jimmy T.
sinusoidal Cox regression
seasonality of birth
Evidence of an association between survival time and date of birth would suggest an etiologic role for a seasonally variable environmental exposure occurring within a narrow perinatal time period. Risk factors that may exhibit seasonal epidemicity include diet, infectious agents, allergens, and antihistamine use. Typically data has been analyzed by simply categorizing births into months or seasons of the year and performing multiple pairwise comparisons. This paper presents a statistically robust alternative, based upon a trigonometric Cox regression model, to analyze the cyclic nature of birth dates related to patient survival. Disease birth-date results are presented using a sinusoidal plot with peak date(s) of relative risk and a single P value that indicates whether an overall statistically significant seasonal association is present. Advantages of this derivative-free method include ease of use, increased power to detect statistically significant associations, and the ability to avoid arbitrary, subjective demarcation of seasons.
2016-07-28T17:39:22Z
2016-07-28T17:39:22Z
2010-11
Article
Cancer Informatics; 9: p. 265-279
1176-9351
http://hdl.handle.net/10342/5840
pmc2998934
10.4137/CIN.S6202
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998934/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/99272022-03-11T08:15:06Zcom_10342_74com_10342_73col_10342_103
Forty-Year Trends in Tooth Loss Among American Adults With and Without Diabetes Mellitus: An Age-Period-Cohort Analysis
Luo, Huabin
Tooth Loss
American Adults
Diabetes
2022-03-10T17:49:36Z
2022-03-10T17:49:36Z
2015-12-03
Article
1545-1151
http://hdl.handle.net/10342/9927
10.5888/pcd12.150309
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/99382022-03-11T08:15:12Zcom_10342_74com_10342_73col_10342_103
Acculturation, Depression and Oral Health of Immigrants in the USA
Luo, Huabin
Acculturation
depression
oral health
2022-03-10T17:55:29Z
2022-03-10T17:55:29Z
2018
Article
0020-6539
http://hdl.handle.net/10342/9938
10.1111/idj.12364
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/97232023-05-26T14:22:57Zcom_10342_122com_10342_74com_10342_73col_10342_123col_10342_103
AN EPIDEMIOLOGIC ANALYSIS OF SARCOIDOSIS IN NC
Wambui, David
Kearney, Gregory D
Public Health
Epidemiology
North Carolina
Mortality
Spatial Distribution
Pulmonary Sarcoidosis
East Carolina University Sarcoidosis Patients Registry
Sarcoidosis
Humans
Sarcoidosis is a rare, complex inflammatory chronic condition that commonly affects the lymphatic system and the lungs. The clinical course of sarcoidosis can vary from acute to progressively chronic conditions including organ dysfunction, other comorbidities and even death. The etiology of sarcoidosis remains largely unknown and there is no cure. Risk factors includes being African American or black race, low socio-economic status, unhealthy lifestyle behavior, and a history of environmental/occupational exposures to antigens. In the U.S., the mortality rate of sarcoidosis is 10 to 11 times higher among African Americans compared to whites. North Carolina (NC) ranks fourth in the nation with the highest sarcoidosis mortality rates. Despite these facts, little published research is available, and no studies have explored the epidemiology of sarcoidosis mortality of NC using a population-based approach. Sarcoidosis in NC is an important public health concern that needs to be further investigated. The overarching aims of this project were to examine sarcoidosis mortality using an applied, public health practice approach. The primary objectives of this study were multifaceted, including, 1) synthesizing relevant literature to examine the relationship between increased risk of physician diagnosed sarcoidosis and exposures to respirable particles; 2) detecting spatial clusters or hotspots of sarcoidosis deaths; 3) evaluating sarcoidosis mortality risk factors and their spatial-temporal distribution in NC; 4) determining common demographic and clinical characteristics among sarcoidosis patients in the East Carolina University Sarcoidosis Patients Registry (ECUSaR); and 5) developing information brochure for ECUSaR .Systematic review and meta-analysis were used to synthesize literature and examine the association between exposure to respirable particles and physician diagnosed sarcoidosis. Spatial distributions of sarcoidosis mortality risk factors, County-level analysis of sarcoidosis mortality clustering, and outlier analysis were performed. To assess the factors associated with observed spatial temporal mortality patterns, a multivariate linear regression model with region, percent of Africa Americans, percent of people working in nature, percent of obese adults and average annual ambient PM2.5 as predictor variables was conducted. Descriptive statistics were conducted to explore sociodemographic and clinical characteristics of sarcoidosis patients in ECUSaR. Although the pooled risk estimated from meta-analysis showed an increase in risk among those exposed to respirable particles compared to the unexposed (odds ratio (OR)=2.18, 95% confidence interval (CI) =0.79 - 5.79), the estimated risk was not statistically significant. Eastern NC had higher sarcoidosis mortality rate (1.16 per 100,000) compared to Piedmont (0.49 per 100,000) and Western (0.32 per 100,000) regions. Statistically significant sarcoidosis mortality clusters were detected in Eastern NC with p-value <0.001 for Global Moran's I. Similarly, associated sociodemographic (percent of African Americans, p-value <0.001, percent of obese adults, p-value <0.001) and environmental (percent working in nature, p-value <0.001) sarcoidosis risk factors were more prevalent in Eastern NC compared to Piedmont and Western regions. Region and percent of African American population were statistically significant predictors of sarcoidosis mortality. Results from the ECUSaR registry identified that most patients were of African American (85.4%) decent, and females accounted for 67.5% of all patients. Body mass index (BMI) was higher among females than males (median =33, Q1 (25th percentile) = 27.6 and Q3 (75th percentile) = 39.1 and median =29, Q1= 24.6 and Q3 = 32.2, respectively). Approximately 42% of patients had restricted lung function which was indicative of majority of patients (>95 %) presenting with pulmonary sarcoidosis. This dissertation advances the field of public health by describing the epidemiology of sarcoidosis mortality, associated risk factors, demographic, spatial, temporal, and clinical characteristics of sarcoidosis in NC. Evidently, Eastern NC region disproportionately bears the largest sarcoidosis mortality burden in the state. This disproportionality could be explained by the prevalence of associated sociodemographic and environmental risk factors in the region. More robust studies that are directed towards uncovering and explaining the patterns that this study has identified may help understand better and develop strategies to minimize sarcoidosis burden in the region.
2022-02-10T15:09:15Z
2022-06-02T08:01:54Z
2021-12
2021-12-15
December 2021
2022-02-08T15:30:52Z
Doctoral Dissertation
text
http://hdl.handle.net/10342/9723
en
application/pdf
application/pdf
East Carolina University
oai:TheScholarship.intra.ecu.edu:10342/113282022-09-27T07:16:35Zcom_10342_74com_10342_73col_10342_103
Effects of the Co-occurrence of Diabetes Mellitus and Tooth Loss on Cognitive Function
Luo, Huabin
Tan, Chenxin
Adhikari, Samrachana
Plassman, Brenda
Kamer, Angela
Sloan, Frank
Schwartz, Mark
Qi, Xiang
Wu, Bei
Cognitive function
diabetes
tooth loss
2022-09-26T18:30:54Z
2022-09-26T18:30:54Z
2021
Article
1567-2050
http://hdl.handle.net/10342/11328
10.2174/1567205019666211223093057
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/99372022-03-11T08:15:02Zcom_10342_74com_10342_73col_10342_103
Self-Reported Cognitive Impairment Across Racial/Ethnic Groups in the United States, National Health Interview Survey, 1997–2015
Luo, Huabin
Cognitive Impairment
Racial/Ethnic Groups
National Health Interview Survey (NHIS)
2022-03-10T17:55:21Z
2022-03-10T17:55:21Z
2018-01-11
Article
1545-1151
http://hdl.handle.net/10342/9937
10.5888/pcd15.170338
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/60652021-03-03T21:12:17Zcom_10342_7351com_10342_6421com_10342_1com_10342_74com_10342_73col_10342_7361col_10342_7360col_10342_6408col_10342_7167col_10342_103
A possible dose–response association between distance to farmers’ markets and roadside produce stands, frequency of shopping, fruit and vegetable consumption, and body mass index among customers in the Southern United States
Jilcott Pitts, Stephanie Bell
Hinkley, Jedediah
Wu, Qiang
McGuirt, Jared T.
Lyonnais, Mary Jane
Rafferty, Ann P.
Whitt, Olivia R.
Winterbauer, Nancy L.
Phillips, Lisa
Farmers' market
Community nutrition
Fruit
Vegetable
Obesity
Consumer behavior
Background: The association between farmers’ market characteristics and consumer shopping habits remains
unclear. Our objective was to examine associations among distance to farmers’ markets, amenities within farmers’
markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and body mass index (BMI). We
hypothesized that the relationship between frequency of farmers’ market shopping and BMI would be mediated by
fruit and vegetable consumption.
Methods: In 15 farmers’ markets in northeastern North Carolina, July–September 2015, we conducted a crosssectional
survey among 263 farmers’ market customers (199 provided complete address data) and conducted
farmers’ market audits. To participate, customers had to be over 18 years of age, and English speaking. Dependent
variables included farmers’ market shopping frequency, fruit and vegetable consumption, and BMI. Analysis of
variance, adjusted multinomial logistic regression, Poisson regression, and linear regression models, adjusted for
age, race, sex, and education, were used to examine associations between distance to farmers’ markets, amenities
within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and BMI.
Results: Those who reported shopping at farmers’ markets a few times per year or less reported consuming 4.4
(standard deviation = 1.7) daily servings of fruits and vegetables, and those who reported shopping 2 or more times
per week reported consuming 5.5 (2.2) daily servings. There was no association between farmers’ market amenities,
and shopping frequency or fruit and vegetable consumption. Those who shopped 2 or more times per week had a
statistically significantly lower BMI than those who shopped less frequently. There was no evidence of mediation of
the relationship between frequency of shopping and BMI by fruit and vegetable consumption.
Conclusions: More work should be done to understand factors within farmers’ markets that encourage fruit and
vegetable purchases.
ECU Open Access Publishing Support Fund
2017-02-07T22:35:22Z
2017-02-07T22:35:22Z
2017-01
Article
http://hdl.handle.net/10342/6065
10.1186/s12889-016-3943-7
en_US
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3943-7
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58472022-11-28T14:58:49Zcom_10342_74com_10342_73col_10342_103
Animal Viruses, Bacteria, and Cancer: A Brief Commentary
Efird, Jimmy T.
Davies, Stephen W.
O'Neal, Wesley T.
Anderson, Ethan
animal viruses
bacteria
epidemiology
cancer
infection
Animal viruses and bacteria are ubiquitous in the environment. However, little is known about their mode of transmission and etiologic role in human cancers, especially among high-risk groups (e.g., farmers, veterinarians, poultry plant workers, pet owners, and infants). Many factors may affect the survival, transmissibility, and carcinogenicity of these agents, depending on the animal-host environment, hygiene practices, climate, travel, herd immunity, and cultural differences in food consumption and preparation. Seasonal variations in immune function also may increase host susceptibility at certain times of the year. The lack of objective measures, inconsistent study designs, and sources of epidemiologic bias (e.g., residual confounding, recall bias, and non-randomized patient selection) are some of the factors that complicate a clear understanding of this subject.
2016-07-28T17:52:47Z
2016-07-28T17:52:47Z
2014-02
Article
Frontiers in Public Health; 2: p. 1-8
2296-2565
http://hdl.handle.net/10342/5847
pmc3923154
10.3389/fpubh.2014.00014
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3923154/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98602022-02-27T08:15:02Zcom_10342_74com_10342_73col_10342_103
Disparities in Healthy Food Zoning, Farmers' Market Availability, and Fruit and Vegetable Consumption Among North Carolina Residents
Pitts, Stephanie
Disparities
Farmers’ market
Zoning ordinance
2022-02-26T16:31:21Z
2022-02-26T16:31:21Z
2015-08-25
Article
0778-7367
http://hdl.handle.net/10342/9860
10.1186/s13690-015-0085-9
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98032022-02-19T08:15:00Zcom_10342_74com_10342_73col_10342_103
Work Safety Climate, Safety Behaviors, and Occupational Injuries of Youth Farmworkers in North Carolina
Kearney, Gregory D.
HIV Self-Test
Migrant and Seasonal Farmworkers
North Carolina
2022-02-18T15:12:13Z
2022-02-18T15:12:13Z
2015-07-01
Article
0090-0036
http://hdl.handle.net/10342/9803
10.2105/AJPH.2014.302519
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/109652022-08-02T07:16:00Zcom_10342_74com_10342_73col_10342_103
Recommendations for the Use of the Veggie Meter for Spectroscopy-Based Skin Carotenoid Measurements in the Research Setting
Jilcott Pitts, Stephanie
Radtke, Marcela D.
Poe, Mykaela
Stookey, Jodi
Moran, Nancy E.
Landry, Matthew J.
Rubin, Lewis P.
Stage, Virginia C.
Scherr, Rachel E.
dietary assessment methodology
biomarker of nutritional status
dietary behaviors
2022-08-01T14:59:31Z
2022-08-01T14:59:31Z
2021
Article
2475-2991
http://hdl.handle.net/10342/10965
10.1093/cdn/nzab104
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98792022-02-27T08:15:05Zcom_10342_74com_10342_73col_10342_103
Concurrent Validity of Skin Carotenoid Status as a Concentration Biomarker of Vegetable and Fruit Intake Compared to Multiple 24-h Recalls and Plasma Carotenoid Concentrations Across One Year: a Cohort Study
Pitts, Stephanie
Resonance Raman spectroscopy
ASA24 Dietary Assessment Tool
Women
2022-02-26T16:33:19Z
2022-02-26T16:33:19Z
2019-11-21
Article
1475-2891
http://hdl.handle.net/10342/9879
10.1186/s12937-019-0500-0
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58422021-03-03T21:11:33Zcom_10342_74com_10342_73col_10342_103
The Combined Influence of Oral Contraceptives and Human Papillomavirus Virus on Cutaneous Squamous Cell Carcinoma
Efird, Jimmy T.
Toland, Amanda E.
Lea, C. Suzanne
Phillips, Christopher J.
cutaneous squamous cell carcinoma
human papillomavirus virus
oral contraceptives
The vast majority of cutaneous squamous cell carcinoma (CSCC) will occur in those with fair complexion, tendency to burn, and high ultraviolet radiation (UVR) exposure. Organ transplant recipients also are an important population at great risk for CSCC. An association has been reported between oral contraceptive (OC) use, human papillomavirus virus (HPV) and cervical cancer, and there could be a similar association for CSCC. The cutaneous HPV β-E6 protein, a close cousin of the transformative E6 protein underlying anogenital cancers, has been shown to inhibit apoptosis in response to UVR damage and stimulate morphologic transformation in rodent fibroblast cell lines. Furthermore, OC use has been shown to enhance HPV transcription and may contribute to CSCC risk through this pathway.
2016-07-28T17:42:04Z
2016-07-28T17:42:04Z
2011-03
Article
Clinical Medicine Insights. Oncology; 5: p. 55-75
1179-5549
http://hdl.handle.net/10342/5842
pmc3076039
10.4137/CMO.S6905
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076039/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/99412022-03-11T08:15:14Zcom_10342_74com_10342_73col_10342_103
Interoperability of Information Systems Managed and Used by the Local Health Departments
Luo, Huabin
Information Systems
Local Health Departments
business process analysis
2022-03-10T17:55:48Z
2022-03-10T17:55:48Z
2016-11-01
Article
1078-4659
http://hdl.handle.net/10342/9941
10.1097/PHH.0000000000000436
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58412021-03-03T21:11:25Zcom_10342_74com_10342_73col_10342_103
Commute Times, Food Retail Gaps, and Body Mass Index in North Carolina Counties
Jilcott Pitts, Stephanie Bell
Liu, Haiyong
Moore, Justin B.
Bethel, Jeffrey W.
Wilson, James
Ammerman, Alice S.
Introduction
The prevalence of obesity is higher in rural than in urban areas of the United States, for reasons that are not well understood. We examined correlations between percentage of rural residents, commute times, food retail gap per capita, and body mass index (BMI) among North Carolina residents.
Methods
We used 2000 census data to determine each county's percentage of rural residents and 1990 and 2000 census data to obtain mean county-level commute times. We obtained county-level food retail gap per capita, defined as the difference between county-level food demand and county-level food sales in 2008, from the North Carolina Department of Commerce, and BMI data from the 2007 North Carolina Behavioral Risk Factor Surveillance System. To examine county-level associations between BMI and percentage of rural residents, commute times, and food retail gap per capita, we used Pearson correlation coefficients. To examine cross-sectional associations between individual-level BMI (n = 9,375) and county-level commute times and food retail gap per capita, we used multilevel regression models.
Results
The percentage of rural residents was positively correlated with commute times, food retail gaps, and county-level BMI. Individual-level BMI was positively associated with county-level commute times and food retail gaps.
Conclusions
Longer commute times and greater retail gaps may contribute to the rural obesity disparity. Future research should examine these relationships longitudinally and should test community-level obesity prevention strategies.
2016-07-28T17:40:31Z
2016-07-28T17:40:31Z
2010-09
Article
Preventing Chronic Disease; 7:5 p. 1-10
1545-1151
http://hdl.handle.net/10342/5841
pmc2938401
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938401/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98012022-02-19T08:15:01Zcom_10342_74com_10342_73col_10342_103
Latinx Child Farmworkers in North Carolina: Study Design and Participant Baseline Characteristics
Kearney, Gregory D.
occupational health
child labor
vulnerable populations
2022-02-18T15:11:59Z
2022-02-18T15:11:59Z
2019
Article
0271-3586
http://hdl.handle.net/10342/9801
10.1002/ajim.22938
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58662021-03-03T21:10:33Zcom_10342_74com_10342_73col_10342_103
Validation of food store environment secondary data source and the role of neighborhood deprivation in Appalachia, Kentucky
Gustafson, Alison
Lewis, Sarah
Wilson, Corey
Jilcott Pitts, Stephanie Bell
Background
Based on the need for better measurement of the retail food environment in rural settings and to examine how deprivation may be unique in rural settings, the aims of this study were: 1) to validate one commercially available data source with direct field observations of food retailers; and 2) to examine the association between modified neighborhood deprivation and the modified retail food environment score (mRFEI).
Methods
Secondary data were obtained from a commercial database, InfoUSA in 2011, on all retail food outlets for each census tract. In 2011, direct observation identifying all listed food retailers was conducted in 14 counties in Kentucky. Sensitivity and positive predictive values (PPV) were compared. Neighborhood deprivation index was derived from American Community Survey data. Multinomial regression was used to examine associations between neighborhood deprivation and the mRFEI score (indicator of retailers selling healthy foods such as low-fat foods and fruits and vegetables relative to retailers selling more energy dense foods).
Results
The sensitivity of the commercial database was high for traditional food retailers (grocery stores, supermarkets, convenience stores), with a range of 0.96-1.00, but lower for non-traditional food retailers; dollar stores (0.20) and Farmer’s Markets (0.50). For traditional food outlets, the PPV for smaller non-chain grocery stores was 38%, and large chain supermarkets was 87%. Compared to those with no stores in their neighborhoods, those with a supercenter [OR 0.50 (95% CI 0.27. 0.97)] or convenience store [OR 0.67 (95% CI 0.51, 0.89)] in their neighborhood have lower odds of living in a low deprivation neighborhood relative to a high deprivation neighborhood.
Conclusion
The secondary commercial database used in this study was insufficient to characterize the rural retail food environment. Our findings suggest that neighborhoods with high neighborhood deprivation are associated with having certain store types that may promote less healthy food options.
2016-08-10T13:15:39Z
2016-08-10T13:15:39Z
2012
Article
BMC Public Health; 12: p. 688-688
1471-2458
http://hdl.handle.net/10342/5866
pmc3491041
10.1186/1471-2458-12-688
http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-688
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/112862022-09-22T07:15:59Zcom_10342_74com_10342_73col_10342_103
Laboratory Evaluation of Low-Cost Optical Particle Counters for Environmental and Occupational Exposures
Sousan, Sinan
Park, Yoo Min
Regmi, Swastika
particulate matter
sensor calibration
environmental monitoring
2022-09-21T13:14:28Z
2022-09-21T13:14:28Z
2021-06-17
Article
1424-8220
http://hdl.handle.net/10342/11286
10.3390/s21124146
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/118432022-12-16T08:16:01Zcom_10342_74com_10342_73col_10342_103
Commentary: Suicide risk is high, but often overlooked, in autistic spectrum disorder populations
Curtis, Luke
Self-Harm Significantly Higher in Populations with ADHD, Anxiety, ASD, Depression, and Eating Disorders. I appreciated your recent paper on the large and well-matched studies on nonfatal self-harm and suicide among adolescents in the UK Clinical Practice Research Datalink (Cybulski et al. 2021). This large study involved 56,008 self-harm cases and 1,399,356 controls aged 10–19 years and reported that many diagnoses were associated with significantly higher rates of self-harm. Compared to controls, the risk of self-harm was significantly higher in attention-deficit/hyperactivity disorder (ADHD) (OR 3.3, 95% CI 3.1–3.4), anxiety disorder (OR 3.8, 95% CI 3.7–3.9), autism spectrum disorder (ASD) (OR 2.4, 95% CI 2.3–2.6), depression (OR 7.9, 95% CI 7.8–8.2), and eating disorders (OR 3.1, 95% CI 3.0–3.2) (Cybulski et al. 2021).
ECU/Wiley Open Access Publishing Account
2022-12-15T16:38:33Z
2022-12-15T16:38:33Z
2022-05-07
Article
Curtis, L. (2022), Commentary: Suicide risk is high, but often overlooked, in autistic spectrum disorder populations. J Child Psychol Psychiatr. https://doi.org/10.1111/jcpp.13627
http://hdl.handle.net/10342/11843
10.1111/jcpp.13627
https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13627
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/113312022-12-13T15:19:59Zcom_10342_74com_10342_73col_10342_103
The Relationship between Traffic-Related Air Pollution Exposures and Allostatic Load Score among Youth with Type 1 Diabetes in the SEARCH Cohort
Bell, Ronny A.
Montresor-López, Jessica A.
Reading, Stephanie R.
Yanosky, Jeffrey D.
Mittleman, Murray A.
Crume, Tessa L.
Dabelea, Dana
Dolan, Lawrence M.
D’Agostino, Ralph B., Jr.
Marcovina, Santica M.
Pihoke, Catherine
Reynolds, Kristi
Urbina, Elaine
Liese, Angela D.
Quirós-Alcalá, Lesliam
Smith, J. Carson
de Mesquita, P. Jacob Bueno
Puett, Robin C.
air pollution
allostatic load
type 1 diabetes
2022-09-28T12:26:14Z
2022-09-28T12:26:14Z
2021-06
Article
0013-9351
http://hdl.handle.net/10342/11331
10.1016/j.envres.2021.111075
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/99362022-03-11T08:15:03Zcom_10342_74com_10342_73col_10342_103
Trends and Racial/Ethnic Disparities in Diabetic Retinopathy Among Adults with Diagnosed Diabetes in North Carolina, 2000-2015
Luo, Huabin
Bell, Ronny A.
Cummings, Doyle M.
Patil, Shivajirao P.
Jones, Katherine
Racial/Ethnic Disparities
Diabetes
Diabetic Retinopathy
2022-03-10T17:55:13Z
2022-03-10T17:55:13Z
2019-03-01
Article
0029-2559
http://hdl.handle.net/10342/9936
10.18043/ncm.80.2.76
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/98772022-02-27T08:15:03Zcom_10342_74com_10342_73col_10342_103
Comparison of Food and Beverage Products' Availability, Variety, Price and Quality in German and US Supermarkets
Pitts, Stephanie
food and beverage
variety, price and quality
German and US supermarkets
2022-02-26T16:33:07Z
2022-02-26T16:33:07Z
2020-09-11
Article
1368-9800
http://hdl.handle.net/10342/9877
10.1017/S1368980020002645
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/114242022-11-28T14:38:41Zcom_10342_74com_10342_73col_10342_103
Snacking, Sugar-Sweetened Beverage Consumption and Child Obesity in Low-Income Households
Pitts, Stephanie B. Jilcott
Walsh, Christine E.
Seguin-Fowler, Rebecca
Ammerman, Alice S.
Hanson, Karla
Kolodinsky, Jane
Sitaker, Marilyn
Ennett, Susan
Dietary intake
Disadvantaged groups
Processed foods
2022-10-05T17:41:42Z
2022-10-05T17:41:42Z
2021
Article
0034-6659
http://hdl.handle.net/10342/11424
10.1108/nfs-02-2020-0048
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/114012022-10-04T07:16:02Zcom_10342_74com_10342_73col_10342_103
Rural-Urban Differences in Dental Service Utilization and Dental Service Procedures Received Among US Adults: Results from the 2016 Medical Expenditure Panel Survey
Luo, Huabin
Wu, Qiang
Bell, Ronny A.
Wright, Wanda
Basu, Rashmita
Moss, Mark E.
Quandt, Sara A.
dental service utilization
dental service procedures
Rural-urban differences
2022-10-03T17:11:31Z
2022-10-03T17:11:31Z
2021-06
Article
0890-765X
http://hdl.handle.net/10342/11401
10.1111/jrh.12500
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/116892022-11-04T07:16:07Zcom_10342_74com_10342_73col_10342_103
SARS-CoV-2 Detection in Air Samples from Inside Heating, Ventilation, and Air Conditioning (HVAC) Systems- COVID Surveillance in Student Dorms
Sousan, Sinan
Fan, Ming
Outlaw, Kathryn
Williams, Sydney
Roper, Rachel L.
Bioaerosol
Virus detection
qRT-PCR analysis
2022-11-03T13:41:22Z
2022-11-03T13:41:22Z
2022
Article
0196-6553
http://hdl.handle.net/10342/11689
10.1016/j.ajic.2021.10.009
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58462021-03-03T21:11:01Zcom_10342_74com_10342_73col_10342_103
Characterization of Residential Pesticide Use and Chemical Formulations through Self-Report and Household Inventory: The Northern California Childhood Leukemia Study
Guha, Neela
Ward, Mary H.
Gunier, Robert
Colt, Joanne S.
Lea, C. Suzanne
Buffler, Patricia A.
Metayer, Catherine
Background: Home and garden pesticide use has been linked to cancer and other health outcomes in numerous epidemiological studies. Exposure has generally been self-reported, so the assessment is potentially limited by recall bias and lack of information on specific chemicals.
Objectives: As part of an integrated assessment of residential pesticide exposure, we identified active ingredients and described patterns of storage and use.
Methods: During a home interview of 500 residentially stable households enrolled in the Northern California Childhood Leukemia Study during 2001–2006, trained interviewers inventoried residential pesticide products and queried participants about their storage and use. U.S. Environmental Protection Agency registration numbers, recorded from pesticide product labels, and pesticide chemical codes were matched to public databases to obtain information on active ingredients and chemical class. Poisson regression was used to identify independent predictors of pesticide storage. Analyses were restricted to 259 participating control households.
Results: Ninety-five percent (246 of 259) of the control households stored at least one pesticide product (median, 4). Indicators of higher sociodemographic status predicted more products in storage. We identified the most common characteristics: storage areas (garage, 40%; kitchen, 20%), pests treated (ants, 33%; weeds, 20%), pesticide types (insecticides, 46%; herbicides, 24%), chemical classes (pyrethroids, 77%; botanicals, 50%), active ingredients (pyrethrins, 43%) and synergists (piperonyl butoxide, 42%). Products could contain multiple active ingredients.
Conclusions: Our data on specific active ingredients and patterns of storage and use will inform future etiologic analyses of residential pesticide exposures from self-reported data, particularly among households with young children.
2016-07-28T17:49:33Z
2016-07-28T17:49:33Z
2012-10
Article
Environmental Health Perspectives; 121:2 p. 276-282
0091-6765
http://hdl.handle.net/10342/5846
pmc3569677
10.1289/ehp.1204926
http://ehp.niehs.nih.gov/1204926/
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/109012022-07-21T08:32:52Zcom_10342_74com_10342_73col_10342_103
Development of a Clinical Research Consortium Position Interview Panel within the Department of Veterans Affairs Health Care System
Johnson, Marcus R.
Willis, Cyenthia
Velarde, Kandi
Bratcher, Karen
Condon, Debra
Clinical Research
Management
Hiring
2022-07-20T14:08:49Z
2022-07-20T14:08:49Z
2021
Article
1539-1590
http://hdl.handle.net/10342/10901
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/58442021-03-03T21:11:44Zcom_10342_74com_10342_73col_10342_103
Patient and Practice Perspectives on Strategies for Controlling Blood Pressure, North Carolina, 2010–2012
Donahue, Katrina E.
Vu, Maihan B.
Halladay, Jacqueline R.
Miller, Cassandra L.
Garcia, Beverly A.
Cummings, Doyle M.
Cené, Crystal W.
Hinderliter, Alan L.
Little, Edwin
Rachide, Marjorie
DeWalt, Darren A.
Introduction
Patient and practice perspectives can inform development of team-based approaches to improving blood pressure control in primary care. We used a community-based participatory research approach to assess patient and practice perceptions regarding the value of team-based strategies for controlling blood pressure in a rural North Carolina population from 2010 through 2012.
Methods
In-depth interviews were conducted with 41 adults with hypertension, purposely sampled to include diversity of sex, race, literacy, and blood pressure control, and with key office staff at 5 rural primary care practices in the southeastern US “stroke belt.� Interviews explored barriers to controlling blood pressure, the practice’s role in controlling blood pressure, and opinions on the use of team care delivery.
Results
Patients reported that provider strategies to optimize blood pressure control should include regular visits, medication adjustment, side-effect discussion, and behavioral counseling. When discussing team-based approaches to hypertension care, patients valued verbal encouragement, calls from the doctor’s office, and the opportunity to ask questions. However, they voiced concerns about the effect of having too many people involved in their care. Practice staff focused on multiple, broad methods to control blood pressure including counseling, regular office visits, media to improve awareness, and support groups. An explicit focus of delivering care as teams was a newer concept.
Conclusion
When developing a team approach to hypertension treatment, patients value high-quality communication and not losing their primary relationship with their provider. Practice staff members were open to a team-based approach but had limited knowledge of what such an approach would entail.
2016-07-28T17:46:27Z
2016-07-28T17:46:27Z
2014
Article
Preventing Chronic Disease; 11: p. 1-12
1545-1151
http://hdl.handle.net/10342/5844
pmc4008946
10.5888/pcd11.130157
https://www.cdc.gov/pcd/issues/2014/13_0157.htm
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/112472022-11-28T14:38:13Zcom_10342_74com_10342_73col_10342_103
Fruit and Vegetable Intake Assessed by Repeat 24 h Recalls, but Not by A Dietary Screener, Is Associated with Skin Carotenoid Measurements in Children
Jilcott Pitts, Stephanie B.
Seguin-Fowler, Rebecca A.
Hanson, Karla L.
Marshall, Grace A.
Belarmino, Emily H.
Kolodinsky, Jane
Sitaker, Marilyn
Ammerman, Alice S.
fruit and vegetable consumption
skin carotenoids
low-income US households
2022-09-13T18:09:47Z
2022-09-13T18:09:47Z
2021-03-18
Article
2072-6643
http://hdl.handle.net/10342/11247
10.3390/nu13030980
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/124122023-03-15T07:16:50Zcom_10342_74com_10342_73col_10342_103
The Association between Neighborhood Social and Economic Environment and Prevalent Diabetes in Urban and Rural Communities: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Cummings, Doyle M.
et al
Neighborhood environment
Diabetes
Community type
2023-03-14T16:14:41Z
2023-03-14T16:14:41Z
2022-03-08
Article
2352-8273
http://hdl.handle.net/10342/12412
10.1016/j.ssmph.2022.101050
en_US
application/pdf
oai:TheScholarship.intra.ecu.edu:10342/50482021-03-03T20:58:35Zcom_10342_7351com_10342_6421com_10342_1com_10342_74com_10342_73col_10342_7362col_10342_6408col_10342_7167col_10342_103
Disparities in healthy food zoning, farmers’ market availability, and fruit and vegetable consumption among North Carolina residents
Mayo Acheson, Mariel Leah
Jilcott Pitts, Stephanie Bell
Ward, Rachel K.
Wu, Qiang
McGuirt, Jared T.
Bullock, Sally L.
Lancaster, Mandee F.
Raines, Justin
Ammerman, Alice S.
Disparities
Farmers’ market
Zoning ordinance
Background
Context and purpose of the study. To examine (1) associations between county-level zoning to support farmers’ market placement and county-level farmers’ market availability, rural/urban designation, percent African American residents, and percent of residents living below poverty and (2) individual-level associations between zoning to support farmers’ markets; fruit and vegetable consumption and body mass index (BMI) among a random sample of residents of six North Carolina (NC) counties.
Methods
Zoning ordinances were scored to indicate supportiveness for healthy food outlets. Number of farmers’ markets (per capita) was obtained from the NC-Community Transformation Grant Project Fruit and Vegetable Outlet Inventory (2013). County-level census data on rural/urban status, percent African American, and percent poverty were obtained. For data on farmers’ market shopping, fruit and vegetable consumption, and BMI, trained interviewers conducted a random digit dial telephone survey of residents of six NC counties (3 urban and 3 rural). Pearson correlation coefficients and multilevel linear regression models were used to examine county-level and individual-level associations between zoning supportiveness, farmers’ market availability, and fruit and vegetable consumption and BMI.
Results
At the county-level, healthier food zoning was greater in more urban areas and areas with less poverty. At the individual-level, self-reported fruit and vegetable consumption was associated with healthier food zoning.
Conclusions
Disparities in zoning to promote healthy eating should be further examined, and future studies should assess whether amending zoning ordinances will lead to greater availability of healthy foods and changes in dietary behavior and health outcomes.
ECU Open Access Publishing Support Fund
2015-09-08T18:20:07Z
2015-09-08T18:20:07Z
2015-08-25
Article
Archives of Public Health; 73:1 p. 35-44
http://hdl.handle.net/10342/5048
26309736
10.1186/s13690-015-0085-9
en
http://www.archpublichealth.com/content/73/1/35
application/pdf
oai_dc///col_10342_103/100