Doctor of Philosophy, The Ohio State University, 2024, Public Health

Introduction: Human milk is the recommended infant food for the first six months of life. Despite recommendations and known health benefits for infants and lactating parents, only a quarter of the infants in the United States meet the recommended human milk feeding goals. While human milk feeding is often a personal decision, engaging in this health behavior may be shaped by neighborhood- and systemic-level factors. Aims: This dissertation aimed to evaluate the association between human milk feeding behaviors and three factors: (1) neighborhood-level social determinants of health, (2) caregiver-reported social needs, and (3) neighborhood-level food access. Methods: I performed secondary analyses of electronic health record data from infants born from April 2019 through July 2022 who attended a well-child visit at Nationwide Children's Hospital (NCH) primary care clinics during the neonatal period. Infant records were linked to Ohio birth certificate data to obtain maternal demographic information and hospital breastfeeding data. During well-child visits at NCH, caregivers are asked about infant food intake. At each visit where feeding data was recorded in the first two years of life, I categorized an infant's human milk consumption as exclusive, mixed, or none. In Aim 1, neighborhood-level social determinants of health were measured using the Child Opportunity Index (COI) 2.0 and the Area Deprivation Index (ADI). In Aim 2, caregiver-reported social needs were assessed using data from routinely administered social needs screenings performed at NCH. In Aim 3, neighborhood-level food access was assessed using the Food Access Research Atlas. Multivariable interval-censored accelerated failure time modeling was used to evaluate the time to cessation of (1) exclusive human milk feeding and (2) any human milk feeding. In secondary analyses, multivariable logistic regression modeling was used to evaluate the odds of (1) breastfeeding initiation and (2) exclusive b (open full item for complete abstract)

MA, University of Cincinnati, 2017, Arts and Sciences: Psychology

Prenatal health behaviors are important factors that protect against or increase the risk of poor pregnancy health and negative birth outcomes (Centers for Disease Control & Prevention, 2016; Lobel et al., 2008). Stress may be an important contributor to prenatal health behaviors, as it has been associated with engagement in negative prenatal health behaviors (Auerbach at al., 2014; Witt et al., 2016). Specifically, research has found that women who experience chronic stress, pregnancy-specific stress, or childhood adversity are more likely to smoke, abuse substances, and have a poor diet (Copper et al., 1996; Lobel et al., 2008; Abel, 2012; Shah, 2010; Chung et al., 2010). Despite the wealth of research about the effects of prenatal health behaviors on pregnancy health and infant outcomes, the influence of psychosocial factors on prenatal health behaviors represents a key gap in the current literature. This is an important area of further study, as the ecobiodevelopmental framework suggests that chronic stress over the lifespan changes the brain's architecture, making it more difficult for individuals to adapt to future adversity in a healthy manner (Shonkoff & Garner, 2012). That is, individuals who experience chronic stress throughout their life adopt unhealthy behaviors as a coping mechanism (Shonkoff & Garner, 2012). However, the existing stress and health behaviors literature does not adequately incorporate the life course perspective. Therefore, the current study aimed to examine the association between prenatal health behaviors and lifetime stress, above and beyond current stress and sociodemographic factors (i.e., education and income). Women (N = 166) who were admitted to the postpartum care unit after delivering an infant were recruited from two large urban hospitals. Results indicated that lifetime stress and the severity of lifetime stress predicts negative prenatal health behaviors, above and beyond relevant sociodemographic factors and current stress (open full item for complete abstract)

Master of Science, The Ohio State University, 2017, Genetic Counseling

Background: Health education and its implementation into maternal and child health programs is not a new concept. The Centers for Disease Control and Prevention (CDC) established guidelines in 2006 for providing access to information and resources regarding preconception health, including the Reproductive Life Plan (RLP). Roughly 3% of all live births in Ohio in 2010 occurred among women 10-19 years of age. These adolescent pregnancies could be associated with negative social and health impacts, including an increase in depression in young mothers. Our goal is to determine if genetic counselors may collaborate with educators to pilot objective-based lesson plans for a middle school health curriculum to facilitate education on a community level to reduce infant mortality and birth defects. Methods: Based on publicly accessible information provided by the Ohio Department of Education, we obtained detailed demographic information for the school districts in and adjacent to Franklin County. Eligibility criteria for high socioeconomic (SES) schools and low SES schools were established based on average annual family income per student and percentage of students living in poverty. Once eligible districts were identified, invitations to participate were sent via email. In-person semi-structured interviews were scheduled with interested respondents to elicit feedback regarding a proposed lesson plan (PLP) based on the “Whole School, “Whole Community, Whole Child” model. We performed thematic analysis using grounded theory via multiple coders to identify emerging themes. Results: A total of 29 health teachers were contacted regarding participation. Nine agreed to participate. Two individuals were lost to follow-up, resulting in an overall participation of seven out of our 29 possible contacts. We initially intended to draw comparisons between high SES and low SES districts, however, we found that of the 14 low SES school districts where contact information could be obtained (open full item for complete abstract)

Doctor of Philosophy, The Ohio State University, 2016, Health Services Management and Policy

Introduction: Although popular and prevalent nationwide, maternal and early childhood home visiting interventions are, in many cases, of uncertain effectiveness. Methods: For Studies 1 and 2, the Nurse Family Partnership (NFP) Columbus, Ohio location was evaluated via propensity score matching with non-participants for its impact on a range of health outcomes. For Study 3, the National Survey of Children's Health (NSCH) was used to create a nationally representative profile of the home visiting population using descriptive statistics and exploratory factor analysis. Results: In Studies 1 and 2, matching revealed greater likelihood to have a C-section, low birth weight, and to be enrolled in WIC for women and infants participating in the Columbus NFP compared to non-participating matches. In Study 3, descriptive statistics and exploratory factor analysis indicated substantial differences between participants and non-participants. Conclusions: There is no conclusive evidence that the Columbus NFP program is effective at achieving its stated goals; however, the studies' limitations were considerable. The national profile created using the NSCH supports that there are substantial differences between participants and non-participants, with home visiting participants reflecting greater health and environmental risks and lower socioeconomic status, but perhaps better parental engagement. Improved data collection and evaluation methods, as well as confirmatory factor analysis and changes in questions for the NSCH data, may help improve opportunities for home visiting evaluation in the future.

Master of Science, The Ohio State University, 2014, Dentistry

Enamel defects in primary teeth predispose children to early childhood caries and are often not detected nor intervened upon until damage from caries has occurred. In this study, we utilized a novel imaging device, the ProScope digital microscope, to assess the enamel quality in vivo of young children ages 9 months -3 years. We also used a parental survey and medical record review to elucidate factors leading to defects in our population. Based on clinical exam, patients were separated into intact and defective enamel groups. The final sample included 45 children with intact enamel and 30 children with enamel defects. ProScope images were captured with a 100x lens during the exam and were later assessed based on the modified Developmental Defects of Enamel index by five raters. We found that children in the defective enamel group had higher dft scores of 1.34 vs. 0.29 (p=0.008), more caregivers who smoke in the home at 50% vs. 26.7% (p=0.04), and more parents reporting soft teeth in their children at 33% vs. 6.7% (p=0.003). The ProScope, when compared to the gold standard of visual clinical exam for detecting enamel defects, had a sensitivity of 82.7% and specificity of 77.3%. We found an inter-rater reliability of 0.438 among the five raters. We concluded that enamel defects in primary teeth might be the missing link between maternal smoking and offspring caries rates as reported in previous studies. Additionally, children with enamel defects and children identified by their parents as having soft teeth had a higher risk of dental caries, and therefore those children should receive increased preventive care and counseling. The ProScope was useful for evaluating enamel defects, but might be best suited for serial evaluation of enamel defects and incipient carious lesions to document progression over time in the same patient.

PHD, Kent State University, 2024, College of Public Health

Background: Infant mortality is a significant problem in the United States (U.S.). In 2018, the infant mortality rate (IMR) was 5.7 deaths per 1,000 live births. Approximately 3,600 infants die annually from Sudden Unexpected Infant Death (SUID) and other sleep-related infant deaths. The infant's sleep environment plays a critical role, as some deaths are linked to unsafe sleep-related practices. Physicians and nurses influence the sleeping practices of parents and caregivers as they provide advice based on the infant safe sleep recommendations of the American Academy of Pediatrics (AAP). To address other health issues, community health workers (CHWs) act as a bridge between the health care providers and their communities and can become advocates for safe sleep. Research on the CHWs' role relative to safe sleep is lacking. Thus, this study aimed to assess CHWs' awareness of AAP recommendations on safe sleep by pursuing the following specific aims: 1) determine the knowledge, attitude, and practice (KAP) of CHWs toward safe sleep practices, 2) understand the methods currently used by CHWs to communicate to parents and caregivers about safe sleep practices, and 3) determine the relationship between KAP and sociodemographic characteristics (age, race, education, years of experience) of CHWs. Methods: A cross-sectional study design approach was employed. A 64-item questionnaire was developed based on AAP infant safe-sleep recommendations. Outcome measures included knowledge of infant safe sleep (12 items), attitude (9 items), and practice (14 items). The questionnaire was distributed to CHWs in partnership with the American Public Health Association (APHA) through their national CHW listserv. Descriptive, One-way ANOVA and regression analyses were used for analysis. Results: Overall, respondents had fair to good levels of knowledge (M =10.14, SD =2.19), attitude (M =.642, S.D. = .491), and practices (M =1.11, SD = 1.07) related to infant safe sleep. CHW (open full item for complete abstract)

Master of Arts, The Ohio State University, 2018, Anthropology

African Americans have the highest rate of infant mortality in the U.S., making them the target of public health messaging emphasizing safe sleep practices. Problematic is the lack of data on sleeping arrangements of African American infants and reasons for parent's choices. In this thesis, I report results from 11 semi-structured interviews with African American mothers living in Columbus, Ohio neighborhoods with high infant mortality rates. I focused on two research questions: 1) in terms of infant sleep positions, why have African American mothers adopted their current practices 2) how do African American mothers perceive current public health safe sleep messaging. Using grounded theory and profile analysis to analyze the interview data, I identified four major themes regarding mothers' justifications for their infants' sleeping patterns. These were convenience, comfort, active sleeper, and child individuality. In terms of maternal perceptions of safe sleep messaging, I identified three major themes, which included modification, skepticism, and what women referred to as “of age”. Importantly, I learned that African American mothers' criteria for infant sleep positions were not easily integrated into the current public health messaging agenda. I suggest that addressing this disconnect is critical for the development of effective public health messaging aimed at reducing infant mortality.

Master of Arts, Miami University, 2018, History

This thesis examines the ways in which early modern medical texts presented the mind-body connection as it impacted child-bearing women in seventeenth century England. The medieval rediscovery of ancient Greek medical knowledge dominated understandings of health and healing for centuries but reached its widest audiences with the explosion of vernacular language printed materials in the early modern period. Foundational to these repurposed ancient medical theories was the belief that the mind and body interacted in complex ways, requiring frequent monitoring of emotional states to achieve good health. For practitioners concerned with women's reproductive health, women's emotional regulation was vital to desirable physical outcomes throughout the period of childbearing, lasting beyond modern designations of conception and childbirth. Thus, this thesis challenges assumptions of how early modern historians should mark the phases of reproduction and argues instead that childbearing, at least for women, continued through the first years of an infant's life.

PhD, University of Cincinnati, 2017, Education, Criminal Justice, and Human Services: Health Education

Introduction: Malaria is a major public health problem and life-threatening disease. In the Democratic Republic of the Congo (DRC), roughly 400 children die every day and almost half of these deaths are attributable to malaria. Malaria is the leading cause of morbidity and mortality in children under age 5 in the DRC, accounting for an estimated 40% of outpatient visits and 40% of childhood mortality. The purpose of this study was to examine whether malaria control methods (i.e., insecticide bed net use and taking sp/fansidar or chloroquine for malaria) differed based on perceived problems preventing pregnant women from seeking medical advice or treatment (big problem, not a big problem), receipt of prenatal care (no, yes) and source of prenatal care (e.g., doctor), and sociodemographic characteristics. Methods: A secondary data analysis of pregnant women (n = 2,404) who completed the Demographic and Health Survey in the DRC (DHS-DRC7) was conducted. Results: Results indicated that use of a mosquito bed net, taking sp/fansidar, and taking chloroquine for malaria significantly differed among pregnant women based on educational attainment, ethnicity, and wealth index. Pregnant women who did not sleep under a bed net were more likely to not receive ANC (p = .002), including 1.95 times more likely (p = .002) to not receive care from a doctor than pregnant women who did not sleep under a mosquito net. Pregnant women who did not take sp/fansidar for malaria during pregnancy were more likely to perceive that distance to a health facility (p < .001) and not wanting to go alone (p = .009) were big problems for getting medical help for themselves. Pregnant women who did not take sp/fansidar during pregnancy were more likely to not receive care from a doctor (p = .01), nurse (p = .002) or birth attendant (p < .001). Pregnant women who did not take chloroquine for malaria while pregnant were 3.6 times more likely (p = .04) to not receive care from a doctor. Discussion: Awarenes (open full item for complete abstract)

Doctor of Philosophy, The Ohio State University, 1980, Graduate School

Master of Arts, Miami University, 2015, Economics

Doctors in the United States in the early 20th century had a limited ability to treat their patients. Most treatments and vaccines for diseases were not developed yet. Furthermore, prior to 1910, many medical schools had scant entrance requirements and limited time practicing treating patients. However, as late as the 19th century, the American medical education system underwent revolutionary changes, drastically improving the way doctors were trained. Despite these changes, physicians still did not have the benefit of antibiotics or vaccinations with which to treat and prevent infectious disease. Given these limitations, how much did the availability of doctors matter and how much did good doctors matter? The models suggest the quality matters much more than quantity. The relationship between doctors per capita and infant mortality is actually positive when accounting for overall physician quality, while physician quality has a strong negative relationship with infant mortality rates.

PHD, Kent State University, 2015, College of Education, Health and Human Services / School of Lifespan Development and Educational Sciences

Early intervention practitioners need professional development opportunities to nurture and sustain strong relationships with the families they serve. Reflective consultation is a form of professional development that addresses a relationship-based approach to service delivery. However, there have been few published empirical studies about the construct of group reflective consultation. The purpose of the qualitative case study of the Relationships Count series was to examine core components and perceived benefits for early interventionists. The series consisted of monthly group sessions that were facilitated by an infant mental health specialist. The participants included 10 early interventionists from a large Midwestern county. Data collection methods included interviewing four early interventionists and observing, recording, and participating in 10 monthly reflective consultation sessions during 2013-2014. Coding, concept mapping, and comparative analysis of data were used to examine what happened during the series as well as to identify and describe perceived benefits for early interventionists. The findings indicate core components of facilitation and participation contributed to a relationship-based approach to supporting the professional development of early interventionists. Specifically, the findings indicate that discussion, observation, practice, and experience of a relationship-based approach were associated with perceived development of competencies including gentle inquiry, reflecting on thoughts and feelings, active listening, supporting without problem-solving, and promoting competence. Early interventionists identified that participation strengthened feelings of competence and confidence in their ability to support children and families. The study contributes to the evidence base of group reflective consultation by linking core components with perceived benefits for early intervention practitioners.

Master of Science (MS), Bowling Green State University, 2015, Communication Disorders/Speech-Language Pathology

Sudden infant death syndrome (SIDS) is defined as an unexplained death in an infant's first year of life. Risk factors for SIDS include maternal smoking, sex, and infant sleep positioning, among others. The current study analyzed dysphonations in the cries of 32 infants 24-66 hours after birth. Dysphonations are acoustic characteristics of cries and include frequency shift (FS), harmonic doubling (HD), biphonation (BP), and noise (N). An interaction effect was found, male infants whose mothers smoked during pregnancy (maternal smoking status) had a significantly lower percent of dysphonations than male infants whose mothers did not smoke during pregnancy (no maternal smoking status). No significant main effects were found for the factors maternal smoking status, sex, infant positioning, or partition. In addition, the types of dysphonations were consistently distributed across groups with noise being the most commonly occurring dysphonation followed by harmonic doubling, frequency shift and then biphonation. It is hypothesized that differences in number and type of dysphonations may either be an effect of differences in infant arousal and/or developmental differences. A lower number of dysphonations seen in male infants with mothers who smoked during pregnancy may suggest a lowered arousal state, which may be associated with the occurrence of SIDS.

PhD, University of Cincinnati, 2013, Nursing: Nursing - Doctoral Program

Despite a reduction in the overall infant mortality rate (IMR) over the past 60 years, there remains an ever-widening gap of disparity between the deaths of Black (12.7/1,000) babies and White babies (5.2/1,000) during their first year of life. Comprehension of this complex and stunning disparity continues to escape full understanding, yet it is likely multifactorial, with one component being inadequate care among African American women during pregnancy. Women who receive early and continuous prenatal care have lower rates of preterm birth and low birth weight infants, two antecedents of infant mortality. Yet African American women are less likely to engage in early and continuous prenatal care for various reasons, some yet to be discovered. The standardized, traditional biomedical model of prenatal care is not tailored to specific cultural and psychosocial needs. The care that pregnant African American women need may be quite different from the biomedical model. This study explored the psychosocial and cultural needs of African American who had given birth in their past to understand the factors that support or hinders meaningful prenatal care. A community-based participatory approach using a photovoice project was conducted for this study. Two theories, Africana Womanism and Critical Race Theory, provided the framework to guide the study. This study was conducted with a purposeful sampling of 11 African American women who had given birth in their past and who lived in an urban, low-income neighborhood in Midwestern, United States. Through photography, the participants shared stories about assets and barriers to meaningful prenatal care. The themes derived from the study were: "access to care," "soul nourishment,"companionship," "help me, teach me," and "the future." Overall, meaningful care encompassed not only physical care but care received through relationships and spirituality. This study revealed the culturally specific and meaningful ways t (open full item for complete abstract)

Master of Arts (MA), Ohio University, 2002, Geography (Arts and Sciences)

This thesis asks if land use is a factor affecting infant mortality patterns in the late nineteenth century using 1880 Baltimore, MD as a case study. Infant mortality rates remain high in late nineteenth century cities. Land uses in these cities tend to be mixed with industries locating near residences. Using 1880 Vital Statistics Death Records, the 1876 Hopkins Atlas, and the 1890 Sanborn Fire Insurance Atlas, a geographic information system is constructed to display the spatial distribution of infant deaths. The resulting infant death and land use data are analyzed using spatial statistics, grid, and visual analysis. Industrial land use in 1880 Baltimore appears to have had little affect on infant mortality patterns. The patterns are uneven and tend to cluster in low-lying areas. This study of infant mortality provides a glimpse into the state of public health and the urbanization process of late nineteenth century American cities.

Psy. D., Antioch University, 2010, Antioch Santa Barbara: Clinical Psychology

An infant's attachment relationship with primary caregivers has been demonstrated to have a long-term relationship to an individual's social and emotional functioning throughout the lifespan. Recognizing the critical importance of this period, interventions to facilitate secure attachment are now being evaluated for treatment efficacy. Evaluation of these treatments has typically focused on the components of treatment, examining changes in maternal sensitivity, parental attachment representations, and concrete support to address basic needs, housing, or other contextual factors, and evidence has been found to support the inclusion of these factors. However, little is known regarding what elements of treatment impact the effectiveness of dyadic parent-child interventions; the research that has been completed has focused primarily on aspects of the intervention. There continues to be considerable debate in the psychotherapy literature regarding whether the specific components of an intervention, or the common factors present in all interventions, are responsible for therapeutic change. The purpose of the present study was to examine the role of one common factor, therapeutic alliance, in facilitating attachment-based protective factors in the child. It was hypothesized that therapeutic alliance, as rated by the parent, would predict improvements in attachment-related protective factors as rated by the treating interventionist following 6 months of dyadic intervention. The results of the present study found that specific subscales of the therapeutic alliance (the goal, task, and total alliance scales) predicted changes in children's initiative behavior, but not their attachment-related engagement behavior. Therapeutic alliance also predicted treatment participation, and it was not possible to rule out treatment exposure as a mediating variable between therapeutic alliance and change in initiative behavior. Implications for future research and practice are discussed (open full item for complete abstract)

MS, University of Cincinnati, 2013, Allied Health Sciences: Nutrition

Objective: To study the effects of caregiver's age, education level, number of children and primary caregiver status on the ability to comprehend and accurately mix infant formula. Design: Descriptive study Participants/setting: Parents or caregivers of children 0-12 months of age (N = 30) who attend the Pediatric Primary Care Center (PPC) at Cincinnati Children's Hospital Medical Center for their primary care. PPC serves a largely low-income population with a majority of patients having Medicaid coverage. Outcome measures: Ability to accurately mix infant formula. Methods: Parents or caregivers were randomly selected from the dietitian consult list to take part in the study. Each parent or caregiver was provided with an illustrated nutrition education tool, developed for this study to use in populations with low health literacy. The educational tool included six colorful pictures depicting step-by-step infant formula mixing instructions with minimal, simple text to support respective pictures. While reviewing the handout, caregivers stated what they believed the meaning of each step to be. Demographic data was self-reported. Then, the parent or caregiver demonstrated to the dietitian how to prepare a bottle of infant formula using the handout. Qualitative data on the handout was collected. The primary outcome was the percentage of caregivers who were able to accurately mix infant formula after reviewing the illustrated nutrition education tool. Results: A significant number (n= 26; 86.7%) of low health literacy caregivers attending a low-income clinic were able to accurately mix infant formula after reviewing the illustrated nutrition education tool. Those who were unable to mix the infant formula were more likely to be parents for the first time and not the primary care giver. Conclusion: The use of an illustrated nutrition education tool enabled most of the sample to accurately mix infant formula. Age and educational level were not barriers to (open full item for complete abstract)

Master of Science, The Ohio State University, 2013, Allied Medical Professions

Objective: Through questionnaires, investigators assessed participant perceptions, surveying nutrition knowledge gained and the impact of the program on diet, lifestyle, and other health behaviors. Methods: Researchers recruited current and previous Moms2B participants. Consenting participants were asked to complete a series of three self-administered questionnaires about their perception of program impact and the nutrition knowledge specific to pregnancy that they gained. Results: A total of 26 participants responded to the questionnaires. The Behavior Change Questionnaire assessed health and nutrition behaviors that changed as a result of Moms2B. The highest possible score was a five and the mean score (± standard deviation) was 4.1 ±1.13. Additionally, 74% of participants agreed or somewhat agreed that the Moms2B program has positively influenced behavior changes. The Support System Questionnaire explored lifestyle adjustments due to the impact of the Moms2B program. The highest possible score was a five and the group mean score was 4.4 ±0.89. Additionally, 84% of participants agreed or somewhat agreed that the Moms2B program has resulted in positive lifestyle change. The Nutritional Knowledge Questionnaire assessed participant knowledge in the context of nutrition and maternal health as they related to successful pregnancy outcomes. The highest possible score was a fourteen with the group mean score of 10.5 ±1.69. Overall, the group had an average score of 75%. Conclusions: While further testing is required to confirm these results, on average the participants agreed or somewhat agreed that their positive behavior and lifestyle changes have resulted from their Moms2B program involvement. Additionally, the results indicated that participants are learning, and possibly retaining, nutritional and maternal health knowledge.