Laura Gaydos | Emory University (original) (raw)
Papers by Laura Gaydos
Journal of Pediatric Intensive Care, Jun 8, 2021
Very little data is available to understand the drivers of burnout amongst health care workers in... more Very little data is available to understand the drivers of burnout amongst health care workers in the pediatric intensive care unit. This is a survey-based, cross-sectional, point-prevalence analysis within a single children's health system with two free-standing hospitals (one academic and one private) to characterize the relationship of demographics, organizational support, organizational culture, relationship quality, conflict and work schedules with self-reported burnout. Burnout was identified in 152 (39.7%) of the 383 (38.7%) respondents. No significant relationship was identified between burnout and demographic factors or work schedule. A more constructive culture (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.77–0.90; p < 0.001), more organizational support (OR, 0.94; 95% CI, 0.92–0.96; p <0 0.001), and better staff relationships (OR, 0.54, 95% CI, 0.43–0.69; p < 0.001) reduced odds of burnout. More conflict increased odds (OR, 1.25; 95% CI, 1.12–1.39; p < 0.001). Less organizational support ( Z β = 0.425) was the most important factor associated with burnout overall. A work environment where staff experience defensive cultures, poor relationships, more frequent conflict, and feel unsupported by the organization is associated with significantly higher odds of burnout in pediatric critical care. The effect of targeted interventions to promote constructive cultures, collegiality, and organizational support on burnout in pediatric intensive care should be studied.
International Journal on Disability and Human Development, 2012
Although it is well recognized that substance abuse during pregnancy is detrimental to maternal a... more Although it is well recognized that substance abuse during pregnancy is detrimental to maternal and fetal health, limited research to date has addressed the relationship between substance use and birth outcomes among women experiencing homelessness. This study investigates the association between women experiencing homelessness and a history of substance use and reported child health outcomes in one southeastern city. Seventy-three clients from a shelter and rehabilitation facility in Atlanta, Georgia, were surveyed, including data for the children of 56 participants. The prevalence of multiple child health outcomes among women with and without substance use during the prenatal period were compared to national or state normative levels. Exposure to substance or tobacco use during pregnancy was significantly higher among mothers who were single, less educated, unemployed, or widowed. Children of substance-using mothers in the sample had more than 1.5-fold increased prevalence of functional problems than children experiencing homelessness alone. Comparatively, no children of mothers without prenatal substance exposure reported physical, cognitive, development, and/or speaking problems. Prenatal substance abuse compounded by other aspects of homelessness results in greater health problems for children than reported previously. An increased focus on preventing prenatal exposure among pregnant women experiencing homelessness may be warranted.
Journal of Pediatric Health Care, Mar 1, 2017
Introduction: Medicaid agencies have been promoting the patient-centered medical home (PCMH) mode... more Introduction: Medicaid agencies have been promoting the patient-centered medical home (PCMH) model. Most caregivers choose physician practices for their children, and we hypothesized that those following healthier childrearing practices are more likely to seek care in a PCMH. Method: We selected children with public insurance plans (n = 20,801) from the 2011-2012 National Survey of Children's Health. We used generalized ordinal logistic regression with state fixed effects to assess the association between home environments and children's use of PCMHs. Results: Children living in the healthiest homes were 1.33 times (p = .001) more likely to receive care from the highest level of PCMH. In states with early PCMH implementation, the odds increased to 2.11 times (p = .001). Discussion: Our results show a significant, sizeable relationship between healthier home environments and the use of PCMH by children from low-income families. They provide implications for assessing the effect of PCMH use on health outcomes and use patterns. J Pediatr Health Care. (2016)- ,- .
Critical Care Medicine, 2020
Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient sa... more Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient safety. Although burnout is prevalent in pediatric intensive care settings, the limited data on environmental contributors precludes creation of data driven, targeted solutions. We sought to delineate factors within the work environment and their contribution to burnout across multiple pediatric ICU environments and professions. Methods: Survey based, cross-sectional, multidisciplinary pointprevalence study across five intensive care units in a children’s hospital system including neonatal, pediatric, and cardiac intensive care units. The primary outcome is burnout, defined as endorsement of symptoms related to emotional exhaustion or depersonalization at least once a week. Factors assessed included demographics, organizational culture and support, relationship quality, conflict frequency and work schedules. Results: The usable survey response rate was 38.7% (383) of whom39.7% (152) reported burnout. Burnout did not vary significantly by demographic, full-time status, ICU experience or work schedule. Respiratory therapists had 2.35 times odds of burnout to physicians [95% CI (1.03-5.57), p = 0.042]. Working in the NICU was associated with approximately half the odds of burnout compared to other unit types [PICU OR: 0.53 (0.32, 0.84), p = 0.007; CICU OR: 0.52 (0.28, 0.98), p=0.043]. Greater perceptions of aggressive-defensive cultures and more conflict were associated with increased odds of burnout [OR 1.15 (1.071.22), p< 0.001 and OR 1.26 (1.13-1.40), p< 0.001, respectively]. Greater perceptions of organizational support, constructive culture, and better relationship quality were all associated with reduced odds of burnout [OR: 0.94 (0.92, 0.96), p < 0.001, OR: 0.84 (0.78, 0.90), p < 0.001 and OR: 0.56 (0.45, 0.70), p < 0.001, respectively]. Conclusions: This is the first side-by-side multi-disciplinary analysis of the specific environmental factors contributing to burnout in the pediatric critical care workforce. Identification of specific environmental factors associated with burnout across multi-professional groups may facilitate derivation and testing of targeted interventions.
Pedagogy in health promotion, Jan 3, 2023
The online Executive MPH (EMPH) Program at Emory University offers three majors, and prior to 201... more The online Executive MPH (EMPH) Program at Emory University offers three majors, and prior to 2015, all integrated learning experiences (ILE) required theses. In 2015, the Program adjusted the ILE requirement based on each major’s intended career outcomes: Applied Epidemiology (Epidemiology: research thesis); Applied Public Health Informatics (Informatics: program-focused capstone courses instead of thesis); Prevention Science (Prevention: choice of research or program-focused thesis or program-focused capstone courses). Our goal was to describe major-specific curricular changes of the ILE requirement aimed to reduce time-to-graduation. We compared three cohort years before (2012–2014) and after (2015–2017) the 2015 curricular change using registrar data of time-to-graduation (339 students) and students’ self-reported satisfaction with their thesis experience (152 students). Informatics and Prevention majors had significantly more students (34%–35%) graduate on time in the 2015–2017, compared to the 2012–2015, cohorts. There was no significant difference by cohorts in perceived student thesis satisfaction in Informatics and Prevention majors and a decrease in satisfaction in Epidemiology majors. Before 2015, the main theme reported as a detractor to thesis satisfaction was lack of Program thesis support. After 2015, this detractor theme was not mentioned and instead a motivator theme was continuous thesis support. After 2015, the main detractor theme was difficulty with time management. Consistent motivator themes across 2012–2015 included thesis committee support and students’ self-fulfillment due to their thesis learning experience. The curricular strategies described can inform other online and residential programs that have a thesis requirement for the ILE.
Critical Care Medicine, 2020
Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient sa... more Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient safety. Although burnout is prevalent in pediatric intensive care settings, the limited data on environmental contributors precludes creation of data driven, targeted solutions. We sought to delineate factors within the work environment and their contribution to burnout across multiple pediatric ICU environments and professions. Methods: Survey based, cross-sectional, multidisciplinary pointprevalence study across five intensive care units in a children’s hospital system including neonatal, pediatric, and cardiac intensive care units. The primary outcome is burnout, defined as endorsement of symptoms related to emotional exhaustion or depersonalization at least once a week. Factors assessed included demographics, organizational culture and support, relationship quality, conflict frequency and work schedules. Results: The usable survey response rate was 38.7% (383) of whom39.7% (152) report...
Psychological Services, 2021
Although partnerships between community-based mental health (MH) organizations and school systems... more Although partnerships between community-based mental health (MH) organizations and school systems to deliver MH services on school grounds (i.e., expanded school mental health, ESMH services) are growing, qualitative research is needed about stakeholders' perspectives on ESMH services. This study collected qualitative data from caregivers, MH providers, and MH administrators recruited from three MH organizations to understand their perspectives regarding potential advantages and challenges associated with ESMH services. The three MH organizations were located in three regions of Georgia and the majority of youth served by the organizations were enrolled in Medicaid. We conducted four focus groups with 33 caregivers and 13 semistructured interviews with MH administrators and providers, and we implemented a thematic content analysis. Caregivers, providers, and MH administrators described how ESMH services could improve MH services by (a) facilitating appointment attendance through the reduction of logistical barriers to care (including geographic barriers, missed class time, and missed work time) and (b) enhancing communication between providers and teachers. However, some participants also described logistical issues with ESMH services including school space constraints and challenges scheduling appointments. In addition, some caregivers expressed concerns about peer stigma if MH services are delivered at school (vs. the clinic). Providers and MH administrators discussed problems with low caregiver engagement and challenges collaborating with school personnel that stem from lack of understanding of MH problems and treatment. Although ESMH services can improve MH treatment among low-income youth, MH providers and MH administrators may consider collaborating with school personnel to proactively develop strategies to address challenges to its success. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Journal of Adolescent Health, 2018
Introduction: Socio-cultural-economic barriers limit Black women's decision about reproductiv... more Introduction: Socio-cultural-economic barriers limit Black women's decision about reproductive health. These barriers also lead Black women to choose unintended pregnancy. We employed a multidisciplinary, two-phase study to examine low- and middle-income, child-bearing, urban Black women's reproductive health and religion/spirituality. Purpose: To identify religion/spirituality's influences on reproductive choices of Black women in a southeastern urban community in Atlanta. Method: PhaseI samples 16 women from a shelter for intensive interviews, over 16 months. PhaseII samples 441 women through surveys and focus groups, collected from the health department. Results: Research revealed dynamic links between religion/spirituality and reproductive health. Religion/spirituality affected women's engagement in sexual activity. Women's spirituality/religiosity is tied to their beliefs about contraceptives. 23.68% identified at least one method of contraception against th...
International Journal on Disability and Human Development, 2012
Although it is well recognized that substance abuse during pregnancy is detrimental to maternal a... more Although it is well recognized that substance abuse during pregnancy is detrimental to maternal and fetal health, limited research to date has addressed the relationship between substance use and birth outcomes among women experiencing homelessness. This study investigates the association between women experiencing homelessness and a history of substance use and reported child health outcomes in one southeastern city. Seventy-three clients from a shelter and rehabilitation facility in Atlanta, Georgia, were surveyed, including data for the children of 56 participants. The prevalence of multiple child health outcomes among women with and without substance use during the prenatal period were compared to national or state normative levels. Exposure to substance or tobacco use during pregnancy was significantly higher among mothers who were single, less educated, unemployed, or widowed. Children of substance-using mothers in the sample had more than 1.5-fold increased prevalence of functional problems than children experiencing homelessness alone. Comparatively, no children of mothers without prenatal substance exposure reported physical, cognitive, development, and/or speaking problems. Prenatal substance abuse compounded by other aspects of homelessness results in greater health problems for children than reported previously. An increased focus on preventing prenatal exposure among pregnant women experiencing homelessness may be warranted.
Journal of the American Academy of Child & Adolescent Psychiatry, 2013
The goals of this study were to identify treatment rates among adolescents with co-occurring majo... more The goals of this study were to identify treatment rates among adolescents with co-occurring major depressive episode (MDE) and substance use disorder (SUD), and to examine the role of health insurance in the treatment of these disorders. Method: Seven years of cross-sectional data (2004-2010) were pooled from the National Survey on Drug Use and Health to derive a nationally representative sample of 2,111 adolescents who had both a past-year MDE and SUD and whose insurance status was known. The associations of public and private insurance with MDE and SUD treatment were examined using multinomial logistic regressions that controlled for health status and sociodemographic variables. Results: Less than one-half (48%) of adolescents received any form of MDE treatment in the past year, and only 10% received any form of SUD treatment. Only 16% of adolescents who received MDE treatment also received SUD treatment. Relative to no insurance, public insurance was associated with an increased likelihood of receiving MDE treatment alone, but not with an increased likelihood of receiving both MDE and SUD treatment. Involvement in the criminal justice system was the major factor affecting the likelihood that an adolescent would receive both MDE and SUD treatment, as opposed to either no treatment or treatment for MDE alone. Conclusions: Exceptionally low rates of SUD treatment were observed in this high-risk sample. Study findings highlight a missed opportunity to assess and to treat SUD among adolescents with co-occurring MDE and SUD who have received some form of MDE treatment in the past year.
Journal of religion and health, 2010
Separate from scholarship in religion and medicine, a burgeoning field in religion and population... more Separate from scholarship in religion and medicine, a burgeoning field in religion and population health, includes religion and reproductive health. In a survey of existing literature, we analyzed data by religious affiliation, discipline, geography and date. We found 377 peer-reviewed articles; most were categorized as family planning (129), sexual behavior (81), domestic violence (39), pregnancy (46), HIV/AIDS (71), and STDs (61). Most research occurred in North America (188 articles), Africa (52), and Europe (47). Article frequency increased over time, from 3 articles in 1980 to 38 articles in 2008. While field growth is evident, there is still no cohesive "scholarship" in religion and reproductive health.
Maternal and Child Health Journal, 2014
The American Academy of Pediatrics recommends that children be placed in the supine position on f... more The American Academy of Pediatrics recommends that children be placed in the supine position on firm bedding and not bed share with parents or other children. Health professionals increasingly understand that many African-American parents do not follow these recommendations, but little research exists on provider reactions to this non-compliance. This study was intended to better understand how low-income, African-American mothers understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. We conducted focus groups with 60 African-American, lowincome, first-time mothers and telephone interviews with 20 providers serving these populations to explore provider counseling and patient decision making. The large majority of mothers reported understanding, but not following, the safe-sleeping recommendations. Key reasons for noncompliance included perceived safety, convenience, quality of infant sleep and conflicting information from family members. Mothers often take measures intended to mitigate risk associated with noncompliance, instead increasing SIDS risk. Providers recognize that many mothers are noncompliant and attribute non-compliance largely to cultural and familial influence. However, few provider attempts are made to mitigate SIDS risks from non-compliant behaviors. We suggest that counseling strategies should be adapted to: (1) provide greater detailed rationale for SIDS prevention recommendations; and (2) incorporate or acknowledge familial and cultural preferences. Ignoring the reasons for sleep decisions by African-American parents may perpetuate ongoing racial/ethnic disparities in SIDS.
Pedagogy in Health Promotion, 2020
Responding to the 2016 Council on Education for Public Health foundational competency requirement... more Responding to the 2016 Council on Education for Public Health foundational competency requirement that students demonstrate the ability to “perform effectively in interprofessional teams,” the distance-based executive master’s program at Emory University developed an innovative interprofessional education (IPE) experience for geographically dispersed mid-career professionals. Because executive students are mid-career professionals from a variety of disciplines, they participated in this experience representing their professional roles and titles. IPE student groups represented at least three distinct disciplines. The executive program created a four-part online experience consisting of (1) a self-paced didactic module, (2) a synchronous case study group discussion, (3) small (three to five students) group development of a video solution to the case study, and (4) peer review of other groups’ case study solutions. The first-year pilot program was evaluated via standard online course ...
Nicotine & Tobacco Research, 2014
A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco u... more A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco use to their employees. Despite their potential to price-discriminate, little systematic empirical evidence of the impacts of these tobacco surcharges has been published. We attempted to assess the impact of a health insurance surcharge for tobacco use on cessation among enrollees in Georgia&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s State Health Benefit Plan (GSHBP). We identified a group of enrollees in GSHBP who began paying the tobacco surcharge at the program&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s inception in July 2005. We examined the proportion of these enrollees who certified themselves and their family members as tobacco-free and no longer paid the surcharge through April 2011, and we defined this as implied cessation. We compared this proportion to a national expected annual 2.6% cessation rate. We also compared our observation group to a comparison group to assess surcharge avoidance. By April 2011, 45% of enrollees who paid a tobacco surcharge starting in July 2005 had certified themselves as tobacco-free. This proportion exceeded the expected cessation based on 3 times the national rate (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The length of enrollment was not statistically different between our observation and comparison groups (p = .427). The reported rates of tobacco cessation among GSHBP enrollees resulting from a tobacco surcharge substantially exceed national rates. These surcharges appear to be effective, but the value of these results, and the effectiveness of health insurance surcharges in changing behavior, are tempered by the important limitation that enrollees&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; certification of quitting was self-reported and not subject to additional, clinical verification.
Pedagogy in Health Promotion
Schools and programs of public health are expanding online course offerings, particularly in resp... more Schools and programs of public health are expanding online course offerings, particularly in response to the transition to remote learning due to COVID-19. While previous research in the health professions suggests that online and in-person modalities are equally effective in supporting student learning, there is minimal evidence of this in public health education. This evaluation examines the effectiveness of newly developed online or hybrid course sections offered to Master of Public Health (MPH) and Master of Science in Public Health (MSPH) students enrolled in on-campus programs. We compared the effectiveness of these new offerings with that of the on-campus in-person courses and hybrid courses in the Executive MPH program. The purposes of this mixed-methods evaluation were to (1) assess student learning across the three course modalities and (2) examine student, instructor, and staff experiences with the modalities. The data included pre- and postcourse student surveys on 17 se...
Pedagogy in Health Promotion
The coronavirus pandemic has caused many colleges and universities throughout the United States t... more The coronavirus pandemic has caused many colleges and universities throughout the United States to pivot from in-person teaching to distance-based instruction, and while this form of education offers many advantages, one challenge facing institutions of higher education is how to best prepare their students for success in the online environment. This article describes the approach used by a hybrid executive Master of Public Health (MPH) program to orient its students, who are all working professionals, to the online environment. In addition to a description of the online orientation course, quantitative and qualitative evaluation findings are shared. The article includes recommendations for establishing an online orientation program. Although the orientation described was developed for working professionals earning an MPH degree, the approach can be applied or adapted to other online programs as they face the need to prepare students for online delivery, whether during a time of eme...
Journal of Pediatric Intensive Care, Jun 8, 2021
Very little data is available to understand the drivers of burnout amongst health care workers in... more Very little data is available to understand the drivers of burnout amongst health care workers in the pediatric intensive care unit. This is a survey-based, cross-sectional, point-prevalence analysis within a single children's health system with two free-standing hospitals (one academic and one private) to characterize the relationship of demographics, organizational support, organizational culture, relationship quality, conflict and work schedules with self-reported burnout. Burnout was identified in 152 (39.7%) of the 383 (38.7%) respondents. No significant relationship was identified between burnout and demographic factors or work schedule. A more constructive culture (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.77–0.90; p < 0.001), more organizational support (OR, 0.94; 95% CI, 0.92–0.96; p <0 0.001), and better staff relationships (OR, 0.54, 95% CI, 0.43–0.69; p < 0.001) reduced odds of burnout. More conflict increased odds (OR, 1.25; 95% CI, 1.12–1.39; p < 0.001). Less organizational support ( Z β = 0.425) was the most important factor associated with burnout overall. A work environment where staff experience defensive cultures, poor relationships, more frequent conflict, and feel unsupported by the organization is associated with significantly higher odds of burnout in pediatric critical care. The effect of targeted interventions to promote constructive cultures, collegiality, and organizational support on burnout in pediatric intensive care should be studied.
International Journal on Disability and Human Development, 2012
Although it is well recognized that substance abuse during pregnancy is detrimental to maternal a... more Although it is well recognized that substance abuse during pregnancy is detrimental to maternal and fetal health, limited research to date has addressed the relationship between substance use and birth outcomes among women experiencing homelessness. This study investigates the association between women experiencing homelessness and a history of substance use and reported child health outcomes in one southeastern city. Seventy-three clients from a shelter and rehabilitation facility in Atlanta, Georgia, were surveyed, including data for the children of 56 participants. The prevalence of multiple child health outcomes among women with and without substance use during the prenatal period were compared to national or state normative levels. Exposure to substance or tobacco use during pregnancy was significantly higher among mothers who were single, less educated, unemployed, or widowed. Children of substance-using mothers in the sample had more than 1.5-fold increased prevalence of functional problems than children experiencing homelessness alone. Comparatively, no children of mothers without prenatal substance exposure reported physical, cognitive, development, and/or speaking problems. Prenatal substance abuse compounded by other aspects of homelessness results in greater health problems for children than reported previously. An increased focus on preventing prenatal exposure among pregnant women experiencing homelessness may be warranted.
Journal of Pediatric Health Care, Mar 1, 2017
Introduction: Medicaid agencies have been promoting the patient-centered medical home (PCMH) mode... more Introduction: Medicaid agencies have been promoting the patient-centered medical home (PCMH) model. Most caregivers choose physician practices for their children, and we hypothesized that those following healthier childrearing practices are more likely to seek care in a PCMH. Method: We selected children with public insurance plans (n = 20,801) from the 2011-2012 National Survey of Children's Health. We used generalized ordinal logistic regression with state fixed effects to assess the association between home environments and children's use of PCMHs. Results: Children living in the healthiest homes were 1.33 times (p = .001) more likely to receive care from the highest level of PCMH. In states with early PCMH implementation, the odds increased to 2.11 times (p = .001). Discussion: Our results show a significant, sizeable relationship between healthier home environments and the use of PCMH by children from low-income families. They provide implications for assessing the effect of PCMH use on health outcomes and use patterns. J Pediatr Health Care. (2016)- ,- .
Critical Care Medicine, 2020
Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient sa... more Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient safety. Although burnout is prevalent in pediatric intensive care settings, the limited data on environmental contributors precludes creation of data driven, targeted solutions. We sought to delineate factors within the work environment and their contribution to burnout across multiple pediatric ICU environments and professions. Methods: Survey based, cross-sectional, multidisciplinary pointprevalence study across five intensive care units in a children’s hospital system including neonatal, pediatric, and cardiac intensive care units. The primary outcome is burnout, defined as endorsement of symptoms related to emotional exhaustion or depersonalization at least once a week. Factors assessed included demographics, organizational culture and support, relationship quality, conflict frequency and work schedules. Results: The usable survey response rate was 38.7% (383) of whom39.7% (152) reported burnout. Burnout did not vary significantly by demographic, full-time status, ICU experience or work schedule. Respiratory therapists had 2.35 times odds of burnout to physicians [95% CI (1.03-5.57), p = 0.042]. Working in the NICU was associated with approximately half the odds of burnout compared to other unit types [PICU OR: 0.53 (0.32, 0.84), p = 0.007; CICU OR: 0.52 (0.28, 0.98), p=0.043]. Greater perceptions of aggressive-defensive cultures and more conflict were associated with increased odds of burnout [OR 1.15 (1.071.22), p< 0.001 and OR 1.26 (1.13-1.40), p< 0.001, respectively]. Greater perceptions of organizational support, constructive culture, and better relationship quality were all associated with reduced odds of burnout [OR: 0.94 (0.92, 0.96), p < 0.001, OR: 0.84 (0.78, 0.90), p < 0.001 and OR: 0.56 (0.45, 0.70), p < 0.001, respectively]. Conclusions: This is the first side-by-side multi-disciplinary analysis of the specific environmental factors contributing to burnout in the pediatric critical care workforce. Identification of specific environmental factors associated with burnout across multi-professional groups may facilitate derivation and testing of targeted interventions.
Pedagogy in health promotion, Jan 3, 2023
The online Executive MPH (EMPH) Program at Emory University offers three majors, and prior to 201... more The online Executive MPH (EMPH) Program at Emory University offers three majors, and prior to 2015, all integrated learning experiences (ILE) required theses. In 2015, the Program adjusted the ILE requirement based on each major’s intended career outcomes: Applied Epidemiology (Epidemiology: research thesis); Applied Public Health Informatics (Informatics: program-focused capstone courses instead of thesis); Prevention Science (Prevention: choice of research or program-focused thesis or program-focused capstone courses). Our goal was to describe major-specific curricular changes of the ILE requirement aimed to reduce time-to-graduation. We compared three cohort years before (2012–2014) and after (2015–2017) the 2015 curricular change using registrar data of time-to-graduation (339 students) and students’ self-reported satisfaction with their thesis experience (152 students). Informatics and Prevention majors had significantly more students (34%–35%) graduate on time in the 2015–2017, compared to the 2012–2015, cohorts. There was no significant difference by cohorts in perceived student thesis satisfaction in Informatics and Prevention majors and a decrease in satisfaction in Epidemiology majors. Before 2015, the main theme reported as a detractor to thesis satisfaction was lack of Program thesis support. After 2015, this detractor theme was not mentioned and instead a motivator theme was continuous thesis support. After 2015, the main detractor theme was difficulty with time management. Consistent motivator themes across 2012–2015 included thesis committee support and students’ self-fulfillment due to their thesis learning experience. The curricular strategies described can inform other online and residential programs that have a thesis requirement for the ILE.
Critical Care Medicine, 2020
Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient sa... more Introduction/Hypothesis: Burnout compromises workforce mental health, productivity and patient safety. Although burnout is prevalent in pediatric intensive care settings, the limited data on environmental contributors precludes creation of data driven, targeted solutions. We sought to delineate factors within the work environment and their contribution to burnout across multiple pediatric ICU environments and professions. Methods: Survey based, cross-sectional, multidisciplinary pointprevalence study across five intensive care units in a children’s hospital system including neonatal, pediatric, and cardiac intensive care units. The primary outcome is burnout, defined as endorsement of symptoms related to emotional exhaustion or depersonalization at least once a week. Factors assessed included demographics, organizational culture and support, relationship quality, conflict frequency and work schedules. Results: The usable survey response rate was 38.7% (383) of whom39.7% (152) report...
Psychological Services, 2021
Although partnerships between community-based mental health (MH) organizations and school systems... more Although partnerships between community-based mental health (MH) organizations and school systems to deliver MH services on school grounds (i.e., expanded school mental health, ESMH services) are growing, qualitative research is needed about stakeholders' perspectives on ESMH services. This study collected qualitative data from caregivers, MH providers, and MH administrators recruited from three MH organizations to understand their perspectives regarding potential advantages and challenges associated with ESMH services. The three MH organizations were located in three regions of Georgia and the majority of youth served by the organizations were enrolled in Medicaid. We conducted four focus groups with 33 caregivers and 13 semistructured interviews with MH administrators and providers, and we implemented a thematic content analysis. Caregivers, providers, and MH administrators described how ESMH services could improve MH services by (a) facilitating appointment attendance through the reduction of logistical barriers to care (including geographic barriers, missed class time, and missed work time) and (b) enhancing communication between providers and teachers. However, some participants also described logistical issues with ESMH services including school space constraints and challenges scheduling appointments. In addition, some caregivers expressed concerns about peer stigma if MH services are delivered at school (vs. the clinic). Providers and MH administrators discussed problems with low caregiver engagement and challenges collaborating with school personnel that stem from lack of understanding of MH problems and treatment. Although ESMH services can improve MH treatment among low-income youth, MH providers and MH administrators may consider collaborating with school personnel to proactively develop strategies to address challenges to its success. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Journal of Adolescent Health, 2018
Introduction: Socio-cultural-economic barriers limit Black women's decision about reproductiv... more Introduction: Socio-cultural-economic barriers limit Black women's decision about reproductive health. These barriers also lead Black women to choose unintended pregnancy. We employed a multidisciplinary, two-phase study to examine low- and middle-income, child-bearing, urban Black women's reproductive health and religion/spirituality. Purpose: To identify religion/spirituality's influences on reproductive choices of Black women in a southeastern urban community in Atlanta. Method: PhaseI samples 16 women from a shelter for intensive interviews, over 16 months. PhaseII samples 441 women through surveys and focus groups, collected from the health department. Results: Research revealed dynamic links between religion/spirituality and reproductive health. Religion/spirituality affected women's engagement in sexual activity. Women's spirituality/religiosity is tied to their beliefs about contraceptives. 23.68% identified at least one method of contraception against th...
International Journal on Disability and Human Development, 2012
Although it is well recognized that substance abuse during pregnancy is detrimental to maternal a... more Although it is well recognized that substance abuse during pregnancy is detrimental to maternal and fetal health, limited research to date has addressed the relationship between substance use and birth outcomes among women experiencing homelessness. This study investigates the association between women experiencing homelessness and a history of substance use and reported child health outcomes in one southeastern city. Seventy-three clients from a shelter and rehabilitation facility in Atlanta, Georgia, were surveyed, including data for the children of 56 participants. The prevalence of multiple child health outcomes among women with and without substance use during the prenatal period were compared to national or state normative levels. Exposure to substance or tobacco use during pregnancy was significantly higher among mothers who were single, less educated, unemployed, or widowed. Children of substance-using mothers in the sample had more than 1.5-fold increased prevalence of functional problems than children experiencing homelessness alone. Comparatively, no children of mothers without prenatal substance exposure reported physical, cognitive, development, and/or speaking problems. Prenatal substance abuse compounded by other aspects of homelessness results in greater health problems for children than reported previously. An increased focus on preventing prenatal exposure among pregnant women experiencing homelessness may be warranted.
Journal of the American Academy of Child & Adolescent Psychiatry, 2013
The goals of this study were to identify treatment rates among adolescents with co-occurring majo... more The goals of this study were to identify treatment rates among adolescents with co-occurring major depressive episode (MDE) and substance use disorder (SUD), and to examine the role of health insurance in the treatment of these disorders. Method: Seven years of cross-sectional data (2004-2010) were pooled from the National Survey on Drug Use and Health to derive a nationally representative sample of 2,111 adolescents who had both a past-year MDE and SUD and whose insurance status was known. The associations of public and private insurance with MDE and SUD treatment were examined using multinomial logistic regressions that controlled for health status and sociodemographic variables. Results: Less than one-half (48%) of adolescents received any form of MDE treatment in the past year, and only 10% received any form of SUD treatment. Only 16% of adolescents who received MDE treatment also received SUD treatment. Relative to no insurance, public insurance was associated with an increased likelihood of receiving MDE treatment alone, but not with an increased likelihood of receiving both MDE and SUD treatment. Involvement in the criminal justice system was the major factor affecting the likelihood that an adolescent would receive both MDE and SUD treatment, as opposed to either no treatment or treatment for MDE alone. Conclusions: Exceptionally low rates of SUD treatment were observed in this high-risk sample. Study findings highlight a missed opportunity to assess and to treat SUD among adolescents with co-occurring MDE and SUD who have received some form of MDE treatment in the past year.
Journal of religion and health, 2010
Separate from scholarship in religion and medicine, a burgeoning field in religion and population... more Separate from scholarship in religion and medicine, a burgeoning field in religion and population health, includes religion and reproductive health. In a survey of existing literature, we analyzed data by religious affiliation, discipline, geography and date. We found 377 peer-reviewed articles; most were categorized as family planning (129), sexual behavior (81), domestic violence (39), pregnancy (46), HIV/AIDS (71), and STDs (61). Most research occurred in North America (188 articles), Africa (52), and Europe (47). Article frequency increased over time, from 3 articles in 1980 to 38 articles in 2008. While field growth is evident, there is still no cohesive "scholarship" in religion and reproductive health.
Maternal and Child Health Journal, 2014
The American Academy of Pediatrics recommends that children be placed in the supine position on f... more The American Academy of Pediatrics recommends that children be placed in the supine position on firm bedding and not bed share with parents or other children. Health professionals increasingly understand that many African-American parents do not follow these recommendations, but little research exists on provider reactions to this non-compliance. This study was intended to better understand how low-income, African-American mothers understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. We conducted focus groups with 60 African-American, lowincome, first-time mothers and telephone interviews with 20 providers serving these populations to explore provider counseling and patient decision making. The large majority of mothers reported understanding, but not following, the safe-sleeping recommendations. Key reasons for noncompliance included perceived safety, convenience, quality of infant sleep and conflicting information from family members. Mothers often take measures intended to mitigate risk associated with noncompliance, instead increasing SIDS risk. Providers recognize that many mothers are noncompliant and attribute non-compliance largely to cultural and familial influence. However, few provider attempts are made to mitigate SIDS risks from non-compliant behaviors. We suggest that counseling strategies should be adapted to: (1) provide greater detailed rationale for SIDS prevention recommendations; and (2) incorporate or acknowledge familial and cultural preferences. Ignoring the reasons for sleep decisions by African-American parents may perpetuate ongoing racial/ethnic disparities in SIDS.
Pedagogy in Health Promotion, 2020
Responding to the 2016 Council on Education for Public Health foundational competency requirement... more Responding to the 2016 Council on Education for Public Health foundational competency requirement that students demonstrate the ability to “perform effectively in interprofessional teams,” the distance-based executive master’s program at Emory University developed an innovative interprofessional education (IPE) experience for geographically dispersed mid-career professionals. Because executive students are mid-career professionals from a variety of disciplines, they participated in this experience representing their professional roles and titles. IPE student groups represented at least three distinct disciplines. The executive program created a four-part online experience consisting of (1) a self-paced didactic module, (2) a synchronous case study group discussion, (3) small (three to five students) group development of a video solution to the case study, and (4) peer review of other groups’ case study solutions. The first-year pilot program was evaluated via standard online course ...
Nicotine & Tobacco Research, 2014
A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco u... more A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco use to their employees. Despite their potential to price-discriminate, little systematic empirical evidence of the impacts of these tobacco surcharges has been published. We attempted to assess the impact of a health insurance surcharge for tobacco use on cessation among enrollees in Georgia&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s State Health Benefit Plan (GSHBP). We identified a group of enrollees in GSHBP who began paying the tobacco surcharge at the program&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s inception in July 2005. We examined the proportion of these enrollees who certified themselves and their family members as tobacco-free and no longer paid the surcharge through April 2011, and we defined this as implied cessation. We compared this proportion to a national expected annual 2.6% cessation rate. We also compared our observation group to a comparison group to assess surcharge avoidance. By April 2011, 45% of enrollees who paid a tobacco surcharge starting in July 2005 had certified themselves as tobacco-free. This proportion exceeded the expected cessation based on 3 times the national rate (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The length of enrollment was not statistically different between our observation and comparison groups (p = .427). The reported rates of tobacco cessation among GSHBP enrollees resulting from a tobacco surcharge substantially exceed national rates. These surcharges appear to be effective, but the value of these results, and the effectiveness of health insurance surcharges in changing behavior, are tempered by the important limitation that enrollees&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; certification of quitting was self-reported and not subject to additional, clinical verification.
Pedagogy in Health Promotion
Schools and programs of public health are expanding online course offerings, particularly in resp... more Schools and programs of public health are expanding online course offerings, particularly in response to the transition to remote learning due to COVID-19. While previous research in the health professions suggests that online and in-person modalities are equally effective in supporting student learning, there is minimal evidence of this in public health education. This evaluation examines the effectiveness of newly developed online or hybrid course sections offered to Master of Public Health (MPH) and Master of Science in Public Health (MSPH) students enrolled in on-campus programs. We compared the effectiveness of these new offerings with that of the on-campus in-person courses and hybrid courses in the Executive MPH program. The purposes of this mixed-methods evaluation were to (1) assess student learning across the three course modalities and (2) examine student, instructor, and staff experiences with the modalities. The data included pre- and postcourse student surveys on 17 se...
Pedagogy in Health Promotion
The coronavirus pandemic has caused many colleges and universities throughout the United States t... more The coronavirus pandemic has caused many colleges and universities throughout the United States to pivot from in-person teaching to distance-based instruction, and while this form of education offers many advantages, one challenge facing institutions of higher education is how to best prepare their students for success in the online environment. This article describes the approach used by a hybrid executive Master of Public Health (MPH) program to orient its students, who are all working professionals, to the online environment. In addition to a description of the online orientation course, quantitative and qualitative evaluation findings are shared. The article includes recommendations for establishing an online orientation program. Although the orientation described was developed for working professionals earning an MPH degree, the approach can be applied or adapted to other online programs as they face the need to prepare students for online delivery, whether during a time of eme...