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Growing hotspots of unvaccinated children corroborate with states that have highly permissive vaccination policies. State-based nonmedical exemption (NME) policies such as religious or philosophical exemptions make it easy for parents to opt out of vaccinating their children thus lowering herd immunity and increasing the risk of outbreaks. Recent studies have

Growing hotspots of unvaccinated children corroborate with states that have highly permissive vaccination policies. State-based nonmedical exemption (NME) policies such as religious or philosophical exemptions make it easy for parents to opt out of vaccinating their children thus lowering herd immunity and increasing the risk of outbreaks. Recent studies have revealed that Phoenix is the metropolitan area with the highest number of nonmedical exemptions in the country with vaccination rates below herd immunity. This thesis investigates the role of the law in enabling low vaccination rates and develops a set of policy recommendations that lawmakers may use as a tool to restore these rates to herd immunity levels. To do this, an in-depth literature review was performed and supplemented with a case study of California’s policy response to the 2014 Disneyland measles outbreak. This information was synthesized into an in-depth policy analysis addressing the political, social, practical, and economic factors of the issue and four potential policy responses for state lawmakers. Based on the analysis and California’s example, eliminating nonmedical vaccine exemptions was identified as the most effective policy option to reach the intended goal of restoring vaccination rates to herd immunity levels. This policy option is both the most cost-effective and productive in reaching herd immunity but infringes the most on parental rights and will be met with the most significant political pushback. Despite these challenges, lawmakers should take this policy step to protect our community and the most vulnerable among us.
ContributorsSaxon, Mary Elizabeth (Author) / Reddy, Swapna (Thesis director) / Speer, Matthew (Committee member) / School of Human Evolution & Social Change (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
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Description
This study examines associations between clean water, sanitation, mosquito net usage, and immune biomarkers among the Tsimane, a remote subsistence population of forager-horticulturalists with a high pathogen load. Interviews with heads of household (n=710, aged 18-92, median age 40 years) were conducted to ascertain household water sources, ownership and usage

This study examines associations between clean water, sanitation, mosquito net usage, and immune biomarkers among the Tsimane, a remote subsistence population of forager-horticulturalists with a high pathogen load. Interviews with heads of household (n=710, aged 18-92, median age 40 years) were conducted to ascertain household water sources, ownership and usage of mosquito nets, and latrine use. In this sample, 21% of households used latrines, 20% always boiled their water, and 85% used mosquito nets. Regression models estimate their associations biomarkers of pathogen exposure, including white blood cell count (WBC), hemoglobin (Hb), eosinophils, and sedimentation rate (ESR). Controlling for age, sex, and distance from the closest market town, latrine use (Std. β = -0.11, p= 0.017) and boiling water (Std. β = -0.08, p= 0.059) are associated with lower WBCs. Latrine use is marginally associated with higher hemoglobin (Std. β = 0.09, p= 0.048), but not boiling water (p= 0.447). ESR trends toward lower levels for households that always boil water (Std. β= -0.09, p= 0.131), but is not associated with latrine use (p=0.803). Latrine use was significantly associated with lower eosinophil counts (Std. β= -0.14, p=0.013), but not boiling water (p=0.240). Mosquito nets are not associated with any of these biomarkers. Both boiling water and latrine use are associated with better health outcomes in this sample. These results suggest that scarce public health resources in rural subsistence populations without malarial risk may wish to prioritize boiling water and latrine use to improve health outcomes.
ContributorsDinkel, Katelyn Aubree (Author) / Trumble, Benjamin (Thesis director) / Costa, Megan (Committee member) / Jehn, Megan (Committee member) / School of Mathematical and Statistical Sciences (Contributor) / School of Human Evolution & Social Change (Contributor) / School of Life Sciences (Contributor) / School of International Letters and Cultures (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
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Description

During the COVID-19 pandemic, increased burdens have been placed on the Arizona healthcare system, and its healthcare providers. Using a survey with a sample of N=308 prescribing providers and nurses in the Arizona healthcare system, the impact of COVID-19 on the wellbeing of healthcare providers was assessed. The survey used

During the COVID-19 pandemic, increased burdens have been placed on the Arizona healthcare system, and its healthcare providers. Using a survey with a sample of N=308 prescribing providers and nurses in the Arizona healthcare system, the impact of COVID-19 on the wellbeing of healthcare providers was assessed. The survey used measures to evaluate for physical and emotional wellbeing, burnout, stressors associated with COVID-19, and work-life experiences, and found an overall negative impact on the wellbeing of healthcare workers during the COVID-19 pandemic with increased levels of reported stress and tiredness, concern for the health of family and loved ones, concern for the hardships of patients, lack of alignment between organizational priorities and personal values, and low levels of support and appreciation from socially and from leadership at work.

ContributorsJohnson, Emma Carina (Author) / Schuster, Roseanne (Thesis director) / Michalec, Barret (Committee member) / School of Molecular Sciences (Contributor) / School of Human Evolution & Social Change (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
Description

This study compares vaccine hesitancy during the COVID-19 pandemic with previous studies on vaccine hesitancy to evaluate the major driving factors behind COVID-19 vaccine hesitancy among undergraduate students at Arizona State University (ASU). Undergraduate students were surveyed with questions regarding different aspects of vaccines, including personal vaccination history, opinions on

This study compares vaccine hesitancy during the COVID-19 pandemic with previous studies on vaccine hesitancy to evaluate the major driving factors behind COVID-19 vaccine hesitancy among undergraduate students at Arizona State University (ASU). Undergraduate students were surveyed with questions regarding different aspects of vaccines, including personal vaccination history, opinions on the COVID-19 vaccine, knowledge of the COVID-19 vaccine, and reasoning behind vaccination status. The survey was distributed through school listservs within ASU. Close-ended questions underwent statistical analysis on IBM SPSS and open-ended questions were analyzed using content analysis. Results indicated that the main driving factors behind vaccine hesitancy are believing in natural immunity, familial influence, lack of trust behind the technology of the COVID-19 vaccine, and preferring the risk of COVID-19 infection over the risk of COVID-19 vaccination. The main driving factors behind vaccine hesitancy appear to be similar to driving factors in the past, with an increase of mistrust surrounding the vaccine.

ContributorsD'Agostino, Annabelle (Author) / Stotts, Rhian (Thesis director) / Marsteller, Sara (Committee member) / Barrett, The Honors College (Contributor) / School of Life Sciences (Contributor) / School of Human Evolution & Social Change (Contributor)
Created2023-05
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Description
Brought on by extended survival due to Highly Active Anti-Retroviral Therapy and increased incidence among older adults, the demographic profile of the HIV epidemic has begun to shift towards the aging population. As people living with HIV (PLWH) begin to age and develop multiple comorbidities, their needs are no longer

Brought on by extended survival due to Highly Active Anti-Retroviral Therapy and increased incidence among older adults, the demographic profile of the HIV epidemic has begun to shift towards the aging population. As people living with HIV (PLWH) begin to age and develop multiple comorbidities, their needs are no longer limited to HIV treatment and disease management; they may require aging services similar to those with a negative HIV status. Increased attention has been placed on HIV and aging to assess the unique needs of older PLWH, however, limited research exists on the preparedness of aging services to provide adequate care to this population. This study aims to assess HIV and aging within Maricopa County, where individuals aged 50 years and older account for nearly half the reported HIV/AIDS cases in the county, and 30% of cases in Arizona. Two focus groups – one with older PLWH and another with aging service professionals – were conducted to gather information about existing aging services and the perspectives of older PLWH regarding their growing needs. Older PLWH were found to experience challenges similar to those that have been well-documented in previous studies: most notably, PTSD and other mental health conditions; fear of the future and isolation; HIV status disclosure and stigma; and economics and financial security. An anonymous survey was developed in conjunction with Aunt Rita’s Foundation to evaluate Maricopa County aging services; it was discovered that providers lack experience with HIV and admit deficiencies in their preparation to address the age-related concerns of older PLWH. The results show that the majority of providers were supportive of offering care to older PLWH and expressed interest in improving their preparedness. Future research is necessary to obtain perspectives from additional aging services in Maricopa County and word towards the development of an aging services directory to connect older PLWH to care.
ContributorsLayon, Sarah (Author) / Jacobs, Bertram (Thesis director) / Coon, David (Committee member) / Spencer, Glen (Committee member) / School of Life Sciences (Contributor) / School of Human Evolution & Social Change (Contributor) / School of Art (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
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Description
Although the indigenous populations of the United States experience substantial disparities in health outcomes, little information is available regarding barriers to their access to specifically baby friendly hospitals and baby friendly services in the United States. Access is important because indigenous patients, especially women, have higher infant mortality and childhood

Although the indigenous populations of the United States experience substantial disparities in health outcomes, little information is available regarding barriers to their access to specifically baby friendly hospitals and baby friendly services in the United States. Access is important because indigenous patients, especially women, have higher infant mortality and childhood obesity than their white counterparts.
This systematic review seeks to uncover potential barriers to baby friendly hospital services for indigenous patients in the United States. This systematic review analyzed the current literature from select databases published between 2000 and 2020 and narrowed literature down into studies deemed relevant because of their focus on the BFHI or equivalent and on indigenous patients. 303 studies were found using a specialized search string and then after evaluation under exclusion and inclusion criteria, 21 were identified for use in this review.
Analysis of these selected studies revealed trends of barriers as well as disparities in indigenous participation in current research. The conclusion of this review is that baby friendly and its “Ten Steps to Successful Breastfeeding” must be altered to allow for implementation in different cultural settings, especially for indigenous patients. Additionally, there is a need for additional research that focuses on indigenous patients in this setting and is written by members of that community. Increased representation from this community will enhance future work towards deconstructing the barriers preventing indigenous patients to access BFHI resources.
ContributorsLindsey, Alyssa Estela (Author) / Schuster, Roseanne (Thesis director) / Hinde, Katie (Committee member) / School of Human Evolution & Social Change (Contributor) / Department of English (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
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Description
Objective: To provide insight into the World Health Organization SAGE Working Group Vaccine Hesitancy Survey by applying the tool to populations across Maricopa County, Arizona. Design: An online survey was conducted using the Qualtrics Survey Software, of individuals residing in Maricopa County, Arizona during the month of October 2019. Results:

Objective: To provide insight into the World Health Organization SAGE Working Group Vaccine Hesitancy Survey by applying the tool to populations across Maricopa County, Arizona. Design: An online survey was conducted using the Qualtrics Survey Software, of individuals residing in Maricopa County, Arizona during the month of October 2019. Results: Of 209 respondents, the followed demonstrated to be the top 3 reasons for either having not received the flu shot yet or having not planned to receive the flu shot: “I’m healthy, I don’t need it”(20.1%); “Worried I might get the flu from it”(17.7%); “I don’t think it works”(17.7%) Statistical analysis demonstrated that vaccine hesitant and non-hesitant respondents are likely to respond differently to topics covering: safety of vaccines; self-perceived health status; importance of the flu shot among one’s peers; flu vaccine related knowledge Conclusions: The WHO VHS applied to the population of Maricopa County, Arizona reported little hesitancy towards the seasonal flu vaccine. Statistical analysis of Vaccine Hesitant respondents vs. Non-Hesitant respondents demonstrates that specified public health education focused on the immunological implications of vaccines may be needed for the hesitant population to gain confidence in vaccine efficacy. A more diverse respondent group that consists of residents beyond the county lines of Maricopa is needed to understand the full scope of vaccine hesitancy that exists in Arizona.
ContributorsMaroofi, Hanna (Co-author, Co-author) / Jehn, Megan (Thesis director) / Muabyi, Anuj (Committee member) / School of International Letters and Cultures (Contributor) / School of Life Sciences (Contributor) / School of Human Evolution & Social Change (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
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Description

Significant health inequalities exist between different castes and ethnic communities in India, and identifying the roots of these inequalities is of interest to public health research and policy. Research on caste-based health inequalities in India has historically focused on general, government-defined categories, such as “Scheduled Castes,” “Scheduled Tribes,” and “Other

Significant health inequalities exist between different castes and ethnic communities in India, and identifying the roots of these inequalities is of interest to public health research and policy. Research on caste-based health inequalities in India has historically focused on general, government-defined categories, such as “Scheduled Castes,” “Scheduled Tribes,” and “Other Backward Classes.” This method obscures the diversity of experiences, indicators of well-being, and health outcomes between castes, tribes, and other communities in the “scheduled” category. This study analyzes data on 699,686 women from 4,260 castes, tribes and communities in the 2015-2016 Demographic and Health Survey of India to: (1) examine the diversity within and overlap between general, government-defined community categories in both wealth, infant mortality, and education, and (2) analyze how infant mortality is related to community category membership and socioeconomic status (measured using highest level of education and household wealth). While there are significant differences between general, government-defined community categories (e.g., scheduled caste, backward class) in both wealth and infant mortality, the vast majority of variation between communities occurs within these categories. Moreover, when other socioeconomic factors like wealth and education are taken into account, the difference between general, government-defined categories reduces or disappears. These findings suggest that focusing on measures of education and wealth at the household level, rather than general caste categories, may more accurately target those individuals and households most at risk for poor health outcomes. Further research is needed to explain the mechanisms by which discrimination affects health in these populations, and to identify sources of resilience, which may inform more effective policies.

ContributorsClauss, Colleen (Author) / Hruschka, Daniel (Thesis director) / Davis, Mary (Committee member) / Barrett, The Honors College (Contributor) / School of Human Evolution & Social Change (Contributor) / Department of Psychology (Contributor)
Created2022-05