Exploring Sexual Orientation Disclosure to Health Care Providers among Sexual Minority Women.

Sexual orientation disclosure (or, “coming out”) to one’s health care provider is championed by members of the medical and public health communities as a lynch pin to improving the health of sexual minority individuals. In this dissertation, I explore and critique this strategy in the context of young adult sexual minority women’s (YSMW’s) lives. Using data from the Michigan Smoking and Sexuality Survey (M-SASS), a web-based cross-sectional study of YSMW ages 18-24, I conducted two sets of analyses. First, I explored individual and interpersonal level factors associated with coming out to health care providers. These results suggest YSMW’s sexual identity and same-sex sexual experiences, along with how “out” they are to others and their experience of internalized homophobia, influence whether or not women in this sample had disclosed their sexual orientation to their health care provider. Second, I examined the relationship between clinical disclosure and discussions about, recommendations for, and receipt of sexual and reproductive health care services. My results suggest that YSMW who had come out to their providers were equally or more likely than those who had not disclosed their sexual orientation to have discussed, been recommended, or received these services. This analysis also showed important differences in receipt of sexual health services based on race, ethnicity, geography, and sexual identity, highlighting the importance of examining the experiences of a diverse sample of YSMW. For my final empirical chapter, I conducted a literature review assessing how sexual orientation disclosure is being measured in the current health science literature. This review also documented the extent to which studies focusing on disclosure attempt to link this health behavior to health outcomes or health care utilization. My review found a great deal of variability in the items researchers employ to measure sexual orientation disclosure to health care providers, and few attempts to explore relationships between disclosure and health or health care utilization. Overall, this dissertation critiques the current state of the science on coming out to providers, seeks to address existing gaps in the disclosure literature, and offers directions for health promotion and future research focused on YSMW’s clinical disclosure experiences.PhDHealth Behavior and Health EducationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/120827/1/youatt_1.pd

Developing a Framework for Population Health in Interprofessional Training: An Interprofessional Education Module

Interprofessional education (IPE) is based on the concept that health professional students are best trained on the skills, knowledge, and attitudes that promote population health when they learn with and about others from diverse health science fields. Previously, IPE has focused almost exclusively on the clinical context. This study piloted and evaluated an IPE learning experience that emphasizes population health in a sample of public health undergraduate students. We hypothesized that students who completed the 2-hour online asynchronous module would better understand the value of public health's role in interprofessional teams, the benefit of interprofessional teamwork in improving health outcomes, and the value of collaborative learning with other interprofessional students. Students engaged in pre- and post-training assessments and individual reflections throughout the module. Sixty-seven undergraduate public health students completed the module and assessments. After completion, a greater proportion strongly agreed that students from different health science disciplines should be educated in the same setting to form collaborative relationships with one another (19 vs. 39% before and after completion, respectively). A greater proportion also strongly agreed that care delivered by an interprofessional team would benefit the health outcomes of a patient/client after the training (60 vs. 75% before and after, respectively). Mean scores describing how strongly students agreed with the above two statements significantly increased post-training. A greater proportion of students strongly agreed that incorporating the public health discipline as part of an interprofessional team is crucial to address the social determinants of health for individual health outcomes after taking the training (40 vs. 55% before and after, respectively). There was little change in attitudes about the importance of incorporating public health as part of an interprofessional team to address social determinants of health for population health outcomes, which were strongly positive before the training. Most students reported being satisfied with the module presentation and felt their understanding of interprofessional practice improved. This training may be useful for students from all health disciplines to recognize the benefits of engaging with and learning from public health students and to recognize the important role of public health in interprofessional practices

Multiple locus VNTR analysis highlights that geographical clustering and distribution of Dichelobacter nodosus, the causal agent of footrot in sheep, correlates with inter-country movements

Dichelobacter nodosus is a Gram-negative, anaerobic bacterium and the causal agent of footrot in sheep. Multiple locus variable number tandem repeat (VNTR) analysis (MLVA) is a portable technique that involves the identification and enumeration of polymorphic tandem repeats across the genome. The aims of this study were to develop an MLVA scheme for D. nodosus suitable for use as a molecular typing tool, and to apply it to a global collection of isolates. Seventy-seven isolates selected from regions with a long history of footrot (GB, Australia) and regions where footrot has recently been reported (India, Scandinavia), were characterised. From an initial 61 potential VNTR regions, four loci were identified as usable and in combination had the attributes required of a typing method for use in bacterial epidemiology: high discriminatory power (D > 0.95), typeability and reproducibility. Results from the analysis indicate that D. nodosus appears to have evolved via recombinational exchanges and clonal diversification. This has resulted in some clonal complexes that contain isolates from multiple countries and continents; and others that contain isolates from a single geographic location (country or region). The distribution of alleles between countries matches historical accounts of sheep movements, suggesting that the MLVA technique is sufficiently specific and sensitive for an epidemiological investigation of the global distribution of D. nodosus

LGBT community, social network characteristics, and smoking behaviors in young sexual minority women.

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106605/1/LGBT community, social network characteristics, and smoking behaviors in young sexual minority women.pd