Body Mass Index and Self-Perceived Weight: Are They Associated with Sexual and Relationship Health?

This dissertation explores associations between body mass index (BMI) and self-perceived weight during adolescence and two health outcomes during young adulthood: 1) testing positive for one or more of three sexually transmitted diseases (STD) (Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis) and 2) reporting intimate partner violence (IPV) victimization. Both papers use National Longitudinal Study of Adolescent Health (Add Health) data from Waves 1, 2, and 3. In the first paper, logistic regression models examined associations between overweight BMI, self-perceived overweight, correct overweight perceptions, and misperceived overweight during adolescence and testing positive for one or more STDs (Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis) during young adulthood as determined by urine testing. In unadjusted and adjusted models, adolescent overweight BMI and self-perceived overweight were not associated with young adult STD status among either gender. Adolescent correctly perceived overweight was associated with young adult STD status among males when pooled by race, and among non-Hispanic Black males in unadjusted models. Associations were no longer statistically significant when sociodemographic variables were included in models. Correctly perceived overweight and misperceived overweight were not significantly associated with STD status among females. Future research should explore the associations of interest in this paper with different adolescent body image measures and a wider variety of STD outcomes to determine if associations exist. In the second paper, logistic regression models examined the effects of adolescent overweight BMI and self-perceived overweight on the odds of experiencing IPV victimization during young adulthood. Overweight BMI and self-perceived overweight during adolescence were not significantly associated with IPV victimization during young adulthood among males. Among females, when pooled by adolescent BMI and race, adolescent overweight BMI was associated with increased odds of IPV victimization in the fully adjusted model. When analyses were stratified by race and adolescent BMI, neither adolescent weight concept was significantly associated with IPV victimization among females. Consistent with previous research, longer relationship duration, cohabitation, non-Hispanic Black race, and child abuse were risk factors for young adulthood IPV victimization. Overall, this dissertation contributes to the literature by exploring the effects of adolescent BMI and body image on understudied outcomes.Doctor of Philosoph

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries

Purpose: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Method: Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. Results: The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Conclusions: Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments

Influences of Community Interventions on Zika Prevention Behaviors of Pregnant Women, Puerto Rico, July 2016–June 2017

We assessed how community education efforts influenced pregnant women’s Zika prevention behaviors during the 2016 Centers for Disease Control and Prevention–Puerto Rico Department of Health Zika virus response. Efforts included Zika virus training, distribution of Zika prevention kits, a mass media campaign, and free home mosquito spraying. We used telephone interview data from pregnant women participating in Puerto Rico’s Women, Infants, and Children Program to test associations between program participation and Zika prevention behaviors. Behavior percentages ranged from 4% (wearing long-sleeved shirt) to 90% (removing standing water). Appropriate mosquito repellent use (28%) and condom use (44%) were common. Receiving a Zika prevention kit was significantly associated with larvicide application (odds ratio [OR] 8.0) and bed net use (OR 3.1), suggesting the kit's importance for lesser-known behaviors. Offer of free residential spraying was associated with spraying home for mosquitoes (OR 13.1), indicating that women supported home spraying when barriers were removed