Browsing by Author "Kline, Nolan"
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Item Assessing the impact of targeted continuing education training on improving dental hygienists’ HPV-related knowledge(2023) Farris, Alexandra; Neelamegam, Malinee; Cotter, Jane; Dickinson, Charlene; Johnson, Kaeli; Kline, Nolan; Thompson, Erika; Griner, StaceyBackground Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States and is attributable to various cancers. Approximately 70% of oropharyngeal cancer diagnoses are linked with an HPV infection. HPV vaccination is an effective prevention method that can protect against multiple high-risk strains including those directly associated with oropharyngeal cancer. Given the connection between HPV and oropharyngeal cancer and the frequency of dental visits compared to annual primary care visits, dental hygienists are uniquely positioned to help reduce the risk of HPV infection among their patients through vaccine education and promotion. The goal of this project is to evaluate the impact of a continuing education (CE) training on dental hygienists’ knowledge about HPV and the HPV vaccine. Methods This study used pre- and post-test survey design to collect data from dental hygienists. The CE training was presented at the Southwest Dental Conference on August 26th, 2022, in Dallas, Texas. Prior to the training, all attendees were asked to complete an online survey assessing their knowledge about HPV and the HPV vaccine. Knowledge questions included modes of transmission, types and sites of HPV-related cancers, and vaccine recommendations and indication. For example, "HPV is transmitted through skin-to-skin contact” was asked as a true or false question. With a total of 18 questions on the knowledge scale, participants were awarded 1 point per correct answer and no points for incorrect answers. Higher averages indicated higher knowledge, with 18 being the highest possible score. Following the 45-minute CE, participants completed a second online survey assessing their knowledge. Data were analyzed in SPSS using t-tests to assess for changes from pre-test to post-test. A p-value of <0.05 was considered statistically significant. Results While a total of 453 oral health providers were registered, only practicing dental hygienists (n=112) who had matched pre- and post-surveys were included in this analysis. Out of 18 items, the average number of correct responses pre-CE was 13.7 (SD=2.7), which was significantly higher following the CE (16.8 correct, SD=1.0; p<0.001). The item with the most significant knowledge increase pertained to the type of vaccine available for HPV (a virus-like particle vaccine, 39.1% pre-CE; 92.0% post-CE, p<0.001). Additional items with increases in knowledge included the various types of cancers directly linked to HPV such as anal cancer (54.9% pre-CE; 99.1% post-CE, p<0.001) and penile cancer (50.4% pre-CE; 97.3% post-CE, p<0.001). Conclusions The HPV vaccine is an FDA-approved form of cancer prevention, and the best predictor of HPV vaccination uptake is recommendation from a healthcare provider. The CE training resulted in increased knowledge regarding HPV-related cancers and the HPV vaccine, indicating a need for similar trainings that can help dental hygienists make stronger, more informed vaccination recommendations to their patients. Equipping dental hygienists with the most up-to-date knowledge, effective communication skills, and confidence to promote HPV vaccination among their patients could greatly reduce the number of missed clinical opportunities to recommend and refer for the HPV vaccine.Item Determining Perceived Self-Efficacy for Preventing Dengue Fever in Two Climatically Diverse Mexican States: A Cross-Sectional Study(MDPI, 2022-03-28) Annan, Esther; Angulo-Molina, Aracely; Yaacob, Wan Fairos Wan; Kline, Nolan; Lopez-Lemus, Uriel A.; Haque, UbydulKnowledge of dengue fever and perceived self-efficacy toward dengue prevention does not necessarily translate to the uptake of mosquito control measures. Understanding how these factors (knowledge and self-efficacy) influence mosquito control measures in Mexico is limited. Our study sought to bridge this knowledge gap by assessing individual-level variables that affect the use of mosquito control measures. A cross-sectional survey with 623 participants was administered online in Mexico from April to July 2021. Multiple linear regression and multiple logistic regression models were used to explore factors that predicted mosquito control scale and odds of taking measures to control mosquitoes in the previous year, respectively. Self-efficacy (beta = 0.323, p-value = < 0.0001) and knowledge about dengue reduction scale (beta = 0.316, p-value =< 0.0001) were the most important predictors of mosquito control scale. The linear regression model explained 24.9% of the mosquito control scale variance. Increasing age (OR = 1.064, p-value =< 0.0001) and self-efficacy (OR = 1.020, p-value = 0.0024) were both associated with an increase in the odds of taking measures against mosquitoes in the previous year. There is a potential to increase mosquito control awareness and practices through the increase in knowledge about mosquito reduction and self-efficacy in Mexico.Item Health Equity Implications of Transgender Policies in the United States: A Legal Epidemiology Approach(2023) Webb, Nathaniel; Kline, Nolan; Johnson, Kaeli; Yording, Hayley; Griner, Stacey; Brunell, DavidIntroduction Transgender (trans) populations experience worse health outcomes compared to cis-gender populations, including higher rates of poor mental health, experiences of medical bias, and communicable diseases. These health disparities are broadly influenced by the political context within individual states that can perpetuate social exclusion. In the last five years, there has been a sharp increase in exclusionary legislation related to trans individuals that can deepen health inequality and exacerbate poor health outcomes. Using a legal epidemiological approach, we conducted a policy scan of state-level legislation in the United States to determine geographic distribution, frequency, and whether the legislation was trans affirming and/or exclusionary. Methods We searched the Westlaw policy database to identify proposed legislation in U.S. states between 2017-2021 using search terms related to "transgender.” The initial search identified 1280 results, of which, 698 proposed bills were included in the final analysis. Five researchers reviewed the proposed legislation and categorized each bill into "affirming” or "exclusionary” categories. Using a priori themes identified in the grey literature and refined among the research team, bills were further categorized by the theme of the legislation into 11 categories: athletics, bathrooms, administrative changes, affirmation care, religious claims, recognition, rights in the healthcare field, training revisions, criminal justice reform, education and school, and government augmentation. These categories were used to calculate affirming density, exclusionary density, and inclusivity scores and corresponding maps for legislation related to trans populations in each state. Results Of the 698 policies reviewed, 567 (81.23%) were affirming of trans identities while 131 (18.77%) were exclusionary of trans identities. Affirming legislation included policies related to government augmentation (20.81%), education/school (18.34%), administrative bills (18.17%), criminal justice reform/legal protections (15.34%), rights in the healthcare field (11.46%), training revisions (10.05%), recognition (4.94%) affirmation care (0.71%), and athletics (0.18%). Exclusionary legislation included policies related to athletics (58.78%), affirmation care (24.43%), bathrooms (7.63%), education/school (3.82%), religious claims (2.29%), administrative changes (1.53%) and rights in the healthcare field (1.53%). Affirming legislation was most prominent in the West Coast, the Northeast, and parts of the Midwest. Conversely, exclusionary legislation was highly prevalent among Southeast, South Central, and Mountain West regions. Discussion This study laid the foundation for further analysis of the political context and its influence on trans health. Exclusionary and affirming density maps indicate vastly different political contexts for trans individuals depending on US state. Such political contexts can contribute to social exclusion of trans individuals that exacerbates poor health outcomes. Further, the magnitude of legislation proposed was starkly different between affirming and exclusionary policies. Exclusionary policies focused on criminalization of trans-related issues such as gender-affirming care. Comparatively, affirming policies were largely focused on forms of representation related to local boards or governing committees (government augmentation). Representation of LGBTQ+ communities in government is incredibly important but may not negate the harm caused by the criminalization of trans-related care. Future research is needed to investigate legal etiologies of health disparities seen in trans populations compared to cisgendered populations.Item Legislature Impacting Transgender Health: A Literature Review Exploring the Possible Implications on Medical Providers(2023-12) Singleton, Nicholas B.; Kline, Nolan; Griner, StaceyThe 2023 midterm cycle saw an increase in bills restricting gender-affirming medical care for transgender Americans. These bills go against the standards of care for the treatment of gender dysmorphia. In this review, the laws from Texas, Oklahoma, and Florida were analyzed along with transgender healthcare literature to postulate the consequences for medical providers if these bills were passed. Additionally, literature describing similar experiences in restrictive healthcare law for undocumented people in the Latinx community were considered. This review showed that the bills from the 2023 midterm cycle poses financial, moral, and professional hardships on providers. To counteract these laws, it is necessary for providers to mobilize and voice their concerns as an advocate for their patients.Item LGBTQ+ Young Adults and Likelihood of Receiving Hypothetical Chlamydia and Gonorrhea Vaccines(2023) Lemuz, Tiffany; Johnson, Kaeli; Kinard, Ashlyn; Terrillion, Ryan; Kline, Nolan; Griner, StaceyBackground Sexual and gender minority (SGM) young adults (those identifying as lesbian, gay, bisexual, transexual, and/or non-binary; often known as LGBTQ+) face a number of health disparities and are among the most at risk of acquiring sexually transmitted infections (STIs) such as chlamydia and gonorrhea. Candidate vaccines against chlamydia and gonorrhea are under development, but an understanding of the likelihood of receiving future vaccines among SGM young adults is vital to promote uptake among these populations. Prior research of STI vaccine acceptability and likelihood, such as that of the human papillomavirus vaccine series, has shown healthcare provider recommendation to be a strong driver of uptake among the general population. The likelihood of the SGM young adult population receiving potential chlamydia and gonorrhea vaccines, however, has yet to be explored. The purpose of this pilot study was to examine the likelihood of SGM young adults receiving future chlamydia and gonorrhea vaccines. Methods Sexually active young adults between the ages of 18 to 24 were recruited to participate in an online survey. Here, we present a sub-analysis of the SGM young adults (n=14) who completed the survey. Items included likelihood of receiving a hypothetical: chlamydia vaccine, chlamydia vaccine if it was recommended by a physician, gonorrhea vaccine, and gonorrhea vaccine if it was recommended by a physician (response options: not very likely to extremely likely, five-point scale). Univariate analyses were conducted using SPSS. Results Participants included 12 individuals identifying as gender non-conforming and 2 identifying as transgender, with mean age of 20.9 years. Only 21% (n=3) of participants were extremely likely to be vaccinated for gonorrhea, and this increased to 36% (n=5) when the vaccine was recommended by a healthcare provider. Similarly, only 21% (n=3) of participants were extremely likely to be vaccinated for chlamydia, which also increased with a recommendation from a healthcare provider to 43% (n=6). Conclusion Results indicate low likelihood of receiving both chlamydia and gonorrhea vaccines among this small sample of SGM young adults. Likelihood of receiving both chlamydia and gonorrhea vaccines increased, however, with provider recommendation, indicating a reliance upon healthcare providers to aid in informed decision making regarding STI vaccines among this vulnerable population. Educating clinicians on the disparities as well as the tailored needs of SGM young adults surrounding chlamydia and gonorrhea infection rates and vaccination should facilitate provider recommendation and subsequently increase likelihood of chlamydia and gonorrhea vaccine uptake among SGM young adults. Additionally, to address overall low likelihood, further interventions, such as inclusive messaging targeted to SGM young adults may be necessary. Future studies would benefit from further exploration of this topic with larger samples, comparisons to cisgender and heterosexual young adults, and identification of additional potential barriers to STI vaccine acceptability among this population.Item Prenatal Providers’ Perceptions of Texas Policy Change and Reproductive Healthcare(2024-03-21) Johnson, Kaeli; Lemuz, Tiffany; Terrillion, Ryan; Kinard, Ashlyn; Kline, Nolan; Griner, StaceyBackground: Stringent healthcare policies and laws can exacerbate pre-existing disparities in access to healthcare. In Texas, there has been a rise in state-level mandates that restrict access to reproductive healthcare, criminally penalize healthcare providers, or limit the scope of practice among prenatal providers. These developments have created a unique environment for clinicians in Texas. Thus, this study aimed to investigate the impact of policy shifts within Texas on the provision of prenatal care by Texas prenatal providers to their pregnant patients. Methods: Texas prenatal providers(n=17;OB/GYNs,/CNMs,/ARNPs/PAs) were recruited from a range of practice settings such as outpatient hospitals, community clinics, and private practices. One-hour in-depth interviews guided by the Consolidated Framework for Implementation Research (CFIR)were conducted with participants. As part of the Outer Setting domain of CFIR, clinicians were asked how recent policy changes in Texas impacted the care of their patients. Interviews were audio-recorded, transcribed, and thematically coded using MAXQDA. Findings: In this analysis, two policy themes surfaced: prenatal COVID vaccines and access to abortion care. Clinicians noticed resistance among their prenatal patients in receiving the COVID vaccine, influenced by Texas’ COVID response and recommendations. They underscored how Texas laws hindered patient access to abortion care, especially within the six-week time frame. Clinicians detailed how these policies heightened the need for documentation and oversight regarding miscarriage and abortion care, including obtaining ethical approval from leadership before delivering care. Implications: The results suggest that prenatal providers perceived the implementation of new policies in Texas as introducing several challenges in their provision of reproductive healthcare. Subsequent research should explore how providers adjust their practices in response to these policy changes when caring for patients.Item Structural Determinants of Health Among Transgender Populations: Policing, Sex Work, and HIV(2023-12) Webb, Nathaniel J.; Kline, Nolan; Griner, Stacey; Rossheim, Matthew; Yockey, AndrewTransgender (trans) populations experience disproportionately high rates of HIV infection compared to cisgender populations. Additionally, due to overlapping layers of discrimination in education, housing, healthcare, and employment, trans populations are more likely to engage in a criminalized form of work, such as sex work. Policing has been identified as a potential structural determinant of HIV infection among individuals engaging in sex work. Trans populations, including those engaging in sex work, are more likely to interact with police and experience some form of police violence. This dissertation investigated policing as a potential structural determinant of HIV status and HIV testing among trans individuals who engage in sex work. Unadjusted and adjusted logistic regression analyses were utilized to identify associations between HIV status/HIV testing and police interactions. Mediation analyses were utilized to investigate police interactions as a potential mediating variable between HIV status/HIV testing and trans individuals who have engaged in street-based sex work. Statistically significant associations were identified between police interactions and HIV status in unadjusted (OR: 2.564, 95% CI: 1.166, 5.641, p-value = 0.019) and adjusted (aOR: 12.055, 95% CI: 3.076, 47.232, p-value <0.001) logistic regression models. Additionally, police interactions were not identified as a statistically significant mediating variable between HIV status/HIV testing and trans individuals engaging in street-based sex work. These findings suggest policing may act as a contributing factor towards HIV infection among trans individuals engaged in sex work, but further research is needed to elucidate this interaction. HIV infection prevention interventions need to include an intersectional lens that incorporates trans identities and address the structural issues that trans populations experience including discrimination in housing, employment, and healthcare.Item Transgender Healthcare and The Impact of Increased Politicization of Medicine(2023) Gill, Lily; Kline, Nolan; Navid, Daniel; Rice, Ellie; Webb, Natey; Johnson, Kaeli; Griner, Stacey; Neelamegam, MalineePurpose Transgender (trans) people have a unique set of health needs that are often misunderstood and/or ignored in health settings. Such misunderstandings contribute to mental and physical health disparities when compared to the cisgender population, such as increased rates of anxiety, depression, suicide, substance abuse, adverse cardiovascular events, and other chronic health conditions. Addressing these disparities requires greater access to gender-affirming care (GAC) with providers who are comfortable and knowledgeable about trans individuals’ unique health needs. However, recently there has been an increase in anti-transgender legislation across the United States. This raises questions about provider regulation and ability to provide culturally appropriate care to trans patients, and potentially widening access and care disparities among trans individuals. Future providers, including medical students, who are being trained during moments of heightened anti-transgender politics, may not feel sufficiently prepared to care for trans patients. This exploratory study examined 1) current medical students’ knowledge and attitudes towards treating trans patients 2) gaps in transgender-focused content in medical curricula, and 3) medical trainings and their degree of impact on transgender healthcare. Methods A literature review was conducted by searching scholarly databases including PubMed using the terms related to transgender health, policy, medical students, gender-affirming care, health providers, and gender dysphoria. Articles that were 1) published after 2014 2) in English, and 3) available as full text were included. The search yielded 52 articles that were then reviewed for content on medical students’ knowledge and attitudes about trans patients, gaps in medical curricula, and perceived efficacy of trans-focused trainings and educational interventions. Results Existing literature suggests that trans health disparities are largely related to provider lack of knowledge and training. Despite potentially positive attitudes regarding this population, most medical students feel their curricula lacks transgender-centered content. This includes diagnosing gender dysphoria, hormone-therapy, puberty blockers, and sex reassignment surgeries. Although some students may feel knowledgeable about trans individuals’ needs overall, many report they still feel ill-prepared to work with trans patients. They request more clinical exposure to gain confidence with proper history taking and interview skills. When assessing the training modalities preferred by medical students, interactive interventions including direct communication with trans patients yield the greatest increase in perceived confidence levels. The most recommended training modalities for practicing physicians are attending professional conferences, acquiring direct clinical mentorship, and implicit bias self-awareness workshops. Conclusion This synthesis of current research highlights the need for increased trans-focused support in medical education, which will contribute to improving overall health outcomes, ease barriers, and ameliorate disparities for transgendered persons. In the current political context, physicians who provide GAC are faced with a unique set of social and legal challenges. Government intrusion of clinical decision-making may force physicians to forgo their obligations to transgender patients, thereby directly eliciting harm to an already marginalized population. Accordingly, current and future providers may need to engage in trans-focused advocacy efforts.