Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jeannette Ickovics

Second Advisor

Elizabeth Claus

Subject Area(s)

Public health

Abstract

To identify health behaviors that may be amenable to brief screening and intervention among children in the Emergency Department, we compared the prevalence of Emergency Department use among middle school children who report health behaviors known to contribute to childhood obesity versus their peers who did not. Participants included 1590 5th, 7th, and 8th grade students who completed health surveys in 2011. Multivariate logistic regression was used to examine the association between health behaviors and Emergency Department use. Children who reported unhealthy dietary behaviors were more likely to use the Emergency Department. In particular, those who reported consumption of energy-dense foods like fried chicken, french fries and ice cream (OR 1.20, 95% CI 1.06-1.37), fast food (OR 1.07, 95% CI 1.00-1.14) and sugar-sweetened beverages (OR 1.24, 95% CI 1.14-1.35) were more likely to use the Emergency Department. There was no association with fruit and vegetable consumption, physical activity or screen time and Emergency Department use. Unhealthy dietary behaviors are associated with Emergency Department use in a low-resource urban population of middle school students. Further research should evaluate the effectiveness of brief diet screenings and interventions in the Emergency Department.

To identify depressive symptoms that may be amenable to brief screening and referral to treatment among adults in the Emergency Department, we compared the prevalence of Emergency Department use among adults who screened positive for depressive symptoms versus their peers who did not. Participants included 1094 adults age 18-64 who completed health surveys in 2013. Multivariate logistic regression was used to examine the association between depressive symptoms and Emergency Department use. Adults who screened positive for depressive symptoms were more likely to use the Emergency Department (OR 1.70), even after controlling for various sociodemographic and health measures. In addition, the absolute number of Emergency Department visits was associated with the prevalence of positive screening for depressive symptoms. Among those who reported no ED visits, 8.5% screened positive for depressive symptoms, but this percentage rose to 29% for participants reporting more than five ED visits. The Cochran-Armitage Trend Test revealed a significant linear trend between number of ED visits and % screening positive for depression (Z Statistic=-4.83, p< 0.001). Depressive symptoms are associated with Emergency Department use in a low-resource urban population of adults. Further research should evaluate the effectiveness of brief depression screenings and interventions in the Emergency Department.

Comments

This is an Open Access Thesis.

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