Janani Rajbhandari-Thapa

University of Georgia | UGA · Department of Health Policy and Management

Obesity is a risk for certain types of cancer; however, awareness of obesity as a risk factor for cancer is low. This study evaluated increases in cancer risk awareness, including obesity as a risk factor for cancer, from a quasi-experimental intervention that provided educational materials and community reinforcement for healthy living. The study...

Objectives: The goal of the Strong4Life School Nutrition Program is to promote healthy eating in school cafeterias in Georgia by training school nutrition managers and staff members to implement changes in the cafeteria to nudge children to make healthier choices. The objective of our study was to evaluate program effect on (1) school nutrition ma...

Objective: To assess depression and anxiety among college students during the COVID-19 pandemic and its association with race. Participants: Using a cross-sectional survey, depression and anxiety among college students at a Predominantly White (PWU) and a Historically Black University (HBU) during 2021 were evaluated. Methods: The patient heal...

Introduction: Home blood pressure monitoring (HBPM) is more convenient and effective than clinic- based monitoring in diagnosing and managing hypertension. Despite its effectiveness, there is limited evidence on the economic impact of HBPM. This study aims to fill this research gap by assessing the health and economic impact of adopting HBPM among...

Considering the importance of social and structural support and resources in recovering health, where people reside could lead to differences in health outcome in Medicare home health care. We used the 2019 Outcome and Assessment Information Set and Area Deprivation Index to examine the association between neighborhood context and successful discha...

Physical activity (PA) plays a vital role in children’s physical and mental health. The built, natural, and socio-demographic environmental variables affect children’s PA behaviors in various ways. However, few studies focus on systematically measuring the environmental spatiality to enhance PA research. We propose a Physical activity Access Dispar...

Introduction: Prior studies of diet quality in the United States (US) have focused on national estimates and trends. Examining geographic variations in diet quality over time can provide actionable and targeted policy insights. Hypothesis: Diet quality is heterogeneously distributed across US geographical locations with higher diet quality in urban...

Introduction: Adherence to anti-hypertensive drugs, which is sub-optimal despite public health and policy efforts, is essential in controlling high blood pressure. Medicare Advantage plans are gaining popularity, partly due to their managed care designs that held promise to improve chronic disease management. Hypothesis: We assessed the hypothesis...

With over 350,000 cases occurring each year, out-of-hospital cardiac arrest (OHCA) remains a severe public health concern in the United States. The correct and timely use of automated external defibrillators (AEDs) has been widely acknowledged as an effective measure to improve the survival rate of OHCA. While general guidelines have been provided...

This mixed methods study assessed the perceptions of food choices among SNAP participants and SNAP-eligible non-participants when exposed to two alternative SNAP policy options: restrictions on sugar-sweetened beverages (SSBs) and incentives for fruit and vegetable (FV) purchases. Twelve focus groups that included a randomized food choice experimen...

Background Disparities in cardiovascular disease (CVD) outcomes persist across the United States. Social determinants of health play an important role in driving these disparities. The current study aims to identify the most important social determinants associated with CVD mortality over time in US counties. Methods and Results The authors used t...

The United States has implemented policy efforts for public and private insurance to cover counseling services related to the treatment of obesity. However, no research has yet studied counseling service utilization among pediatric patients with obesity. We used 3 years (2017-2019) of IBM MarketScan Commercial Claims and Encounters Database and IBM...

The present study investigates the spatial correlation between built and natural environments that promote physical activity (PA) and children’s fitness. Previous work has been conducted on various geographic scales such as from a county level. However, evaluations from a school attendance zone level, which are the policy and program administration...

The COVID-19 pandemic has resulted in more than 600 million confirmed cases worldwide since December 2021. Cardiovascular disease (CVD) is both a risk factor for COVID-19 mortality and a complication that many COVID-19 patients develop. This study uses Twitter data to identify the spatiotemporal patterns and correlation of related tweets with daily...

Telomere length is affected by lifestyle and environmental factors and varies between racial and ethnic groups; however, studies are limited, with mixed findings. This study examined the effects of tobacco use and smoke exposure on mean telomere length to identify critical age periods by race/ethnicity. We used time-varying effect modeling on the N...

Background: While malaria and neglected tropical disease (NTD) morbidity and mortality rates among children <5 years old have decreased through public health efforts in the United Republic of Tanzania, associations between household environments and disease outcomes are relatively unknown. Methods: We conducted latent class analysis (LCA) on 201...

Objective To understand the design and implementation models of US produce prescription programs. Methods In a mixed-methods study, program providers completed an online survey and an individual phone interview regarding their 2019 programming. Results Twenty-three programs completed surveys; 20 completed interviews. Program locations included th...

Introduction Using a cross-sectional population-based survey, electronic vapor product (EVP) use was evaluated in relation to physical activity levels among high school students in Georgia. Methods We used self-reported EVP and cigarette use from the Georgia Student Health Survey 2.0 data from 2018 (N =362 933) and used multi-level multinomial log...

Introduction: In the United States, physical activity (PA) among adolescents is declining; 75% of high school students do not meet daily PA guidelines. Low rates of PA are more prevalent among high school girls. Schools provide an optimal environment to target and promote PA. However, school climate has not yet been studied for its importance in p...

Objective To report and examine associations with infant vitamin D intake and meeting recommendations among a national sample participating in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Design Secondary analysis from the 2013–2015 WIC Infant Toddler Feeding Practices Study-2. Participants US Infants. Variables...

A healthy diet is an important protective factor to prevent cardiometabolic disease. Traditional face-to-face dietary interventions are often episodic, expensive, and may have limited effectiveness, particularly among older adults and people living in rural areas. Telehealth-delivered dietary interventions have proven to be a low-cost and effective...

Background Prostate-specific antigen (PSA) surveillance testing is a cornerstone of prostate cancer survivorship because patients with biochemical recurrence often have no symptoms. However, the investigation of guideline-concordant PSA surveillance across racial groups is limited. We examined racial differences in PSA surveillance testing 5-years...

Objective: We examine role of ACEs and pathways to risk of opioid misuse among young adults. Participants and Methods: A cross-sectional survey of validated measures of ACEs, risk of opioid misuse, and health conditions with a sample of 1,402 students from a large public university followed by multivariate logistic regression and pathway analysis....

Effective COVID-19 vaccine distribution requires prioritizing locations that are accessible to high-risk target populations. However, little is known about the vaccination location preferences of individuals with underlying chronic conditions. Using data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we grouped 162,744 respondent...

Background Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is associated with lower breastfeeding rates, compared to similar income non-participants. Breastfeeding decisions are often made before birth hence; the prenatal period may be critical for breastfeeding support. Objective To explore wheth...

Physician shortages are more pronounced in rural than in urban areas. The geography of medical school application and matriculation could provide insights into geographic differences in physician availability. Using data from the Association of American Medical Colleges (AAMC), we conducted geospatial analyses, and developed origin–destination (O–D...

Purpose: Limited English proficiency and increased language isolation are known to be associated with adverse health outcomes. It is not clear how neighborhood-level linguistic isolation may impact individual health and risk of death among Hispanic older adults. We examined the link between living in a linguistically isolated neighborhood and all-c...

Introduction: Cardiometabolic diseases (CMDs), which include coronary heart disease (CHD), hypertension (HTN), type 2 diabetes (DM) and obesity, are an interrelated set of highly preventable conditions. Food insecurity, another pervasive public health issue, is associated with CMDs. We aim to characterize the prevalence of CMD by food security (FS)...

Background The gender pay gap in the United States (US) has narrowed over the last several decades, with the female/male earnings ratio in the US increased from about 60% before the 1980s to about 79% by 2014. However, the gender pay gap among the healthcare workforce persists. The objective of this study is to estimate the gender pay gap in the US...

Purpose: Socioeconomic and geographic determinants of medical school application and matriculation may help explain the unequal distribution of physicians in the United States. This study describes trends in MD-granting medical school application and matriculation rates and explores the relationship between county median family income, proximity t...

Background. The gender pay gap in the United States (US) has narrowed over the last several decades, with the female/male earnings ratio in the US increased from about 60% before the 1980s to about 79% by 2014. However, the gender pay gap among the healthcare workforce persists. The objective of this study is to estimate the gender pay gap in the U...

Background: With the growing rate of obesity and associated chronic conditions in China, there is a need to assess the health and economic burden of obesity and examine the effectiveness of pharmaceutical, medical, and comprehensive weight-loss interventions. Areas covered: This article reviewed publications retrieved from PubMed and Google Schola...

Background Bereavement is the experience of an individual following the death of a person of significance to the individual, most often referring to the spouse. Increased morbidity, health care utilization, and mortality are known to be associated with bereavement. Given China’s growing population of older adults, there is a critical need to assess...

Introduction Previous studies have reported a “weekend effect” on stroke mortality, whereby stroke patients admitted during weekends have a higher risk of in-hospital death than those admitted during weekdays. Aims We aimed to investigate whether patients with different types of stroke admitted during weekends have a higher risk of in-hospital mor...

Objectives. To evaluate the statewide implementation of childhood fitness assessment and reporting in Georgia. Methods. We collected survey data from 1683 (919 valid responses from a random-digit-dialed survey and 764 valid responses from a Qualtrics panel) parents of public school students in Georgia in 2018. Results. Most parents reported that th...

This study aims to examine the trend in the diagnosis of obesity and the use of surgical treatment in in‐patient settings as well as per person and national costs associated with the surgical treatment of obesity. We conducted cross‐sectional and trend analyses of in‐patient obesity diagnosis and surgical treatment for obesity using data from the N...

Background College dining halls offer a variety of menu offerings; however, little is known about how student perception of a dining hall's menu healthiness influences student eating habits. Objective To determine factors that influence eating behaviors in dining halls in order to shape future nutrition education efforts in college dining. Study...

Background: To address change in the gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change over time. Methods: The temporal trend in GGLE was evaluated using retrospective demographic analysis with Joinpoint regression. Causes of death were coded in...

Adolescent use of electronic vapor products (EVP) is increasing; however, changes in EVP use in the context of cigarette smoking is less certain. We analyzed trends in EVP and cigarette use among high school students in the state of Georgia. We used self-reported EVP and cigarette use from the annual Georgia Student Health Survey 2.0 for 2015 to 20...

Objective This study examines insurance coverage rates among working‐age adults with low income and with or without obesity before and after Medicaid expansion under the Affordable Care Act. Methods Individual‐level data on noninstitutionalized and nonpregnant adult participants aged 18 to 64 years with household income below $15,000 from the Cent...

Background: To address change in gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change overtime. Methods: Retrospective demographic analysis with application of Joinpoint regression to evaluate the temporal trend in GGLE. Causes of death were coded in...

Background Even as many states adopt physical activity policies to promote physical activity and prevent childhood obesity, little is known about differences in policy implementation based on school characteristics. We studied association of school characteristics and changes in physical activity opportunities at the school level during the impleme...

Background To address change in gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change overtime. Methods Retrospective demographic analysis with application of Joinpoint regression to evaluate the temporal trend in GGLE and using life table technique an...

Background: To address change in gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change overtime. Methods: Retrospective demographic analysis with application of Joinpoint regression to evaluate the temporal trend in GGLE. Causes of death were coded in...

Background To address change in gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change overtime. Methods Retrospective demographic analysis with application of Joinpoint regression to evaluate the temporal trend in GGLE. Causes of death were coded in ac...

Chronic disease and opioid-related hospitalizations in the United States are increasing. We analyzed nationally representative data on patients aged 18 years or older from the 2011-2015 National Inpatient Sample to assess the association between opioid-related hospitalization and chronic diseases. We found that most patients with opioid-related hos...

Background: Obesity continues to grow in prevalence in the United States and within the state of Georgia. Obesity is a risk factor for many chronic and preventable diseases. As such, obese individuals have higher demand for health care services than non-obese individuals. In addition, the health care system can play a role in preventing obesity and...

Fruit and vegetable consumption in the United States is below the recommended level for two reasons: lack of access and low preference. In this work, we identify lack of preference for vegetables as a public health issue and apply theories from psychology and marketing literature to study the effect of partitioned presentation of vegetables on cons...

The healthy immigrant effect-whereby immigrants are on average healthier than the native-born-have been well studied. However, little is known about the relationship between immigration and the health of the native-born. This study fills this important research gap by examining the association between neighborhood immigrant density and several popu...

Background: Data on adolescents' physical activity and determinants are scarce in Nepal. In this study, we aim to assess the level of physical activity, its correlates and the sedentary behavior of high school students in an urban district of Nepal. Methods: This is a cross-sectional study. Participants were selected using two-stage cluster samp...

Purpose: Most residents in rural regions of the United States consume fewer amounts of fruits and vegetables (FVs) compared with their urban counterparts. Difficulties in access to FVs often contribute to different consumption patterns in rural regions, aside from a lack of education or motivation for eating healthy foods. This article uses simulat...

Background: Obesity is classified as having a body mass index (BMI) greater than 30 and is associated with higher risks of type 2 diabetes, coronary heart diseases, hypertension, and other adverse health outcomes. In 2015, the prevalence of self-reported obesity among adults in Georgia was 30.7. The present study focused on how, in 2015, lifestyle...

Background Students live outside of their family homes for the first time in college and are expected to make their own decisions regarding dietary choices. College food environment could be a major determinant of dietary intake and is of importance in relation to obesity. This research determines the impact of removing cafeteria trays on student’s...

Telestroke is a telemedicine intervention that facilitates communication between stroke centers and lower-resourced facilities to optimize acute stroke management. Using administrative claims data, we assessed trends in telestroke use among fee-for-service Medicare beneficiaries with acute ischemic stroke and the association between providing teles...

Background: Obesity has become a global epidemic, with substantial impacts on children's health. Numerous intervention studies for the prevention of obesity in children have been conducted during the most recent decade, but very few have evaluated the long-term and sustainable effectiveness of such prevention efforts. Methods: We conducted a fol...

Most residents in New York City (NYC) do not consume sufficient fruits and vegetables every day. Difficulties with access and high prices of fruits and vegetables in some neighborhoods contribute to different consumption patterns across NYC neighborhoods. We developed an agent-based model (ABM) to predict dietary behaviors of individuals at the bor...

Purpose: This study aimed to assess the relationship between rural or urban residence and having a usual source of care (USC), and the utilization of preventive dental checkups among adults. Methods: Cross-sectional analysis was conducted using data from the Medical Expenditure Panel Survey 2012. We performed a logit regression on the relationsh...

This paper estimates the relationship between green space and body mass index (BMI) in the U.S. We find that accounting for the heterogeneity of green space matters: BMI is significantly lower in counties with larger forestland per-capita, but not in those more abundant in rangeland, pastureland or cropland. This is after controlling for state-spec...

A systematic review was conducted to provide a comprehensive overview on the emerging success of applying behavioral economics tools to promote healthy food choice decisions in school lunchrooms. This paper summarizes the current knowledge on the topic and facilitates meeting the recommendations of the White House Task Force on Obesity, and the Ins...