Digital Commons Network^™

“Their Body, Their Choice. Your Body, Your Choice. Your Baby, Your Choice.”: A Reflexive Thematic Analysis Of Vaccine Access And Acceptance Among U.S. Pregnant People On Reddit, Sydney Marie Perlotto

Public Health Theses

Compared to the general population, pregnant people and newborns are at a higher risk of contracting infectious diseases and experiencing worse adverse outcomes. Vaccines delivered during pregnancy, known as prenatal vaccines, represent a critical yet underused form of preventive care for these populations in the United States. Increasing successful prenatal vaccination uptake requires a focus on both access and acceptance, which pregnant people may experience differently than non-pregnant people due to their unique physiological and social state. Given the evolution of vaccine hesitancy following the COVID-19 pandemic, coupled with the recent expansion of the U.S. prenatal immunization schedule, this study …

“I Didn't Want Them To Feel Like I Was Fragile”: A Qualitative Analysis Of Disability, Intimacy, And Sexual Culture At Yale, Mafalda Von Alvensleben

Public Health Theses

This thesis examines how Yale as an educational institutional shapes disabled students’ sexual and romantic lives. It explores the ways in which the institution's policies, culture, and physical environments influence these experiences via a qualitative and landscape analysis. The analysis was based off nine semi-structured interviews with students who self-identified as disabled from both undergraduate and graduate programs, as well as a landscape analysis that incorporates formal, journalistic style interviews with eleven Yale faculty, staff, and administrators. Taken together, this study illuminates the challenges posed by systemic ableism within the university's academic and social frameworks. It highlights the inadequacies of …

Analyzing Pediatric Department Documentation Of Patient Social Needs With Icd-10 Z-Codes, 2019-2020, Oluwatofunmi Jummie Akinwunmi

Public Health Theses

The 10th revision of the International Classification of Diseases (ICD-10) allows healthcare professionals to document social needs with ICD-10 Z-codes. Data derived from documentation of ICD-10 Z-codes can be leveraged to identify at-risk populations for targeted intervention. However, there remains concern for underutilization of these codes particularly in the pediatric population. We sought to examine the documentation of ICD-10 Z-codes in the pediatric outpatient setting of the largest Connecticut hospital network by specialty type and age group. We examined deidentified electronic health records of pediatric outpatient patients from 2019-2020. We used descriptive statistics to measure the proportion of patients with …

A Dna-Extraction-Free Method For The Molecular Detection Of Streptococcus Pneumoniae Carriage In Saliva, Tzu-Yi Lin

Public Health Theses

Pneumococcal carriage is a prerequisite for pneumococcal disease and surveillance of carriage is crucial for evaluating and informing vaccination strategies. In recent years, molecular methods have improved the sensitivity of pneumococcal carriage detection as compared to the gold standard culture-based method. However, nucleic acid extraction from samples collected is resource-intensive, limiting scalability for extensive surveillance, particularly in low-resource settings. We previously developed a saliva-based PCR test for SARS-CoV-2, having identified that nucleic acid extraction can be omitted and replaced with a simple enzymatic lysis or heat treatment step without compromising the accuracy and efficiency of testing. Here, we compared pneumococcus …

A Retrospective Cohort Study: Association Of Sex And Race Differences On 30-Day Retention In Addiction Treatment For Substance Use Disorders After Discharge, Bingning Wang

Public Health Theses

Objective: Little is known about the association of sex and racial differences in accessing SUD treatment. little is known whether these disparities continue despite hospitalization. The main objective was to determine the association of race and sex differences on 30-day retention in addiction treatment for all substance use disorders after discharge. Design: A Retrospective Cohort Study using the Yale Addiction Medicine Consult Service databaseSubjects: Patients with SUD who were hospitalized at Yale New Haven Hospital from Oct 26th, 2018 to Jun 30th, 2021 are eligible, which has 2557 observations. Methods: Mixed effect multivariable logistic regression for sex and racial differences …

Psychological Resilience In U.S. Military Veterans: Results From The 2019-2020 National Health And Resilience In Veterans Study, Michael Georgescu

Public Health Theses

Psychological resilience is the most common response following exposure to traumatic life events. To date, most research has focused on factors associated with adverse post-trauma mental health outcomes rather than understanding those associated with psychological resilience. In particular, little is known about factors associated with resilience in veterans, despite their high rates of trauma exposure, such as combat and military sexual trauma. To address this gap, we used a discrepancy-based psychiatric resilience (DBPR) analytic approach to operationalize resilience and to identify modifiable health and psychosocial factors associated with resilience in a nationally representative sample of U.S. veterans (N = 4,069). …

Cleft Lip And Depression In Adults: A Multi-Ancestry Mendelian Randomization Study, Anne Lyon Havlik

Public Health Theses

Background: Clefting of the lip with or without cleft palate (CLP) is the most common congenital craniofacial abnormality globally, affecting one in 700 live births. Traditional observational studies suggest an increased risk of adult depression among subjects with CLP, but these studies are subject to residual confounding.Objective: We aimed to address residual confounding by evaluating the association between the genetically-predicted risk of CLP on the risk of adult depression in a Mendelian randomization framework. Methods: We used single-nucleotide polymorphisms strongly associated with CLP as genetic instruments. Genetic associations with adult depression were extracted from separate studies. Three ancestry groups were …

For “Them”, Not Us: A Qualitative Study Of Asian American Pacific Islander Perceptions Of Substance Use And Harm Reduction, Winnie Ho

Public Health Theses

Background: Asian American Pacific Islander (AAPI) substance use data is typically aggregated in a way that not only produces overly generalized results, but also potentially perpetuates stereotypes created by the Model Minority Myth (MMM). This has mutually reinforced a lack of representation and understanding of AAPI substance use experiences and needs. This presents a public health concern that is both excluding them from consideration by the field of harm reduction, but also themselves from considering harm reduction. Disaggregated data shows rising rates of substance use and associated harms that are often hidden or not taken as seriously as a public …

"Hair-Esteem Toolkit For Black Girls": The Development Of A Self-Esteem Toolkit For Black Adolescent Girls Centering Hair As A Tool For Empowerment, Sydney Hussett-Richardson

Public Health Theses

Background: For Black adolescent girls, hair is a strong staple of gender and ethnic identity, influencing intrapersonal and interpersonal interactions. Gendered racism and Eurocentric beauty standards pathologize Black girls and their hair, leading them to experience high rates of hair harassment and discrimination. These experiences negatively impact the self-esteem of Black girls, which has important implications for a host of health behaviors. The purpose of this study was to explore the relationship between self-esteem and hair among Black girls and integrate findings into a culturally relevant digital toolkit to promote and develop hair-esteem and self-esteem among Black girls.Methods: This study …

“To Live In The Body Of A Survivor ”: Unique And Cumulative Disaster Exposure And Mental Health In A Sample Of Hurricane Katrina Survivors, Noelle Serino

Public Health Theses

Introduction: Fueled by the escalation of climate change, weather-related disasters are increasing in frequency and severity. Existing research has documented the extensive harm induced by such disasters, yet few studies have examined how individuals’ psychological well-being fares when exposed to multiple, diverse threats, including other weather-related and public health disasters (e.g., COVID-19). As such, the present study explores posttraumatic and psychological distress in the context of unique and cumulative disaster exposure.Methods: The data utilized for this study came from the Resilience in Survivors of Katrina (RISK) Project. The sample was comprised of 381 predominantly Non-Hispanic Black (84.5%) women who experienced …

“For The Future, For Him, And For Our Life Together”: The Relationship Goals And Well-Being Of Persons Living With Dementia And Their Spousal Care Partners, Claire Leigh Szapary

Public Health Theses

Background. Identities and dynamics in relationships can change when one spouse develops dementia. This study aimed to understand the various types of goals both spousal care partners and persons living with dementia (PLWD) have for their relationship, and to explore whether approach or avoidance goals were associated with individual wellbeing and relational support – as well as their partners’ wellbeing and support.

Methods. A secondary analysis of data from sixty-two spousal dyads where one partner has dementia was conducted. Thematic goal-type categories were determined through a card-sort content analysis methodology using participants’ brief qualitative responses to a question asking about …

Estimating Urinary Nitrate Excretion In Rural Iowans From Dietary And Drinking Water Sources, Timothy Skalaban

Public Health Theses

Nitrate levels are increasing in our environment, and epidemiological studies have found evidence of adverse health risks from this exposure. Therefore, it is important to characterize the magnitude of nitrate exposure from food and drinking water sources. This study assesses the magnitude of nitrate exposure for 47 farmers from the Agricultural Health Study (AHS) in 2018-2019. The participants in our study use private wells as their main drinking water source and live in agricultural area of Iowa (10 counties) where ground water is vulnerable to nitrate contamination. The extent of nitrate exposure is determined by several factors, including the types …

Support Or Interference: Relational Influences On Mother’S Exclusive Breastfeeding Practices In Ghana, Georgiana Esteves

Public Health Theses

Childhood malnutrition is a challenge that needs to be understood as a global health threat. Exclusive breastfeeding (EBF) is recognized as the best practice to improve a child’s growth and cognitive development in the first months of life. The World Health Organization recommends EBF until 6 months. Mothers need family support to adhere to EBF practices. This study aimed to understand the interpersonal level relational influences of fathers, grandmothers, and other family members on the mother-child dyad adherence to EBF practices, as well as document community and societal influences on EBF. This study took place in the Central Region of …

The Role Of Childhood Trauma In Intergenerational Trauma (Igt), Audrey Huang

Public Health Theses

Emerging research has focused on the intersection of personal and parental trauma within intergenerational trauma (IGT) transmission, specifically offspring adverse childhood experiences due to trauma-related parenting behaviors. However, the role that offspring childhood trauma and its various subtypes may play in moderating or mediating IGT transmission, as well as the impact of caregiver sex, are still remains largely understudied. We examined how the transmission of PTSD between survivors of the 1994 genocide to their offspring might be either (a) mediated by overall and subtypes of offspring childhood trauma, or (b) moderated by overall and subtypes of offspring childhood trauma, and …

Xylazine In The Drug Supply: Emerging Threat In Connecticut And Lessons Learned From Philadelphia, Thomas A.G. Quijano

Public Health Theses

Background: Xylazine, a sedative analgesic drug approved as an animal tranquilizer but not for human use, has become an adulterant in the supply of heroin/fentanyl.(Greene & Thurmon, 1988) Between 2019 and 2020, prevalence of xylazine in overdose death reports increased by 44.8% nationally.(Friedman et al., 2021) The three jurisdictions in 2020 with the highest prevalence of xylazine were Philadelphia (25.8%), Maryland (19.3%), and Connecticut (10.2%).(Friedman et al., 2021) Not much is known about how xylazine’s impacts on service provider’s practices and the people they serve.

Objectives: Use a multiple methods approach to understand xylazine’s presence and impact in Connecticut, and …

Prevalence And Health Burden Of Cardiovascular Disease In Older U.S. Veterans: Results From The 2019-2020 National Health And Resilience In Veterans Study, Cailin Arechiga

Public Health Theses

Importance. Cardiovascular disease (CVD) is one of the leading causes of death in the U.S. and is associated with a range of demographic, military, trauma, and clinical characteristics and physical and mental health conditions. Older military veterans may have an increased risk for CVD, given their advanced age and military experiences. However, the prevalence and health burden of CVD in population-based samples has not been well characterized. Objective. To characterize the current prevalence of CVD, and its association with sociodemographic, military, trauma, and clinical variables in a large, contemporary, and nationally representative sample of older U.S. veterans. Design. Cross-sectional study …

Health Care Utilization And Costs For Dementia Patients In China, Fang Ba

Public Health Theses

The number of people in the world living with Alzheimer’s Disease and related dementias (ADRD) continues to rise rapidly, which places a substantial burden on people with dementia (PWD), their families, and the society. Such a burden has been rising faster in low-income and middle-income countries (LMIC) where around two-thirds of PWD live. While prior research documents dementia prevalence in China and indicates its large geographic disparities, no study to date has documented the national pattern of health care utilization, quality and costs in China. The absence of knowledge would largely impede the effective allocation of resources for combating dementia …

Assessing Changes In The Epidemiology Of Cutaneous Leishmaniasis In Southwest Colombia Following The Peace Accord With Fuerzas Armadas Revolucionarias De Colombia (Farc), Matthew Stephen Benczkowski

Public Health Theses

The Colombian Conflict persisted for over 50 years, recently coming to an end in November 2016 after the signing of Colombia’s Peace Agreement between the government and FARC guerrilla group. Internal armed conflict is often entangled with the exacerbation of health outcomes, including promoting the spread of infectious diseases like cutaneous leishmaniasis (CL). CL is a vector-borne parasitic disease localized to the human tegument that decreases quality of life through lesions leading to scars and associated stigmatization. This study assessed changes in demographic and clinical characteristics of patients with CL in Southwest Colombia before and after the signing of the …

Healthcare Provider Perspectives On The Influence Of Cultural Beliefs On Infant And Young Child Feeding Practices Within Ghanaian Refugee Camps: A Qualitative Analysis, Morgan Nadene Veronica Buchanan

Public Health Theses

Adherence to breastfeeding and complementary feeding recommendations is a proven strategy for promoting the well-being of infants and young children and ensuring their proper development. Cultural beliefs inform caregivers’ likelihood to follow these guidelines as they influence caregivers’ thoughts about maternal behavior during the prenatal and lactation periods, child feeding behaviors, and health. Refugee camps or settlements are a unique space to study the coexistence of cultural beliefs held by residents and staff. Understanding the pathways by which cultural beliefs modulate caregiver infant and young child feeding (IYCF) behavior (and therefore impact child health) within these settings is of paramount …

Sexual Orientation Disclosure And Depression Among Thailand Men Who Have Sex With Men: Associations With Intimate Partner Violence And Social Support, Eduardo Encina

Public Health Theses

Objectives: The analytical goal of this project is to better understand the association of sexual orientation disclosure among different social networks of Thailand men who have sex with men (MSM) and depression. Along with this, we aim to extensively explore the intersectional influence of social support and intimate partner violence (IPV) experiences with each other, with disclosure, and ultimately depression outcomes.

Methods: The secondary dataset for this project was comprised of results from a cross-sectional study. This study utilized a web-based epidemiological and behavioral survey, distributed among young MSM ages 15-24. Self-reported data was provided through collaboration with Mahidol University …

Smoking And Early-Onset Basal Cell Carcinoma, Zhaopei Liu

Public Health Theses

Background – Smoking has been identified as a risk factor for many cancers. While many studies have investigated the association between smoking and basal cell carcinoma (BCC), the results have been inconsistent, and no study has evaluated this association among a young population.

Methods – Early-onset BCC cases (n=374) and controls with minor benign skin conditions (n=384) under age 40 were identified through Yale Dermatopathology. Participants over 18 years old were asked whether they ever smoked (defined as ever smoked at least 100 cigarettes) during an in-person interview. Those who responded affirmatively were then asked about their smoking history. We …

Impact Of Covid-19 On Participants Of A Fruit And Vegetable Program, Christabelle Ong

Public Health Theses

Objective: To investigate the impact of COVID-19 on the participants of a multi-city fruit and vegetable incentive program.Design: A six-month cohort study was conducted. Pre-program and post-program data were collected using an online survey platform. Setting: Eight cities across the United States. Participants: A total of 822 individuals were recruited through local site partners to participate in a fruit and vegetable incentive program (n=822; 79.4% women, 20.6% men; median age: 57 years old). Intervention: Participants received $50 monthly fruit and vegetable vouchers, a sneaker gift card or gift basket, and access to a weight loss app. Main Outcome Measures: The …

Health-Related Quality Of Life In Endometrial Cancer Survivors, Michelle Sodipo

Public Health Theses

Background: Endometrial cancer is the most common cancer of the female reproductive organs and one of few cancers in the United States with rising incidence and mortality rates. Few studies have examined factors that influence health-related quality of life (HRQOL) of endometrial cancer survivors after active treatment and existing studies have been limited in sample size. In this study, we examined sociodemographic and clinical factors associated with HRQOL and symptom burden in a national sample of endometrial cancer survivors.

Methods: We evaluated 331 endometrial cancer survivors from the longitudinal American Cancer Society’s Study of Cancer Survivors-I who completed self-administered questionnaires …

Long-Term Cancer Survivors' Use Of Healthcare Providers, Madeleine Tessier-Kay

Public Health Theses

Abstract

Introduction: The number of long-term (>5 years post-diagnosis) cancer survivors in the United States is growing, making it critical to understand how they utilize healthcare for their past cancer diagnosis. There are limited data on patient characteristics associated with care utilization patterns. Methods: Data are reported from the 9-year post-diagnosis follow-up of the Connecticut participants (n=399) in the American Cancer Society’s Study of Cancer Survivors-I. We assessed characteristics associated with long-term primary cancer care provider (cancer specialist vs. primary care physician (PCP), shared care vs. PCP) and number of PCP visits in the past year via multinomial logistic …

Identification Of Genetic Factors For Metabolically Healthy Obese And Metabolically Obese Normal-Weight, Junli Zhu

Public Health Theses

Though obesity is typically associated with metabolic dysfunction and cardiometabolic diseases, there are both obese individuals who have favorable metabolic profiles (metabolically healthy obese; MHO) and individuals who present obesity alterations despite their normal weight (metabolically obese normal weight; MONW). Genetic studies suggest that there is a genetic component underlying these phenotypes. However, previous research has been restricted by the use of the candidate gene approach, limited choice of metabolic indicators, and low statistical power. A genome-wide association (GWA) study that examines both MHO and MONW in a single large-scale population cohort is necessary to uncover the genetic determinants of …

Exploring Thai Physicians’ Perceptions Of And Willingness To Prescribe Pre-Exposure Prophylaxis (Prep), Brandi E. Moore

Public Health Theses

Background: Oral pre-exposure prophylaxis (PrEP) is a daily medication that can prevent HIV infection. PrEP may further support HIV prevention initiatives in Thailand, particularly as it becomes more accessible in the country’s government clinics and hospitals. While studies have explored perceptions of PrEP for at-risk people in Thailand, there has been limited investigation into Thai physicians’ opinions of and willingness to prescribe PrEP. Methods: Using convenience sampling, this cross-sectional study recruited 132 Thai physicians to complete an anonymous, online survey. The survey assessed physicians’ concerns about PrEP, experience with PrEP, and willingness to prescribe PrEP. Bivariate and multivariable logistic regressions …

Factors Associated With Early Childhood Development Outcomes For Children Of Adolescent And Young Adult Mothers In Brazil, Lily Benson Kofke

Public Health Theses

Objectives: A descriptive analysis to explore the risks for early childhood development (ECD) delays among children of adolescent and young adult mothers in Brazil. Methods: A secondary analysis of cross-sectional data of a representative sample of children under age 2 and their mothers from community health centers in Brasília, Brazil. The Denver Developmental Screening Test II was used to assess overall and domain-specific ECD (personal-social, fine motor, gross motor, and language). Mothers were subset into two groups based on age. Bivariate analyses and multivariable logistic regressions were used to examine the associations between maternal age and risk of ECD delay, …

The Impact Of Economic Intimate Partner Violence On Women’S Sexual And Reproductive Health In Asia & The Pacific, Marina Katague

Public Health Theses

Intimate partner violence is a human rights violation and serious threat to global public health. Economic intimate partner violence is a unique form of abuse whose effects on health need clarification. Data from the 2011-2012 UN Multi-country Study on Men and Violence, comprised of cross-sectional samples in China, Papua New Guinea, and Sri Lanka were collected on ever-partnered women aged 18-49 years. The sample averaged some (1.14) economic violence exposure across summed behaviors (range 0-12; standard deviation=2.04). Multivariable regressions were run to assess the relationship between severity of IPV abuse types and 14 sexual and reproductive health outcomes. Adjusted analyses …

Caesarean Delivery Among Women Of Color Is Associated With Risk Of Early Childhood Developmental Delays In Brazil, Haley Case

Public Health Theses

Background. Poverty, racism, and other sources of oppression threaten children’s nurturing environments and associated early childhood development (ECD). Women of Color and their children are disproportionately exposed to risk factors for poor ECD in Brazil. There is a growing body of evidence supporting the claim that unnecessary cesarean section (CS) is associated with poor maternal health outcomes and ECD delays. There is an existing gap in the literature on risk factors, including obstetric factors, of poor ECD among children of Women of Color in Brazil.

Objective. The objective of this thesis was to investigate factors, including obstetric characteristics of CS …

Screening For Legionnaires’ Disease: A Predictive Model For Improving Health And Economic Outcomes, Alyssa K. Amick

Public Health Theses

Introduction: Legionnaires’ disease (LD), caused by the Legionella bacterium, is a rare but serious atypical pneumonia that is often underdiagnosed in the clinical setting. Recent guideline changes by the American Thoracic Society limited use of the urinary Legionella tests, the primary form of diagnosis, due to the excessive costs of regular testing. Delays in testing and diagnosis of LD result in increased cost of treatment and risk of death.

Objective: To develop a predictive model to estimate a patient’s probability of having LD. This model would serve as a screen to better target diagnostic efforts, prevent misdiagnosis, and reduce the …