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Restoring, Protecting, And Expanding Abortion Access In The United States: Seeking Consensus Through The Delphi Method, Sarah Pickering

Dissertations and Theses

Background: The Dobbs v. Jackson Women’s Health Organization Supreme Court decision exacerbated inequitable access to abortion in the US. Agreement is needed on which strategies should be prioritized to restore, protect, and expand abortion access.

Methods: We convened a multidisciplinary, geographically diverse Delphi panel of clinical, research, policy, legal, and advocacy experts to reach consensus (i.e., agreement >67%) on recommended actions. Using feedback from three rounds of surveys, and input from a select expert advisory group (N=10), we iteratively refined the statements and recommendations.

Results: The panel (N=85) developed 25 consensus statements and 32 recommendations for action by advocates, funders, …

Application Of Methods To Population-Based Surveys To Reduce Bias In Estimates Of Sars-Cov-2 Infection Burden In The Population, Saba Qasmieh

Dissertations and Theses

BACKGROUND: Population-based surveys designed to randomly sample the population can be a critical and complementary tool to traditional surveillance approaches. Probability-based surveys enable the measurement of SARS-CoV-2 testing and outcomes that avoid issues around self-selection into testing, making them an effective approach to address ascertainment bias in passive surveillance. For surveys to be a useful and reliable surveillance tool for understanding the burden and distribution of SARS-CoV-2 infection, they need to capture prevalence estimates that are both valid and reliable to be optimally informative for public health measures. The dissertation was undertaken to address three main gaps that have implications …

A Mixed Methods Approach To Understanding The Links Between Mining, Climate Change And Selected Health Outcomes In India, Mary J. Cheruvillil

Dissertations and Theses

Despite ample evidence of the significant role that mining activities play in determining health outcomes, in India there is a dearth of comprehensive health studies that draw linkages between mining and health. The purpose of the following study is to investigate the impact of mining activities on population health in India using three different methods: ecological multivariable regression, exploratory spatial data analysis (ESDA) and content analysis of government documents using a phenomenological approach. The first aim uses the ecological multivariable regression to examine associations between mining activities and children’s malnutrition outcomes at the district level. Census data, the Demographic Health …

Factors Associated With Racial And Ethnic Disparities In Cesarean Delivery Among Women With Low-Risk Pregnancies At New York City Hospitals, 2012-2017, Ellen Brazier

Dissertations and Theses

BACKGROUND: While Cesarean delivery is a life-saving procedure when certain complications arise, it is associated with increased risks of maternal mortality and morbidity, as well as neonatal and childhood morbidities, and increased risks for women during subsequent pregnancies. Stark and persistent racial/ethnic disparities in Cesarean delivery that are not explained by clinical risks raise concerns about overuse of the procedure, as well as the contribution of potentially avoidable Cesareans to disparities in maternal mortality and morbidity. Understanding the extent to which disparities in Cesarean delivery may be attributable to differences in care during labor is critical for addressing these disparities. …

Burdern Of Chronic Health Conditions And Healthcare Utilization Among Mobile Populations In Sub-Saharan Africa, Elizabeth M. Ortiz

Dissertations and Theses

Background: Much of public health research in sub-Saharan Africa on mobile occupations, such as truck drivers and sex workers, has focused on HIV risk. However, evidence is emerging to suggest that the HIV epidemic among these groups is coupled with a high prevalence of chronic health conditions (CHC), specifically hypertension, diabetes, and obesity. For people living with HIV, increased risk of CHC may also be linked to HIV-related chronic inflammatory cascade. In Africa, there has been little research on CHC risk factors or patterns of healthcare utilization among mobile populations. Therefore, the objectives of this study are to examine the …

Use Of Plumage And Gular Pouch Color To Evaluate Condition Of Oil Spill Rehabilitated California Brown Pelicans (Pelecanus Occidentalis Californicus) Post-Release, Deborah L. Jaques, Kyra L. Mills, Barton G. Selby, Richard R. Veit, Michael H. Ziccardi

Publications and Research

Sublethal effects of oil spills may dampen seabird rehabilitation success due to lingering negative impacts of contamination and stress on reproduction and long-term survival. These effects can be difficult to measure while birds are in care as well as once birds are released. Expression of sexually selected traits that are sensitive to condition can provide information on physiological status of birds. We evaluated plumage molt and gular pouch skin color of California brown pelicans (Pelecanus occidentalis californicus) following oil contamination and rehabilitation to test for differences between previously oiled and rehabilitated (post-spill) and presumably uncontaminated pelicans. Post-spill pelicans released with …

Incorporating Place And Space: A Hierarchical Spatial Approach To Exploring Preventable Congestive Heart Failure Hospitalizations In New York City, Rachael Weiss Riley

Dissertations and Theses

Background: Faced with rising medical care costs, increasing prevalence, and widening health disparities, preventing congestive heart failure (CHF) hospitalizations is a central public health concern. Despite evidence of geographical clustering in preventable CHF admissions, there is a lack of research designed to examine spatial patterning of CHF and the local area neighborhood determinants that contribute to this variability. This study sought to assess and evaluate the importance of both space and place in analyzing preventable CHF hospitalizations and readmissions by applying appropriate statistical techniques, clarifying the assumption inherent in each method, and interpreting the findings within the context of existing …

Acute Memory And Psychotomimetic Effects Of Cannabis And Tobacco Both ‘Joint’ And Individually: A Placebo-Controlled Trial, C. Hindocha, T. P. Freeman, J. X. Xia, N. D. C. Shaban, H. V. Curran

Publications and Research

Background. Cannabis and tobacco have contrasting cognitive effects. Smoking cannabis with tobacco is prevalent in many countries and although this may well influence cognitive and mental health outcomes, the possibility has rarely been investigated in human experimental psychopharmacological research.

Method. The individual and interactive effects of cannabis and tobacco were evaluated in 24 non-dependent cannabis and tobacco smokers in a randomized, placebo-controlled, double-blind, 2 (cannabis, placebo) × 2 (tobacco, placebo) crossover design. Verbal memory (prose recall), working memory (WM) performance including maintenance, manipulation and attention (N-back), psychotomimetic, subjective and cardiovascular measures were recorded on each of four sessions.

Results. Cannabis …

Ecological Correlations Of Dietary Food Intake And Mental Health Disorders, Jordan Hoerr, Joshua Fogel, Benjamin Van Voorhees

Publications and Research

This paper examines the ecological association of dietary food intake with mental health outcomes on the group level across countries. Published data from the World Mental Health Survey were used to compare lifetime prevalence of four categories of mental health disorders (anxiety disorders, mood disorders, impulse control disorders, and substance use disorders) with a country’s fish/seafood and sugar/sweetener supply quantity using the Spearman rank correlation. Data were compared for 17 countries across the world. Sugar and sweetener supply quantity was significantly and positively associated with anxiety disorders (rho = 0.75, p = 0.001), mood disorders (rho = 0.75, p = …

Gait Changes In A Line Of Mice Artificially Selected For Longer Limbs, Leah M. Sparrow, Emily Pellattt, Sabrina S. Yu, David A. Raichlen, Herman Pontzer, Campbell Rolian

Publications and Research

In legged terrestrial locomotion, the duration of stance phase, i.e., when limbs are in contact with the substrate, is positively correlated with limb length, and negatively correlated with the metabolic cost of transport. These relationships are well documented at the interspecific level, across a broad range of body sizes and travel speeds. However, such relationships are harder to evaluate within species (i.e., where natural selection operates), largely for practical reasons, including low population variance in limb length, and the presence of confounding factors such as body mass, or training. Here, we compared spatiotemporal kinematics of gait in Longshanks, a long-legged …

Integrating Social Determinants Of Health With Treatment And Prevention: A New Tool To Assess Local Area Deprivation, Andrew R. Maroko, Thao M. Doan, Peter S. Arno, Megan Hubel, Shirley Yi, Deborah Viola

Publications and Research

We assessed the appropriate geographic scale to apply an area deprivation index (ADI), which reflects a geographic area’s level of socioeconomic deprivation and is associated with health outcomes, to identify and screen patients for social determinants of health. We estimated the relative strength of the association between the ADI at various geographic levels and a range of hospitalization rates by using age-adjusted odds ratios in an 8-county region of New York State. The 10-km local ADI estimates had the strongest associations with all hospitalization rates (higher odds ratios) followed by estimates at 20 km, 30 km, and the regional scale. …

Factors Associated With Initiation Of Antiretroviral Therapy In The Advanced Stages Of Hiv Infection In Six Ethiopian Hiv Clinics, 2012 To 2013, Denis Nash, Olga Tymejczyk, Tsigereda Gadisa, Sarah Gorrell Kulkarni, Susie Hoffman, Muluneh Yigzaw, Batya Elul, Robert H. Remien, Maria Lahuerta, Shalo Daba, Wafaa El Sadr, Zenebe Melaku

Publications and Research

Introduction: Most HIV-positive persons in sub-Saharan Africa initiate antiretroviral therapy (ART) with advanced infection (late ART initiation). Intervening on the drivers of late ART initiation is a critical step towards achieving the full potential of HIV treatment scale-up. This study aimed to identify modifiable factors associated with late ART initiation in Ethiopia.

Methods: From 2012 to 2013, Ethiopian adults (n=1180) were interviewed within two weeks of ART initiation. Interview data were merged with HIV care histories to assess correlates of late ART initiation (CD4+ count <150 cells/mL or World Health Organization Stage IV).

Results: The median CD4 count at enrolment in HIV care was 263 cells/mL (interquartile range …

'At-Risk' Places: Inequaties In The Distribution Of Environmental Stressors And Prescription Rates Of Mental Health Medications In Glasgow, Scotland, Juliana A. Maantay, Andrew Maroko

Publications and Research

Using geospatial analytical methods, this study examines the association between one aspect of the built environment, namely, the concentration of vacant and derelict land (VDL), and the prevalence of mental health disorders (using the proxy variable of mental health medication prescription rates) in Glasgow, Scotland. This study builds on our previous research, which demonstrated the spatial correspondence between the locations of VDL in Glasgow and several physical health outcomes. Numerous studies of other locales have found similar correspondence between different elements of the built environment and various health outcomes. This is the first study of its kind to look at …

Effect Of The New York City Overdose Prevention Program On Unintentional Heroin-Related Overdose Death, 2000-2012, Anne Elizabeth Siegler

Dissertations, Theses, and Capstone Projects

Background: Drug overdose mortality is the leading cause of injury death in both the United States (US) and New York City (NYC). Heroin-related overdoses make up the majority of overdoses in NYC. Since 2006, when a law was passed that allowed for layperson administration of naloxone, an opioid antagonist, heroin-related overdose deaths have decreased in NYC. No studies to date have investigated a possible association between the implementation of this intervention and heroin-related overdose mortality.

Objectives: To investigate the possible association between overdose prevention programs (OPPs) and heroin-related overdose mortality in NYC, using interrupted time series and geospatial analytic …

Identifying Individual Risk Factors And Documenting The Pattern Of Heat-Related Illness Through Analyses Of Hospitalization And Patterns Of Household Cooling, Michael T. Schmeltz, Grace Sembajwe, Peter J. Marcotullio, Jean A. Grassman, David U. Himmelstein, Stephanie Woolhandler

Publications and Research

Background
As climate change increases the frequency and intensity of extreme heat events researchers and public health officials must work towards understanding the causes and outcomes of heat-related morbidity and mortality. While there have been many studies on both heatrelated illness (HRI), there are fewer on heat-related morbidity than on heatrelated mortality.

Objective
To identify individual and environmental risk factors for hospitalizations and document patterns of household cooling.

Methods
We performed a pooled cross-sectional analysis of secondary U.S. data, the Nationwide Inpatient Sample. Risk ratios were calculated from multivariable models to identify risk factors for hospitalizations. Hierarchical modeling was also …

Low Risk Of Attrition Among Adults On Antiretroviral Therapy In The Rwandan National Program: A Retrospective Cohort Analysis Of 6, 12, And 18 Month Outcomes, Harriet Nuwagaba-Biribonwoha, Aleksandra Jakubowski, Veronicah Mudisha, Paulin Basinga, Anita Asiimwe, Denis Nash, Batya Elul

Publications and Research

Background
We report levels and determinants of attrition in Rwanda, one of the few African countries with universal ART access.

Methods
We analyzed data abstracted from health facility records of a nationally representative sample of adults [≥18 years] who initiated ART 6, 12, and 18 months prior to data collection; and collected facility characteristics with a health facility assessment questionnaire. Weighted proportions and rates of attrition [loss to follow-up or death] were calculated, and patient- and health facility-level factors associated with attrition examined using Cox proportional hazard models.

Results
1678 adults initiated ART 6, 12 and 18 months prior to …

Changing Corporate Practices To Reduce Cancer Disparities, Nicholas Freudenberg, Sandro Galea, Marianne Fahs

Publications and Research

While reducing racial/ethnic and socioeconomic disparities in cancer mortality has been identified as a national goal, current policies are unlikely to achieve it. In order to advance the development of policies for the primary prevention of cancer and cancer disparities, we propose that the practices of the tobacco, alcohol, and food industries be considered as modifiable social determinants of health. We review evidence that the practices of these industries in product design, marketing, retail distribution, and pricing contribute to cancer risk behavior, incidence, and disparities, then examine public health strategies designed to reduce health-damaging practices of these industries and encourage …

Does Economic Development Contribute To Sex Differences In Ischaemic Heart Disease Mortality? Hong Kong As A Natural Experiment Using A Case-Control Study, Mary Schooling, Tai Hing Lam, Sai Yin Ho, Kwok Hang Mak, Gabriel M. Leung

Publications and Research

Background
The male excess risk of premature ischemic heart disease (IHD) mortality may be partially due to an unknown macro-environmental influence associated with economic development. We examined whether excess male risk of IHD mortality was higher with birth in an economically developed environment.

Methods
We used multivariable logistic regression in a population-based case-control study of all adult deaths in Hong Kong Chinese in 1998 to compare sex differences in IHD mortality (1,189 deaths in men, 1,035 deaths in women and 20,842 controls) between Hong Kong residents born in economically developed Hong Kong or in contemporaneously undeveloped Guangdong province in China. …