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High-Dimensional Feature Selection And Multi-Level Causal Mediation Analysis With Applications To Human Aging And Cluster-Based Intervention Studies, Hachem Saddiki

Doctoral Dissertations

Many questions in public health and medicine are fundamentally causal in that our objective is to learn the effect of some exposure, randomized or not, on an outcome of interest. As a result, causal inference frameworks and methodologies have gained interest as a promising tool to reliably answer scientific questions. However, the tasks of identifying and efficiently estimating causal effects from observed data still pose significant challenges under complex data generating scenarios. We focus on (1) high-dimensional settings where the number of variables is orders of magnitude higher than the number of observations; and (2) multi-level settings, where study participants …

Investigating The Developmental Impacts Of 3,3’-Dichlorobiphenyl (Pcb-11) In Zebrafish (Danio Rerio), Monika A. Roy

Doctoral Dissertations

The environmental pollutant 3,3’-dichlorobiphenyl (PCB-11) is a lower-chlorinated polychlorinated biphenyl (PCB) congener present in air and water samples. Both PCB-11 and its metabolite, 4-PCB-11-Sulfate, are detected in humans, including in pregnant women. The work conducted for this dissertation takes a developmental toxicology approach and uses zebrafish (Danio rerio) to investigate PCB-11’s potential impacts to the liver and pancreas. Chapter 1 introduces PCBs and the current knowledge gaps. Chapter 2 investigates PCB-11 interactions in short-term 4-day exposures with the Aryl hydrocarbon receptor (Ahr) pathway in both 0-20 mM individual and mixture exposures with other Ahr agonists. In Chapter 3, …

Sleep, Reproduction, And Pregnancy, Joshua R. Freeman

Doctoral Dissertations

Sleep, and particularly sleep timing, prior to conception may be important for reproductive and pregnancy health. Evidence of a biological mechanism relating sleep to reproductive health from laboratory studies suggests that sleep may influence the hypothalamic-pituitary-ovarian (HPO) axis. The role of sleep in the HPO axis may also impact many reproductive outcomes including reproductive hormones, ovulation, pregnancy, live birth, pregnancy loss, and adverse pregnancy outcomes. However, epidemiological evidence for associations between sleep, especially sleep timing, and these reproductive health endpoints is limited with most studies typically assessing shift work, and not sleep patterns directly. To address these gaps, we evaluated …

Mental Health And Adiposity: The Effects Of Racial Discrimination And Social Relationships, Nicole D. Fields

Doctoral Dissertations

Excess adiposity is associated with increased risk of cardiovascular disease, type 2 diabetes, and premature mortality. It is well-documented that Black women are disproportionately affected by excess adiposity. Research has focused on lifestyle factors, such as diet and physical activity, to explain the higher prevalence of obesity among Black women compared to white women; however, there is much less research on the association between psychological distress and adiposity, which may be important for understanding racial disparities. To date, no studies have examined the social context by which mental health and physical health are related. Black women in U.S. society live …

Policing And Health: Police Encounters As A Fundamental Cause Of Racial Health Disparities, Richard S. Carbonaro

Doctoral Dissertations

Structural racism has taken many forms throughout American history and to this day continues to drive social, economic, and health inequalities. Mass incarceration is a modern tool of social marginalization with well documented and deep-rooted racial inequalities. Research has continually shown that mass incarceration negatively impacts the health of disadvantaged communities. Even police stops, the most common and mundane form of criminal justice contact has been linked with deleterious health outcomes at the individual and community level. In this dissertation, I identify specific social and biological mechanisms connecting encounters with the police and health outcomes. In the first chapter, I …

Evaluating Public Masking Mandates On Covid-19 Growth Rates In U.S. States, Angus K. Wong

Masters Theses

U.S. state governments have implemented numerous policies to help mitigate the spread of COVID-19. While there is strong biological evidence supporting the wearing of face masks or coverings in public spaces, the impact of public masking policies remains unclear. We aimed to evaluate how early versus delayed implementation of state-level public masking orders impacted subsequent COVID-19 growth rates. We defined “early” implementation as having a state-level mandate in place before September 1, 2020, the approximate start of the school-year. We defined COVID-19 growth rates as the relative increase in confirmed cases 7, 14, 21, 30, 45, 60-days after September 1. …

Examining The Co-Infection Effects Of Helminths And Malaria In An Indonesian Community, Andrea Rodríguez-Sánchez

Masters Theses

Malaria is one of the most prevalent vector-borne infectious diseases with major morbidity and mortality in sub-Saharan Africa and Southeast Asia. Recent epidemiological studies have shown that co-occurrence of soil-transmitted helminth (STH) infections, or infection caused by parasitic worms, are associated with increased risk of malaria infection. However, studies of the association between STH and malaria, and the effect of antihelminth (deworming) treatments that are more commonly used in areas with high STH infection rates, are sparse. Therefore, we explored the relationship between STH and malaria infection in an Indonesian community (N=1997) with high prevalence of both STH and malaria …

Birthweight And Risk Of Autoimmune And Thyroid Conditions Within The Women’S Health Initiative, Brian C. Monahan

Masters Theses

Autoimmune and thyroid conditions account for a substantial proportion of the morbidity and mortality experienced in the United States, affecting >40 million Americans combined. Co-occurrence of both an autoimmune and thyroid condition is also likely, particularly among women. Epidemiologic studies on both sets of conditions have examined many risk factors, including demographic, lifestyle, genetic, and environmental risk factors. However, one area which has been neglected is the effect of early life exposures on the development of autoimmune and thyroid conditions. To investigate the potential association between an individual’s birth weight (by category;in uteroand early childhood, extending the hypothesis to include …

Tai Chi And Mindfulness Training To Improve Balance In People With Multiple Sclerosis: A Community-Based Intervention Study, Julianna Eve

Doctoral Dissertations

Introduction: Tai Chi and meditation have led to improved quality of life, and reduced fatigue and depressive symptoms in people with multiple sclerosis (MS). Tai Chi interventions have successfully improved balance, however the few studies evaluating meditation impact on motor skill improvement have reported conflicting results. Benefits of meditation on improving alertness and attention have been reported, but it is unknown whether these benefits might extend to physical balance. Objective: determine the impact of an 8-week Tai Chi or Mindfulness Based Stress Reduction (MBSR) intervention on physical balance, psychosocial wellbeing, and sensorimotor function; and whether benefits are retained after …

Subnational Analysis Of Birth Weight In Ghana Using Bayesian Spatial Regression Models, Barbara E. Mottey

Masters Theses

Child mortality in sub-Saharan Africa is reducing but the levels remain high with subnational within-country variations. Birth weight is a key predictor of child survival and monitoring birth weight outcomes, in particular, prevalence of low birth weights, is important for resource allocation to improve child survival outcomes.

Past research in sub-Saharan Africa has found that different individual-level factors are associated with birth weight including BMI of mother, sex of baby, educational level of mother, and wealth index of household. Some environmental factors are found to be associated with birth outcomes. However, past findings regarding the association of birth weight with …

Hospital Assessment And Response To Environmental Pollution As A Population Health Need: Identifying Prevalence And Predictors In Community Benefit Practices, Sarah Valentine

Doctoral Dissertations

Hospitals have a growing role in improving population health. Environmental pollution is an important determinant of health with disproportionate effects on Communities of Color. This warrants hospital action. To advance such action, it is important to take stock of current hospital engagement with environmental pollution and to identify factors associated with such engagement. I investigated the following. To what extent do New York State (NYS) non-profit hospitals assess, identify, and respond to environmental pollutants as part of community benefit practices? Do factors previously reported as associated with hospital engagement of social determinants predict engagement with environmental pollution as a community …

The Role Of Vegetative Cover In Enhancing Resilience To Climate Change And Improving Public Health, Anastasia D. Ivanova

Masters Theses

Changing temperature and precipitation patterns are causing degraded soil, water, and air quality which is negatively affecting the safety and health of people, and the productivity of urban and rural communities. However, research shows that implementing urban forests and cover crops into urban and rural landscapes, respectively, can mitigate these effects by providing ecosystem services. As extreme precipitation and heat events continue to intensify, there is a need for comprehensively assessing these ecosystem services under changing climates and for this information to be easily accessible by communities for rapid land-use decision making. Therefore, I investigated the role of urban forests …

Mitigation Of Teratogenic Agents: Is There Promise In Ion Modulating Drugs?, Aastha Pokharel

Masters Theses

As reported by the CDC, birth defects remain a common occurrence in the United States, with malformations originating in many places in the developing organism. Furthermore, the etiology of many of these defects remain unknown, with some factors consisting of genetics, environmental pollutants and teratogens. In our study, we examined whether insults by teratogenic agents, ethanol in particular, can be mitigated by hyperpolarizing agents acting to restore the cell’s potential. We first evaluated whether three hyperpolarizing drugs (Lamotrigine, Gabapentin, and Ivermectin) induced teratogenic effects on CD-1 mice and found that Ivermectin induced craniofacial malformations, and exposure to Lamotrigine and Gabpentin …

Validity Parameters For Step Counting Wearable Technologies During Treadmill Walking In Young People 6-20 Years Of Age, Zachary Gould

Masters Theses

Introduction: Wearable technologies play an important contemporary role in the measurement of physical activity (PA) and promotion of human health across the lifespan, including for young people (i.e., children, adolescents, and young adults). As new objective wearable technologies continue to develop, standardized approaches to documenting validation parameters (i.e., measures of accuracy, precision, and bias) are needed to ensure confidence and comparability in step-defined PA. Purpose: To produce validity parameters for step counting wearable technologies during treadmill walking in young people 6-20 years of age Methods: 120 participants completed 5-minute treadmill bouts from13.4 to 134.1 m·min^-1. Participants wore eight …

Geographical Disparity Of Adverse Childhood Experiences And Chronic Diseases In Saudi Arabia, Fahad Alhowaymel

Doctoral Dissertations

Background: Adverse childhood experiences (ACEs) have been linked to numerous negative physical and mental health outcomes and have been shown to increase risk for chronic diseases in adulthood. In Saudi Arabia, few studies have examined ACEs prevalence and their relation to chronic diseases across geographical settings. Purpose: The purpose of this study was to examine ACEs prevalence and association with chronic diseases across the provinces of Saudi Arabia, and to determine the moderating effect of geographical setting on the ACE-chronic disease relationship. Methods: A cross-sectional design was used with an existing Saudi national dataset from the National Family Safety Program …

Redox Signaling In The Zebrafish Embryo And Implications For Endocrine Pancreas Morphogenesis, Archit Rastogi

Doctoral Dissertations

The glutathione (GSH) system evolved to combat oxygen toxicity in nearly all living organisms, and serves as the predominant cellular redox buffer in vertebrates. This dissertation explores the roles of GSH during embryogenesis using the zebrafish (Danio rerio). The first agnostic in vivo characterization of GSH utilization in the embryo revealed strict spatiotemporal GSH profiles in developing organ systems. Interruption of these GSH profiles by exogenous xenobiotics led to organ specific adverse developmental outcomes; pancreatic β-cells were found to be especially susceptible and developed atypical morphologies following redox active xenobiotic exposures. Pancreatic β-cells lacked expression of Nrf2a (Nuclear …

Rare Diseases In The United States: Establishing Prevalence, The Insurance Experience, And Orphan Drug Expenditures In Medicare Part D, Tai Pasquini

Doctoral Dissertations

In the United States, there are an estimated 30 million people living with one or more rare diseases. Each rare disease impacts fewer than 200,000 people. Small patient populations create research and medical challenges. Patients and the healthcare system experience high costs. To adequately address patient needs and prepare our healthcare system, it is critical that we conduct research that contextualizes the U.S. rare disease experience. This dissertation includes three related studies that look at the U.S. rare disease experience. The first paper investigates the availability and data quality of rare disease prevalence estimates and the healthcare infrastructure that could …

Sperm Mitochondrial Dna Biomarkers As A Measure Of Male Fecundity And Overall Sperm Quality, Allyson Rosati

Masters Theses

Introduction. Sperm parameter analysis is the standard method of male fecundity testing; however, minimal evidence supports associations between individual sperm parameters and reproductive outcomes. Our previous work shows strong associations between sperm mitochondrial DNA copy number (mtDNAcn) and time-to-pregnancy (TTP) in general populations, and between mtDNAcn and fertilization outcomes in clinical populations. Thus it is possible for sperm mtDNA biomarkers to act as summary measures of semen quality. In this study, we developed a sperm quality index (SQI) from semen parameters and compared its ability to measure fecundity to sperm mtDNAcn.

Methods. We received 384 semen samples from the Longitudinal …

Sexual Experiences And Association With Depression And Anxiety Among Sexual Minority Women, Brie Engelbrecht

Masters Theses

Depression and anxiety are among the most prevalent forms of mental illness in the U.S, affecting an estimated 18% of the population. Recent studies have shown that sexual minority women may undergo sexual experiences that affect their risk of anxiety and depression. However, prior studies of this association are sparse and have largely been conducted among sexual majorities and have yet to examine differences between vulnerable sexual orientation groups. Therefore, we evaluated the relationship between sexual experiences (i.e., sexual assertiveness, sexual self-efficacy, and outness) and anxiety and depression among young sexual minority women in a cross-sectional study (N=328) from the …

The Association Between Dengue Virus Infection And Liver And Kidney Function Among Cambodian Children, Ashley Moineau

Masters Theses

Severe liver and kidney dysfunction are prevalent in 10%-30% of the Southeast Asian population. Dengue virus infection has been reported as a modifiable risk factor for liver and kidney dysfunction, especially among children in Southeast Asia. Epidemiologic studies assessing this relationship are sparse, often failed to include children, and did not adjust for important covariates. Therefore, we evaluated the relationship between dengue virus infection and liver and kidney dysfunction among hospitalized children in Cambodia (n=551). Participants with a serologically confirmed dengue virus infection were categorized according to increasing severity of infection (i.e. dengue fever, dengue hemorrhagic fever, or dengue shock …

A Cross-Sectional Study Of Phthalate Exposure And Inflammation Biomarker Levels Among Postmenopausal Women, Avery Trim

Masters Theses

Phthalates are industrial chemicals added to plastics found in products such as children’s toys, cosmetics, and household items, and some laboratory studies suggest phthalates may increase levels of inflammation. Chronic inflammation is associated with many chronic health conditions, such as diabetes and rheumatoid arthritis. Although research is limited, recent studies suggest a strong positive relationship between mono-butyl phthalate (MBP), mono-isobutyl phthalate (MiBP), and monocarboxynonyl phthalate (MCNP) and c-reactive protein (CRP), as well as monoethyl phthalate (MEP) and mono-3-carboxypropyl phthalate (MCPP) and interleukin-6 (IL-6). Additionally, this relationship has not been examined among postmenopausal women, a population that is at higher risk …

Reproductive Factors And Postmenopausal Fsh Levels, Rebecca Costa

Masters Theses

Recent studies have shown that postmenopausal follicle stimulating hormone (FSH) levels may be predictive of future cardiovascular disease risk. However, little is known about postmenopausal FSH levels, including the level of variation between women and factors associated with this variation. We assessed the relationship of multiple reproductive factors with FSH levels among 588 postmenopausal women in the Kuopio Ischemic Heart Disease Risk Factor Study. Participants were aged 53 to 73 years and not using hormone therapy at baseline (1998-2001). Reproductive factors were assessed at baseline, along with FSH levels. After adjustment for sex steroids, adiposity measures, plasma lipids, blood pressure, …

Impact Of Parity On Gait Biomechanics, Bekah P. Stein

Masters Theses

Background: Symptomatic knee osteoarthritis (OA) is an incurable condition that affects nearly 50% of adults, and women are twice as likely as men to develop OA. Throughout pregnancy, women experience large changes in morphology and gait mechanics, as well as changes in joint loading. It is possible these adaptations could cause lasting changes postpartum, which may potentially contribute to initiation of OA, thereby increasing the overall risk of OA for women.

Purpose: This exploratory study looked to identify differences between lower limb gait mechanics of healthy nulliparous women and healthy parous women.

Methods: 28 healthy female participants (14 parous, 14 …

Utilization Of Emulsion Chemistries For Delivery And Antiviral Application Of Carvacrol, Hao-Yuan Hsu

Masters Theses

Human norovirus (HuNoVs) are the most common enteric pathogen around the world that cause ~50% of foodborne illness of disease outbreaks annually. HuNoVs are the member of the Caliciviridae family, which consist of small (38 nm), unenveloped, single stranded RNA (ssRNA) viruses. Norovirus are divided into 5 genogroup (GI, GII, GIII, GIV, GV, GVI and GVII). The GI, GII, and GIV cause human illness, in addition, GII.4 genotype cause the most human disease. Due to HuNoVs are difficult cultured in vitro, the cultivable HuNoVs surrogates have been widely studied. Recently, some studies have been conducted with HuNoVs surrogates, for …

Cross-Cutting Narratives Of Opioid Use Disorder Among Pregnant Women And Mothers: Implications For Humanistic Care, Alice Fiddian-Green

Doctoral Dissertations

Opioid-related fatalities in the U.S. have increased drastically. Pregnant women and mothers with opioid use disorders (OUD) are a rapidly growing and vulnerable population. Using a critical narrative approach, this dissertation examines how the syndemic of trauma, substance use, and mental health conditions influences opioid use and treatment trajectories among pregnant women and mothers across the lifecourse. The goal of this dissertation was to examine three discursive resources that shape the social construction of perinatal and maternal opioid use across all strata of social life: macro-level (news media), meso-level (scientific), and micro-level (individual) narratives. Informed by 18-months of ethnographic observation, …

Improving Chinese Mothers’ Health Literacy: A Wechat Intervention, Qiong Chen

Doctoral Dissertations

The health literacy and eHealth literacy of women during the reproductive age is crucial, as it can affect their health and the health of their children. Promoting health literacy is essential to achieve mothers’ empowerment by improving access to and capacity of using health information effectively. However, functional, interactive, and critical health literacy and eHealth literacy have never been assessed among Chinese women. The first study during this dissertation assessed functional, interactive, and critical health literacy and eHealth literacy among 421 of Chinese mothers with children under 3 years old. The results revealed overall less than optimal level of health …

Multi-Level Barriers To Art Adherence Among Hiv-Infected Women In Rural Eswatini: A Mixed Methods Approach, Nozipho Becker

Doctoral Dissertations

Eswatini has the highest global prevalence of HIV despite universal access to free treatment. Lack of compliance continues to be a significant challenge for HIV care and management programs throughout the country. Studies investigating barriers to antiretroviral therapy (ART) adherence, particularly in women, who are the most vulnerable to HIV infections, are limited. The disproportionate impact of HIV on women can be attributed to multiple risk factors at the individual, household, and community/structural levels. Women living in rural settings are particularly at risk as a result of socio-cultural and environmental vulnerabilities such as oppressive traditional practices, intimate partner violence, and …

Estimating Age-Specific Contraceptive Use For Spacing Of Childbirth For All Countries In Sub-Saharan Africa From 1985 To 2030 Using A Bayesian Hierarchical Time Series Model, Gregory Guranich

Masters Theses

Contraceptive usage for spacing of childbirth is an important indicator for understanding family planning practices as well as fertility transitions. Fertility transition are especially important in sub-Saharan Africa where fertility remains high in many countries. However, estimates and short-term projections are generally not available for countries in this region. We developed a Bayesian hierarchical time series model to estimate and project usage of contraceptives for spacing by 5-year age groups for all countries in sub-Saharan Africa for the years 1985-2030. Estimating country-age-year specific usage is challenging due to limited data availability. We use Bayesian hierarchical models to share information across …

Markov Decision Process Approach To Strategize National Breast Cancer Screening Policy In Data-Limited Settings, Vijeta Deshpande

Masters Theses

Early diagnosis is a promising strategy to reduce premature mortalities and for optimal use of resources. But the absence of mathematical models specific to the data settings in LMIC’s impedes the construction of economic analysis necessary for decision-makers in the development of cancer control programs. This thesis presents a new methodology for parameterizing the natural history model of breast cancer based on data availabilities in low and middle income countries, and formulation of a control optimization problem to find the optimal screening schedule for mammography screening, solved using dynamic programming. As harms and benefits are known to increase with the …

Gestational Weight Gain, Offspring Asthma And Wheeze Phenotypes In Project Viva, Kathryn Wagner

Masters Theses

In the US, 8.4% of children are diagnosed with asthma by age 18, making asthma one of the most common chronic conditions among children. Additionally, 25% of children experience persistent wheezing by age 6, an indicator of childhood asthma. Both childhood asthma and persistent wheezing may be linked to inflammatory and immune mechanisms, which are associated with inadequate and excessive gestational weight gain. Studies investigating the relationship between gestational weight gain and offspring asthma and wheeze phenotypes are limited by self-reported gestational weight gain, early age at asthma and wheeze assessments, limited adjustment for potential confounders and no trimester-specific evaluations. …