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Physical Activity On Multiuse Trails And In A Novel Bike Park Within An Urban Wilderness, Douglas Gregory

Doctoral Dissertations

Research has shown that the presence of, access to, and use of parks and trails is associated with increased levels of PA. However, little research exists on nature-based, recreational multiuse trails and bike-specific amenities within parks and their impact on PA. Therefore, to explore the effect trails and bike parks have on PA, this dissertation conducted three investigations to: 1) determine the impact of trail/greenway interventions on PA, 2) investigate how seasonality and weather influence nature-based recreational trail use, and 3) develop a demographic and PA profile of bike park users.

Investigation 1 (Chapter 4) systematically reviewed the literature specific …

Effects Of The U.S. Veterinary Feed Directive Final Rule On The Prevalence Of Violative Antibiotic Residues And Antibiotic-Resistant Bacteria In Animal Products, Md Shamim Sarkar

Doctoral Dissertations

Antibiotic-resistant is a public health concern. The dissertation objective was to assess the effect of the implementation of the Veterinary Feed Directive (VFD) rule changes on the prevalence of violative antibiotic residues and antibiotic-resistant bacteria in food-animal tissues, retail meats, and cecal samples from food animals compared to the pre-VFD rule change period in the U.S. To understand the effect of implemented VFD rule changes on violative antibiotic residues in food-animal tissues, inspector-generated sampling (IGS) data from the U.S. National Residue Surveillance Program (NRP) was analyzed. An important observation was that implementing VFD rule changes was associated with the decreased …

Spatial Epidemiology Of Prediabetes And Diabetes In Florida, Md Marufuzzaman Khan

Doctoral Dissertations

The burden of diabetes and diabetes-related Emergency Department (ED) visits has increased in Florida. However, Diabetes Self-management Education (DSME) Program participation remained considerably low. Little is known about disparities of DSME participation, diabetes complications, and ED use by diabetes patients in Florida and yet this information is important for guiding health programs aimed at reducing diabetes burden. Therefore, the objectives of this study were to investigate: (a) disparities of diabetes prevalence and DSME participation; (b) disparities of diabetes-related ED visit risks; and (c) prevalence and predictors of stroke among persons with prediabetes and diabetes.

Behavioral Risk Factor Surveillance System and …

Advanced Air Quality Management With Machine Learning, Cheng-Pin Kuo

Doctoral Dissertations

Air pollution has been a significant health risk factor at a regional and global scale. Although the present method can provide assessment indices like exposure risks or air pollutant concentrations for air quality management, the modeling estimations still remain non-negligible bias which could deviate from reality and limit the effectiveness of emission control strategies to reduce air pollution and derive health benefits. The current development in air quality management is still impeded by two major obstacles: (1) biased air quality concentrations from air quality models and (2) inaccurate exposure risk estimations

Inspired by more available and overwhelming data, machine learning …

Healthcare Service Utilization And Life Satisfaction In South Africa, Tamara Chavez-Lindell

Doctoral Dissertations

South Africa has achieved improvements in many health measures over the past 30 years, yet significant disparities in healthcare utilization and health outcomes persist. There is evidence that healthcare utilization has a strong influence on health outcomes and life satisfaction. Unfortunately, rural areas tend to have poorer accessibility and utilization of health services, leading to disparities in health outcomes. In rapidly urbanizing countries such as South Africa, identification of disparities and predictors of public healthcare utilization and life satisfaction may provide information that can be used to guide development of programs aimed at improving population health outcomes, quality-of-life, and overall …

Perinatal Health In North Dakota: Emerging Issues, Grace N. Njau

Doctoral Dissertations

Preterm birth, newborn screening refusal, and postpartum depression represent three emerging areas of concern that have not been previously investigated in North Dakota. Their potential impact creates significant social, behavioral, and economic burdens. Although various studies have investigated preterm birth and postpartum depression, to the best of my knowledge, newborn screening refusal in the United States has not been previously investigated. In alignment with the role of Title V of the Social Security Act (Maternal and Child Health) Programs to conduct ongoing statewide needs assessments, the objectives of this study was to investigate and identify predictors of preterm birth, newborn …

Genealogy Tells: Informing Health And Aging Policies Using East Tennessean Older Women's Family Histories, Perceptions, And Experiences Of Health Inequity, Heather Davis

Doctoral Dissertations

Older women face unique health inequities challenges. This study aims to provide an understanding of older women’s perceptions and situated experiences regarding the gendered health inequities they face and the social determinants (SDH) thereof. It examines how these health inequities are situated in older women’s genealogical (familial) and geographical health and mortality outcomes histories and how their perceptions and experiences of health inequities and their familial mortality outcomes histories are characterized by the geopolitical and social norms in which they live. The purpose of this project is to present policy and decision-makers with insights about and recommendations from older women …

Design And Development Of The Urban Population Health Observatory To Improve Disease Surveillance And Response, Whitney Brakefield

Doctoral Dissertations

Chronic and infectious diseases have a profound impact on the quality and length of life of populations that suffer from these conditions. Scientists, physicians, and health officials are seeking innovative approaches to decrease the morbidity and mortality of deadly diseases. Incorporating artificial intelligence and data science techniques across the health science domain could improve disease surveillance, intervention planning, and policymaking. In this dissertation, we describe the design and development of the Urban Population Health Observatory (UPHO), an explainable knowledge-based multimodal big data analytics platform. A common challenge for conducting multimodal big data analytics is integrating multidimensional heterogeneous data sources, which …

An Epidemiologic Study Of Vaccination Exemptions And Pertussis Risk, Corinne B. Tandy

Doctoral Dissertations

The incidence of pertussis, a vaccine-preventable disease that can have severe complications in infants, has been increasing in the United States over the past three decades. Vaccine hesitancy and refusal have also increased and are associated with vaccination exemptions, which in turn are associated with outbreaks of vaccine-preventable diseases, including pertussis. Understanding attitudes towards vaccinations and identifying geographic disparities of vaccination exemptions and pertussis risks is useful for guiding control programs. Therefore, the objectives of this study were to: (i) investigate attitudes towards vaccinations; (ii) identify county-level geographic disparities and sociodemographic predictors of vaccination exemptions in Florida; (iii) investigate county-level …

Rural Hospital Closures And Perceived Access To Care: A Qualitative Descriptive Study In An Appalachian County Of Tennessee, Amanda M. Letheren

Doctoral Dissertations

Background: Tennessee has suffered more hospital closures per capita than anywhere else in the nation. The impact of hospital closures on access to care in rural and economically distressed Appalachian counties of Tennessee is of particular concern because these communities experience great health disparities. Hospital closures may exacerbate these disparities and create additional barriers when accessing care.

Objectives: The aim of this study was to describe community residents’ perceptions of health and access to care following a hospital closure in a rural and economically distressed Appalachian county of Tennessee.

Methods: This study used a qualitative descriptive approach to present community …

Emerging Adults’ Experiences As Receivers Of Sexually Transmitted Infection Disclosures From Sexual Partners: A Three-Part Examination, Kayley D. Mcmahan

Doctoral Dissertations

Each year in the United States, over 20 million cases of sexually transmitted infections (STIs) are diagnosed, mostly among those in the developmental period of emerging adulthood (ages 18-29). Research on STI disclosure to romantic and sexual partners has increased over the last two decades, but this research has (a) generally lacked a developmental and theoretical focus, (b) not examined disclosure recipients, and (c) not been systematically and critically synthesized. To address these limitations, I conducted a three-part examination. First, I systematically reviewed the STI disclosure literature and summarized findings, critical limitations, and future research and intervention directions. Next, I …

A Collective Metamorphosis Of Breastfeeding Mothers: A Phenomenological Exploration Of A Face-To-Face Healthcare Provider Facilitated Peer Support Group, Emily Alexandria Tucker

Doctoral Dissertations

This research study used phenomenology to examine a face-to-face healthcare facilitated breastfeeding support group. Participant observations and phenomenology were used to address the following research questions: 1) what are the lived experiences of the women participating a breastfeeding support group, 2) how does the group influence their lived experiences, and 3) what were the common experiences of these women? The support group participants were observed while the researcher acted as a participant observer over the course of an eleven-month period. There were a total of seven women interviewed about their lived experiences breastfeeding and attending the support group. Data from …

Prevalence Of Rats And Rodent Borne Pathogens Across Post-Katrina New Orleans, Bruno Marco Ghersi

Doctoral Dissertations

Disasters are happening at an increasingly higher rate and intensity a trend that is expected to continue as more humans migrate to coastal urban areas. Disasters, and as importantly, disaster recovery can affect how native and pest populations will recover. My aim was to improve understanding of disease risk by evaluating the socioecological conditions that have shaped commensal rat recovery and distribution, as well as the pathogens they carry, across New Orleans after Hurricane Katrina. I first estimated relative abundance and distribution of commensal rats from rodent trapping conducted between mid-2014 and early-2017 across 96 sites in 10 areas of …

Emerging Zoonotic Pathogens At The Human-Wildlife Interface In Protected Areas: Game In The Southeastern United States And Bushmeat In Northern Uganda, Breeanna M. Dell

Doctoral Dissertations

The emergence of zoonotic pathogens through contact with animal reservoirs is a well-documented phenomenon and growing concern for public health. Particularly in light of the ongoing Ebola epidemic in the Democratic Republic of the Congo and the coronavirus pandemic, the need to understand mechanisms of contact and disease transmission at the human-wildlife interface and to understand which infectious agents may reside within wildlife reservoirs crucial. In this project, we investigated the potential introduction of zoonotic cestode Echinococcus canadensis to public lands in Tennessee subsequent to elk translocation effort and aimed to identify whether a transmission cycle was established in this …

Exploring The Geography Of Neighborhood Mental Health Vulnerability In The Context Of Racial/Ethnic Residential Segregation, Donghee Koh

Doctoral Dissertations

Mental health matters because it affects all aspects of our lives. There is a growing body of literature about neighborhood effects on mental health. These studies argue that individuals living in socioeconomically disadvantaged neighborhoods are more likely to suffer from mental illnesses due to the higher prevalence of chronic stressors and their inability to cope with such problems. A neighborhood, however, is much more than just the sum of its socioeconomic characteristics, and I argue that there are many other important contextual factors that need to be considered to better understand the impact of neighborhood environment on mental health. Hence, …

Adverse Childhood Experiences And Health Related Quality Of Life As Well As Cognitive Decline In Adult Population In Tennessee, Pragya Poudel

Doctoral Dissertations

Adverse childhood experiences (ACEs) have been linked to increased risk of negative health outcomes in later life. At least half of the population in Tennessee experience one ACE. Further, Tennessee ranks amongst the top five states in terms of cognitive decline in adult populations age 45 and above. To our knowledge, there is yet no study that has explored ACEs and adult health outcomes (health-related quality of life (HRQOL) and cognitive decline) in Tennessee.

The goal of this study was to examine the relationship between ACEs [by overall, individual, type/domain, and dose-response effect of ACE] and HRQOL as well as …

Evaluation Of Increased Targeted Enforcement And Community-Based Outreach And Education Programs To Increase Nighttime Seatbelt Use In East Tennessee, Kwaku Frimpong Boakye

Doctoral Dissertations

According to the National Highway Traffic Safety Administration (NHTSA), motor vehicle crashes are the leading cause of death among people aged 1-54 in the United Sates. In 2015, the number of motor-vehicle deaths on U.S. roadways totaled 35,092, a 7% increase from 2014 (32,744). Though lower gas prices and increased vehicle mileage combined with risky driving behaviors (e.g. speeding, driving while texting) account for the increased fatality rate, seatbelt non-use has been a significant contributory factor. It is estimated that nearly half (48%) of passenger vehicle occupants involved in fatal crashes each year are unrestrained.

In a recent 2014 report …

Estimating The Effects Of Arizona-Style Omnibus Immigration Policies On Latino Children’S Access To Health Care, Chenoa Dawn Allen

Doctoral Dissertations

Since 2005, US states have passed hundreds of immigration policies. Among state policies that restrict rights for immigrants, omnibus immigration policies are the harshest. Omnibus immigration policies expand local enforcement of federal immigration law; create penalties for employers who hire undocumented immigrants; and restrict undocumented immigrants’ access to public benefits.

Omnibus immigration policies have attracted considerable attention and concern from researchers, policymakers, health care providers, and civil rights advocates. However, no single resource has compiled a comprehensive list of omnibus immigration policies. In Paper 1, I used a clear definition of omnibus immigration policies—policies that incorporate three or more immigration-related …

Effect Of Exposure To 3,4,4′-Trichlorocarbanilide (Tcc) During Critical Developmental Life Stages, Rebekah Charlene Kennedy

Doctoral Dissertations

Triclocarban (3,4,4'-trichlorocarbanilide; TCC) is a non-prescription antimicrobial compound found in bar soaps. Once applied to the skin, TCC is absorbed and can be detected systemically. Evidence of endocrine disruption has been documented both in vitro and in vivo in adult and immature rats. To date, little research attention has been paid to early life TCC exposure. Here, we demonstrated reduced survival among neonates born to rats provided 0.2 percent w/w or 0.5 percent w/w TCC supplemented chow during lactation. TCC was detected in the breastmilk and suckling neonates developed distended abdomens with liquid mustard colored diarrhea indicating a disturbance of …

High Reliability Organizational Suggestions To Reduce The Risk Of Hospital-Associated Infections, Sandra Catrice Affare

Doctoral Dissertations

Over 1.7 million hospital-associated infections (HAIs), resulting in 99,000 deaths, occur each year in the United States. HAIs are defined as infections that occur within 48 hours of hospital admission without evidence of the infection being present or incubating at the time of admission. HAIs are a major concern to the medical community due to the potential loss of life and high costs. Healthcare providers should be accountable for reducing the rates of HAIs and society needs to hold them accountable for the safe implementation and outcomes of the services they provide.

A high-reliability organization (HRO) is commonly described as …

Population Modeling For Resource Allocation And Antimicrobial Stewardship, Jason Bintz

Doctoral Dissertations

This dissertation contains two types of population models with applications in conservation biology and epidemiology. In particular, it considers models for resource allocation and antimicrobial stewardship.

In a population model with a parabolic differential equation and density dependent growth, we study the problem of allocating resources to maximize the net benefit in the conservation of a single species while the cost of the resource allocation is minimized. The net benefit is measured in terms of maximizing population abundance and the goal of maximizing abundance is divided between the goal of maximizing the overall abundance across space and time and the …

Living With Hypertension: Experiences Of Black Men Related To Their Perceptions Of The Clinical Encounter At Diagnosis, Glenda Mccartney Feild

Doctoral Dissertations

Introduction: In the U.S., hypertension (HTN) is the most common primary diagnosis and HTN related illnesses are the number one cause of death. Being a member of the Black population increases the risk for developing HTN. Black males are reported to develop HTN earlier in life and have a high incidence of undiagnosed, untreated, and uncontrolled HTN. Sociocultural and gender barriers influence this population’s perceptions of medical experiences, which affects their participation in health-promoting behaviors such as eating a healthy diet, engaging in regular physical activity, avoiding tobacco, limiting alcohol consumption, and decreasing stress.

Purpose: The purpose of this study …

Communication, Control, And Time: The Lived Experience Of Uncertainty In Adolescent Pregnancy, Elizabeth Dortch Dalton

Doctoral Dissertations

This study qualitatively examined the lived experience of uncertainty among pregnant adolescents. Utilizing a phenomenological approach, long interviews were conducted with 10 pregnant adolescent women between the ages of 15-18 years. Interviews were transcribed and analyzed using the process of phenomenological explication. Data, emergent themes, memos, and a detailed audit trail were maintained using the qualitative data analysis package Nvivo 10 for Mac (beta version). Findings can be summarized with eight themes that underlie the essence of uncertainty in adolescent pregnancy: suspicion and denial, disclosure and reactions, controlling the flow of information, relational renegotiation, the emerging reality of pregnancy, information …

Intimacy Uncertainty And Identity In Gay Male Couples Dealing With A Serodiscordant Hiv Status, Scott Allen Eldredge

Doctoral Dissertations

When individuals are diagnosed with a chronic illness, their lives instantly change. Daily routines are interrupted and attendance to the symptoms and side effects of illness and medication becomes a daily chore. However, the patient is not the only one that feels the disruptive effects of illness and the partner of the chronically ill patient must also contend with the daily effects of an illness that they themselves do not have. In the case of HIV, the infectious nature of the disease, along with the stigma associated with the disease, serve to be additional sources of stress in an already-stressful …

Hospital Competitive Strategies And Performance Outcomes, Wei Wu

Doctoral Dissertations

Hospitals are under increasing pressure to improve performance and healthcare outcomes. The existing literature does not point to a clear conclusion on whether competition can help address the performance challenges of hospitals which lead to improvements in clinical outcomes. Prior research on the effects of hospital competitive strategies usually focuses on one strategy or one type of outcome at a time. As such, there is a dearth of systematical studies on different hospital competitive strategies and their consequent performance outcomes.

The main objective of this dissertation is to examine several hospital competitive strategies and quantitatively validate the implications of each …

Development Of The Biostatistics And Clinical Epidemiology Skills Assessment For Medical Residents, Patrick Brian Barlow

Doctoral Dissertations

This study developed the Biostatics and Clinical Epidemiology Skills (BACES) assessment, and established its preliminary item characteristics and validity evidence. Unlike previous instruments, the BACES assessment was developed and tested using an item response theory (IRT) approach to measurement to create a new, adaptive biostatistics and clinical epidemiology knowledge assessment for graduate medical professionals. Thirty multiple-choice questions were written to focus on interpreting relevant examples of clinical epidemiology and statistical methods. A four person expert panel reviewed these items for content validity. After this review, the BACES assessment was administered to 147 medical residents across three academic medical centers. Results …

Associations Of Total Activity Counts And Physical Activity Intensity Levels With The Metabolic Syndrome: A Structural Equation Modeling Approach, Dana Lizbeth Wolff

Doctoral Dissertations

To clarify the protective benefits of physical activity (PA), epidemiologists and public health researchers continue to seek improved methods of assessing PA. In particular, accelerometers have gained acceptance with researchers as they provide reliable estimates of PA and can record both the amount and intensity of ambulatory movement. However, there is concern that accelerometer data reduction techniques may not provide quantitatively accurate measurements of time spent in various PA intensity categories. One way to circumvent these inaccuracies is to use the accelerometer-derived total activity counts (TAC), which is a more direct expression of what the monitor records.

In order to …

Exploration Of Breastfeeding Concepts Among Current And Future Parents: Results Of Questionnaires Administered To Chinese And Us University Students And To New Mothers In China, Zixin Lou

Doctoral Dissertations

The objectives were to explore breastfeeding knowledge, attitudes, and intention of future parents, and to investigate indicators and causes of perceived insufficient milk (PIM) supply among Chinese mothers. Objectives were accomplished using a cross-sectional study design. Two questionnaires were developed, one targeting Chinese and US undergraduates, and a second targeting Chinese mothers. In total, 597 undergraduates (395 Chinese; 202 US) and 392 Chinese mothers participated in the study. Data cleaning resulted in a final sample size of 572 for undergraduates (383 Chinese; 189 US) and 341 for Chinese mothers. Results showed that undergraduates in both countries possessed some breastfeeding knowledge …

Geographic And Temporal Epidemiology Of Campylobacteriosis, Jennifer Weisent

Doctoral Dissertations

Campylobacteriosis is a leading cause of gastroenteritis in the United States. The focus of this research was to (i) analyze and predict spatial and temporal patterns and associations for campylobacteriosis risk and (ii) compare the utility of advanced modeling methods. Laboratory-confirmed Campylobacter case data, obtained from the Foodborne Diseases Active Surveillance Network were used in all investigations.

We compared the accuracy of forecasting techniques for campylobacteriosis risk in Minnesota, Oregon and Georgia and found that time series regression, decomposition, and Box-Jenkins Autoregressive Integrated Moving Averages reliably predict monthly risk of infection for campylobacteriosis. Decomposition provided the fastest, most accurate, user-friendly …

The Psychosocial Effects Of Beryllium Sensitization And Chronic Beryllium Disease, Jeffrey Robert Miller

Doctoral Dissertations

The purpose of this study was to develop and validate a theoretical model that explains the psychosocial effects of beryllium sensitization (BeS) and chronic beryllium disease (CBD). Sequential, mixed research methods were used. The study population was current and former workers from Department of Energy laboratories and manufacturing facilities who have either BeS or CBD. A theoretical model based on uncertainty in illness and psychosocial adjustment to illness theories was developed. It was hypothesized that uncertainty had a negative effect on health quality of life unless mediated by the ability to make psychosocial adjustments to illness. Qualitative study results supported …