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Physical Activity During Pregnancy And Birth Outcomes In South Carolina 2009-2015, Andrew Tyler Broadway

Theses and Dissertations

Physical activity is known to be beneficial to adults in general, including pregnant women, but the literature on physical activity and neonatal outcomes has been inconsistent. Few studies have differentiated between physical activity prior to pregnancy and during pregnancy to see whether the typical beneficial effect is not due to having a more active lifestyle in general. The Pregnancy Risk Assessment Monitoring System (PRAMS) is a national cross-sectional surveillance system. Our data from SC PRAMS included 6391 respondents and was weighted to be representative of population of pregnant women that delivered in the state. We excluded births that were not …

The Association Of Hospital Practices To Breastfeeding Behaviors In South Carolina: Analysis Of 2013-2015 Pregnancy Risk Assessment Monitoring System (Prams) Data, Larisa Donnette Bruner

Theses and Dissertations

Objective: The purpose of this study was to determine whether hospital practices are associated with breastfeeding initiation and breastfeeding duration for ≥10 weeks.

Methods: We analyzed the 2013-2015 South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) data. The population of interest was mothers who delivered a single live birth in the hospital. The infant was alive and living with the mother at the time of the survey. Chi-square and logistic regression were used to examine breastfeeding initiation and duration among all women who delivered in a hospital and those who stated that they initiated breastfeeding while in the …

The Importance Of Interdisciplinarity: Redefining The Health Belief Model, Ross F. Lordo

Senior Theses

Throughout academia, there lacks an existence of a commonly utilized multicomponent and interdisciplinary approach in understanding our outside world. This thesis provides an analysis of the current state of interdisciplinarity and the need to develop interdisciplinary theory. Through this effort, the researcher utilizes the health belief model as a framework that is severely limited in applicable scope due to its constructs. Contrastingly, systems theory and game theory are validated as examples of theories with an interdisciplinary nature. Through the coding of the literature pertaining to the qualitative characteristics of the health belief model, game theory and systems theory, guidelines in …

Impressions Of Participants In A Chemical Mass Casualty Exercise, Ethan J. Start, Joan M. Culley, Abbas Tavakoli

Senior Theses

A mass casualty exercise was performed to investigate triage and decontamination of patients exposed to an irritant gas. Nursing students participated in two groups: emergency department triage (ED) and decontamination (DECON). While participants felt overall that the experience was valuable, DECON participants had a greater interest in emergency response and were more likely to volunteer again.

A Qualitative Exploration Of Experiences And Motivations For Diabetes Self-Management In African American Men Between The Ages Of 40-85 With Type 2 Diabetes, Anthony Q. Walker

Theses and Dissertations

Diabetes is a devastating disease that can affect an individual’s health and quality of life, but if managed properly, individuals with diabetes can have a good quality of life. Diabetes strikes African American men at a high rate. This study used a qualitative design to explore African American men between the ages of 40-85 with type 2 diabetes (T2DM) and their definition of diabetes and motivation, their experience of living with diabetes, their self-management behaviors, their motivations for managing diabetes, and what they and healthcare providers believe motivates them to self-manage diabetes and to attend diabetes self-management education (DSME) programs. …

Investigating Drug-Related Violence In Indian Country: The Lumbee Tribe Of North Carolina, Asa Alena Revels

Theses and Dissertations

Drug-related violence (DRV) impacts the over-all wellbeing of communities, with disparate health outcomes observable in many poor, minority communities. The purpose of this study was to better understand the multi-level social and environmental factors influencing elevated rates and prevention of DRV within the Lumbee, a southeastern American Indian Tribe. This was accomplished via in-depth, one-on-one interviews with 37 Lumbee Tribal Members and Key Leaders. The findings align with existing research, revealing the influence of such factors as poor socioeconomic conditions, coping strategies, broken family structures, and the influence of federal policy. Of interest was the substantial influence of the local …

Patient Characteristics, Discharge Disposition, And Hospital Factors Associated With All Cause 30-Day Hospital Readmission For Total Joint Arthroplasty In 2014, Hamad Yahya Alzamanan

Theses and Dissertations

Objective: Recent improvements in hospital care have come from a growing knowledge of factors that contribute to readmission. The objective of this work is to identify and describe the national readmission rate after Total Joint Arthroplasty, and to evaluate selected hospitals’ and patients’ factors for their association with the all-cause 30-day readmission rate after TJA in the United States in 2014. Method: Retrospective analysis of 938,504 TJA acute care hospital discharge records was performed, using a nationally representative database that is dedicated to the study of hospital readmissions, and accounts for 51% of total US hospitalizations. Logistic regression models were …

A Longitudinal Analysis Of Shiftwork And Self-Reported Depression In A Police Cohort, Meghan Holst

Theses and Dissertations

Background: Shiftwork is associated with many chronic diseases stemming from the disruption of circadian rhythms. Police officers have a high risk for many adverse conditions including depression. Abnormal bodily functions, such as increased stress and disturbed sleeping patterns, may play an important role in the development and severity of depression. This study was designed to assess the association between depressive symptoms and shiftwork in a police cohort from Buffalo, NY

Methods: This longitudinal analysis consists of 470 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Data were collected during visit 3 between 2004-2005 and visit …

Sleep, Shiftwork Adaptation, Autonomic Dysfunction, And Metabolic Syndrome, Torrance Torrance

Theses and Dissertations

Background: Sleep is considered a physiological necessity and its disruption is associated with a wide variety of adverse mental and physical health outcomes including increased incidence of obesity, cancer, hypertension, cardiovascular disease, type 2 diabetes mellitus, stroke, depression, post-traumatic stress disorder (PTSD), work-related and vehicle accidents, and aberration of the autonomic nervous system.

Methods: Three studies were conducted from three separate populations. The first study examined the latent trajectories of self-reported sleep quality in active duty Army soldiers over a 3-year period using data from the Global Assessment 2.0 survey and Repeated Measures Latent Class Analysis (RMCLA) procedures. Generalized Estimating …

The Importance Of Person And Place In Predicting Prostate Cancer Incidence And Mortality Among United States Veterans Seeking Veterans Health Administration Care, Peter Georgantopoulos

Theses and Dissertations

T Introduction: There are several unique characteristics in the epidemiology of prostate cancer (PrCA) that make it an interesting and important cancer to study. The first is that while prostate cancer is the most common cancer that men develop, it is one of the least common cancers that men die from. This indolent nature of PrCA has led to the idiom among health scientists that “men are more likely to die with PrCA than due to PrCA”. Just like other cancers, several individual-level risk factors (e.g., family history of the disease, age, and race) are well established for both PrCA …

The Impact Of The Medicaid Coverage Expansion And The Removal Of Cost-Sharing Under The Affordable Care Act On Mammography And Pap Tests, Abeer Alharbi

Theses and Dissertations

Background: The Affordable Care Act (ACA) aimed at making health care affordable and accessible including the use of preventive care services. To achieve these aims, the ACA expanded Medicaid coverage to population with income below 138% of FPL and removed cost-sharing when using preventive care services recommended by the USPSTF. This study tried to assess the impact of these provisions on the rate of mammography and Pap tests among women. Methods: Data was obtained from the Medical Expenditure Panel Survey - Household Component MEPS-HC. A difference-indifference design was used to determine the effect of Medicaid eligibility expansion on the outcomes …

Factors Affecting Patient Satisfaction With Healthcare System Of Turkey, Serdar Aydin

Theses and Dissertations

The World Health Organization (WHO) defines health system as comprising of all the organizations, resources, and institutions dedicated to improving health. Health systems have a responsibility not just to improve the health of the population they serve but to provide financial protection against the costs of illness and to respond to people’s expectation with dignity. Besides, healthcare satisfaction and consumer satisfaction have become the latest trend in measuring quality to have a competitive advantage or best practice in the healthcare industry. Over the past 30 years, consumer satisfaction has gained widespread recognition as a measure of quality in many services …

Chronic Conditions Profiles And Cardiometabolic Risk Factor Control Among A Diverse Sample Of Older Adults With Type 2 Diabetes Mellitus, Tsion Kidanie

Theses and Dissertations

Background: Multiple chronic condition is common in older adults with diabetes. Several prior studies have shown that having multiple chronic condition impact cardiometabolic risk factor controls (i.e., blood pressure, High-density lipoprotein (HDL) cholesterol level, and high glycated hemoglobin (HbA1c). However, it is not clear whether these results extend to a multiethnic sample of older adults.

Objectives: 1). Examine the association between Comorbidity profile and ABCs goals achievement. 2). Examine whether the association between comorbidity profile and ABCs goals achievement is moderated by race/ethnicity.

Methods: A sample of 3532 participants from Health and Retirement Study (HRS) years 2010 and 2012 and …

The Impact Of False Positive Mammography Results On Breast Cancer Screening Intention Among Black Women, Deeonna E. Farr

Theses and Dissertations

Extensive research indicates that false-positive mammograms (FPM) have been associated with negative psychosocial and cancer-related beliefs, but only a handful of studies examine Black women’s reactions to this experience. Additionally, these studies do not investigate how organizational and provider-level factors in concert with individual patient characteristics shape Black women’s experiences and reactions to FPM results. The purpose of this study was to determine the impact of organizational, provider, and individual-level factors on the processes and outcomes associated with FPM results in Black women. This study had two specific aims:

1) To describe, using a mixed methods approach, the organizational and …

Association Of Objective Measures Of Sleep And Inflammation Markers On Police Officers: A Cross-Sectional Analysis, Megan R. Buss

Theses and Dissertations

Police officers are a unique occupational group due to the fact that they have more health problems than many other occupations. These health problems could be a result of elevated inflammation markers caused by poor sleep. Sleep influences circadian rhythms, which thereby influences the function of the immune system. The immune system is responsible for the body’s inflammatory response using pro-inflammatory cytokines such as IL-6, CRP, Fibrinogen, and TNF-a. These cytokines can become elevated if disruption of the sleep cycle occurs. Elevated levels of inflammatory markers are associated with increased risk of cardiovascular disease. Police officers also work shifts and …

Understanding The Mechanisms Linking Gendered Intrahousehold Bargaining Power And Child Nutrition In Rural Nepal, Shibani Kulkarni

Theses and Dissertations

Child undernutrition is a serious issue in Nepal as 36% of children below five years of age are chronically undernourished. Reducing child undernutrition is an important priority to prevent adverse effects through the life course that perpetuate the cycle of undernutrition and poverty.

Women’s intra-household bargaining power is an important determinant of child nutrition. Intra-household bargaining power is an individual’s relative social and economic position within the household to access and control resources, and influence decision-making. In our research, we use women’s intra-household bargaining power as a resource for care, which enables women to be exposed to nutrition information, gain …

Healthy Motivations For Moms-To-Be (Healthy Mom2b) Study: A Mobile Health Intervention Targeting Gestational Weight Gain Among U.S. Women, Alicia Anne Dahl

Theses and Dissertations

INTRODUCTION: Almost one-half of all pregnant women in the U.S. exceed the Institute of Medicine’s (IOM) gestational weight gain (GWG) guidelines. Healthy GWG is critical for reducing adverse health outcomes associated with excessive GWG for the mother and infant. Electronic health (e-health) interventions delivered through mobile apps and websites hold potential as readily available resources for targeting health behaviors and monitoring GWG during pregnancy. The development of the Healthy Motivations for Moms-To-Be (HM2B) intervention was informed by health behavior theories, a systematic review of existing in-person and technology mediated interventions (Aim 1 of this dissertation), and results of an online …

How Do Health System Employees With Established Musculoskeletal Complaints Decide On Their Treatment Pathway? A Qualitative Approach, Noor Alshareef

Theses and Dissertations

Purpose: Non-pharmacologic treatment such as physical therapy (PT) are advocated for musculoskeletal pain for decreasing opioid use. Early access to PT has been shown to decrease costs and improve outcomes through direct access via self-referral. Although self-referral to PT is permitted in the majority of U.S states, health insurance coverage has been identified as a barrier preventing some patients with musculoskeletal complaints from using it. There are few studies examining patient factors related to early access to physical therapy via self-referral. The purpose of this study was to identify the factors outside of insurance that influence the choice to access …

Examining Faith-Based Communities As Leverage Points For The Prevention Of Childhood And Adolescent Obesity, Caroline Glagola Dunn

Theses and Dissertations

Faith-based research and partnerships are becoming more popular as an approach to address the health of underserved populations including racial and ethnic minorities and rural populations. Despite growing interest in faith-health partnerships, little research is available assessing faith-based interventions as potential leverage points for the prevention of childhood and adolescent obesity and the promotion of healthy behaviors. This research aimed to examine the potential for such partnerships within the context of ongoing research partnerships in South Carolina. Specifically, the first study assessed current peer-reviewed literature to determine reporting of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM elements) in faith-based nutrition …

Interpersonal Communication About Cigarette Warning Labels Among U.S. Smokers: Differences Between Latinos And Whites, Victoria Catherine Lambert

Theses and Dissertations

Pictorial health warning labels (HWLs) on cigarette packs are used worldwide to curb cigarette smoking, the leading preventable cause of death in the United States While individual-level mediators of HWLs’ effects on cessation have been thoroughly studied, interpersonal communication about HWLs has received less attention in HWL research. However, results from one study demonstrated the importance of interpersonal communication, finding that conversations about HWLs predicted quit attempts in Australia, Canada, and Mexico. That study also found that smokers in Mexico, where most smokers are Latino, reported more conversations than smokers in Australia and Canada, where most smokers are non-Latino White. …

Polyp Detection During Colonoscopy Among Uninsured Patients In South Carolina, Lauren Hill

Theses and Dissertations

Little information is known on what demographic, behavioral, and procedural factors influence the number of polyps found during a colonoscopy screening for colorectal cancer (CRC). The main objective of this study is to describe the polyp detection rate (PDR), number of polyps removed, and predictors of polyp count overall and for high-risk polyps among uninsured patients undergoing colonoscopy in the Colorectal Cancer Prevention Network (CCPN) program of South Carolina. We performed a secondary data analysis on CCPN data for colonoscopies performed between May 2014 and May 2017. We assessed the association of polyp count with the following variables: age, race, …

Effect Modification By Stroke To The Relationship Between Tooth Loss And Cognitive Decline, Amanda Collins

Theses and Dissertations

Background: A decline in cognitive functioning is one of the greatest burdens that older adults face. Studies indicate that periodontal disease is positively associated with cognitive decline. The link between stroke and cognitive decline is well-established, and literature supports that tooth loss and stroke are associated as well, but the role that stroke plays in the relationship between tooth loss and decline in cognitive functioning is, as of yet, unclear. This study uses data from the REGARDS cohort to examine the effect of stroke on the relationship between periodontal disease and cognitive function.

Methods: The REGARDS cohort is comprised of …

Food Insecurity And Hypertension Prevalence, Awareness, Treatment And Control, Alexandra N. Luttrell

Theses and Dissertations

Objective: To examine the association between food insecurity and the prevalence of pre-hypertension and hypertension among U.S. adults. Additionally, this project will examine the association between food insecurity and the awareness, treatment and control (ATC) of hypertension.

Design: A cross-sectional study using data from the National Health and Nutritional Examination Survey (NHANES) 2011-2012 and 2013-2014 waves was deployed to examine the association between food insecurity and the prevalence and ATC of hypertension. Food security was measured by the cumulative number of affirmative responses to the 10-item U.S. Household Food Security Survey Module (HFSSM) questionnaire which were graded into four categories; …

Food Acquisition And Shopping Patterns And Associations With Body Mass Index, Xiaonan Ma

Theses and Dissertations

Background: Obesity is a big public health concern in the US. Previous studies examined its association with food shopping practices measured by distance to the food store, shopping frequency, and type of store selected. However, not much is known about the actual food acquisition and shopping habits integrating multi-dimensional aspects. The purpose of this study was to identify distinct food acquisition and shopping patterns in populations primarily residing in food deserts in South Carolina (SC) and a general population in the US and characterize these patterns with respect to socioeconomic status (SES), nutritional knowledge, and perceptions and store selection …

Association Of Insurance And Provider Type With Patients’ Perceived Cost And Ease Of Access To Healthcare Services Among Medicare Beneficiaries Diagnosed With Diabetes, Metria Harris

Theses and Dissertations

Medicare beneficiaries diagnosed with diabetes are likely to have health complications or episodes associated with diabetes, resulting in higher health care utilization and costs. Andersen’s Health Care Utilization Behavior Model (HCBM) includes predisposing, enabling, and need factors, but it excludes perception. Ajzen’s Theory of Planned Behavior (TPB) shows that perception influences health service use. This study was performed using a real-world model integrating Andersen’s HCBM and Ajzen’s TPB to determine whether there was an association between insurance type (Medicare Part D versus non-Part D) and perceived ease of access or cost among Medicare beneficiaries with diabetes. The second objective was …

Introduction Of Innovative Medical Practices In Mayo Clinic: Effect Of The Interventions On Patient Outcomes, Duaa I. Aljabri

Theses and Dissertations

Purpose: Assessment of health technologies in medical practice is an ongoing process to provide clinicians and policymakers with information on the value of those applications. This dissertation aims to add to the existing body of literature and fill the gaps in prior studies by assessing two health technologies in Mayo Clinic Florida (MCF). The first paper provides an assessment of patient portal adoption and activity during hospitalization among cancer patients, and determines whether a portal application is associated with selected indices of patient safety, utilization and satisfaction. The second paper provides an assessment of a new approach in pain …

Racism, Black College Students’ Mental Health, And The Efficacy Of Diversity And Inclusion Initiatives: A Case Study., Kaleea R. Lewis

Theses and Dissertations

Black college students who attend predominantly White institutions of higher education (PWIs) regularly encounter subtle and explicit forms of racism on campus. These daily experiences of prejudice and discriminatory behaviors can have an adverse impact on their mental health. This study examines the intersections of racism and mental health, particularly within an environment where racism is socially unacceptable. More specifically, this study uses qualitative methods to explore how Black college students who attend a predominately White institution of higher education (PWI) make meaning of their experiences with racial discrimination and its impact on their mental health, as well as their …

Body Mass Index Trajectories And The Relationship Between Stressful Life Changes And Nutrition-Related Health Outcomes Among United States Army Soldiers, Julianna Marie Jayne

Theses and Dissertations

Body mass index (BMI) has risen among members of the military, though to a lesser degree than in civilian populations. BMI as an anthropometric tool has been essential for population surveillance and documenting the obesity epidemic and its health consequences. One use for BMI in population surveillance is to model the BMI trajectories of a population over time. Many studies are available on the BMI trajectories and determinants of BMI in civilians, but few studies of this nature in military populations exist. Establishing the shape and determinants of BMI trajectories among Soldiers is critical given the importance of weight management …

The Effect Of Neighborhood Characteristics And Acculturation On Vegetable Intake Among U.S. Hispanics, Anna Victoria Mesa

Theses and Dissertations

The growing prevalence of chronic disease among the U.S. Hispanic population has drawn increasing attention to modifiable behaviors such as diet in an effort to curb the burden of disease among this population. While factors affecting dietary intake among U.S. Hispanics have been largely studied, this study broadens the scope of existing analyses from examining the role of individual-level factors, including acculturation, to also include environmental factors such as neighborhood ethnic composition. Multilevel mixed modeling was employed to test the interaction of individual acculturation with neighborhood ethnic composition to predict vegetable intake among a sample of U.S. Hispanics. Individuals who …

Comparative Effectiveness Of Conventional And Novel Sampling Methods For The Recruitment Of Sexual Minority Identified Women, Sarah M. Piperato

Theses and Dissertations

Sexual minority identified (SMI) women have an amplified risk for risky health behaviors and chronic health conditions. Current research on mechanisms related to health disparities in SMI women is limited. Research targeting SMI women has relied on small, convenience samples to address health disparities. Due to the nature of this population, probability sampling methods are ineffective and inefficient and cost prohibitive. The purpose of this dissertation was threefold. First, we examined the current state of literature to gain insight on prevalent sampling strategies used to access SMI women for health-related research. Second, we compared the efficacy of two sampling strategies, …