Digital Commons Network^™

Exploring The Associations Between Sexism, Physical Behaviors, And Psychosocial Correlates Of Physical Activity In Young Women, Melanna Cox

Doctoral Dissertations

Physical behaviors (PB), defined as physical activity (PA) and sedentary behavior (SB), tend to be less favorable in women than in men. Low self-efficacy (SE) and social support (SS), and gender norms hinder women’s PB. Benevolent sexism, a theory on gender norms, could explain the gender disparity. PURPOSE: To 1) assess the associations among benevolent sexism endorsement (BSEN), experiences with benevolent sexism (EBS), PB, SE, and SS, 2) evaluate if BSEN or SE mediate the relationship between EBS and PB, and 3) develop a questionnaire that measures a woman’s sexist experiences in PA. METHODS: Study 1: Women (N=186) completed a …

Impact Of Child/Parent Characteristics On Ultra-Processed Food Intake In Preschool-Aged Children, A Latent Class Analysis Of Obesity-Related Factors And Obesity Risk, And The Qualitative Impact Of 9-11 Year Old's Perception Of Unhealthy Food Marketing, Jennifer E. Carroll

Doctoral Dissertations

Childhood overweight/obesity is an epidemic in the US. Modifiable risk factors, such as intake of foods that are highly processed, are heavily marketed to children. Exposure to food advertisements, along with home environment factors, family meal styles, and digital media habits shapes children’s preferences, tastes, and habits. Predictors of ultra-processed food (UPF) intake in children are unclear and the potential effect of ad exposure on UPF intake is unknown. It is also unknown if there are distinct response patterns among a collection of potentially obesity-related factors, and if distinct groups affect child BMI. Additionally, more qualitative research is needed to …

Weight Bias In Pre-Professional Health Students, Heather A. Wemhoener

Doctoral Dissertations

Weight bias includes negative attitudes or judgements towards people in larger bodies. It is associated with poor health outcomes. Weight bias is highly common in the United States, and pre-professional health students are known to exhibit it. Given its impact, finding effective interventions to reduce weight bias is important. The first paper reviewed literature on existing interventions for weight bias reduction. The search revealed three main intervention types: targeting attributions, increasing empathy, and targeting social consensus. Interventions, regardless of strategy, yielded mixed results for weight bias reduction, and, in some cases, increased bias. The second paper tested a novel intervention …

Mining High Impact Combinations Of Conditions From The Medical Expenditure Panel Survey, Arjun Mohan

Masters Theses

The condition of multimorbidity — the presence of two or more medical conditions in an individual — is a growing phenomenon worldwide. In the United States, multimorbid patients represent more than a third of the population and the trend is steadily increasing in an already aging population. There is thus a pressing need to understand the patterns in which multimorbidity occurs, and to better understand the nature of the care that is required to be provided to such patients.

In this thesis, we use data from the Medical Expenditure Panel Survey (MEPS) from the years 2011 to 2015 to identify …

Association Of Birth Weight And Preterm Birth With Subsequent Risk For Hypertension In Women From The Women’S Health Initiative, Christian P. Daniele

Masters Theses

Hypertension is a chronic disease with an estimated prevalence of nearly 50% in US adults. In addition to sociodemographic and lifestyle factors, evidence suggests that in utero and early life exposures may contribute to life-long risk of hypertension. This study aimed to investigate the potential associations between an individual’s birthweight and preterm birth status with their risk for hypertension in the Women’s Health Initiative (WHI) cohort. WHI is a large, multi-racial cohort of postmenopausal women. At study entry, birthweight and preterm birth status were self-reported by category (< 6 lbs., 6-7 lbs. 15 oz., 8-9 lbs. 15 oz., or ≥ 10 lbs.; ≥ 4 weeks premature or full term). Baseline and incident hypertension status were self-reported; mean systolic blood pressure, diastolic blood pressure, and 30-second pulse were also recorded at baseline by trained study staff. Linear, logistic, and Cox-proportional hazards regression models were used to generate crude and adjusted beta estimates, odds ratios, and hazards ratios, respectively. After adjusting for demographic and lifestyle factors, we found that participants born at a low birthweight had a higher mean systolic blood pressure than participants born at a normal birthweight and were at increased risk for both baseline and incident hypertension. Women born at a higher birthweight had a lower mean systolic blood pressure and were at lower risk for baseline and incident hypertension. When compared to participants born full term, participants born preterm were at increased risk for baseline and incident hypertension. These results support current research on early life exposures and health risks later in life. Long term follow-up or targeted counseling may be required for individuals born prematurely or at low birthweights to prevent and treat hypertension and associated cardiovascular outcomes.

Sexual Orientation Differences In The Association Between Cancer Diagnosis And Mental Health Outcomes, Pablo Fernandez

Masters Theses

Background: Since the early 1960s, survival rates among cancer survivors have been increasing. Surviving cancer can be a stressful experience due to the multifaceted changes that come with diagnosis, treatment, and recovery. Therefore, studying the mental health of cancer survivors is vital for their well-being. Among queer groups (including those identifying as gay, lesbian, or bisexual), poor mental health is more prevalent than among heterosexuals. However, cancer survivorship among queer populations is not well studied. This study examines the association between cancer survivorship and poor mental health, focusing on potential sexual orientation differences.

Methods: Data are from the 2019-2021 National …

Sexual Orientation Differences In The Association Between Physical Activity And Allostatic Load: Results From The National Health And Nutrition Examination Study, Natalia I. Putnam

Masters Theses

Higher levels of allostatic load (AL), a composite measure of the impact of chronic stress on the body, are found among socially marginalized groups compared to privileged groups. AL is associated with premature aging and death, as well as a variety of chronic health conditions that impact quality of life. Effects of AL may be offset by physical activity (PA). Queer populations (including those who identify as lesbian, gay, or bisexual) may be at risk for elevated AL due to repeated exposure to discrimination in the form of sexual minority stress. There is mixed literature on sexual orientation differences in …

Forecasting Covid-19 With Temporal Hierarchies And Ensemble Methods, Li Shandross

Masters Theses

Infectious disease forecasting efforts underwent rapid growth during the COVID-19 pandemic, providing guidance for pandemic response and about potential future trends. Yet despite their importance, short-term forecasting models often struggled to produce accurate real-time predictions of this complex and rapidly changing system. This gap in accuracy persisted into the pandemic and warrants the exploration and testing of new methods to glean fresh insights.

In this work, we examined the application of the temporal hierarchical forecasting (THieF) methodology to probabilistic forecasts of COVID-19 incident hospital admissions in the United States. THieF is an innovative forecasting technique that aggregates time-series data into …

"The Land That Feminism Forgot": Birthzillas, Madwives, And The Politics Of Chilbirth, Amber Vayo

Doctoral Dissertations

“The Land that Feminism Forgot” is an in-depth exploration of the politics of childbirth that draws together qualitative and quantitative evidence to theorize the connections between treatment in childbirth and maternal mortality. Situating the qualitative research in the larger national context, the second chapter offers a State Reproductive Autonomy Index that provides an overview of the reproductive policy landscape at the national level. The dissertation then explores the role of institutionalized childbirth, medical mistrust, and obstetric violence in the U.S.’s longstanding maternal mortality crisis and offers policy suggestions in key public health areas. Through 120 qualitative interviews with people who …

Bifidobacterial Metabolism Of Fucosylated Human Milk Oligosaccharides Influences Structure And Function Of The Infant Gut Microbiome, Liv R. Dedon

Doctoral Dissertations

Human milk contains human milk oligosaccharides (HMOs) that are indigestible and pass intact through the infant gastrointestinal tract where they are available for microbial metabolism. HMOs incorporate the same monosaccharide building blocks but vary structurally in primary sequence of monomeric components. Primary sequences are further diversified by degree of polymerization, branching, and secondary modifications such as fucosylation. Fucosylated HMOs (fHMOs) are highly abundant and can account for over 30% of total HMOs. Infant-colonizing Bifidobacterium longum subsp. infantis (B. infantis) possesses a specialized gene cluster conveying the ability to metabolize fHMOs. This study presents an in-depth analysis of B. …

Differential Toxicity Of Pm2.5 Components And Modified Health Effects Modeling: A Case Study In Nepal, Jeremy Brownholtz

Masters Theses

During the latter part of the 20^th century, a transition away from coal as a major energy source in developed countries was accompanied by a notable decrease in air pollution-related deaths in those countries. Currently the same phenomenon is being observed in developing nations like China and India. However, many areas that do still rely on coal for their energy production or industrial needs also reflect a gap in research on the effects of those specific processes on local populations. Located in Nepal at the foot of the Himalayan Plateau, Kathmandu represents one such location. The local economy of …

Feasibility, Acceptability And Process Evaluation Of A Physical Activity Intervention In Toddler Aged Children: The Tap-A-Long Study, Luke M. Sudarsky

Masters Theses

Recent literature has suggested the importance of physical activity in early childhood such as during the toddler years (12 months - 3 years.) Despite this, most toddlers are not physically active. There is a need to determine the types of physical activity programs that would interest toddlers within the settings they spend a significant amount of time in (e.g., childcare center). Currently, data on the feasibility, implementation, and process evaluation of physical activity interventions in toddler age children attending childcare centers is lacking within the literature. Therefore, the purpose of the Toddler Activity Pilot (TAP-A-LONG) study was to examine the …

The Political Economy Of Intimate Partner Violence And Crisis Management: An Institutional Ethnography In Rural Vermont, Anna L. Mullany

Doctoral Dissertations

Intimate partner violence (IPV) is a significant public health issue affecting one in four women in the United States. Tasked with addressing IPV, crisis centers can significantly impact women’s health outcomes and approaches to perpetrator accountability and community education. Informed by eight months of field work at a rural crisis center and 40 in-depth interviews, this dissertation investigated how the lives of Vermont women experiencing violence and crisis center work are both shaped by larger social, political, and economic relations within capitalism. Dorothy Smith’s method of institutional ethnography provides an investigative pathway for centering survivor experiences and examining crisis center …

Mixture Models For Interval Censored Outcomes, Yibai Zhao

Doctoral Dissertations

Silent events such as the first detectable HIV infection, the onset of Type 2 diabetes and prostate cancer progression are often ascertained by diagnostic tests and/or self-reports that are scheduled periodically. In such applications, we only observe the time to the event of interest to lie between the times of last negative and the first positive tests, resulting in interval-censored observations. In addition, in some medical studies, a substantial proportion of participants may experience the events before the study, so-called prevalent cases, or participants may never experience the event, that is regarded as non-susceptible cases (or indolent cancer or long-term …

Interplay Of Environmental Pollutants And Folate In The Etiology Of Autistic Traits Analysis Using Multipollutant Approaches, Michael T. Mascari

Doctoral Dissertations

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by a spectrum of communication deficits and repetitive behaviors. The challenges in learning, thinking, and problem-solving abilities of people with ASD can be debilitating. There is currently no cure for ASD. Many environmental pollutants are suspected to contribute to the etiology of ASD and its associated traits, whereas folate and folate supplements have been shown to exhibit both protective and adjuvant roles. Little is known about the interplay of multiple environmental pollutants and folate in the etiology of ASD. Additionally, statistical approaches that consider the effects of pollutant mixtures instead …

Development Of A Predictive Model For Frailty Utilizing Electronic Health Records, Kye Poronsky

Masters Theses

Frailty is a multifaceted, geriatric syndrome that is associated with age-related declines in functional reserves resulting in increased risks of in-hospital death, readmissions and discharge to nursing homes. The risks associated with frailty highlights the need for providers to be able to quickly, and accurately, assess someone’s frailty level. Previous studies have shown that bedside clinician assessment is not a reliable or valid way to determine frailty, meaning that a more reliable, valid and concise method is needed. We developed a prediction model using discharge ICD-9/ICD-10 diagnostic codes and other demographic variables to predict Reported Edmonton Frail Scale scores. Participants …

Preterm Birth And Subsequent Risk Of Type 2 Diabetes Among Postmenopausal Women In The Women’S Health Initiative, Aaron Holman-Vittone

Masters Theses

Type 2 diabetes (T2D) is increasing in the United States, currently affecting 11.3% of the nation. The Developmental Origins of Health and Disease Hypothesis suggests that environmental stresses in utero and in early stages of life, such as preterm birth (age), can lead to development of adulthood diseases, including T2D. However, research on the association between preterm birth and T2D is sparse and predominantly based on European ancestry populations. We examined this association in postmenopausal women (N = 85,356) from the Women’s Health Initiative, a nationwide prospective cohort. Logistic regression models were used to examine the association between self-reported preterm …

The Relationship Between Pm2.5 And Chronic Respiratory Disease In Senegal, Bailey Glenn

Masters Theses

Chronic respiratory diseases such as asthma and chronic bronchitis have significantly increased in prevalence in Africa over the past 10 years. Recent studies have demonstrated that exposure to air pollution may be associated with an increased risk of chronic respiratory diseases. However, such studies have predominantly been conducted in western societies or often used urbanicity as a proxy for exposure to air pollution. Therefore, we evaluated the association between PM_2.5 exposure and asthma/chronic bronchitis in Senegal. A cross-sectional study was conducted for the time period of 3 October 2010 to 28 April 2011 using annual concentrations of PM_{2.5 …}

Three Dimensional Spatio-Temporal Cluster Analysis Of Sars-Cov-2 Infections, Keith W. Allison

Masters Theses

The COVID-19 pandemic has heightened the need for fine-scale analysis of the clustering of cases of infectious disease in order to better understand and prevent the localized spread of infection. The students living on the University of Massachusetts, Amherst campus provided a unique opportunity to do so, due to frequent mandatory testing during the 2020-2021 academic year, and dense living conditions. The South-West dormitory area is of particular interest due to its extremely high population density, housing around half of students living on campus during normal conditions. Using data gathered by the Public Health Promotion Center (PHPC), we analyzed the …

The Impact Of A Lifestyle Intervention On Risk Factors Of Cardiovascular Disease And Type Ii Diabetes Among At-Risk Hispanic Women, Kathryn A. Wagner

Doctoral Dissertations

Cardiovascular disease and type 2 diabetes are global epidemics affecting approximately 127 and 21 million people in the U.S., respectively. Women who are overweight, obese or who develop glucose intolerance during pregnancy represent high-risk groups for the development of cardiovascular disease and type 2 diabetes. Hispanic women are both more likely to begin their pregnancies as overweight or obese and have a higher prevalence of type 2 diabetes, compared to non-Hispanic whites. However, prior lifestyle interventions have largely been limited to non-Hispanic whites. Therefore, this research assessed how culturally tailored lifestyle modification may affect cardiovascular disease and type 2 diabetes …

Endocrine Disrupters And Adverse Health Outcomes Among Post-Menopausal Women, Gabriela Vieyra

Doctoral Dissertations

Globally, chronic diseases that require ongoing medical attention, and limit daily living activities, are the leading cause of disability and mortality. The older population in the U.S. is rapidly growing, and the risk of chronic diseases is higher in this population, specifically older women. In 2018, 51.3% of women compared to 41.8% of men had two or more chronic conditions. Thus, the Women’s Health Initiative (WHI) study, Chapter 1, focused on preventing leading causes of death, disability, and frailty in older women. Phthalates are synthetic industrial compounds, Chapter 2, commonly added to daily used consumer goods, nutritional and dietary supplements, …

Quality Of Life For Women With Chronic Lyme Disease: A Socioeconomic Investigation, Dale M. Jones

Doctoral Dissertations

This is a mixed methods investigation of how chronic Lyme disease, including Lyme-like diseases and co-infections, affects the quality of life of women who have chronic Lyme. Both quantitative and qualitative methods were used during three phases of research: a 91-question survey instrument followed by focus group discussions and written narratives. The research considered the socioeconomic impact on quality of life in five areas: obtaining a diagnosis, relationships and personal support systems, struggles with the medical system, the ability to work, and access to treatment. There were 500 responses to the survey, of which 373 were analyzed; 11 participants in …

Elucidating Mechanisms Influencing Maternal Postpartum Health: The Protective Benefits Of Breastfeeding And Associations With Allostatic Load, Experiences Of Stress, And Resiliency, Bi-Sek J. Hsiao

Doctoral Dissertations

Research has established breastfeeding as protective of maternal health, but little is known about the ways breastfeeding interacts with chronic stress pathways and interfaces with stressors such as discrimination and neighborhood deprivation, which are salient in the experiences of many marginalized communities. This research addresses these knowledge gaps through secondary analyses of prospective cohort data generated by the Community Child Health Research Network through Community Based Participatory Research processes. Analytical samples were derived from 2510 postpartum women from five regions in the U.S. who self-identified as Black, Hispanic, or White. Study 1 investigated and found an inverse association between breastfeeding …

Sperm Epigenetics Mediates The Effects Of Paternal Preconception Phthalate Exposures And Aging On Reproductive Outcomes And Embryonic Programming, Oladele Amos Oluwayiose

Doctoral Dissertations

Infertility, which is the inability to achieve clinical pregnancy within 12 months of unprotected sexual intercourse, affects 15% of all couples globally. Emerging evidence shows, just as females, males are equally likely to contribute to couple infertility, suggesting the relevance of male factor in couple reproductive success. The potential factors thought to drive male infertility include male preconception environment and aging. Thus, this dissertation focused on two (DNA methylation and small non-coding RNAs (sncRNAs)) of the three major potential epigenetic mediators that occur during spermatogenesis and sperm maturation prior to conception using human and mice model. First, to explore the …

Decision-Analytic Models Using Reinforcement Learning To Inform Dynamic Sequential Decisions In Public Policy, Seyedeh Nazanin Khatami

Doctoral Dissertations

We developed decision-analytic models specifically suited for long-term sequential decision-making in the context of large-scale dynamic stochastic systems, focusing on public policy investment decisions. We found that while machine learning and artificial intelligence algorithms provide the most suitable frameworks for such analyses, multiple challenges arise in its successful adaptation. We address three specific challenges in two public sectors, public health and climate policy, through the following three essays. In Essay I, we developed a reinforcement learning (RL) model to identify optimal sequence of testing and retention-in-care interventions to inform the national strategic plan “Ending the HIV Epidemic in the US”. …

Oxybenzone And The Mammary Gland: Impact Of An Environmental Pollutant On Health, Disease & Ethical Decision-Making, Klara Matouskova

Doctoral Dissertations

The environmental pollutant and common sunscreen compound oxybenzone is a benzophenone type UV light chemical filter used in industrial and consumer goods. This chemical widely contaminates human tissues, non-human species, and environmental matrices. In this dissertation, oxybenzone is investigated for its effects on the mouse mammary gland in the offspring following perinatal exposure; after perinatal and prepubertal exposures as a dual environmental insult during two sensitive times of development; and in adults after exposure during pregnancy & lactation as an environmental factor potentially increasing the tissue susceptibility to mammary tumors. Chapter 1 introduces the mammary gland. Chapter 2 reviews UV …

Factors Associated With The Perception Of Diet Quality: Analysis Of The National Health And Nutrition Examination Survey (Nhanes) 2007-2018, Kiara Y. Amaro-Rivera

Doctoral Dissertations

Perceived diet quality is a potential modifiable factor that could explain dietary choices. Research has shown that some individuals tend to misperceive the healthfulness of their diet, rating it more or less healthy than it actually was when compared to dietary recommendations. In particular, overestimation of diet quality has been associated with lower intention to change dietary behaviors. Using the National Health and Nutrition Examination Survey (NHANES) dataset, this dissertation explores factors associated with the perception of diet quality among U.S. adults. In Chapter 1, we derived dietary patterns using latent class analysis and explored their association with perceived diet …

Applied Infectious Disease Forecasting For Public Health, Graham Gibson

Doctoral Dissertations

Infectious disease modeling has emerged as a powerful data driven tool for monitoring outbreaks, assessing intervention strategies, and allocating public health resources. This thesis addresses a variety of challenges faced in real-world infectious disease forecasting. We first present methods for aggregating forecasts made at different spatial scales, where explicitly modeling the spatial dependency would be computationally prohibitive. We then extend the mechanistic model framework to create an operational forecasting model capable of handling real-world COVID-19 surveillance system issues. Finally, we propose a new framework for merging mechanistic and statistical approaches to infectious disease forecasting. This framework allows modelers to construct …

Accelerometer-Determined Physical Behavior Metrics And Their Associations With Sarcopenia Among Oldest-Old Adults, Eric M. Eberl

Masters Theses

INTRODUCTION: Sarcopenia is a loss of muscle function and muscle mass which frequently occurs among the oldest-old adult population (aged 85+ years). The analysis of accelerometer-determined physical behavior volumes and patterns of oldest-old adults might provide novel insights into the associations with sarcopenia and its components. METHODS: A total of 145 participants in the primary sample and 87 participants in the subsample with a mean age of 88.2 (2.5) years from the Health, Aging, and Body Composition study cohort provided cross-sectional data of handgrip strength, appendicular lean mass, gait speed, and accelerometry. Probable, confirmed, and severe sarcopenia were assessed based …

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, …