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Relationships Among Pregnancy, Substance Use, Social Determinants Of Health And Assessment, Referral, And Utilization Of Treatment: A Secondary Analysis Of Nsduh Data, Heather Lynn Coddington

Graduate Theses, Dissertations, and Problem Reports

ABSTRACT

Relationships Among Pregnancy, Substance Use, Social Determinants of Health and Assessment, Referral, and Utilization of Treatment: A Secondary Analysis of NSDUH Data

Heather Coddington

Background: Assessment and referral for substance use disorder during pregnancy is crucial to improving outcomes for mothers and newborns during the antepartum and postpartum period. Healthcare professionals are essential during the entirety of the pregnancy during each trimester to provide effective communication when assessing for substance use early and throughout each trimester of pregnancy. The purpose of this study was to determine if there was a relationship between assessment, referral, and utilization of treatment …

Clinical And Economic Burden Of Inflammatory Chronic Conditions Among Adults In The United States: Evidence From Three Nationally Representative Surveys, Mohammad Ikram

Graduate Theses, Dissertations, and Problem Reports

A significant proportion of adults in the United States (US) suffer from various inflammatory chronic conditions (ICCs). They include a wide range of diseases such as diabetes, rheumatoid arthritis, asthma, and chronic obstructive pulmonary diseases. ICCs are not curable, and their management typically involves medications such as NSAIDs and corticosteroids. Recently, a whole health approach that places patients’ well-being at the center is increasingly being used for better management of ICCs. The whole health approach uses an integrated approach that includes multimodal management with complementary and alternative medicines (CAM) and prescription drugs. However, the use of CAM and prescription drugs …

Optimizing Sample Collection And Data Interpretation For Effective Wastewater-Based Epidemiology In Combined Sewer Systems, Christopher Allen Anderson

Graduate Theses, Dissertations, and Problem Reports

COVID-19 has spurred growth in the science surrounding wastewater-based epidemiology (WBE) pertaining to the detection of severe acute respiratory virus 2 (SARS-CoV-2) in waste streams as an early warning signal for public health. However, the highly variable wastewater environment has made it difficult to standardize an approach for sampling and analysis, especially in locations using combined sewer infrastructure. This study addresses knowledge gaps of WBE via three specific aims: (1) to compare diurnal fluctuations of SARS-CoV-2 and the human fecal indicator, pepper mild mottle virus (PMMoV) in wastewater treatment plant (WWTP) influent samples collected during dry versus wet weather conditions; …

Nature Based Interventions For Human Health And Wellbeing, Samantha I. Moyers

Graduate Theses, Dissertations, and Problem Reports

Background. Nature exposure is beneficial to human health and wellbeing, but the evidence base for nature-based interventions (NBI) is still developing. Heterogeneous naming conventions, study designs, and intervention contexts create difficulty in accessing and assessing the evidence for such programming. While NBI have been utilized in a wide array of human populations, no interventions have been reported among clinical health professions students. Aims. The objectives of this dissertation project were to review the existing body of NBI literature exploring health and wellbeing outcomes, and to conduct a feasibility trial of forest bathing, a type of NBI, among clinical students. Specifically, …

Physical Activity Promotion, Assessment, And Engagement In Clinical Settings In The United States, Kristin A. Grogg

Graduate Theses, Dissertations, and Problem Reports

Physical inactivity is an important contributor to morbidity and all-cause mortality and the 2018 Physical Activity Guidelines Advisory Committee recommended that physicians increase their role in physical activity assessment and promotion to combat physical inactivity and related comorbidities. Healthcare providers are increasingly called upon to initiate physical activity promotion with their patients to manage conditions like obesity, diabetes, and cardiovascular diseases. Still, recent reports indicate that less than half of primary care visits include some type of physical activity promotion. Although the National Physical Activity Plan includes some recommendations for clinicians and the healthcare sector on physical activity promotion, it …

The Application Of Time Series Analysis To Injury Epidemiology Data, Eric Wayne Lundstrom

Graduate Theses, Dissertations, and Problem Reports

Introduction: Injury fatality rates in the United States (US) decreased throughout the majority of the 20th century, mostly due to declining rates of occupational and motor vehicle injuries. However, near the beginning of the 21st century, fatal injury rates in the US began to increase. This is principally due to the nation’s opioid epidemic, which has been characterized by different epidemic “waves”, each driven by overdoses associated with specific substances. Given the temporally dynamic nature of US injury trends, this study aimed to explore the application of time series analysis to injury data in the US. First, rates of non-fatal …

Study Of Barrier Face Coverings And Respirator Exhalation Filtration Efficiency And Exhaled Air Velocity During Wear, Weihua Yang

Graduate Theses, Dissertations, and Problem Reports

This study aimed to assess the effectiveness of different types of respiratory protection, including National Institute for Occupational Safety and Health (NIOSH) Approved respirators and surgical masks in healthcare settings, as well as barrier face coverings (BFCs) used by the public as source control. The assessment was based on three components: total outward leakage (TOL), particle size distribution, and exhalation airflow velocity. To achieve this, the study utilized headform testing systems to measure TOL and airflow velocity. Specifically, a hard surface headform was used for NIOSH Approved respirators and surgical masks, while two soft surface headforms of different sizes were …

Exploring Prenatal Care In A Rural Appalachian State: A Project Watch Study Of Barriers And Facilitators In All Births From May 2018 To March 2022, Madelin Gardner

Graduate Theses, Dissertations, and Problem Reports

Introduction: PNC is essential in protecting the health of birthing person and infant. Teenage and advanced maternal age (AMA) birthing persons are known risk factors for poor birth outcomes. However, less is known about whether these age groups are associated with inadequate PNC. Births to teenagers continue to be of concern in rural areas however, little is known about the association between inadequate PNC and poor infant outcomes in teenage populations. Previous studies have determined that greater risk of inadequate PNC has been linked to more rural areas compared to more urban areas. WV is the third most rural state …

Driving After Marijuana Use Among Us College Students During The Covid-19 Pandemic, Yuni Tang

Graduate Theses, Dissertations, and Problem Reports

Introduction: Adolescents and college-aged adults account for a large proportion of the United States population and are susceptible to drugs, including marijuana. Since the late 1960s in the United States, numerous states have legalized marijuana for medical and recreational purposes. These recent policy changes may alter people’s attitudes and behaviors about marijuana use, particularly young adults. The expansion of state-level marijuana legalization may also increase accessibility in younger populations and increase reckless driving behavior associated with marijuana use, including driving after marijuana use. During the COVID-19 pandemic, adolescents and young adults experienced heightened stress and anxiety, which have significantly contributed …

The Process And Case Study Approach To Implementing A Nutrition-Specific Dissemination And Implementation Science Training In Appalachia, Ayron E. Walker

Graduate Theses, Dissertations, and Problem Reports

Introduction: Nutrition professionals face implementation challenges due to their lack of knowledge to incorporate D&I science into intervention design. To improve intervention outcomes, nutrition professionals must be trained in D&I science, which are currently absent in the field.

Aims: To identify and assess nutrition educators and practitioners perceived motivations, self-efficacy, and attitudes in using D&I science to inform the educational design and strategies of a nutrition-specific D&I curriculum for nutrition educators. Then to test feasibility of the nutrition-specific curriculum in increasing knowledge, self-efficacy, and attitudes by a case study approach, pre/post intervention design.

Methods: First, scoping review methodology involved the …

Screen Media Use Among Children And Adolescents – Applications Of Supervised And Unsupervised Machine Learning And Sentiment Analysis, Yifan Zhang

Graduate Theses, Dissertations, and Problem Reports

Screen media has become increasingly pervasive in our everyday lives and has profoundly changed the way people communicate and interact with each other. However, we are still unclear about the long-term influence of screen media use on our physical health, mental health, and social wellbeing. Children and adolescents are in an important stage of brain development and are susceptible to the environmental influence that screen media possess. This dissertation pursued three aims to address research gaps related to screen media use among children and adolescents: 1) identify topics and knowledge gaps in screen media use research among children and adolescents …

Examining The Spatial Relationship Between Maternal Morbidity, Access To Health Care, And Community Characteristics In West Virginia, Sarah E. Woolard

Graduate Theses, Dissertations, and Problem Reports

Maternal-related morbidity rates in the United States have risen almost three fold since the early 1990’s. Issues related to rurality, socioeconomic disparities, and pre-existing health conditions increase the risk of poor pregnancy outcomes and introduce barriers to accessing advanced maternal health care. West Virginia (WV) has higher maternal morbidity rates than many other states in the United States (US), and is considered to be driven by all 55 counties being classified as Appalachian, possessing the highest prenatal smoking rate in the US, and having disparities in access to health care. Despite this, no previous studies have evaluated maternal morbidity in …

Psychosocial Influences On And Behavioral Characteristics Of Young Adult Food Addiction, Rachel A. Wattick

Graduate Theses, Dissertations, and Problem Reports

Introduction. Research on food addiction has increased in recent years, but there are few studies focusing on college-attending young adults, who may be at risk of developing food addiction due to the stress of the college environment. Additionally, causes and characteristics of food addiction are under-explored.

Aim. This dissertation aims to 1) determine the impact of adverse childhood experiences (ACEs) and other early life influences on the development of food addiction in college-attending young adults and 2) determine the psychosocial and behavioral characteristics of young adults with food addiction.

Methods. A sequential explanatory mixed-methods design was used for aims 1 …

Examining The Pulmonary Response To Repeated Vishniacozyma Victoriae Exposure And Its Association With Allergic Airway Disease, Rachael Erin Rush

Graduate Theses, Dissertations, and Problem Reports

Allergic airway diseases such as asthma continue to increase in incidence in industrialized nations like the United States. These diseases are complex inflammatory processes involving numerous cells and mediators and are strongly influenced by fungal exposures. Recent developments in fungal detection methods have highlighted the contribution of Basidiomycota yeast species in indoor environments such as Vishniacozyma (syn. Cryptococcus) victoriae. However, despite the high levels of this yeast detected in indoor environments, very little is known about it or its role in respiratory morbidity. V. victoriae is phylogenetically similar to pathogenic Cryptococcus neoformans but lacks a capsule and is …

Implementing Trauma-Informed Care Through A Multi-Agency Learning Collaborative: A Theory-Driven Analysis Of Outcomes And Sustainability, Mira D H Snider M.S.

Graduate Theses, Dissertations, and Problem Reports

Learning collaboratives (LCs) are often used in large-scale implementation initiatives to promote evidence-based practice across provider networks. Although the outcomes and stakeholder perspectives of many LCs have been documented, support for the effectiveness of LCs is equivocal, and the means by which LCs achieve long-term improvements in clinical care are not understood. The current study investigated outcomes and sustainability of a multi-agency LC for implementing trauma-informed care in 23 rural Pennsylvania counties. Changes in outcomes (i.e., trauma symptom screening, trauma-informed care training attendance, clinician confidence with using trauma informed-care, utilization of trauma-related diagnostic codes, retention in service, service unit density) …

Preconception Substance Use And Risk Of Unintended Pregnancy, Saima Shafique

Graduate Theses, Dissertations, and Problem Reports

Background: In the United States, unintended pregnancy is a serious public health issue due to its persistent high prevalence. In the series of three studies, our first two investigations examined the risk and potential determinants of unintended pregnancy among substance and polysubstance using women of childbearing age. In the third study, we conducted a systematic review (SR) with meta-analysis (MA) to assess the association of illicit and recreational drugs to the risk of unintended pregnancy.

Methods: We performed a secondary data analysis on a subset of Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-17 phase 8 data (n=75,543). The outcome variable …

Factors Associated With Service Utilization In Injured Workers In West Virginia, Brandy Brown

Graduate Theses, Dissertations, and Problem Reports

Introduction: Minimal research has been conducted on healthcare utilization among injured workers residing in rural areas. These workers are often at high risk for work-related injury due to the industries in which they work and commonly experience barriers to accessing healthcare. The first study in this dissertation series explored general characteristics of injured workers receiving care at occupational medicine clinics in West Virginia (WV). The second and third studies explored the moderating effects of rurality, pain medication, and psychiatric medication on sociodemographic and health status factors and number of medical encounters.

Methods: Each study used a cross-sectional design with data …

Association Of Incident Cancer To Low-Value Care And Healthcare Cost Burden Among Elderly Medicare Beneficiaries, Chibuzo Iloabuchi

Graduate Theses, Dissertations, and Problem Reports

In the United States (US), 25% of healthcare spending is considered wasteful because it is spent reimbursing low-value care. Low-value care is the utilization of healthcare services, medical tests, and procedures that have unclear or no clinical benefit to patients but still exposes them to risk. World-wide, low-value care imposes a significant economic burden on patients, payers, governments, and society. Cancer care among older adults > 65 years is one of the biggest drivers of healthcare expenditure in the US and accounts for nearly 40% of all spending, and low-value care among cancer patients is prevalent and contributes to the financial …

An In-Depth Exploration Of Hospital-Based Physical And Occupational Therapists’ Needs, Perceptions And Participation In A Safe Patient Handling And Mobility Program, Kimeran W. Evans

Graduate Theses, Dissertations, and Problem Reports

Introduction - Patient mobility performed in the hospital setting places healthcare workers at high risk for WMSDs. The healthcare industry has responded through the creation of SPHM programs that are successful in reducing work-related injuries broadly. However, less is known about the distinct experiences of rehabilitation professionals. Therefore, an in depth exploration of the perceptions, participation, and needs pertaining to lift equipment usage among rehabilitation professionals was performed.

Methods – A qualitative case study approach explored this bounded system. Six focus groups were conducted with 25 members of the rehabilitation team and three interviews were conducted with key administrative personnel. …

Perceptions Of Integrated Mental And Behavioral Health In Pediatric Specialty Care Settings: A Mixed-Methods Study, Desireé Nicole Williford

Graduate Theses, Dissertations, and Problem Reports

Pediatric patients are at an increased risk of experiencing mental and behavioral health concerns, which have direct associations with HRQOL, physiological health, and likelihood that youth will engage in health promoting behavior. Researchers and practitioners have increased their awareness of these concerns and identified strategies for improving the mental and behavioral health of these youth, specifically via implementing organizational efforts (i.e., task forces) and guidelines around integrating psychosocial screening and other services into routine practice. Despite this, there are several identified barriers to families receiving mental/behavioral health care in these settings. These barriers exist at all levels, including at the …

Quantification Of Bacterial Shedding From The Respiratory Tract Of Health Care Workers Wearing Paprs And Other Types Of Air-Purifying Respirators On Sterile Conditions In A Simulated Operating Rooms (Ors), Segun Olanrewaju Ajewole

Graduate Theses, Dissertations, and Problem Reports

The role of powered air- purifying respirators (PAPRs) in healthcare settings during infectious diseases outbreaks and highly contagious pathogens (e.g., SARS, HINI, Ebola, COVID etc.) has attracted much interest based on the level of respiratory protection they provide and their many positive user features. A common practice among healthcare workers to minimize airborne contaminant exposure has been to use surgical masks or N95 filtering facepiece respirators (FFRs). Surgical masks have been shown to offer minimal respiratory protection and while N95 FFRs offer better respiratory protection, they are not comfortable to use for a prolonged period. With current PAPR designs, exhaled …

Aerosol Sampling Strategy: Effect Of Particle Transfer To Sampler Covers And Estimation Of Conversion Factors Between The United States And German Methods For Quartz Sampling, Godwin Akpevwe Erekaife

Graduate Theses, Dissertations, and Problem Reports

ABSTRACT

AEROSOL SAMPLING STRATEGY: Effect of Particle Transfer to Sampler Covers and Estimation of Conversion Factors between the United States and German Methods for Quartz sampling

GODWIN A. EREKAIFE

In many countries, communities of experts, including industrial hygienists, have developed unique sampling strategies to determine workers’ exposure to aerosolized particles (e.g., metals, wood dust etc.). However, using different sampling and analytical methods for the same chemical often results in different exposure levels for a similar exposure group (SEG). The exposure discrepancies among different countries that are caused by using different measurement strategies are not always systematically defined. Therefore, this study …

Hands And Health: Quantifying Occupational Exposures And Implications Of Disability, Sueann R. Woods

Graduate Theses, Dissertations, and Problem Reports

Introduction: Hand grip strength (HGS) has been negatively correlated with both biologic, cognitive, and mental health markers. Aim one investigated how occupational metabolic equivalents (OMETs), impacted HGS. Aim two investigated lost time from work and the association with HGS. Finally, aim three investigated the health outcomes of workers’ compensation claimants who have lost time from work, following diagnosis of CTS.

Results:HGS was positively associated with OMET (rs = 0.078, p = 0.009). Linear regression model demonstrated a statistically significant association between HGS and OMETs, F(1, 31) = 9.735, p = .001. Aim two found that all occupation groups had …

In Vitro And In Vivo Toxicological Evaluation Of Emissions From The Fused Filament Fabrication Three-Dimensional Printing, Mariana T. Farcas

Graduate Theses, Dissertations, and Problem Reports

Fused filament fabrication (FFF), a three-dimensional (3-D) printing process, is an emerging technology that has recently gained wide popularity among both consumers and manufacturers. As filament is heated to above its glass transition temperature in a 3-D printer, a portion may undergo thermal decompostion, which releases ultrafine particles (UFP) and volatile organic compounds (VOCs) with potential adverse respiratory health effects are released into the air. This study's central hypotheses is that emissions generated during 3-D printing are toxic and exposure to these emissions induces pulmonary and systemic adverse health effects. Considering that currently, limited understanding is available on the health …

Economic Burden Of Low-Value Healthcare On Patients With Localized Prostate Cancer: Statistical & Machine Learning Approaches, Ryan Fiano

Graduate Theses, Dissertations, and Problem Reports

Adults with incident localized prostate cancer represent a large, medically complex population at risk for low-value care. Evidence-based guidelines recommend conservative management (CM) for localized prostate cancer patients with multimorbidity and limited life expectancy, however, 2 in 3 still choose treatment. This dissertation pursued three Aims to address research gaps related to healthcare practices associated with significant morbidity and economic burden on older men with incident localized prostate cancer: 1) examine the leading predictors of low-value healthcare practice of prostate cancer treatment for low-risk prostate cancer; 2) assess the role of patient‐reported experience with care on high-value prostate cancer management; …

Hepatitis B In At-Risk Groups: Three Studies To Guide Education, Testing, And Vaccination Efforts In West Virginia, Stacy Tressler

Graduate Theses, Dissertations, and Problem Reports

Background and Objectives: For over a decade, West Virginia’s (WV) rate of acute hepatitis B has been the highest in the United States (US). In 2017, WV’s rate was 11.7 per 100,000 population, almost 12 times higher than the national rate. The increase in acute hepatitis B cases is largely due to substance misuse, including injection drug use (IDU). Hepatitis B is a vaccine preventable disease yet many at-risk adults remain unvaccinated and susceptible to infection. The objectives of our studies are to 1) describe yearly changes in acute hepatitis B incidence in WV and assess county-level impact of the …

A Phenomenological Photovoice Exploration Of Female Exercisers’ Experiences Of Their Body In Fitness Center Environments, Katherine E. Fairhurst

Graduate Theses, Dissertations, and Problem Reports

For many women, the relationship with their body and exercise is complex. Exercise can have positive effects on body image, however, not all women appear to benefit positively from all types of exercise. To date, body image research has focused on exercise as an activity and less so on the context in which exercise is performed. Women frequently exercise in fitness centers as young adults which, unfortunately, is associated with body dissatisfaction. Using an Interpretative Phenomenological Analysis (IPA) approach with Photovoice methodology, we explored young adult women’s lived body experiences while exercising in fitness centers. A purposive sample of 11 …

Multimorbidity, Immune Checkpoint Inhibitor Use, And Healthcare Expenditures Among Older Patients With Late-Stage Melanoma, Pragya Rai

Graduate Theses, Dissertations, and Problem Reports

With decades of unchanged cancer care with no added survival benefit, immune checkpoint inhibitors (ICI) changed the treatment landscape of late-stage melanoma in 2011. A key factor in determining the use of ICIs is the presence of pre-existing chronic conditions, which can influence the outcome. However, the prevalence of multimorbidity (defined as presence of two or more chronic conditions) among older patients with late-stage melanoma remains unknown. It also remains unknown if the presence of multimorbidity factors into the use of ICIs. Hospital-related factors associated with ICI use have been studied. Yet, patient-level factors, such as age, sex, marital status, …

Changing Dynamics Of Opioid Overdoses In West Virginia And Impact Of Medication For Opioid Use Disorder And Recurrence Of Overdose On Reducing Mortality Among West Virginia Medicaid Beneficiaries, Zheng Dai

Graduate Theses, Dissertations, and Problem Reports

Background

With increasing number of opioid overdoses in West Virginia (WV) in recent years and limited number of people receiving treatment, the dissertation study aims to better understand fatal overdose problems in WV and the impact of medication for opioid use disorder (MOUD) in preventing overdose deaths.

Method

WV drug-related deaths from 2005 to 2018 was used to describe the involvement of fentanyl and FAs. WV Medicaid claim data was analyzed to describe the recurrent opioid overdose and the changes in receipt of MOUD. Further, a Medicaid opioid overdose cohort was created to evaluate the effect of occurrence of recurrent …

Breaking The Chain: Evaluating The Links Between Opioid Use Disorder, Overdose, And Suicide, Amanda Nicole Stover Mph

Graduate Theses, Dissertations, and Problem Reports

Previous research has estimated that 20–30% of individuals with opioid use disorder (OUD) have a history of both suicide attempt and unintentional opioid overdose. In 2018, more than 1.9 million adults 18 years and older had an OUD; while 1.4 million adults attempted suicide that same year (SAMHSA, 2019). The key to understanding this relationship is examining behaviors that precede these potentially fatal behaviors. One such precursory behavior is self-injury. Self-injurious behaviors (SIB) are one of the most important risk factors for future suicide (Cavanagh et al.,2003). This study has three primary objectives. The first is to conduct a systematic …