Medicine and Health Sciences Commons^™

Strengthening U.S. Jail Systems’ Response To Infectious Diseases: An Evaluation Of The Covid-19 Pandemic, Erinn Bacchus

Dissertations and Theses

Jails across the United States were struck with increased infections and deaths during the COVID-19 pandemic. Studies have shown the structural make up of jails, lack of preparedness plans, and overcrowding contributed to health risks and poor health outcomes both inside jails and local communities. Yet little research has been dedicated to strengthening jail responses to infectious disease outbreaks spanning prevention measures, data collection, and reentry planning. Gaps include information on the (1) myriad infectious disease mitigation strategies used in jails and adherence to CDC prevention guidelines, (2) development of a standardized epidemiologic surveillance system, and (3) experiences working at …

Ethnic Minorities And Family Health History: An Autoethnography Of Guyanese Americans And Kidney Disease, Dhaneesha R. Bahadur

Dissertations, Theses, and Capstone Projects

Exploring family health histories (FHHs) has emerged in recent years as an inexpensive genomic tool in public health. Families and clinicians can also use them to uncover family histories and experiences, which could inform better lifestyle choices to prevent or delay the onset of diseases. Exploring family health histories focuses on an individual’s genetic makeup and considers differences in lifestyle and environment. Despite national campaigns, it is an underutilized tool that could lead to engagement in effective strategies and better health outcomes. One important and serious condition that families should be more aware of is chronic kidney disease (CKD). One …

Exploring Opportunities To Expand And Improve Prep Uptake In Vulnerable Us Communities., Pedro B. Carneiro

Dissertations and Theses

The implementation of preexposure prophylaxis (PrEP) in the United States has fallen short of meeting both 2020 and projected 2030 milestones, with less than one-third of those who would benefit most from PrEP choosing to initiate it. High discontinuation rates and persistently elevated HIV incidence underscore the need for improvement. However, opportunities exist to enhance PrEP uptake, supported by a growing pipeline of PrEP innovations. To achieve this, effective implementation of available tools to combat HIV and the inclusion of all communities as stakeholders are essential. One such tool is event-driven (ED) PrEP, also known as PrEP 2-1-1, which is …

Social Identities And Campus Belonging As Predictors Of Flourishing Among College Students, Christine Gilchrist

Dissertations, Theses, and Capstone Projects

Annual data since 2012 shows college students’ flourishing (a measure of psychological well-being) in continuous decline, with 2022 showing the largest decrease. Since the knowledge base of the predictors of flourishing is limited, how college executives can best address this issue is unclear. Variations in flourishing have been observed in studies that examined the relationship between food insecurity (DeBate et al., 2021), race/ethnicity (Lipson et al., 2018, 2022; Nyunt et al., 2022; Parr, 2022), immigration status (Cadenas & Nienhusser, 2021), as well as gender identity and sexual orientation (Parr, 2022). The intersectional impact of demographic and social identities has not …

"I Stayed There The Whole Night": Exploring Caregivers' Experiences With The Healthcare System When Caring For A Parent At The End Of Life, Lillian Mehran

Dissertations and Theses

Background: In the United States, there are nearly 53 million individuals serving as caregivers to a loved one. Half of all caregivers are caring for a parent or parent-in-law, and 79% of caregivers are caring for a person aged 50 or older. In New York State, there are an estimated 4.1 million caregivers who collectively provide over 2.6 billion hours of unpaid care, with those caring for a person at the end of life providing twice as many hours of caregiving per week compared to other caregivers. The number of individuals requiring caregiving is expected to increase as a significant …

Race, Gender, Physical Activity, And Cancer: A Quantitative Investigation, Shawna A. Townsend

Dissertations, Theses, and Capstone Projects

Black women are more likely to die from cancer than any other population in the United States. Physical activity is known to be associated with preventing and reducing cancer burden. However, Black women are less physically active than their White counterparts and have a higher prevalence of diseases related to lack of physical activity than any other female group. To better understand these issues, this study employed the self-and-family management framework and intersectionality as theoretical frameworks through a secondary analysis of the Health Information National Trends Survey (HINTS) dataset and hierarchical regression modeling to examine the relative impact of (a.) …

Sit Less, Move More: A National Study Of Physical-Activity Behavior And Cancer, Stella O. Nwogugu

Dissertations, Theses, and Capstone Projects

Background: Physical activity is associated with lower risks of cancer, the second leading cause of death among Americans. Yet, sedentary behavior is the prevailing lifestyle for about 80% of American adults. Additionally, cancer survivors remain significantly inactive, even though physical activity has been shown to decrease risk of cancer and cancer recurrence, improve tolerance of cancer therapy, and reduce mortality. This research explores the relative impact of personal agency, social support, and key demographic variables on physical-activity behavior for a national sample of adults as well as how these relationships differ for cancer survivors and their counterparts.

Methods: Using the …

Working Conditions, Type 2 Diabetes Mellitus, And Health Behaviors In Latino And Other Minoritized Groups Living In The United States, Tailisha M. Gonzalez

Dissertations and Theses

Background: Type 2 Diabetes Mellitus (T2DM or ‘diabetes’) poses a significant public health challenge to the healthcare system, economy, and well-being of communities in the United States (U.S.). There are also substantial racial/ethnic and social disparities in diabetes incidence and control that have persisted for decades. For Latinos and other minoritized groups in the U.S., diabetes disparities may be linked to working conditions. Globally, work is considered a major determinant of health and yet studies in the U.S. tend to focus on legacy hazards, such as chemical, biological, and environmental factors. In recent years, occupational health scholars have argued …

Engagement Journalism In Action: Supporting New Yorkers With Long Covid, Sarah Luft

Capstones

What do asthma and long COVID have in common? 1 in 13 U.S. adults are living with them. This report is a recap of my efforts to address the information needs of New Yorkers with long COVID as a student in CUNY's Craig Newmark Graduate School of Journalism engagement program. For my final project, I partnered with THE CITY, a nonprofit news outlet serving New Yorkers, to expand the MISSING THEM project. The report details the what, why, and how of my engagement reporting process, including a community engagement framework, a service journalism series, and lessons to carry forward. You …

Gobernar Es Prever: Health Management Self-Efficacy Among A National Sample Of Latinx Adults, Giselle Gerardi

Dissertations, Theses, and Capstone Projects

Background: Minority populations, such as Latinx people, are more likely to develop chronic diseases and increased complications related to disease severity when compared to Non Latinx Whites (NLW). Furthermore, Latinx people are less likely to engage and maintain health promoting behaviors (HPB) to prevent disease development. HPB are effective in preventing or delaying chronic disease. Despite interventions and resources aimed at supporting Latinx populations, often, there are low participation and high attrition rates.

Methods: This research explores the relative impact of aspects of health, built environment and key demographic domains on HMSE of a national sample of Latinx adults through …

Harm Reduction En La Ciudad De Nueva York, Dimitri Fautsch, Jason Gonzalez

Capstones

Entrevistamos especialistas del Educadores de la Reducción de Daños de Nueva York y Sarah Evans quien era un líder del primero centro de la prevención de sobredosis en America Norte. Encontramos que este campo es una solución pragmática para la crisis de addición a los opioides.

Spanish - https://dimitrifautsch.medium.com/la-reducci%C3%B3n-de-da%C3%B1os-en-nueva-york-a0a8c8ccef4a

English - https://jasongonzalez76.wixsite.com/website/post/new-york-s-first-supervised-safe-injection-sites-are-a-first-of-its-kind-in-the-united-states

An Examination Of Hiv Risk, Testing And Prevention Intervention Participation Among Vulnerable Youth, Bianca V. Lopez

Dissertations and Theses

Background: Young gay, bisexual and other men who have sex with men (YGBM) of color are disproportionately affected by HIV and bear the burden of the disease in the United States. Gay and bisexual men – referred to in surveillance systems as men who have sex with men (MSM) – continue to be the risk group most severely affected by HIV in the United States. The dissertation study explored factors related on HIV prevention intervention participation, HIV testing and sexual risk behaviors among YGBM ages 13-29 in the Bronx. Additionally, this dissertation endeavored to study the concept of “intervention fatigue”, …

An Evaluation Of A Web-Based Tool To Improve Feeding Practices And The Home Environment Among Parents Of Low-Income Minority Preadolescents At-Risk For Childhood Obesity, Katrina F. Mateo

Dissertations and Theses

Background: Web-based/mHealth interventions may be an engaging approach to promote positive dietary-related behaviors among parents of youth at-risk for childhood obesity. Importantly, childhood obesity research highlights the role of parents as a key support mechanism in improving child dietary outcomes. Intervention INC is a childhood obesity intervention that comprises a unique, interactive web-based child nutrition comic aimed at improving dietary behaviors among urban Black/African American (AA) and Latino preadolescents, and also weekly online parent newsletters (with feeding tips, healthy printable recipes, links to coupons to support healthy eating/feeding and health-promoting local/community events, and access to the child nutrition comic) to …

Shadow Standards And The Logic Of Costs: Care, Stewardship, And Data In U.S. Community Health, Margarite J. Whitten

Dissertations, Theses, and Capstone Projects

This dissertation examines the delegation of responsibility for providing health care to particular categories of marginalized populations in the United States in the absence of a uniform and universal health care system. It explores how the U.S. federal government governs patient populations at a distance by mandating that healthcare providers collect, produce, and report on patient data. Drawing from eighteen months of ethnographic research in Massachusetts clinics for the homeless and the frail elderly between 2014-2015, I argue that when marginalized patients are unable to satisfy the neoliberal ideal of self-governance to maintain their health in cost-effective ways, providers are …

Exploration Of The Complex Relationship Among Multilevel Predictors Of Prep Use Among Men Who Have Sex With Men In The United States, Kristina M. Rodriguez

Dissertations and Theses

Background: Men who have sex with men (MSM) remain the group most heavily affected by HIV in the United States (US), with MSM of color further disproportionately represented. In July 2012, the US Food and Drug Administration (FDA) approved the use of tenofovir disoproxil fumarate plus emtricitabine (TDF-FTC, Truvada) for use as pre-exposure prophylaxis (PrEP) in HIV-negative adults who are at high-risk of HIV infection. Despite its effectiveness, PrEP prescriptions are reaching only a small proportion of those who could benefit from the drug and prescription rates vary both by race and geographic region. The goal of this dissertation was …

Intimate Partner Violence Among Expectant Adolescent Couples: Psychological And Relational Predictors And Sexual Risk, Jessica Lewis

Dissertations, Theses, and Capstone Projects

BACKGROUND/PURPOSE: Intimate partner violence (IPV) is prevalent and tends to be bilateral in adolescent relationships. Expectant adolescent couples are at even higher risk. Using the Actor-Partner Interdependence Model (APIM), this study sought to: (1) describe the patterns of physical/sexual and psychological IPV victimization of women and men in expectant adolescent couples from pregnancy through twelve months postpartum; (2) examine the associations between psychosocial and relational factors during pregnancy and postpartum IPV; and (3) investigate the relationship between IPV victimization and later sexual risk across the perinatal period.

METHODS: Data were collected from pregnant adolescents and their male partners (N=296) recruited …

Increasing Access To Pre-Exposure Prophylaxis (Prep) Among Transgender Women And Trans Feminine Non-Binary Individuals In New York City, Augustus Klein

Dissertations, Theses, and Capstone Projects

In the United States transgender women (i.e., individuals born male whose gender identity is on the feminine spectrum) are a highly vulnerable and marginalized population at high risk for HIV. Substance use, survival sex work, depression, unstable housing, and high levels of victimization and violence are commonly reported by transgender women and trans feminine individuals, indicating the potential for multiple concurrent HIV risks and underlying vulnerabilities. Structural forms of discrimination may contribute to these risk factors, possibly leading to poor outcomes such as unemployment or underemployment, homelessness, and lack of access to gender-affirming health care. Given this context, a biomedical …

Casualties Of Racism: Racial And Ethnic Discrimination And Suicidal Thoughts And Behaviors Among Racial And Ethnic Minority Emerging Adults, Lillian Anais Polanco

Dissertations, Theses, and Capstone Projects

The evidence demonstrating that experiences of racial/ethnic discrimination is detrimental to the mental health of racial/ethnic minority youth is unequivocal. What remains unclear, however, is whether racial/ethnic discrimination increases vulnerability for suicidal thoughts and behaviors in particular, and if so, what are the underlying mechanisms to explain this relation. Drawing upon the Race-based Traumatic Stress Theory (Carter, 2007), which suggests that some individuals may experience racial/ethnic discrimination as a traumatic stressor, and thus, eliciting a traumatic stress response, the present study examined posttraumatic stress reactions (i.e., posttraumatic stress, depression, dissociation, stress sensitivity) as mediators in the relation between racial/ethnic discrimination …

Factors Associated With Household Contacts' Tuberculosis Testing And Evaluation, Elvy G. Barroso

Dissertations, Theses, and Capstone Projects

Contact investigation (CI) is one of the core elements of tuberculosis (TB) control. It is intended to achieve early identification of contacts who may have been exposed to a patient with infectious active TB and contacts who may benefit from treatment for latent tuberculosis infection (LTBI). LTBI is an infection in which the Mycobacterium tuberculosis organisms cause no signs and symptoms but the infection can be reactivated and develop into full-blown active TB disease. Failure to be identified as a contact is the primary reason for disease development in more than half of TB patients, thus a complete and timely …

Whether, When, And How: Fertility Intentions And Age In The U.S., Andrea Melnikas

Dissertations and Theses

Thinking about, planning for, and having children is a deeply personal experience influenced by myriad factors at individual, intrapersonal, community and larger social levels. Examining fertility intentions is of interest to researchers from numerous social science disciplines in part because these intentions are potentially tied to larger demographic and economic shifts. In recent years in the U.S. the mean age at first birth has been increasing, with more women of older ages (age 35 and older) giving birth, due to both delays in childbearing that accompanied larger social trends such as increased educational and career opportunities and a decrease in …

Mental Hell, Jesenia De Moya, Hanaa' Tameez, Maritza Villela

Capstones

Mental Hell explores how difficult it is for low-income Latinos in New York City to access mental health care. Through explanations from experts and the personal stories of three Latinas New Yorkers who have gone through the process of trying to get the care they need, the story guides the reader through the many roadblocks this demographic encounters specifically under the insurance of Medicaid.

This is an extremely important topic that affects many New Yorkers, and we believe something needs to be done to make this type of healthcare more accessible for Latinos. New York City has a very high …

Exploring The Health Effects Of Precarious Employment By Sex/Gender Using Mixed Methods, Kathleen Flandrick

Dissertations and Theses

Employment in the United States has changed dramatically since the mid-1970s. Labor market forces like globalization and diversification of the American workforce have led to a heavily segmented labor market where new types of flexible employment such as temporary, contingent, and nonstandard work arrangements are increasingly common. These newer types of work are often on the lower end of the precarious employment continuum, categorizing jobs by their degree of: 1) temporariness, 2) disempowerment, 3) vulnerability, 4) compensation (wages), 5) rights, and 6) ability to exercise worker rights. The increase in precarious employment likely disproportionately affects women when compared to men, …

From Food To Food Justice: Pathways And Narratives Of Young Food Activists In New York City, Amy Kwan

Dissertations and Theses

With a rise in obesity and other non-communicable, diet-related health problems and the persistence of food insecurity among many vulnerable populations, the involvement of young people in the current, burgeoning food-justice movement has the potential to bring forth transformative changes to our food system and thus improve population health. While much is known about the outcomes of providing opportunities for young people to be actively and civically engaged in their communities, there is a lack of research on the pathways, narratives, and experiences that bring young people into food justice activism.

Through semi-structured, in-depth interviews with 25 young food activists …

Incorporating Place And Space: A Hierarchical Spatial Approach To Exploring Preventable Congestive Heart Failure Hospitalizations In New York City, Rachael Weiss Riley

Dissertations and Theses

Background: Faced with rising medical care costs, increasing prevalence, and widening health disparities, preventing congestive heart failure (CHF) hospitalizations is a central public health concern. Despite evidence of geographical clustering in preventable CHF admissions, there is a lack of research designed to examine spatial patterning of CHF and the local area neighborhood determinants that contribute to this variability. This study sought to assess and evaluate the importance of both space and place in analyzing preventable CHF hospitalizations and readmissions by applying appropriate statistical techniques, clarifying the assumption inherent in each method, and interpreting the findings within the context of existing …

The Role Of Socioeconomic Context In The Association Between Educational Attainment And Morbidity And Mortality, Jennifer Brite

Dissertations and Theses

Although the association between educational attainment and health is one of the most studied in the social science, little is known about the role of social and economic context. Fundamental Cause Theory suggests that the education-health gradient will be weakest in contexts where the better educated are unable to leverage their resources to achieve better health. This dissertation tests several different factors that may moderate the association between educational attainment and morbidity and mortality: 1. Demographic characteristics, including race, immigration status, and gender, 2. Status consistency (defined as education equivalent to that required for current occupation), 3. Unemployment rates at …

A Green Oasis: What Makes Community Gardens Worth Saving? While Researchers Amass Evidence Of Benefits, Advocates Develop New Strategy To Prove Their Value., Joel Wolfram

Capstones

Green Valley Community Garden in Brownsville, Brooklyn, is one of about a dozen gardens on land owned by the New York City Department of Housing Preservation and Development that are being uprooted by plans to build affordable housing. The gardeners are fighting back to prevent the garden’s destruction, saying that the food-producing green space is a source of healthy eating in a community with high rates of health problems, like diabetes and obesity. Researchers are attempting to tease out the public health benefits of community gardens as one metric of their value, but the science is still catching up with …

Cause For Question: Risk And Postmodern Panic In The Vaccine Safety Debate, Marygrace Trifilio

Theses and Dissertations

This thesis analyzes the thoughts and feelings of non-vaccinating parents in America and argues that contemporary vaccine refusal results from overwhelming information saturation in the Internet age. Non-vaccinating parents express distrust of competing scientific research and call for a return to a more natural, toxin-free lifestyle.

Perceptions Of Fidelity And Adaptation In Evidence-Informed Interventions By Women Of Color Sexuality Health Educators, Sara C. Flowers

Dissertations, Theses, and Capstone Projects

Sexuality health educators (SHEs) adapt interventions to the participants’ needs in the dissemination and implementation of comprehensive sexuality education (CSE) programming. However, there is a lack of understanding of how, why and when SHEs make such adaptations. Success or failure of the transfer of prevention technology to practitioners occurs by determining community capacities and preparedness to adopt/adapt high-impact interventions to effectively manage implementation. Experts argue for evidence-informed interventions (EII), as opposed to evidence-based interventions (EBI), as the best way to incorporate research in applied settings. EBIs are solely guided by recommendations from current evidence, whereas EIIs recognize and incorporate the …

The Effects Of Health-Related Fitness On School Attendance In New York City 6th-8th Grade Youth, Emily M. D'Agostino

Dissertations, Theses, and Capstone Projects

Background: Only 42% of youth ages 6-11 in the United States meet the World Health Organization’s recommendation for ≥60 minutes of daily moderate to vigorous physical activity. Estimates for adolescents ages 12-19 are even lower, ranging from 8-17%. Literature suggests low levels of youth health-related fitness (fitness) may negatively impact attendance, potentially due to reduced physical and psychosocial wellness. Nationally, 10-15% of (5-7.5 million) students are chronically absent, meaning that they miss ≥10% of the school year (or ≥20 days of school per year). Moreover, 20-30% of students in high-poverty, urban school districts do not attend school regularly (≥6 days …

Ethnicity Matters: Implications For Understanding And Acting Upon Disparities In Health Affecting Black Men In The United States, Helen V. S. Cole

Dissertations, Theses, and Capstone Projects

Compared to non-Hispanic whites, non-Hispanic blacks have higher rates of mortality from heart disease, cancer, cardiovascular disease, and HIV/AIDS. Black men have a life expectancy approximately 4.7 years than the life expectancy of non-Hispanic white men, due in part to higher prevalence of chronic disease among black men. Many factors are hypothesized to contribute to disparities in health between races, including differences in socioeconomic status; culturally-linked behaviors such as diet, substance use, and physical activity; access to quality healthcare and other resources; and experiences of racism, both institutional and interpersonal. However, in public health research, race is usually treated as …