Medicine and Health Sciences Commons^™

"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. …

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

Doctoral Dissertations

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

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 …

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 …

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 …

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, …

Sleep, Reproduction, And Pregnancy, Joshua R. Freeman

Doctoral Dissertations

Sleep, and particularly sleep timing, prior to conception may be important for reproductive and pregnancy health. Evidence of a biological mechanism relating sleep to reproductive health from laboratory studies suggests that sleep may influence the hypothalamic-pituitary-ovarian (HPO) axis. The role of sleep in the HPO axis may also impact many reproductive outcomes including reproductive hormones, ovulation, pregnancy, live birth, pregnancy loss, and adverse pregnancy outcomes. However, epidemiological evidence for associations between sleep, especially sleep timing, and these reproductive health endpoints is limited with most studies typically assessing shift work, and not sleep patterns directly. To address these gaps, we evaluated …

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

Doctoral Dissertations

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

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

Redox Signaling In The Zebrafish Embryo And Implications For Endocrine Pancreas Morphogenesis, Archit Rastogi

Doctoral Dissertations

The glutathione (GSH) system evolved to combat oxygen toxicity in nearly all living organisms, and serves as the predominant cellular redox buffer in vertebrates. This dissertation explores the roles of GSH during embryogenesis using the zebrafish (Danio rerio). The first agnostic in vivo characterization of GSH utilization in the embryo revealed strict spatiotemporal GSH profiles in developing organ systems. Interruption of these GSH profiles by exogenous xenobiotics led to organ specific adverse developmental outcomes; pancreatic β-cells were found to be especially susceptible and developed atypical morphologies following redox active xenobiotic exposures. Pancreatic β-cells lacked expression of Nrf2a (Nuclear …

Cross-Cutting Narratives Of Opioid Use Disorder Among Pregnant Women And Mothers: Implications For Humanistic Care, Alice Fiddian-Green

Doctoral Dissertations

Opioid-related fatalities in the U.S. have increased drastically. Pregnant women and mothers with opioid use disorders (OUD) are a rapidly growing and vulnerable population. Using a critical narrative approach, this dissertation examines how the syndemic of trauma, substance use, and mental health conditions influences opioid use and treatment trajectories among pregnant women and mothers across the lifecourse. The goal of this dissertation was to examine three discursive resources that shape the social construction of perinatal and maternal opioid use across all strata of social life: macro-level (news media), meso-level (scientific), and micro-level (individual) narratives. Informed by 18-months of ethnographic observation, …

Improving Chinese Mothers’ Health Literacy: A Wechat Intervention, Qiong Chen

Doctoral Dissertations

The health literacy and eHealth literacy of women during the reproductive age is crucial, as it can affect their health and the health of their children. Promoting health literacy is essential to achieve mothers’ empowerment by improving access to and capacity of using health information effectively. However, functional, interactive, and critical health literacy and eHealth literacy have never been assessed among Chinese women. The first study during this dissertation assessed functional, interactive, and critical health literacy and eHealth literacy among 421 of Chinese mothers with children under 3 years old. The results revealed overall less than optimal level of health …

Young Adult Early Childhood Home Visitors’ Perceptions Of Fan (Facilitating Attuned Interactions) And Its Potential Protection To Burnout, Lee Mackinnon

Doctoral Dissertations

ABSTRACT YOUNG ADULT EARLY CHILDHOOD HOME VISITORS’ PERCEPTIONS OF FAN (FACILITATING ATTUNED INTERACTIONS) AND ITS POTENTIAL PROTECTION TO BURNOUT FEBRUARY 2019 LEE MACKINNON, B.A., WILLIAMS COLLEGE Ed.M., HARVARD UNIVERSITY Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Claire E. Hamilton This qualitative study investigated the experience of young adult early childhood home visitors in the training and implementation of a family engagement tool, Facilitating Attuned Interactions (FAN) (Gilkerson, 2015). Using Interpretative Phenomenological Analysis, the case study explored how 5 home visitors, who were under 30 years of age, viewed their training and use of FAN in three components of their …

Maternal Postpartum Depression And Father Involvement Across The Transition To Parenthood, Katie Newkirk

Doctoral Dissertations

Maternal postpartum depression is a common complication of childbirth that affects the whole family. Fathers’ greater involvement in childcare can buffer children from the negative effects of mothers’ depression, and aid in mothers’ recovery, so it is important to understand under what conditions fathers become more or less involved when mothers are depressed. Prior research has supported both a compensation hypothesis, whereby fathers compensate for the effects of mothers’ depression on mothers’ parenting by being more involved in parenting, and a spillover hypothesis, whereby mothers’ negative emotionality causes fathers to pull back from family life and be less involved in …

Foki Vitamin D Receptor Gene Polymorphisms And Metabolic Health In Pregnant Saudi Women, Maysa Alzaim

Doctoral Dissertations

Lifestyles have been dynamically changing in the past few years in Saudi Arabia, and the prevalence of non-communicable diseases (NCDs), such as obesity, diabetes, hypertension, high cholesterol, and other cardiovascular diseases (CVD), is notably increasing. In fact, NCDs are affecting a growing number of people in SA, especially women of childbearing age. Vitamin D deficiency has also become pandemic and a major public health concern among the Saudi population despite the abundance of sunlight. The most vulnerable groups are pregnant women and their newborns. Previous studies have correlated low vitamin D status with a higher risk of adverse short- and …

Feasibility Of A Combined Physical Activity And Sleep Education Intervention For Girls Living In A Low Socioeconomic Status Urban Community, Cory J. Greever

Doctoral Dissertations

Declining sleep duration and poor sleep quality is a public health epidemic disproportionately effecting elementary age girls living in low socioeconomic status urban communities. The Girls Dancing and Sleeping for Health (Girls DASH) program was designed to test the feasibility, acceptability, and efficacy of a combined physical activity and sleep education program in this population. In combination with baseline data from a previously conducted intervention in elementary age urban girls living in a low SES community in Springfield, MA, results from a cross-sectional analysis indicated that greater screen time was positively associated with parental reports of child’s sleep quality. Additionally, …

Stress And Depression During Pregnancy Among Hispanic Women: Risk For Adverse Birth Outcomes And The Role Of Physical Activity, Kathleen Szegda

Doctoral Dissertations

Preterm birth and low birth weight are among the leading causes of infant mortality and morbidity in the United States. Puerto Rican women are at increased risk for these adverse birth outcomes and elevated levels of depression and psychosocial stress during pregnancy when compared to non-Hispanic Whites. Therefore, it is important to understand whether these psychological factors increase risk for these adverse birth outcomes and mechanisms to prevent/reduce depression in this high-risk population. The first study of this dissertation examined associations between perceived stress during pregnancy and preterm birth, low birth weight, and birth of a small-for-gestational age infant (SGA) …

Psychosocial Factors Affecting Pregnant Hispanic Women, Marushka L. Silveira

Doctoral Dissertations

Prenatal psychosocial stress, anxiety, and depression are common, with higher rates among Hispanic women. While evidence supports an adverse effect of psychosocial factors on glucose intolerance and oral health, studies during pregnancy are sparse, particularly among Hispanic women. Therefore, we examined correlates of psychosocial factors and their associations with glucose intolerance and oral health among pregnant women. The first project examined correlates of high stress among 1,426 pregnant Hispanic participants in Proyecto Buena Salud, a prospective cohort study. Cohen’s Perceived Stress Scale was administered in early, mid- and late pregnancy. Using multivariable logistic regression, we found that increasing age, pre-pregnancy …

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

Doctoral Dissertations

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

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

Doctoral Dissertations

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