Medicine and Health Sciences Commons^™

The Impact Of A Parent-Only Pediatric Obesity Intervention Program On Quality Of Life In Racially Diverse Children, Taylor Vashro

Theses and Dissertations

Pediatric obesity has been associated with significant decrements in pediatric quality of life (QOL) comparable with severe pediatric diseases such as cancer. Parenting interventions have yielded health benefits for children with obesity; however, few studies have investigated the impact of parent-focused interventions on QOL in children with overweight and obesity. This study investigated the impact of a 6-week intensive parenting intervention program on the QOL of 5-12 year old, predominantly Black children with overweight and obesity. Parents were randomized into either the parenting intervention (NOURISH+) or a control group, and QOL, as well as variables related to child and parenting …

Development Of A Qa Plan For A 3.0t Cannon Galan Mr-Sim, Nathaniel D. Teague

Theses and Dissertations

Purpose: To develop and incorporate a QA (quality assurance) program for a Canon Galan 3 tesla MR Simulator for applications in radiation therapy.

Methods and materials: The QA program was centered around tests performed with three separate levels of frequency. The daily QA procedure consisted of scanning a vendor provided daily QA cube phantom that measures basic performance parameters. Additionally, a series of basic safety check were performed. The monthly QA procedure consisted of several tests, including scanning the ACR MRI large accreditation phantom and manually performing its corresponding image quality tests. Scanning the MagPhan RT for its detailed geometric …

Access To Hiv Prevention, Care, And Treatment Services In The Us: The Role Of Primary Care, Jessica S. Kiernan

Theses and Dissertations

This dissertation examines the role of access to primary care in benefitting HIV outcomes through increased access to HIV prevention, care, and treatment services, among populations disproportionately affected by HIV in the US. Over 30,000 individuals are newly diagnosed with HIV annually in the US and diagnoses are concentrated in specific populations. At an individual-level, ~ 70% of new diagnoses are among gay and bisexual men and of those diagnoses, 70% are among Non-Hispanic Black and Hispanic gay and bisexual men. At a community-level, over 50% of new HIV diagnoses occur in less than 2% of US counties (48), Washington, …

Prospective Investigation Of Insomnia Symptoms And Sleep Duration As Risk Factors For Stroke Incidence And All-Cause Mortality In U.S Adult, Wendemi Sawadogo

Theses and Dissertations

Background and Objectives: Stroke is the second leading cause of death in the world. In the United States, on average, someone has a stroke every 40 seconds and someone dies as a result of stroke every 3.5 minutes. Identifying modifiable risk factors of stroke is therefore a public health priority. The purpose of this study was to investigate the extent to which insomnia symptoms and sleep duration contribute to stroke incidence, all-cause mortality, and explore potential causal pathways.

Methods: The Health and Retirement Study (HRS) and the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were …

Behavioral Screening And Chiral Bioanalysis Of Emerging Stimulant-Type Drugs In Rats, Tyson R. Baird

Theses and Dissertations

The epidemic of drug use in the United States and elsewhere in the world has resulted in tragic loss of life and substantial economic costs. Novel psychoactive substances (NPS) are one of the contributors to this problem, and the lack of information about many of these drugs compounds their risk. This dissertation proposes a strategy to use intracranial self-stimulation (ICSS) as a behavioral screening tool to assess emerging drugs of abuse for their abuse potential in order to generate a proactive threat assessment. A series of stimulant-type drugs including methcathinone, α-pyrrolidinohexanophenone (α-PHP), cocaine, and the phenyltropane analogs of cocaine WIN35428 …

A Technology-Based, Mixed Methods Approach To Examining The Psychosocial Determinants Of Maternal Health Disparities, Hannah M. Ming

Theses and Dissertations

Background: Exposure to racism and discrimination in the U.S. increases Black women’s risk for experiencing maternal health disparities. Additionally, racism and discrimination affect maternal psychosocial well-being, creating evidence for a biopsychosocial relationship between racism and maternal health outcomes. However, current research does not define the psychosocial Black maternal self well. Given the dynamic relationship between racism, psychosocial well-being, and Black maternal health outcomes, research must comprehensively examine the Black maternal self. The operationalization of a comprehensive construct for Black maternal psychosocial well-being can improve understanding of the relationship between racism, psychosocial well-being, and Black maternal health outcomes.

Purpose: …

An Analysis Of The Special Focus Facility Program And Nursing Home Quality, Annie S. Rhodes

Theses and Dissertations

The Special Focus Facility Program is an intensive program meant to rapidly support 88 of the lowest quality nursing homes in the United States, as determined by the Five-Star Quality Ranking system. There are also 435 facility candidates which are similarly low performing but not enrolled in the program. Academic literature has largely ignored this program, and the existing grey literature is more than a decade old and does not include COVID-19 data. Applying a political economy of aging framework and using a case matching methodology, Special Focus Facilities (SFF), Special Focus Facility Candidate (SFFc) nursing homes, and 5-star nursing …

Detailing The Genetic And Environmental Influences Shared Between Conventional And Electronic Cigarette Use Across Measures Of Initiation And Past 12-Month Use, James Clifford

Theses and Dissertations

Introduction. Tobacco use is a public health crisis with nearly 500,000 Americans suffering premature mortality attributable to tobacco use in 2014. New development efforts have created new nicotine delivery systems whose health consequences are not yet fully understood such as electronic cigarettes (ECIG). It is possible there are shared genetic and environmental factors that influence an individual’s liability to initiate cigarette (CIG) or ECIG use, as both systems are designed to deliver nicotine.

Methods. Four study designs were used to resolve the genetic and environmental influences that underlie CIG and ECIG initiation. A twin study, scoping review, genome-wide association study …

Exploring Predictors In The Receipt Of Patient/Family-Centered Care, Arami Anwell

Theses and Dissertations

Study 1

OBJECTIVES: The research aim of this study was to identify predictors associated with the receipt of PFCC among U.S. children/families

METHODS: Caregivers of 38,803 non-institutionalized children, aged 0 to 17 years, were surveyed by the National Survey of Children’s Health (NSCH) 2018–20019. Patient/family-centered care (PFCC) was measured using five components of health care delivery that were answered on a 4-point Likert scale. Logistic regression models were analyzed for the overall receipt of PFCC and each component of PFCC, with survey weighting added to adjust for complex sampling design.

RESULTS: Many predictors were associated with the receipt of PFCC. …

Mathematical Models Of Infection Prevention Programs In Hospital Settings, Kelly A. Reagan

Theses and Dissertations

Hospitals play a vital role in providing for the healthcare needs of a community. Patients can develop hospital-acquired infections (HAIs) during their hospitalization due to exposure to foreign bacteria, viruses, and fungi. Infection prevention programs target and reduce HAIs, but implementing the infection prevention programs often comes with a cost. The goal of my research is to use mathematical models to quantify the impact of infection prevention programs on cases of HAIs and total healthcare costs. First, I use a Markov chain model to quantify how one infection prevention program reduces general HAIs in the hospital. Then, I calculate the …

Estimating Weighted Panel Sizes For Primary Care Providers: An Assessment Of Clustering And Novel Methods Of Panel Size Estimation On Electronic Medical Records, Martin A. Lavallee

Theses and Dissertations

Primary Care is on the frontlines of healthcare, thus they see the most diverse set of patients. In order to achieve high functioning primary care, a practice must establish empanelment, the pairing of patients to providers. Enumeration of empanelment, or estimating panel sizes, helps ensure that the demands of the patients demand the supply of providers and optimize the balance of primary care resources to improve quality of care. Further we can adjust panel sizes by using patient-level data on healthcare utilization and complexity extracted from the electronic medial record to determine the amount of care or burden of work …

A Novel Approach To Reducing Adiposity Among Young Men, Jean M. Reading

Theses and Dissertations

Background

Lifestyle intervention is the first line treatment for obesity. Yet, young men are underrepresented in lifestyle interventions, which is posited to be the result of unmet needs and overall low concern for weight management. The aims of this dissertation are to:

Papers 1 and 2: Test the preliminary efficacy, feasibility, and acceptability of a self-guided lifestyle intervention for young men.

Paper 3: Explore the behavioral and physiological factors associated with changes in adiposity among young men and women enrolled in a more intensive lifestyle intervention.

Results

Papers 1 and 2: The self-guided intervention produced modest weight …

Pharmacists' Role In Opioid Use Disorder And Overdose Prevention And Treatment And Their Attitudes And Perceptions Towards Distributing Naloxone Under A Standing Order, Stephen C. Ijioma

Theses and Dissertations

Background: Opioids are a class of drugs that bind to opioid receptors (mu, delta, and kappa), located in the central and peripheral nervous systems, to exert responses such as analgesia, respiratory depression, euphoria, and miosis. The opioid epidemic is characterized in large part by an increase in opioid overdose deaths. Community pharmacists are one of the most accessible healthcare professionals who frequently interact with patients and can implement OUD and opioid overdose prevention strategies. Treatment for opioid overdose and OUD include naloxone for overdose deaths as well as medication-assisted treatment for OUD.

Objective: The specific aims of this thesis include …

Using Difference-In-Difference To Assess The Impact Of Medicaid Policy On The Addiction Treatment Provider Workforce And Prescribing Behavior In Virginia, Erin Britton

Theses and Dissertations

This dissertation is unified by both policy opportunity and estimation method, examining the impact of Medicaid behavioral health policy in Virginia using a difference-in-differences framework. Medicaid-covered substance use disorder (SUD) treatment benefits in Virginia were significantly enhanced through a Section 1115 SUD waiver, which are required to be budget neutral. Therefore, it is critical to understand whether the objectives of the waiver are met using reliable, unbiased estimation methods. This dissertation includes two empirical research projects evaluating the impact of Medicaid policy on removing barriers in access to care and one methodological project comparing the performance of alternate approaches to …

Policies Addressing Barriers To Low-Income Women And Children’S Health Care Utilization In The United States And Kenya: The Role Of Physician Payments And Cash Transfer Programs, Muloongo Simuzingili

Theses and Dissertations

This dissertation examined two policies to improve low-income women and children’s healthcare utilization: physician payments and cash transfer programs. Higher physician payments increase the supply of healthcare services while cash transfers increase individuals’ demand for healthcare services. Cash transfer programs can improve health outcomes, yet the extent to which they are a cost-effective strategy is largely understudied. Therefore, this dissertation examines three overarching research questions:

1. Are Medicaid physician fees associated with access to substance abuse disorder (SUD) treatment among low-income women of reproductive age?
2. Do economic preferences moderate cash transfer program effects on children’s health care utilization? Evidence from a …

A Mixed Methods Approach To Examine Racial Disparities In Adherence To Surveillance Mammography Among Breast Cancer Survivors, Megan C. Edmonds

Theses and Dissertations

PURPOSE: Annual surveillance mammography is a critical part of routine cancer care for breast cancer (BC) survivors; reducing mortality by 39%. However, disparities exist with regard to adherence to surveillance mammograms among BC survivors; Black women are 44% less likely to adhere than their White counterparts. Despite the existence of this racial disparity for over a decade, little is known about factors that explain reasons for Black BC survivors’ non-adherence. This is because most studies have not evaluated the role of healthcare delivery or psychosocial factors. Guided by the Behavioral Model for Vulnerable Populations, the purpose of this mixed methods …

Associations Between Social Determinants Of Health And Chlamydia Infections Among Georgia Counties, Bre'auna K. Beasley

Theses and Dissertations

Chlamydia is a growing public health concern that disproportionately impacts southern states. While social determinants of health are not direct causes of chlamydia infections, studies have found that these determinants do influence infections by creating environments that promote or hinder health seeking behaviors, as well as exposure to risk factors. Guided by the Social Ecological Model of Public Health and the Healthy People 2030 Social Determinants of Health Conceptual Framework, this dissertation study aimed to examine the associations between social determinants of health and chlamydia infections among Georgia counties. This study employed a correlational research design. Aggregate-level secondary data for …

Feeling The Squeeze: The Association Between Multigeneration Caregiving And Informal Caregivers’ Health, Christine L. Patterson

Theses and Dissertations

While U.S. public policy and research has focused on the health needs of the aging population, less attention has been given to the consequences informal caregivers face caring for this generation. With the segment of the population aged 65 years or older growing rapidly, it is important to understand the factors that place informal caregivers at risk for poor health outcomes and health behaviors. Since multigeneration caregivers balance more personal, work, and caregiving demands than single-generation informal caregivers of older adults, they may be at higher risk for poor health outcomes. The aim of this study was to examine the …

Modeling Substance Use And Mental Disorder Comorbidity Using Latent Variable And Network Approaches, Courtney T. Blondino

Theses and Dissertations

Introduction. Substance use disorder (SUD) is a common condition that affects millions of Americans. Addressing SUD has been complicated by comorbid mental disorders and co-occurring substance use. Consequently, detailing and addressing SUD and comorbid SUD represent an important goal to improve the health of Americans.

Objective. The research goal of this dissertation was to characterize the comorbidity between substance use, including tobacco use, and mental disorder symptoms measured as negative affect and externalizing symptoms in a population-based sample using latent variable and network approaches.

Methods. Waves 1 – 3 from the Population Assessment of Tobacco and Health Study were used. …

Psychological Sense Of Community Among Older Adults In Puerto Rico Two Years After Hurricane María, Thomas D. Buckley

Theses and Dissertations

Hurricane María devastated Puerto Rico in 2017 and resulted in adverse long-term outcomes. Psychological sense of community (PSOC) may serve as a protective factor against the effects of Hurricane María for older adults in Puerto Rico. Using a three-paper format, this dissertation draws on a resilience framework and theories of PSOC and the Ecological Theory of Aging to examine the role of PSOC among older adults in Puerto Rico two years after Hurricane María.

Paper one is a scoping review of the concept of PSOC in research with community dwelling older adults. I begin by presenting findings on study characteristics …

A Deep Learning U-Net For Detecting And Segmenting Liver Tumors, Vidhya Cardozo

Theses and Dissertations

Visualization of liver tumors on simulation CT scans is challenging even with contrast-enhancement, due to the sensitivity of the contrast enhancement to the timing of the CT acquisition. Image registration to magnetic resonance imaging (MRI) can be helpful for delineation, but differences in patient position, liver shape and volume, and the lack of anatomical landmarks between the two image sets makes the task difficult. This study develops a U-Net based neural network for automated liver and tumor segmentation for purposes of radiotherapy treatment planning. Non-contrast simulation based abdominal CT axial scans of 52 patients with primary liver tumors were utilized. …

The Role Of Insurance Coverage In Outpatient Substance Use Disorder Treatment Referral, Utilization, And Outcomes, Huyen Pham

Theses and Dissertations

Opioid-related overdoses increased dramatically in recent years. Medicaid plays a predominant role in paying for opioid use disorder (OUD) treatment. However, there is a critical gap in understanding the role of Medicaid coverage in referrals to treatment, treatment utilization, and treatment retention. The three studies used observational and quasi-experimental (i.e., natural experiment) designs leveraging state and year variation in Medicaid expansion to characterize the role of Medicaid coverage in OUD treatment. We found that individuals with OUD with Medicaid insurance were more likely to use outpatient treatment, whereas those who were uninsured were more likely to use self-help groups only. …

Health Outcomes And Utilization Associated With Renal Diseases In Patients With Cancer In The United States, Mitisha Dedhia

Theses and Dissertations

Background: Adverse events and impairments associated with cancer and its treatments causes worse outcomes. Increased incidence of renal diseases among cancer patients is of particular concern. Objective: To determine the risk factors for renal disease in cancer patients and compare healthcare costs, utilization and health-related quality of life (HRQoL) of cancer patients with a renal disease and cancer patients without renal diseases. Methods: Medical Expenditure Panel Survey files from 2009 – 2018 for cancer patients was used for this study. Multiple logistic regression, generalized linear model, Poisson regression and multiple linear regression for analyses after adjusting for demographic, socioeconomic and …

Another Step In Diagnostics Consultation Model© Actualization: Examining The Impact Of Consultation Workflow Processes On Providers' Clinical Decision Making, Elizabeth K. Leibach

Theses and Dissertations

Background
Communication errors in health services delivery significantly compromise quality in clinical decision making (CDM). Diagnostic information generated by clinical laboratories (CL) accounts for as much as 93% of objective data in the clinical record and therefore is foundational in CDM. This work describes the Diagnostics Consultation Model© (DCM©), a CL communications portal, which supports CDM within interprofessional teams, providers, and institutions. Specific aims were to develop and validate a workflow prediction index (the complexity index, CI) to assign resolution of consultation requests based on an algorithm comprised of characteristics available at the point of consultation initiation. The CI functions …

Identifying And Addressing Barriers To Accessing Treatment For Substance Use Disorders Among Opioid-Misusing Individuals Following Implementation Of The Affordable Care Act, Mirinda A. Gormley

Theses and Dissertations

BACKGROUND: This project utilized opioid-misusing adults to investigate the association between type of opioid misuse and perceived readiness, financial, structural, and stigma-related barriers to accessing SUD treatment; identified classes of PSU and the association between patterns of PSU and perceived barriers, and evaluated effectiveness of an out-of-hospital opioid-treatment connection program.

METHODS: Respondents from 2015-2018 NSDUH included insured adults reporting past year opioid misuse. Multivariate logistic regression assessed relationship between type of opioid misuse and perceived barriers to SUD treatment. LCA identified patterns of PSU, and multivariate logistic regression assessed association between PSU classes and perceived barriers. EMS ePCRs for nonfatal …

“Is Therapy For Me?” Perceptions Of Therapy Inclusivity And Willingness To Seek Help Among Black Emerging Adults, Randl B. Dent

Theses and Dissertations

Mental health issues are prevalent among Black emerging adults; however, they tend to underutilize mental healthcare services. The goals of the current study were to examine whether: (1) perceived therapy inclusivity would predict willingness to utilize mental healthcare services and (2) the relationship between perceived therapy inclusivity and willingness would be moderated by two indices of racial identity (i.e., centrality and private regard). Results provide evidence that greater perceptions of therapy inclusivity are associated with greater willingness to seek mental health services even after controlling for factors, such as gender, self-stigma, and previous mental healthcare utilization. Additionally, there was no …

Reducing Disparities In Smoking For Adults With Mental Illness: Are U.S. Tobacco Prevention Policies Effective?, L. Morgan Snell

Theses and Dissertations

One in five people in the U.S. are estimated to experience “any mental illness” (AMI); however this group represents an estimated 40% of the annual, adult cigarette consumption in the U.S. Tobacco prevention policies have been successful at reducing smoking prevalence among the U.S. population as a whole, however it is unclear whether these efforts have had significant impact on tobacco use rates among individuals with AMI. The three papers that comprise this project combined longitudinal, nationally-representative data and online behavioral experiments from U.S. adults to compare demand for cigarettes among adult smokers with and without AMI. Taken together, our …

The Relationships Among External Environments, Organizational Structures, And Performance In Pursuit Of The Clinical And Academic Missions At Academic Health Centers, Eric J. Strucko

Theses and Dissertations

Clinical and academic missions place Academic Health Centers (AHCs) at the center of the American health care system, and the future viability of these institutions requires successful performance in competitive environments. AHCs are organizations involving hospitals, physician group practices, and medical schools, and treat patients with complex conditions, conduct bio-medical and health science research, and educate future physicians and health professionals. AHCs account for 20% or $540 billion of national health care expenditures, conduct over 80% of all heart, liver, and lung transplants, utilize over $27 billion in annual sponsored research funding, and graduate approximately 17,300 medical doctors annually. Financial …

A Theoretically-Based Mixed Methods Approach To Examining Mental Health Disorders And Help-Seeking Behaviors Among University-Enrolled African American Men, Kofoworola D.A. Williams

Theses and Dissertations

Recent studies show that African American men in college are disproportionately experiencing high levels of psychological distress, increasing their risk of developing mental health symptoms associated with depression and anxiety. Despite being at higher risk for developing mental health symptoms, university-enrolled, African American men are not seeking help even when experiencing high levels of stress and anxiety, impacting their academic performance. The evidence base describing mental health symptom prevalence and evidence-based prevention strategies among university-enrolled, African American men is limited. To that end, this dissertation work utilized a concurrent, mixed methods approach, theoretically-based in the Social Ecological Model (SEM), to …

The Intersection Of Social Stress, Mental Well-Being, And Sexual Health Among Black Women In Emerging Adulthood, Brandi Galloway

Theses and Dissertations

With an estimated 37,000 new HIV infections each year, HIV continues to be a major public health concern. HIV affects some populations more than others. Young Black women, in particular, are disproportionately affected by HIV. While being a woman does not typically increase a person’s HIV risk, being Black and being a woman does.

Data indicate that individual-level factors do not fully address the differences in HIV and STIs between Black emerging adult women and their White counterparts. Thus, it is critical to better understand contextual factors such as social stress and mental-wellbeing which might better account for these disparities. …