Medicine and Health Sciences Commons^™

Psychological Resilience In U.S. Military Veterans: Results From The 2019-2020 National Health And Resilience In Veterans Study, Michael Georgescu

Public Health Theses

Psychological resilience is the most common response following exposure to traumatic life events. To date, most research has focused on factors associated with adverse post-trauma mental health outcomes rather than understanding those associated with psychological resilience. In particular, little is known about factors associated with resilience in veterans, despite their high rates of trauma exposure, such as combat and military sexual trauma. To address this gap, we used a discrepancy-based psychiatric resilience (DBPR) analytic approach to operationalize resilience and to identify modifiable health and psychosocial factors associated with resilience in a nationally representative sample of U.S. veterans (N = 4,069). …

For “Them”, Not Us: A Qualitative Study Of Asian American Pacific Islander Perceptions Of Substance Use And Harm Reduction, Winnie Ho

Public Health Theses

Background: Asian American Pacific Islander (AAPI) substance use data is typically aggregated in a way that not only produces overly generalized results, but also potentially perpetuates stereotypes created by the Model Minority Myth (MMM). This has mutually reinforced a lack of representation and understanding of AAPI substance use experiences and needs. This presents a public health concern that is both excluding them from consideration by the field of harm reduction, but also themselves from considering harm reduction. Disaggregated data shows rising rates of substance use and associated harms that are often hidden or not taken as seriously as a public …

"Hair-Esteem Toolkit For Black Girls": The Development Of A Self-Esteem Toolkit For Black Adolescent Girls Centering Hair As A Tool For Empowerment, Sydney Hussett-Richardson

Public Health Theses

Background: For Black adolescent girls, hair is a strong staple of gender and ethnic identity, influencing intrapersonal and interpersonal interactions. Gendered racism and Eurocentric beauty standards pathologize Black girls and their hair, leading them to experience high rates of hair harassment and discrimination. These experiences negatively impact the self-esteem of Black girls, which has important implications for a host of health behaviors. The purpose of this study was to explore the relationship between self-esteem and hair among Black girls and integrate findings into a culturally relevant digital toolkit to promote and develop hair-esteem and self-esteem among Black girls.Methods: This study …

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State, Anna Grace Preston

Public Health Theses

Background: Despite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the …

“For The Future, For Him, And For Our Life Together”: The Relationship Goals And Well-Being Of Persons Living With Dementia And Their Spousal Care Partners, Claire Leigh Szapary

Public Health Theses

Background. Identities and dynamics in relationships can change when one spouse develops dementia. This study aimed to understand the various types of goals both spousal care partners and persons living with dementia (PLWD) have for their relationship, and to explore whether approach or avoidance goals were associated with individual wellbeing and relational support – as well as their partners’ wellbeing and support.

Methods. A secondary analysis of data from sixty-two spousal dyads where one partner has dementia was conducted. Thematic goal-type categories were determined through a card-sort content analysis methodology using participants’ brief qualitative responses to a question asking about …

Support Or Interference: Relational Influences On Mother’S Exclusive Breastfeeding Practices In Ghana, Georgiana Esteves

Public Health Theses

Childhood malnutrition is a challenge that needs to be understood as a global health threat. Exclusive breastfeeding (EBF) is recognized as the best practice to improve a child’s growth and cognitive development in the first months of life. The World Health Organization recommends EBF until 6 months. Mothers need family support to adhere to EBF practices. This study aimed to understand the interpersonal level relational influences of fathers, grandmothers, and other family members on the mother-child dyad adherence to EBF practices, as well as document community and societal influences on EBF. This study took place in the Central Region of …

The Role Of Childhood Trauma In Intergenerational Trauma (Igt), Audrey Huang

Public Health Theses

Emerging research has focused on the intersection of personal and parental trauma within intergenerational trauma (IGT) transmission, specifically offspring adverse childhood experiences due to trauma-related parenting behaviors. However, the role that offspring childhood trauma and its various subtypes may play in moderating or mediating IGT transmission, as well as the impact of caregiver sex, are still remains largely understudied. We examined how the transmission of PTSD between survivors of the 1994 genocide to their offspring might be either (a) mediated by overall and subtypes of offspring childhood trauma, or (b) moderated by overall and subtypes of offspring childhood trauma, and …

Intelligibility Benefit For Familiar Voices Does Not Depend On Better Discrimination Of Fundamental Frequency Or Vocal Tract Length, Emma Holmes, Ingrid Johnsrude

Brain and Mind Institute Researchers' Publications

Speech is more intelligible when it is spoken by familiar than unfamiliar people. Two cues to voice identity are glottal pulse rate (GPR) and vocal tract length (VTL): perhaps these features are more accurately represented for familiar voices in a listener’s brain. If so, listeners should be able to discriminate smaller manipulations to perceptual correlates of these vocal parameters for familiar than unfamiliar voices. We recruited pairs of friends who had known each other for 0.5–22.5 years. We measured thresholds for discriminating pitch (correlate of GPR) and formant spacing (correlate of VTL; ‘VTL-timbre’) for voices that were familiar (friends) and …

Prevalence And Health Burden Of Cardiovascular Disease In Older U.S. Veterans: Results From The 2019-2020 National Health And Resilience In Veterans Study, Cailin Arechiga

Public Health Theses

Importance. Cardiovascular disease (CVD) is one of the leading causes of death in the U.S. and is associated with a range of demographic, military, trauma, and clinical characteristics and physical and mental health conditions. Older military veterans may have an increased risk for CVD, given their advanced age and military experiences. However, the prevalence and health burden of CVD in population-based samples has not been well characterized. Objective. To characterize the current prevalence of CVD, and its association with sociodemographic, military, trauma, and clinical variables in a large, contemporary, and nationally representative sample of older U.S. veterans. Design. Cross-sectional study …

Healthcare Provider Perspectives On The Influence Of Cultural Beliefs On Infant And Young Child Feeding Practices Within Ghanaian Refugee Camps: A Qualitative Analysis, Morgan Nadene Veronica Buchanan

Public Health Theses

Adherence to breastfeeding and complementary feeding recommendations is a proven strategy for promoting the well-being of infants and young children and ensuring their proper development. Cultural beliefs inform caregivers’ likelihood to follow these guidelines as they influence caregivers’ thoughts about maternal behavior during the prenatal and lactation periods, child feeding behaviors, and health. Refugee camps or settlements are a unique space to study the coexistence of cultural beliefs held by residents and staff. Understanding the pathways by which cultural beliefs modulate caregiver infant and young child feeding (IYCF) behavior (and therefore impact child health) within these settings is of paramount …

‘I’M Never Saying A Damn Word Again’: Approaches To Community Support And Help Seeking Among Black Youth Experiencing Suicidal Thoughts, Alexis Renee Hopkins

Public Health Theses

Background. Suicidal behavior among Black youth is rising in the United States , yet little is known about how Black Youth engage and navigate suicidality. While we know that suicide ideation and death by suicide is decreasing overall among youth in the U.S., incidences of death by suicide are still rising among Black youth. There is very little understanding of what community support is accessible to Black youth who are experiencing suicidality. The present study examines how Black young adults who experienced suicidality in their youth turned to their social support systems and communities for support. Method. Seventeen semi-structured in-depth …

Uniting The Front: A Qualitative Exploration Of The Community Health Worker Covid-19 Pandemic Response In Connecticut, Serena Ly

Public Health Theses

Background: Community health workers (CHWs) are becoming increasingly recognized for their contributions to community health. As the COVID-19 pandemic continues to devastate poor and underserved communities, leveraging CHWs’ experiences with vulnerable community members is key to developing an equity-centered pandemic response. This qualitative research study aimed to explore how CHWs have addressed emerging community needs and whether health and emergency management systems have fully integrated CHWs in the COVID-19 pandemic response. This study further aimed to assess, through CHWs perceptions, how well health systems have safeguarded CHWs’ health and wellbeing as they support impacted communities.

Methods: CHWs and their managers …

The Impact Of Economic Intimate Partner Violence On Women’S Sexual And Reproductive Health In Asia & The Pacific, Marina Katague

Public Health Theses

Intimate partner violence is a human rights violation and serious threat to global public health. Economic intimate partner violence is a unique form of abuse whose effects on health need clarification. Data from the 2011-2012 UN Multi-country Study on Men and Violence, comprised of cross-sectional samples in China, Papua New Guinea, and Sri Lanka were collected on ever-partnered women aged 18-49 years. The sample averaged some (1.14) economic violence exposure across summed behaviors (range 0-12; standard deviation=2.04). Multivariable regressions were run to assess the relationship between severity of IPV abuse types and 14 sexual and reproductive health outcomes. Adjusted analyses …

Sensors And Wearables In Oncology: A Study Of The Barriers And Facilitators To Adoption, Sam Hanna

Doctor of Philosophy in Translational Health Sciences Dissertations

Innovation, although a subject of considerable debate (e.g., Baregheh et al., 2009; Christensen, 1997), can be defined as the introduction and dissemination of a new or a different idea into use or practice that drives impact (Solis and Sinfield, 2014). Many studies and editorials have highlighted the complexity of the United States health system and detailed the slow speed by which innovative ideas materialize into impactful innovations (Continuing America’s leadership (2017); England & Stewart (2007); Kannampallil, Schauer, Cohen & Patel (2011)). While there are many advances in sensor and wearable technologies in this instance, the adoption rate by oncologists has …

Experiences And Beliefs About Violence And Sexual Health: A Qualitative Analysis Of The Experiences Of Female Migrant Lao Workers At The Border Of Thailand And Laos, Rachel Michele Brase

Public Health Theses

Background: It is estimated that 10% of Thailand’s total labor force is estimated to be made up of migrant workers. While the exact number of migrant workers from nearby countries is unknown, border towns and provinces are acknowledged to utilize a large population of undocumented and documented migrant workers. A majority of undocumented and a nearly half of documented migrants were reported to be female. While previous research has explored the health needs of female migrant workers in specific industries, such as the sex work industry and manufacturing industry, few studies have examined the health needs and beliefs of female …

Marketing Of (Bms): Content Analysis Of Breast Milk Substitutes Digital Marketing On Chinese E-Commerce Platforms, Shannon Han

Public Health Theses

Background: China has one of the largest and fastest-growing breast milk substitutes (BMS) industries and a disproportionately low exclusive breastfeeding rate. The rapid penetration of technology and the internet, together with convenience-oriented lifestyles, has led to the dominance of the e-commerce industry in China. Many BMS manufacturers have established e-commerce flagship stores and use them as main retail and marketing channels.

Objective: This study aimed to analyze the BMS retail websites on the largest business to consumer (B2C) e-commerce platform TMall, to characterize the marketing themes and strategies used to target consumers. It was specifically designed to improve our understanding …

Association Between Opening A Jail And Sexually Transmitted Infections In Rural Counties Across The United States, Tyler Harvey

Public Health Theses

Abstract

Objective

To estimate the effect of openings jail in rural counties on county-level chlamydia, gonorrhea, and syphilis prevalence rates.

Methods

We used county-level data from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (2005-2017) to obtain chlamydia, gonorrhea, and syphilis rates, and the American Correctional Association’s National Jail and Adult Detention Directory (2013-2014) to locate rural jail openings. Using a generalized synthetic control method, we estimated the effect of opening jails in 41 rural counties between 2010 and 2012 across the United States on sexually-transmitted infections.

Results

We found an average treatment effect for chlamydia prevalence …

A Feel For The Space: Engagement With The Built Environment Of Treatment Spaces Among Individuals In Recovery, James Richey

Public Health Theses

Background

Treatment spaces for substance use disorders (SUD) are diverse with respect to treatment modality and population served. However, there is a lack of literature describing the design of treatment spaces and treatment engagement. This project aims to identify how the built environment of SUD treatment spaces play a role in treatment acceptability, retention, and outcomes.

Methods

We conducted 15 semi-structured interviews with individuals in outpatient SUD treatment in southern Connecticut. These interviews explored individuals’ experience with the built environment of treatment spaces and facilities, including architectural and design-related features (e.g., functionality, spatial arrangement), and how space influences adherence to …

The Effects Of Rental Assistance On Housing Stability, Quality, Autonomy And Affordability, Rebecca G. Schapiro

Public Health Theses

In light of the current affordable housing crisis in the United States, this paper examines how rental assistance is associated with four housing outcomes: housing stability, quality, autonomy, and affordability to expand the current knowledge base on benefits of rental assistance. We use data from the first four waves (2017-2019) of the JustHouHS Study, a cohort study of low-income adults designed to examine the intersection of housing, mass incarceration, and health in New Haven, Connecticut. We use Generalized Estimating Equations to examine how rental assistance is associated with participants’ housing stability, quality, autonomy, and affordability. Participants receiving rental assistance had …

Medical Student Mistreatment And Burnout: An Intersectional Approach, Bethelehem Getachew Teshome

Public Health Theses

Importance

While prior studies have described mistreatment in an undergraduate medical setting by sex, sexual orientation, and race/ethnicity, no studies have examined the degree of mistreatment and symptoms of burnout experienced by students with multiple marginalized identities with national data.

Objective

To describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education.

Design

This cohort study utilized data from the Graduate Questionnaire administered annually by the Association of American Medical Colleges.

Setting

This study utilized student responses from the 140 U.S. medical schools accredited by the Association of American Medical Colleges’ Liaison Committee on Medical …

Evaluating The Appropriateness Of Oral Antibiotic Therapy Following Discharge For Patients With Urinary Tract Infection, Sera Yoo

Public Health Theses

Introduction: Inappropriate use of antibiotics is common in healthcare settings, with urinary tract infections (UTI) being one of the most common indications for antibiotic prescriptions. This study evaluated the appropriateness of oral antibiotic therapy among adult patients with suspected UTI who were admitted to Yale New Haven Hospital during January 2018. We hypothesized that 60% of antibiotics were inappropriate, and that inappropriate therapy was associated with Clostridioides difficile infection, hospital readmission and/or mortality.

Methods: We conducted a retrospective cohort study of adult patients who were admitted to Yale New Haven Hospital from January 1, 2018 to January 31, 2018. Data …

Provider Experiences Implementing Group Care: A Qualitative Study, Noureen Ahmed

Public Health Theses

Objective/Purpose: Group Well Child Care is an innovation in primary care delivery that may help meet the quadruple aim of health care. The objective of this study is to characterize Group Well Child Care providers’ experiences, perceptions, and strategies.

Introduction: In Group Care, also known as shared medical appointments, patients with similar medical needs attend appointments together. The practice of Group Care has spread, particularly where social support is beneficial (e.g., early parenting) and among those who might experience shame or stigma for their diagnosis or background (e.g., poverty). Group Care has shown promise in improving patient outcomes, such as …

Efficacy Of The Feline Temperament Profile In Evaluating Sheltered Cats For Adoption Into Families Of A Child With Autism Spectrum Disorder, Angélique Lamontagne, Rebecca A. Johnson, Gretchen K. Carlisle, Leslie A. Lyons, Jessica L. Bibbo, Colleen Koch, Steven J. Osterlind

Animal Studies Journal

This project was part of the Feline Friends Study, which matches shelter cats with families of children with Autism Spectrum Disorder (ASD) to study children’s social behaviour and cats’ stress. Cats were screened for calm temperament using the Feline Temperament Profile (FTP). The FTP consists of ten phases, with a list of ‘acceptable’ and ‘questionable’ behaviours under each phase. Our aim was to answer the following research questions: What items of the FTP best predict temperament in shelter cats? What are similarities and differences in temperament between cats who qualified or did not qualify for placement? Forty-four shelter cats were …

“Malicious Medicine”: A Qualitative Study Of Medical Mistrust And Prep Perceptions For African American And Hispanic Men And Women In New Haven, Ct, Alexandra Lee Grimaldi

Public Health Theses

Objective: To understand how medical mistrust impacts perceptions of PrEP and willingness to use PrEP for African American and Hispanic men and women in New Haven, Connecticut.

Methods: This qualitative study utilized semi-structured interviews to examine medical mistrust, PrEP awareness, and willingness to use PrEP amongst African American and Hispanic men and women in New Haven, Connecticut.

Results: The majority of participants did not know about PrEP before their first interview of this study and the majority of participants did not decide to use PrEP over the course of this study. For those who are not interested in using PrEP, …

Attachment Security And Psychological Health In Adult Child Caregivers And Their Parents With Alzheimer’S Disease And Related Dementias, Wei Aiko Chang

Public Health Theses

Objective: Attachment theory is a helpful framework for examining one of the most fundamental needs in parent-child dyads across the lifespan and how attachment security might protect both dyad members’ psychological health, especially in times of crisis. In this study of adult child caregivers and their parents with early stage Alzheimer’s disease and related dementias (ADRD), we examined the associations between both dyad members’ attachment security, the adult child’s depressive symptoms, and quality of life of the parent with ADRD.

Method: Thirty-four individuals (parents) with ADRD and their 34 adult-child caregivers each completed the 12-item Experiences in Close Relationship Scale …

Evaluation Of A Patient Navigation Program For Vulnerable Families, Hillary Chisholm

Public Health Theses

Abstract

Objectives: Low-income and minority children experience worse health outcomes for reasons that are complex and multifactorial. The aims of this study were to examine the experiences of caregivers and providers who participated in a patient navigation program designed to address these disparities, and to understand how the program was impactful to participants.

Methods: As part of a larger pilot-stage intervention, we conducted a qualitative study using a modified Realist Evaluation approach. Between April and October 2018, we conducted semi-structured interviews of a group of caregivers who were enrolled in the intervention, and the providers who cared for these children. …

Estimating Mortality After Natural Disasters In Low- And Middle-Income Countries: A Systematic Review, Joseph Clingerman

Public Health Theses

Background

The outcomes of natural disasters produce many complex uncertainties and statistics, many of which have no metrics to assess how accurate they are. In particular, mortality estimates in low- and middle-income countries encompass many variables in their inherently challenging physical, political, and logistical landscapes. Given that there has been no known systematic review of assessing mortality estimation methodologies, the author aimed to provide a systematic review of known methodologies and provide a framework to assess mortality estimation methodologies.

Methods

The author performed a systematic search of electronic databases from the past two decades up to January 2019. In addition, …

Wholesome Wave Communities Market Approach, Nikita Mehta

Public Health Theses

In 2017, approximately 1.2 million residents, or 14.4% of the population, in New York City were identified as food insecure, which is higher than the national rate of 11.8%. Wholesome Wave is a non-profit organization based in the Northeastern region of the United States that develops programming for consumers to make healthier food choices through increases in affordable access to healthy, locally and regionally grown foods. Wholesome Wave makes fruits and vegetables affordable through their Wholesome Communities initiative which includes the SNAP Double Value Program and the FVRx. This report builds a strategic go-to-market approach by identifying key funders, partners, …

What Does It Meme? A Qualitative Analysis Of Adolescents’ Perceptions Of Tobacco And Marijuana Messaging, Jessica Liu

Public Health Theses

With increasing popularity of e-cigarettes and legalization of marijuana, messaging from online sites and platforms are shaping product perceptions and use. Quantitative studies have examined social media statistics of posts; however, there is a lack of research explaining the aesthetic appeal of these advertisements from the adolescents and young adults (AYA) perspective.

Twenty-four participants were recruited from a larger study of adolescents' perceptions and tobacco use (N=772 high school students). Participants were grouped by whether or not they had used tobacco or marijuana products before, with N=8 non-users and N=16 users. Data were collected through individual semi-structured interviews, where participants …

Perspectives Of Type 2 Diabetes Patients On Their Interactions With Providers, Marleen Z. Jones-Pool

Public Health Theses

Effective patient-provider communication has been shown to help achieve optimal health results, particularly in patients with diabetes. While previous studies have identified patient-perceived barriers in communicating with their providers, this study highlights factors in the patient-provider interaction that may contribute to effective health communication. As part of a larger mixed-methods study, 10 semi-structured interviews were conducted with patients with self-reported diabetes at a primary health center. These interviews sought to understand patient-perceived communication factors that influenced their interactions with their providers. Interviews were recorded and transcribed verbatim. Interview transcripts were then coded and analyzed utilizing a grounded theory approach. Findings …