Medicine and Health Sciences Commons^™

Racial And Ethnic Disparities In Alcohol-Attributed Deaths In The United States, 1999–2020, Ibraheem M. Karaye, Nasim Maleki, Ismaeel Yunusa Ph.D.

Faculty Publications

The disparities in alcohol-attributed death rates among different racial and ethnic groups in the United States (US) have received limited research attention. Our study aimed to examine the burden and trends in alcohol-attributed mortality rates in the US by race and ethnicity from 1999 to 2020. We used national mortality data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database and employed the ICD-10 coding system to identify alcohol-related deaths. Disparity rate ratios were calculated using the Taylor series, and Joinpoint regression was used to analyze temporal trends and calculate annual and …

Fixing The System: A Comparative Review Of The United Kingdom, Germany, And United States’ Healthcare Systems And Lessons Learned For Potential Improvements In The United States, Jessica Goddard

Senior Theses

In an effort to provide recommendations to the United States’ considerations of a universal healthcare system, this thesis analyzes the United States healthcare system alongside the sophisticated systems of the United Kingdom and Germany. Literature review and an analysis of 10 health outcomes and indicators guided the framework for a set of interview questions to be asked of healthcare professionals in all three countries. The interview response data was then organized and used to guide the suggested recommendations to the United States in its path towards universal healthcare. While a limited number of solutions could be provided given the time …

Greenspace Across The United States: Exploring Equity And Associations With Physical Activity, Obesity, And Health-Related Quality Of Life, Ellen W. Stowe

Theses and Dissertations

Neighborhood greenspace is important for health and well-being but may not be equitably present in neighborhoods across the United States. Also, many adults are physically inactive, have obesity, and report poor health-related quality of life. Greenspace has been tied to these health conditions, but with mixed findings. The purpose of this study was to 1) use an environmental justice perspective to examine variations in 11 measures of greenspace by neighborhood race/ethnicity, income, and rurality in block groups across the contiguous United States and 2) examine 11 greenspace measures in connection to physical activity, obesity, and health-related quality of life in …

Nutrition Facts Label Use Among U.S. Adolescents, Jennifer Beth Mandelbaum

Theses and Dissertations

Despite the promise of Nutrition Facts label (NFL) use as a population-level intervention with broad reach, few studies have examined determinants of adolescents’ NFL use, and how this label use may be associated with nutrition behaviors. This study used data from the International Food Policy Study, an online cross-sectional survey of trends in dietary patterns and policy-relevant behaviors in the U.S. and five other countries. First, this study examined 1) whether NFL use was associated with healthy eating efforts and 2) whether there were sociodemographic differences in NFL use among U.S. adolescents. Results demonstrated that NFL use was positively associated …

Quantile Differences In The Age-Related Decline In Cardiorespiratory Fitness Between Sexes In Adults Without Type 2 Diabetes Mellitus In The United States, Andrew Ortaglia, Melissa Stansbury, Michael David Wirth, Xuemei Sui, Matteo Bottai

Faculty Publications

Objective: To comprehensively assess the extent to which the decline in cardiorespiratory fitness (CRF) with age differs between sexes. Participants and Methods: This study used data from the Aerobics Center Longitudinal Study, conducted between September 1974 and August 2006, consisting primarily of White adults from middle-to-upper socioeconomic strata restricted to adults without type 2 diabetes mellitus (33,742 men and 9,415 women). Quantile regression models were used to estimate the differences in age-associated changes in CRF between the sexes, estimated using a maximal treadmill test. Results: For adults aged up to 45 years, significant differences in slopes relating to age and …

Retrospective Cohort Evaluating The Comparative Effectiveness Of Ceftaroline And Daptomycin As First-Line Therapies For Inpatient Treatment Of Diabetic Foot Infection In The United States Veterans Health Care System, Alyssa C. Eaves, Chengwen Teng Pharm.D., Ph.D., Kirk E. Evoy, Christopher R. Frei

Faculty Publications

Background Both ceftaroline and daptomycin are possible therapeutic options for diabetic foot infection (DFI) and both are active against methicillin-resistant Staphylococcus aureus (MRSA) infection; however, no previous studies have evaluated their efectiveness head-to-head.

Objective This study compared hospital readmission and mortality proportions among patients receiving ceftaroline fosamil or daptomycin for DFI.

Patients and Methods This was a retrospective cohort, comparative efectiveness study of adults (aged ≥ 18 years) admitted to United States Veterans Health Care System hospitals with a diagnosis code for DFI between 1 October 2010 and 30 September 2014 with an electronic order for ceftaroline or daptomycin as …

How Different Pre-Existing Mental Disorders And Their Co-Occurrence Affects Covid-19 Clinical Outcomes? A Real-World Data Study In The Southern United States, Shan Qiao Ph.D., Jiajia Zhang Ph.D., Shujie Chen, Bankole Olatosi Ph.D., Suzanne Hardeman, Meera Narasimhan, Larisa Bruner, Abdoulaye Diedhiou, Cheryl Scott, Ali Mansaray, Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Background: Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes.

Methods: Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data …

Social Capital, Urbanization Level, And Covid-19 Vaccination Uptake In The United States: A National Level Analysis, Shan Qiao, Zhenlong Li, Jiajia Zhang, Xiaowen Sun, Camryn Garrett, Xiaoming Li

Faculty Publications

Vaccination remains the most promising mitigation strategy for the COVID-19 pandemic. However, existing literature shows significant disparities in vaccination uptake in the United States. Using publicly available national-level data, we aimed to explore if county-level social capital can further explain disparities in vaccination uptake rates when adjusting for demographic and social determinants of health (SDOH) variables, and if association between social capital and vaccination uptake may vary by urbanization level. Bivariate analyses and a hierarchical multivariable quasi-binomial regression analysis were conducted, where the regression analysis was stratified by urban–rural status. The current study suggests that social capital contributes significantly to …

Risk Of Opioid Overdose Associated With Concomitant Use Of Oxycodone And Selective Serotonin Reuptake Inhibitors, Ismaeel Yunusa, Joshua J. Gagne, Kazuki Yoshida, Katsiaryna Bykov

Faculty Publications

Importance Some selective serotonin reuptake inhibitors (SSRIs) inhibit the enzymes responsible for the metabolism of oxycodone, a potent prescription opioid. The clinical consequences of this interaction on the risk of opioid overdose have not been elucidated.

Objective To compare opioid overdose rates in patients initiating oxycodone while taking SSRIs that are potent inhibitors of the cytochrome-P450 2D6 enzyme (CYP2D6) vs SSRIs that are not.

Design, Setting, and Participants This cohort study included adults who initiated oxycodone while receiving SSRI therapy between 2000 and 2020 whose data were included in 3 US health insurance databases.

Exposures Use of SSRIs that strongly …

Trends In Insulin Prescribing For Patients With Diabetes During The Covid-19 Pandemic In The Us, Ismaeel Yunusa Ph.D., Bryan L. Love Pharm D., Chao Cai, Tessa Hastings, Claiborne E. Reeder, Elizabeh W. Blake, Cynthia Phillips

Faculty Publications

Introduction

For the approximately 7 million US individuals with diabetes who rely on insulin,¹ the number of insulin prescriptions rose steadily in the decade before the COVID-19 pandemic.² Reduced access to medical care and disruptions in supply related to the pandemic may have decreased access to insulin,³ with possible adverse consequences for diabetes control.⁴ Conversely, emergency Medicaid expansions that increased capacity for telemedicine services during the pandemic may have been associated with improved access to treatment.⁵ Therefore, this study aimed to assess whether changes to insulin prescription claims occurred during the COVID-19 pandemic.

Methods

In …

Rabies Postexposure Prophylaxis In The United States: Opportunities To Improve Access, Coordination, And Delivery, Gavin T. Howington, Huy-Binh Nguyen, P Brandon Bookstaver, Peter Akpunonu, Joshua T. Swan

Faculty Publications

No abstract provided.

Limitations And Consequences Of Migrant And Refugee Healthcare- An Analysis Of The Current State Of Migrant Health, Meghan Herilla

Senior Theses

Migrants and refugees are an often-neglected specialized population in the field of healthcare, although making up over 14% of the world’s population.

The following paper examines the current state of migrant healthcare, including but not limited to ease of access, quality of care, and the accompanying stigmatization of immigrants in general. It then analyzes current policies, both national and global, influencing the healthcare of immigrants in both the United States and abroad. Finally, a comparison of migrant healthcare in the United States versus Thailand shows how the current U.S. healthcare system can be improved to better accommodate migrants and refugees. …

Association Of Patient-Centered Medical Home Designation And Quality Indicators Within Hrsa-Funded Community Health Center Delivery Sites, Nathaniel Bell, Rebecca Wilkerson, Kathy Mayfield-Smith, Ana Lòpez-De Fede

Faculty Publications

BACKGROUND: Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes.

METHODS: Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were …

Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among The Insured Elderly, Minjee Lee, M Mahmud Khan, Heather M. Brandt, Ramzi G. Salloum, Brian Chen

Faculty Publications

BACKGROUND: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning in January 1, 2011. This study investigated the effect of the ACA's directive to remove the financial barriers on the receipt of colonoscopies among the elderly insured, who are predominantly covered by Medicare. METHODS: Data from the 2008-2016 Behavioral Risk Factor Surveillance System (BRFSS) were used to examine the receipt of colonoscopies in two years prior to the implementation of the ACA (2008 and 2010) and three years after the change (2012, 2014, and 2016). Multivariate logistic regressions were estimated to examine the …

Online Availability Of Fish Antibiotics And Documented Intent For Self-Medication, Weiwei Zhang, Austin Williams, Nicole Griffith, Jessica Gaskins, P Brandon Bookstaver

Faculty Publications

Self-medication and antibiotic utilization without healthcare oversight may lead to delayed appropriate treatment, transmission of communicable infections, untoward adverse events, and contribute to antimicrobial resistance. Previous data suggest people obtain over-the-counter (OTC) animal antibiotics for their personal use. This study examined the availability of OTC fish antibiotics online and the documented intent for self-medication. The authors conducted a web-based cross-sectional study using Google search engine to identify vendor websites selling fish antibiotics in the United States. Vendor websites were included if product information, consumer reviews, and comments were publicly available. Nine fish antibiotics were chosen due to their possibility of …

Development And Psychometric Properties Of A Prostate Cancer Knowledge Scale For African American Men, Otis L. Owens, Abbas Tavakoli Drph, Theda Rose, Nikki R. Wooten

Faculty Publications

African American men have the highest prostate cancer-related mortality nationally. In response to this disparity, targeted interventions are emerging to enhance African American men's prostate cancer (PrCA) knowledge to ensure they are equipped to make informed decisions about PrCA screening with health-care providers. African American men's PrCA knowledge has been measured inconsistently over time with limited psychometric evidence. The factor structure of this construct in African American men is relatively unknown. This study describes the development and psychometric evaluation of an 18-item Prostate Cancer Knowledge Scale among 352 African American men. Exploratory factor analysis (EFA) was conducted using weighted least …

Development And Psychometric Properties Of A Prostate Cancer Knowledge Scale For African American Men, Otis L. Owens, Abbas S. Tavakoli, Theda Rose, Nikki R. Wooten

Faculty Publications

African American men have the highest prostate cancer-related mortality nationally. In response to this disparity, targeted interventions are emerging to enhance African American men's prostate cancer (PrCA) knowledge to ensure they are equipped to make informed decisions about PrCA screening with health-care providers. African American men's PrCA knowledge has been measured inconsistently over time with limited psychometric evidence. The factor structure of this construct in African American men is relatively unknown. This study describes the development and psychometric evaluation of an 18-item Prostate Cancer Knowledge Scale among 352 African American men. Exploratory factor analysis (EFA) was conducted using weighted least …

A Comparison Of The United States And Costa Rican Health Care Systems And Their Influence On Immigrant Women's Maternal And Child Health Outcomes, Tamera R. Sullivan

Senior Theses

Health is a fundamental right for all humans, and every nation has a unique system for health care delivery. While the United States and Costa Rica follow two different welfare state models, there is still value in comparing the two countries. This project was inspired by my public health-based study abroad experience in Costa Rica in May 2018, which sparked a desire to learn more about the structures that form the health care system of each country. The United States has a more privatized and fragmented health care system, while Costa Rica has a public, universal health care system. Although …

Food Insecurity And Violence In A Prospective Cohort Of Women At Risk For Or Living With Hiv In The U.S., Amy A. Conroy, Mardge H. Cohen, Edward A. Frongillo Jr., Alexander C. Tsai, Tracey E. Wilson, Eryka L. Wentz, Adaora A. Adimora, Daniel Merenstein, Ighovwerha Ofotokun, Lisa Metsch, Mirjam-Colette Kempf, Adebola Adedimeji, Janet M. Turan, Phyllis C. Tien, Sheri D. Weiser

Faculty Publications

Background Food insecurity and violence are two major public health issues facing U.S. women. The link between food insecurity and violence has received little attention, particularly regarding the temporal ordering of events. The present study used data from the Women’s Interagency Human Immunodeficiency Virus Study to investigate the longitudinal association of food insecurity and violence in a cohort of women at risk for or living with HIV.

Methods Study participants completed six assessments from 2013–16 on food insecurity (operationalized as marginal, low, and very low food security) and violence (sexual or physical, and psychological). We used multi-level logistic regression, controlling …

Precision Of Provider Licensure Data For Mapping Member Accessibility To Medicaid Managed Care Provider Networks, Nathaniel Bell, Ana Lòpez-Defede, Rebecca Wilkerson, Kathy Mayfield-Smith

Faculty Publications

BACKGROUND:

In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. There have been few published studies of whether there is accurate geographic information on primary care providers to monitor network adequacy.

METHODS:

We analyzed a sample of nurse practitioner (NP) and physician address data registered in the state labor, licensing, and regulation (LLR) boards and the National Provider Index (NPI) using employment location data contained in the patient-centered medical home (PCMH) data file. Our main outcome measures were address discordance (%) at the …

Body Mass Index Trajectories And The Relationship Between Stressful Life Changes And Nutrition-Related Health Outcomes Among United States Army Soldiers, Julianna Marie Jayne

Theses and Dissertations

Body mass index (BMI) has risen among members of the military, though to a lesser degree than in civilian populations. BMI as an anthropometric tool has been essential for population surveillance and documenting the obesity epidemic and its health consequences. One use for BMI in population surveillance is to model the BMI trajectories of a population over time. Many studies are available on the BMI trajectories and determinants of BMI in civilians, but few studies of this nature in military populations exist. Establishing the shape and determinants of BMI trajectories among Soldiers is critical given the importance of weight management …

Common Histories And Common Failures: How The Historical Events Of Ireland And The United States Have Led To Their Vastly Different, Equally Failing, Health Care Systems, Kimberly Narro

Senior Theses

The United States healthcare system is a constant source of debate and public interest, with the only common ground between political parties being that the current system is deeply flawed and needing improvement. Individuals often point to European single-payer systems as the answer, neglecting to mention the flaws also inherent in these systems. This thesis aims to suss out the successes and failings of the Irish and American healthcare systems through a thorough scholarly literature review, with an emphasis on the two countries’ origins and development, to lead to a discussion about why two countries with similar historical beginnings have …

Disability: Becoming An Advocate For Persons With Disabilities And Understanding The History Of The Disability Movement In The United States, Frances Mason Ramsay

Senior Theses

The purpose of this thesis is to look at the different facets that make up disability in the United States, with a specific focus on the children with disabilities. These facets include related legislation, the education system, activism, services, and what it means to care for a child with disabilities. Throughout the research process, each of these facets were analyzed to include the most significant events for the section, an overview of each section to provide insight and a small amount of background and history for someone relatively unfamiliar with the history of disability in the United States. Beyond research …

Variation In Type And Frequency Of Diagnostic Imaging During Trauma Care Across Multiple Time Points By Patient Insurance Type, Nathaniel Bell, Laura Repáraz, William R. Fry, R Stephen Smith, Alejandro Luis

Faculty Publications

BACKGROUND:

Research has shown that uninsured patients receive fewer radiographic studies during trauma care, but less is known as to whether differences in care are present among other insurance groups or across different time points during hospitalization. Our objective was to examine the number of radiographic studies administered to a cohort of trauma patients over the entire hospital stay as well as during the first 24-hours of care.

METHODS:

Patient data were obtained from an American College of Surgeons (ACS) verified Level I Trauma Center between January 1, 2011 and December 31, 2012. We used negative binomial regression to construct …

Does Reactance Against Cigarette Warning Labels Matter? Warning Label Responses And Downstream Smoking Cessation Amongst Adult Smokers In Australia, Canada, Mexico And The United States, Yoo Jin Cho, Jim Thrasher, Kamala Swayampakala, Hua-Hie Yong, Robert Mckeever, David Hammond, Dien Anshari, K. Michael Cummings, Ron Borland

Faculty Publications

Objective

Some researchers have raised concerns that pictorial health warning labels (HWLs) on cigarette packages may lead to message rejection and reduced effectiveness of HWL messages. This study aimed to determine how state reactance (i.e., negative affect due to perceived manipulation) in response to both pictorial and text-only HWLs is associated with other types of HWL responses and with subsequent cessation attempts.

Methods

Survey data were collected every 4 months between September 2013 and 2014 from online panels of adult smokers in Australia, Canada, Mexico, and the US were analyzed. Participants with at least one wave of follow-up were included …

What Do We Know About Gmos: A Comparison Of Regulations And Labeling In The United States And Netherlands, Alexa Nicole Black

Senior Theses

This senior thesis will articulate the similarities and differences in food regulations related to organic and GMO foods in the US versus the Netherlands and identify factors that contribute to these differences. The main goal of this thesis is to explain, through research and my own observations, the need for more comprehensive research and labeling of GM foods.

A Comparison Of Health Care Systems In The Western World, Katherine Regan Lawall

Senior Theses

This senior thesis evaluates the health care systems of the Netherlands, Belgium, Switzerland, and Denmark, before looking at how their approaches could be adapted to the U.S. system. I picked these specific countries due to their similarity in geographic location, demographic, religious affiliations, and population size but have different styles of health care systems (public, mixed, and private) that are set up in varying ways. Additionally, these populations have similar health issues to one another, such as aging-populations, and to the U.S. as well like the top causes of death. However, these four western European countries have longer life expediencies …

Waterpipe Tobacco Smoking And Susceptibility To Cigarette Smoking Among Young Adults In The United States, 2012–2013, Ramzi G. Salloum, M. Rifat Haider, Tracey E. Barnett, Yi Guo, Kayla R. Getz, Jim Thrasher, Wasim Maziak

Faculty Publications

INTRODUCTION:

Waterpipe tobacco smoking, also known as hookah and shisha, has surged in popularity among young people in the United States. Waterpipe is also increasingly becoming the first tobacco product that young people try. Given the limited access to and limited portability of waterpipes, waterpipe smokers who become more nicotine dependent over time may be more likely to turn to cigarettes. This study examined the relationship between waterpipe tobacco smoking and susceptibility to cigarette smoking among young adults in the United States.

METHODS:

Using data from the 2012-2013 National Adult Tobacco Survey, a nationally representative sample of US adults, we …

Dissemination Of An Electronic Manual To Build Capacity For Implementing Farmers’ Markets With Community Health Centers, M Aaron Guest, Darcy Freedman, Kassandra A. Alia, Heather M. Brandt, Daniela B. Friedman

Faculty Publications

Community-university partnerships can lend themselves to the development of tools that encourage and promote future community health development. The electronic manual, "Building Farmacies," describes an approach for developing capacity and sustaining a community health center-based farmers' market that emerged through a community-university partnership. Manual development was guided by the Knowledge to Action Framework and experiences developing a multivendor, produce-only farmers' market at a community health center in rural South Carolina. The manual was created to illustrate an innovative solution for community health development. The manual was disseminated electronically through 25 listservs and interested individuals voluntarily completed a Web-based survey to …

Census-Based Socioeconomic Indicators For Monitoring Injury Causes In The Usa: A Review, Nathaniel Bell, Amanda Arrington, Swann Arp Adams

Faculty Publications

BACKGROUND:

Unlike the UK or New Zealand, there is no standard set of census variables in the USA for characterising socioeconomic (SES, socioeconomic status) inequalities in health outcomes, including injury. We systematically reviewed existing US studies to identify conceptual and methodological strengths and limitations of current approaches to determine those most suitable for research and surveillance.

METHODS:

We searched seven electronic databases to identify census variables proposed in the peer-reviewed literature to monitor injury risk. Inclusion criteria were that numerator data were derived from hospital, trauma or vital statistics registries and that exposure variables included census SES constructs.

RESULTS:

From …