Public Health Commons^™

Examining Stigma And Its Effect On Hiv Prevention & Care Among People Living In Florida, Angel B. Algarin

FIU Electronic Theses and Dissertations

Persistent increases of HIV incidence in Florida has made it essential to study ways to improve HIV prevention strategies. Treatment as Prevention (TasP) and Preexposure Prophylaxis (PrEP) are two recent methods in HIV prevention; however, their success may be limited due to barriers such as stigma. This dissertation explored the relationship between HIV-related stigma and 1) antiretroviral therapy adherence and viral suppression and 2) symptoms of anxiety and depression. Additionally, it sought to develop and validate a scale to measure community PrEP-related stigma.

We used data from the Florida Cohort Study which include 932 people living with HIV (PLWH). The …

Factors Associated With Hiv Testing Behaviors Among Latino Emerging Adults, Daisy Ramirez Ortiz

FIU Electronic Theses and Dissertations

Latino emerging adults account for a significant proportion of incident HIV cases among emerging adults aged 18-24 in the United States, but have a lower prevalence of HIV testing compared to other racial/ethnic emerging adult groups. Yet, factors that influence HIV testing behaviors among Latino emerging adults are poorly understood. This dissertation examined sociocultural and psychological factors of HIV testing behaviors among a sample of 157 sexually active Latino emerging adults aged 18 to 25. Cross-sectional data from the Project on Health among Emerging Adult Latinos (Project HEAL) were used. Robust Poisson regressions were used to estimate adjusted prevalence ratios …

Developing Triage Tools For Retention In Care And Viral Suppression, And Identifying Predictors Of Sexually Transmitted Infections Among People With Hiv, Merhawi T. Gebrezgi

FIU Electronic Theses and Dissertations

This study developed risk prediction tools for non-retention in HIV care and non-viral suppression, and identified factors associated with self-reported chlamydia and gonorrhea diagnosis among people with HIV (PHIV) in the Miami-Dade County Ryan White Program (RWP). Using retrospective cohort study data, we used stepwise logistic regression to develop score-based risk prediction tools for non-retention in care and non-viral suppression. We then used bootstrapping to internally validate the risk prediction tools. We also assessed the prevalence of self-reported chlamydia and gonorrhea diagnoses and factors associated with the diagnoses cross-sectionally using multivariate logistic regression.

Among the 7439 people meeting the inclusion …

Longitudinal Association Between Video Game Use And Physical, Mental, And Social Health Outcomes In Young Adults In The United States, Ari D. Hozman

FIU Electronic Theses and Dissertations

Background: Increasing adolescent engagement in video game use and its associations with public health outcomes has been a controversial topic over the last several decades, with studies conducted in the United States only managing to produce contradictory results. This dissertation explores the statistical associations between video game use in adolescents and various physical, mental and social health outcomes as they develop into adulthood in the United States.

Methodology: Secondary data analysis was conducted, guided by Life Course Theory, utilizing publicly available data from the National Longitudinal Study of Adolescent to Adult Health.

Results: Video game use during adolescence was significantly …

Individual Level Factors Associated With Hiv Care Continuum Metrics Among Mash Cohort Participants From 2009-2014, Kristopher Myers

FIU Electronic Theses and Dissertations

This dissertation assessed the following: 1) the individual-level factors’ individual, syndemic, and interactive associations with retention in HIV care; 2) the individual-level factors’ individual, syndemic, and interactive associations with adherence among retained persons; and 3) the individual-level factors’ individual, syndemic, and interactive associations with viral suppression among retained persons. In the first study, Non-Hispanic Black race/ethnicity was associated with improved retention (OR=2.44, 95%CI: 1.06–5.75, p≤0.05). “Black-Hispanic” and “Other” racial/ethnic identities were associated with increased retention among participants (OR=4.84, 95%CI: 1.16–25.79, p≤0.05 and OR=7.24, 95%CI: 1.54–54.05p≤0.05, respectively). The interaction between depressive symptoms and alcohol use disorder was significantly and negatively associated …

Swiping Right And Sexually Transmitted Diseases (Std): Examining Venue Selection, Risky Sexual Behaviors, And Std Among Persons Living With Hiv, Florida, 2014-2017, Isabel S. Griffin

FIU Electronic Theses and Dissertations

The incidence of sexually transmitted diseases (STDs) are on the rise, nationwide (World Health Organization, 2015). In Florida, the incidence of bacterial STDs has increased from 425.3 per 100,000 persons per year in 2006 to 684.7 per 100,000 persons per year in 2017 (Florida Charts, 2018). This rise in STDs has gone hand-in-hand with the recent advancement of technology, beginning with at-home internet in the early 1990s to the introduction of social networking smartphone applications (SNSA) on mobile Smartphones in the late 2000s (Grov et al., 2011; Klausner et al., 2011; Winetrobe et al., 2014). In fact, some STDs, such …

The Impact Of Socioeconomic Factors On Food Insecurity Among Syrian Refugees In Florida, Racha Sankar

FIU Electronic Theses and Dissertations

Syrian refugees settled in the United States may experience food insecurity due to different socioeconomic factors that may include nutrition knowledge, language proficiency, women’s education, and perceived stress. The structure and the type of households may also contribute to food insecurity in this population.

The objective of this study was to measure food security among Syrian refugees residing in Florida. It also aimed to determine the socioeconomic factors that may attribute to food insecurity at household level.

A comprehensive 228-item questionnaire was administered to N=80 households (n=43 in rural areas, n=37 in urban areas). Families with and without children were …

A Nutrition Education Intervention With Maternal Support Among Children Participating In Summer Camps To Prevent Overweight And Obesity In Kuwait, Mashael Huwaikem

FIU Electronic Theses and Dissertations

Kuwait has the highest prevalence of obesity within Arab countries at 37.8%. The prevalence of childhood obesity, believed to be a reliable measure of future obesity, is increasing in there year after year. However, the potential effect of any type of preventive measures has not been adequately studied. Therefore, this dissertation aimed to increase awareness of long-term risks of childhood obesity among children and their mothers. Additionally, to assess the impact of the Healthy Habits (HH) program on changing eating behaviors among 6 to10 year-old children participating in summer camps.

Seventy-nine children participated in two summer camps for 8 weeks …

The Effect Of Collective Efficacy And Neighborhood Structural Disadvantage On Depressive Symptoms Among Adolescents In The United States, Christyl Teres Dawson

FIU Electronic Theses and Dissertations

The purpose of this dissertation was to examine (1) the moderating role of parental neighborhood perceptions on the relationship between neighborhood structural disadvantage and adolescent depressive symptoms, (2) if adolescent neighborhood perceptions moderated the association between neighborhood structural disadvantage and adolescent depressive symptoms, and (3) the effects of neighborhood structural disadvantage on depressive symptom trajectories as well as the moderating role of neighborhood perceptions on the relationship from adolescence to young adulthood. Data came from the National Longitudinal Study of Adolescent to Adult Health (Add Health) (N=12,105), and random effects multilevel modeling along with growth curve modeling were used.

Results …

Identifying Gay Neighborhoods And Estimation Of The Size Of The Men Who Have Sex With Men Population In Florida Who Would Benefit From Pre-Exposure Prophylaxis, Daniel Mauck

FIU Electronic Theses and Dissertations

Given the potential benefit of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) at risk for human immunodeficiency virus (HIV), it would be useful to assess the size of the at-risk population and their geographic distribution to target PrEP and other prevention programs efficiently. In 2017, Florida ranked third for HIV diagnosis rates in the US, and 63% of those who received a new HIV diagnosis in Florida were MSM. The purpose of this dissertation was to 1) summarize population-based methods to estimate the size of the population of MSM, 2) identify gay neighborhoods using latent class …

Poly-Tobacco Use Among Youth And Adults In The United States, Olatokunbo Osibogun

FIU Electronic Theses and Dissertations

This dissertation 1) described prevalence and correlates of poly-tobacco use among US youth and young adults; 2) addressed positive and negative transitions of e-cigarettes among US youth and adults and 3) examined the 2-year transition of dual e-cigarette/cigarette use among US adults in relation to nicotine dependence (ND) symptoms, interest in quitting, and cardiovascular disease (CVD) factors. Data from 2013-2016 of the Population Assessment of Tobacco and Health Study were used. In the first study, 3.6% of youth (12-17years) and 18.3% of young adults (18-34years) were current poly-tobacco users between 2013-2014. Common poly-tobacco products combination was cigarettes and e-cigarettes for …

Organizational Factors In Patient-Centered Medical Home Implementation And Chronic Disease Management In Hrsa-Funded Community Health Centers, Willmarie Latorre

FIU Electronic Theses and Dissertations

The Patient-Centered Medical Home (PCMH) model has attracted the attention of numerous health organizations in the United States for its potential to enhance quality of care and improve health outcomes among those living with chronic diseases. Community Health Centers (CHCs) funded by HRSA have been implementing this model for several years. Nevertheless, not all have achieved anticipated improvements. Several researchers have suggested that organizational factors may have a more determining role than the actual implementation of the PCMH model.

This qualitative case study explored organizational factors that distinguished or affected PCMH implementation at two CHCs with PCMH status recognized by …

Heart Disease And Its Risk Factors Among Slum-Dwelling Women In Mysore, India, Karl Krupp

FIU Electronic Theses and Dissertations

Background: Cardiovascular diseases (CVDs) are the largest cause of premature mortality globally. Annually, about 18 million people die from all CVDs, and about 7.6 million, from coronary heart disease (CHD) [2, 3]. About three quarters of CHD-related mortality occurs in low- and-middle income countries (LMIC) with India having the greatest number of deaths worldwide. Risk for CHD in India is thought to be highest among residents of Indian slums since studies have found a high prevalence of CHD risk factors like hypertension and tobacco use among slum dwellers but no studies to date have assessed the prevalence of CHD in …

Human Papilloma Virus Vaccine Acceptability Among Parents Of Adolescent Girls In Mysore, India, Abraham Degarege Mengist

FIU Electronic Theses and Dissertations

This study examined factors that directly affect, mediate, and moderate parental intention-to-vaccinate adolescent daughters with HPV vaccine in Mysore district, India. A cross-sectional study was conducted among 1,609 parents of adolescent girls (778 urban and 831 rural) attending schools in Mysore between February 2010 and October 2011. A validated questionnaire in Kannada was used to assess parental attitudes and beliefs related with HPV infection, cervical cancer, HPV vaccine and general vaccinations. Structural equation modeling was used to estimate parameters and check if a proposed model based on the integrative behavior theory (IBT) could fit the current data.

More than two-thirds …

Decipher Mechanisms By Which Nuclear Respiratory Factor One (Nrf1) Coordinates Changes In The Transcriptional And Chromatin Landscape Affecting Development And Progression Of Invasive Breast Cancer, Jairo Ramos

FIU Electronic Theses and Dissertations

Despite tremendous progress in the understanding of breast cancer (BC), gaps remain in our knowledge of the molecular basis underlying the aggressiveness of BC and BC disparities. Nuclear respiratory factor 1 (NRF1) is a transcription factor (TF) known to control breast cancer cell cycle progression. DNA response elements bound by NRF1 positively correlate with the progression of malignant breast cancer. Mechanistic aspects by which NRF1 contributes to susceptibility to different breast tumor subtypes are still not fully understood. Therefore, the primary objective of this dissertation was to decipher mechanisms by which NRF1 coordinates changes in the transcriptional and chromatin landscape …

Understanding And Improving Older Male Participation And Older Adult Adherence In Evidence-Based Health Promotion Programs, Chelsie L. Anderson

FIU Electronic Theses and Dissertations

The aging population and burden of chronic conditions have led researchers and practitioners to develop, implement, and evaluate evidence-based programs (EBPs) for older adults. The Healthy Aging Regional Collaborative (HARC) was established to make EBPs including Diabetes Self-Management Program, Chronic Disease Self-Management Program, Matter of Balance, and EnhanceFitness (EF) accessible in south Florida. According to the REAIM model, reach, effectiveness, adoption, implementation, and maintenance determine the impact of EBPs. Evaluation of HARC demonstrated widespread adoption of EBPs by community organizations that reached diverse participants and effectiveness among participants attending the recommended number of sessions, but only 19% of EBP participants …

Predictors Of Cervical Cancer Screening And Physician Recommendations Among Women In The United States Using Current Screening Guidelines, Vincy Samuel

FIU Electronic Theses and Dissertations

In 2015, there were 257,524 women with cervical cancer (CC) in the United States (U.S.). CC is preventable; screening detects early-stage cancer when treatment is most successful. This study aimed to identify predictors for CC screening adherence among U.S. women, describe predictors for screening adherence by marital status, and examine physician recommendation for CC screening and adherence to those recommendations. Predictors were grouped as demographic, acculturation, access to care, chronic conditions, and health behaviors. Descriptive analyses were performed on a sample of 10,667 women from the 2015 National Health Interview Survey, and multiple logistic regression models determined predictors of CC …

Patterns Of Regularity Noncompliance Identified By The U.S. Food And Drug Administration And Their Effects On Meta-Analyses, Craig A. Garmendia

FIU Electronic Theses and Dissertations

The objective of this study was to determine the patterns of regulatory noncompliance, as identified by the U.S. Food and Drug Administration (FDA), and their effects on meta-analyses. In order to achieve these objective, three studies were undertaken: analysis of citations issued by FDA Investigators at the conclusion of an inspection; analysis of regulatory actions taken by the FDA towards clinical researchers based on the observations cited by FDA Investigators; and sensitivity analysis of meta-analyses based on the Agency’s determination of research misconduct, primarily the falsification of data. FDA Investigator citations were analyzed using Chi-Square analysis based on geographic location …

Impact Of A Lifestyle Modification Intervention On Health Behaviors And Health Outcomes In A Mexican American Population: A Mixed-Methods Study, Ramandeep Kaur

FIU Electronic Theses and Dissertations

Metabolic syndrome (MetS), a global public health problem, is the primary cause of type 2 diabetes and cardiovascular disorders. Lifestyle modification interventions (dietary and physical activity modifications) are effective in preventing and ameliorating MetS and associated comorbidities. However, the impact of lifestyle changes on MetS among Mexican Americans has yet to be investigated, particularly due to high attrition rates in this population.

The overall goal of the explanatory mixed-methods study presented in this dissertation was to identify efficacious lifestyle modification efforts directed towards Mexican Americans to promote their retention in lifestyle modification programs, ameliorate the severity of MetS, and understand …

Cervical Infection With High Risk Human Papillomavirus Anogenital Subtypes In Indigenous Women In Alta And Baja Vera Paz Guatemala, Anne Jeffries

FIU Electronic Theses and Dissertations

Cervical cancer, caused by oncogenic (high risk [hr]) human papillomavirus (HPV) subtypes, is the most common cancer in women in Guatemala and the most common cause of cancer mortality in women aged 15-44 years. Visual inspection with acetic acid (VIA) with onsite cryotherapy “test-and-treat” is recommended for underserved Guatemalan indigenous rural women. This research assessed: 1) hrHPV infection prevalence in women screened by VIA; 2) Sensitivity and specificity of VIA in detecting hrHPV infection and cytologically identified precancerous and cancerous lesions; and 3) Factors associated with hrHPV infection. Analysis of anonymous data collected during VIA clinics in 2013 (N …

Elucidating The Role Of Neighborhood Deprivation In Hypertensive Disorders Of Pregnancy, Kelly M. Winter

FIU Electronic Theses and Dissertations

This dissertation examined risk factors for hypertensive disorders of pregnancy (HDP) — specifically whether neighborhood socioeconomic deprivation exacerbates individual socioeconomic disadvantage (deprivation amplification) to increase the likelihood of developing HDP. To select the optimal areal unit at which to investigate HDP, geographic proxies for neighborhoods were explored.

A thematic review qualitatively examined nontraditional neighborhood boundaries identified through internet sources. Data from 2008–2012 Miami-Dade County, Florida birth records (n=121,421) and the U.S. Census Bureau were used for the remaining analyses. Ordinary least squares (OLS) and geographically weighted regression (GWR) analysis empirically compared the proportion of HDP prevalence explained by six areal …

Evaluation Of A Brief Intervention To Improve Human Papillomavirus-Related Awareness, Knowledge, And Attitudes Among Ethnically And Sexually Diverse College Students, Sharice M. Preston

FIU Electronic Theses and Dissertations

Human papillomavirus (HPV) is a preventable infection responsible for anogenital and oropharyngeal cancers, as well as genital warts. Two safe and effective vaccines are recommended for adolescents and young adults to protect against HPV infection. Both are severely underutilized. Sexual and ethnic minorities are disproportionately affected by HPV infection and its sequelae. The goals of this study were to (1) assess baseline differences in HPV-related awareness, knowledge, and attitudes between men and women, and (2) evaluate the differential efficacy of a brief, educational HPV intervention among ethnically and sexually diverse college students. Students attending undergraduate courses from 2015 to 2017 …

A Model For The Association Between Attention-Deficit/ Hyperactivity Disorder And Obesity: Effects Of Physical Activity, Sedentary Behavior, Gender, And Medication, Danielle Quesada

FIU Electronic Theses and Dissertations

Attention-deficit hyperactivity disorder (ADHD) and obesity both present a significant burden to the health of children and adolescents. Research suggests a possible association between ADHD and obesity. This dissertation focused on examining the association between ADHD and obesity, and the roles physical activity, sedentary behavior, gender, and medication might play in this relationship.

The first manuscript is a review of the literature examining research on the association between ADHD and obesity in children and adolescents. The search included studies that reported on the prevalence of obesity among those with ADHD, the prevalence of ADHD among those who are obese, clinical …

Eating Frequency And The Role Of Snacking On Body Weight Of Wic Preschool Children, Andrea Charvet

FIU Electronic Theses and Dissertations

The objective of this study was to understand the influence of eating episodes and snack quality on body weight of children ages 3-4.9 years participating in the Broward County Special Supplementation Nutrition Program for Women, Infants, and Children (WIC).Additional objectives were to evaluate obesity risk factors and to examine the effect of childcare arrangements on body weight. Data was collected from 7 Broward County Health Department WIC clinics over 4 months via a researcher-administered questionnaire. Additional data was extracted from the WIC data system. BMI-for-age percentiles were used to categorize children by weight according to Centers for Disease Control (CDC) …

The Role Of Id3 And Pcb153 In The Hyperproliferation And Dysregulation Of Lung Endothelial Cells, Mayur Arvind Doke

FIU Electronic Theses and Dissertations

Uncontrolled growth of vascular stem cells as a result of endothelial-mesenchymal transition is considered to cause hyper-proliferative vascular remodeling in severe pulmonary arterial hypertension (PAH) patients. Hyperplastic intimal growth is one of the causes of closure of the lumen of pulmonary arterioles. This abnormal vessel remodeling leads to the progressive increase in pressure of the pulmonary arterioles causing severe PAH; and debilitating harm to patients resulting in mortality from right heart failure. Environmental factors, including polychlorinated biphenyls (PCBs), are considered to be involved in hyper-proliferative vascular remodeling because genetic makeup can only explain about 10% of severe PAH cases. PCB …

Exposure To Estrogenic Endocrine Disrupting Chemicals And Brain Health, Mark Preciados

FIU Electronic Theses and Dissertations

The overall objective of this dissertation was to examine exposures to the estrogenic endocrine disrupting chemicals (EEDCs), phthalates, bisphenol-A (BPA), and the metalloestrogens cadmium (Cd), arsenic (As), and manganese (Mn) in an older geriatric aged-population and examine associations with brain health. Given the evidence that EEDCs affect brain health and play a role in the development of cognitive dysfunction and neurodegenerative disease, and the constant environmental exposure through foods and everyday products has led this to becoming a great public health concern. Using a bioinformatic approach to find nuclear respiratory factor 1 (NRF1) gene targets involved in mitochondrial dysfunction, that …

Addressing Alcohol And Marijuana Use Disparities Among Latino Adolescents, Jessica Weissman

FIU Electronic Theses and Dissertations

In the early 1990s, a series of seminal research studies were published on substance use disorders among Latino adolescent males in Miami-Dade County, Florida. Expanding upon these studies, the aims of the present dissertation project were to (1) Determine whether the following adolescents’ and parents’ characteristics/cultural values are associated with current (past 30 days) or lifetime (ever) alcohol or marijuana use among Latino adolescents: sex, age, country of birth, GPA, family’s socio-economic status, living with both parents, mother’s highest level of education, father’s highest level of education, Familism Support, Familism Obligations, Familism Referents, Respect, Religion, …

Cross-Sectional Predictors Of Hiv Risk Among Latino Migrant Workers, Ailin Rodriguez

FIU Electronic Theses and Dissertations

The relationship between suspected predictors of current HIV risk, i.e. self-efficacy, social norms, expectancies, alcohol use, past HIV risk, past history sexual abuse, social support, and behavioral intention was investigated in a sample of Latino migrant workers living and working in the United States (N=270) using baseline data from a previous study.

A series of multiple regression analyses were performed by adjusting for socio-demographic characteristics such as age, gender, marital status, educational attainment, and length of stay. Zero-inflated Poisson regression analysis showed that self-efficacy was associated with behavioral intention (β= 0.03, p= 0.04) and expectancies was associated with behavioral intention …

Associations Of Hiv Risk Behaviors Among Older Latinas And Their Adult Daughters, Gira J. Ravelo

FIU Electronic Theses and Dissertations

This dissertation examines the associations between adult Latina daughters’ HIV risk behaviors and that of their older Latina mothers’ HIV risk behaviors. The central hypothesis of the study is that adult Latina daughters’ influence their older mothers’ behaviors and that such behaviors interact with the level of their attachment.

Older Latinas are a vulnerable population that face cultural risk factors, health care provider bias, and engage in low rates of HIV testing. The primary mode of HIV infection for Latinas is through heterosexual contact. Yet, traditional gender norms such as marianismo belief place pressure on Latina women to be submissive …

Risk Associated With E-Cigarette Use And Marketing Messages On Other Tobacco Products Use And Dependence Symptoms Among Adolescents, Rehab Auf

FIU Electronic Theses and Dissertations

E-cigarettes became available in the United States during 2007. Studies using national data have found an increase in e- cigarette use among adolescents as early as 2011. In 2014, e-cigarettes became the most commonly used tobacco product among adolescents; however, little is known about its association with other tobacco products use. Therefore, the present study aimed to: 1) Examine the association between initiating tobacco use via e-cigarettes and subsequent use of other tobacco products; 2) Examine the association between the exposure to e-cigarettes marketing messages and tobacco use; 3) Describe symptoms of nicotine dependence associated with e-cigarette use, compared with …