Public Health Commons^™

Analyzing Pediatric Department Documentation Of Patient Social Needs With Icd-10 Z-Codes, 2019-2020, Oluwatofunmi Jummie Akinwunmi

Public Health Theses

The 10th revision of the International Classification of Diseases (ICD-10) allows healthcare professionals to document social needs with ICD-10 Z-codes. Data derived from documentation of ICD-10 Z-codes can be leveraged to identify at-risk populations for targeted intervention. However, there remains concern for underutilization of these codes particularly in the pediatric population. We sought to examine the documentation of ICD-10 Z-codes in the pediatric outpatient setting of the largest Connecticut hospital network by specialty type and age group. We examined deidentified electronic health records of pediatric outpatient patients from 2019-2020. We used descriptive statistics to measure the proportion of patients with …

Does Environmental Testing Of C. Difficile Predict Whether A Patient Is Positive With C. Difficile?, David Caccese

Public Health Theses

Clostridioides difficile is a major public health threat and frequent cause of healthcare-associated infections. Hospitals have struggled to control C. difficile due in part to the challenge of identifying asymptomatic C. difficile carriers and because of C. difficile’s ability to survive on environmental surfaces for long periods. Asymptomatic carriers and environmental surfaces can contribute to C. difficile transmission. Screening of all patients for C. difficile upon hospital admission is not feasible and asymptomatic patients may not be accepting of surveillance testing. Thus, this study examines whether sampling the patient’s room environment once they have been admitted can indicate a patient …

A Dna-Extraction-Free Method For The Molecular Detection Of Streptococcus Pneumoniae Carriage In Saliva, Tzu-Yi Lin

Public Health Theses

Pneumococcal carriage is a prerequisite for pneumococcal disease and surveillance of carriage is crucial for evaluating and informing vaccination strategies. In recent years, molecular methods have improved the sensitivity of pneumococcal carriage detection as compared to the gold standard culture-based method. However, nucleic acid extraction from samples collected is resource-intensive, limiting scalability for extensive surveillance, particularly in low-resource settings. We previously developed a saliva-based PCR test for SARS-CoV-2, having identified that nucleic acid extraction can be omitted and replaced with a simple enzymatic lysis or heat treatment step without compromising the accuracy and efficiency of testing. Here, we compared pneumococcus …

Interrupted Time Series Analysis To Evaluate Regional Greenhouse Gas Initiative Health Impacts, Julia Sweatman

Public Health Theses

Abstract

Background & Aims: Fossil fuel combustion emits a spectrum of ambient air pollutants, with the most harmful health effects seen from particulate matter 2.5 μm or less in diameter (PM2.5). Pricing carbon can reduce PM2.5 emissions and yield co-benefits for public health. The Regional Greenhouse Gas Initiative (RGGI) is a cooperative carbon pricing initiative among twelve states aiming to curb carbon dioxide emissions from the power sector. This preliminary analysis explores methodological approaches to quantify the health benefits associated with PM2.5 changes after RGGI was first implemented in 2009.

Methods: An interrupted time series analysis was performed to compare …

A Retrospective Cohort Study: Association Of Sex And Race Differences On 30-Day Retention In Addiction Treatment For Substance Use Disorders After Discharge, Bingning Wang

Public Health Theses

Objective: Little is known about the association of sex and racial differences in accessing SUD treatment. little is known whether these disparities continue despite hospitalization. The main objective was to determine the association of race and sex differences on 30-day retention in addiction treatment for all substance use disorders after discharge. Design: A Retrospective Cohort Study using the Yale Addiction Medicine Consult Service databaseSubjects: Patients with SUD who were hospitalized at Yale New Haven Hospital from Oct 26th, 2018 to Jun 30th, 2021 are eligible, which has 2557 observations. Methods: Mixed effect multivariable logistic regression for sex and racial differences …

Recommendations For Climate Adaptation To Preserve Connecticut Drinking Water Quality And Quantity, Matthew Salvatore Di Vitto

Public Health Theses

Climate change impacts drinking water both directly and indirectly. Increases in temperature, drought frequency, and precipitation are among the climate impacts which currently and are projected to affect water quality and quantity in the continental United States. These impacts limit access to clean and abundant water sources by damaging habitat, spreading toxic substances via runoff and favoring the growth of harmful algal blooms. States can learn from one another to adopt best practices and policies to increase water resilience around the country. This paper explores how Connecticut can employ strategies from the States of New York, New Jersey, Massachusetts, Minnesota, …

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). …

Cleft Lip And Depression In Adults: A Multi-Ancestry Mendelian Randomization Study, Anne Lyon Havlik

Public Health Theses

Background: Clefting of the lip with or without cleft palate (CLP) is the most common congenital craniofacial abnormality globally, affecting one in 700 live births. Traditional observational studies suggest an increased risk of adult depression among subjects with CLP, but these studies are subject to residual confounding.Objective: We aimed to address residual confounding by evaluating the association between the genetically-predicted risk of CLP on the risk of adult depression in a Mendelian randomization framework. Methods: We used single-nucleotide polymorphisms strongly associated with CLP as genetic instruments. Genetic associations with adult depression were extracted from separate studies. Three ancestry groups were …

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 …

“To Live In The Body Of A Survivor ”: Unique And Cumulative Disaster Exposure And Mental Health In A Sample Of Hurricane Katrina Survivors, Noelle Serino

Public Health Theses

Introduction: Fueled by the escalation of climate change, weather-related disasters are increasing in frequency and severity. Existing research has documented the extensive harm induced by such disasters, yet few studies have examined how individuals’ psychological well-being fares when exposed to multiple, diverse threats, including other weather-related and public health disasters (e.g., COVID-19). As such, the present study explores posttraumatic and psychological distress in the context of unique and cumulative disaster exposure.Methods: The data utilized for this study came from the Resilience in Survivors of Katrina (RISK) Project. The sample was comprised of 381 predominantly Non-Hispanic Black (84.5%) women who experienced …

“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 …

Estimating Urinary Nitrate Excretion In Rural Iowans From Dietary And Drinking Water Sources, Timothy Skalaban

Public Health Theses

Nitrate levels are increasing in our environment, and epidemiological studies have found evidence of adverse health risks from this exposure. Therefore, it is important to characterize the magnitude of nitrate exposure from food and drinking water sources. This study assesses the magnitude of nitrate exposure for 47 farmers from the Agricultural Health Study (AHS) in 2018-2019. The participants in our study use private wells as their main drinking water source and live in agricultural area of Iowa (10 counties) where ground water is vulnerable to nitrate contamination. The extent of nitrate exposure is determined by several factors, including the types …

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 …

Exploring Climate Policy And Health Perspectives In Samoa: A Mixed Methods Study, Erika-Ann Fumiko Kim

Public Health Theses

Background: Greenhouse gas emissions have driven human-induced climate change, bringing several impacts to small island nations in the Pacific. Samoa, a small island developing state located in the south Pacific Ocean, is at disproportionate risk from impacts of climate change such as rising surface temperatures, rising sea levels, increases in frequency and degree of heavy precipitation events, and increases in the frequency of droughts. Simultaneously, Samoan populations possess a high prevalence of non-communicable diseases such as diabetes, heart disease, and hypertension. For multiple decades, the Government of Samoa has framed climate change as a key issue that threatens the lives, …

A Prediction Model Of Rotavirus Vaccine Performance Based On Meta-Analysis And Variable Selection, Yueqi Li

Public Health Theses

Background: Rotavirus is the leading cause of diarrheal diseases worldwide and is responsible for substantial morbidity and mortality among children younger than 5 years of age. The introduction of national immunization programs against rotavirus has greatly reducedhospital admissions and deaths from rotavirus gastroenteritis, but vaccine efficacy and effectiveness vary substantially between high- and low-income settings. Given the disparity of vaccine performance across countries, we built a model to predict how well the vaccines would work in settings without vaccine introduction. Methods: Data on vaccine performance and relevant predictor variables were extracted from the literature and repositories. We performed a meta-analysis …

Evaluating The Cost-Effectiveness Of Varied Vaccination Strategies For Ebola Virus Disease In The Democratic Republic Of The Congo, Rachel Amanda Lobe-Costonis

Public Health Theses

Introduction: The 2018 outbreak of Ebola virus in the Democratic Republic of Congo was the first to occur in the context of an ongoing complex humanitarian emergency. Despite optimism for an effective response given the efficacious one-dose Merck vaccine (ERVEBO), the immense challenges to public health efforts caused by the ongoing armed conflict posed unprecedented complications to the recommended ring vaccination strategy. In the end, contract tracing efforts for ring vaccination reached only 82% of individuals at best estimate, and the outbreak lasted 89 weeks with a total cost of $734 million. In comparison, transmission dynamic modeling has shown the …

Evaluation Plan For A Mortality Surveillance System In Northwest Syria, Hanna Peterson

Public Health Theses

AbstractIntroduction: Cause-specific population mortality data is one of the most useful metrics used to monitor and evaluate the severity of a crisis. However, the unique context of fragile and protracted armed conflicts creates obstacles for establishing a mortality surveillance system. When CRVS are not feasible, VA can be used to generate high-quality mortality rate estimates. There is currently little documentation of implementation and evaluation of mortality surveillance systems in conflict settings, and guidance for both is extremely limited. This thesis aims to contribute to these two knowledge gaps by providing an evaluation plan for a mortality surveillance system in Northwest …

Xylazine In The Drug Supply: Emerging Threat In Connecticut And Lessons Learned From Philadelphia, Thomas A.G. Quijano

Public Health Theses

Background: Xylazine, a sedative analgesic drug approved as an animal tranquilizer but not for human use, has become an adulterant in the supply of heroin/fentanyl.(Greene & Thurmon, 1988) Between 2019 and 2020, prevalence of xylazine in overdose death reports increased by 44.8% nationally.(Friedman et al., 2021) The three jurisdictions in 2020 with the highest prevalence of xylazine were Philadelphia (25.8%), Maryland (19.3%), and Connecticut (10.2%).(Friedman et al., 2021) Not much is known about how xylazine’s impacts on service provider’s practices and the people they serve.

Objectives: Use a multiple methods approach to understand xylazine’s presence and impact in Connecticut, and …

Melissa: Monitoring The Environment With Living Investigatory Sentinel Species Apis Mellifera, Brady Rowe

Public Health Theses

Without the ability to meaningfully detect an environmental contaminant, public health efforts can get behind the curve, and people suffer for it. Industrial polluters are the major source of environmental contamination. Despite regulation, industrial compliance efforts are often limited by the difficulty of getting samples to analyze due to cost and logistical challenges. The current method requires a compliance officer to gather a sample or rely on self-reported measures from the potential polluters. This process can be remarkably costly both in capital and human labor. These issues can be remedied by relying on the domesticated honeybee to gather the “samples.” …

Navigating A Patchwork Maze: Individuals’ Experience Of Administrative Burden When Accessing Homeless Assistance Services, Leah Robinson

Public Health Theses

Despite significant efforts to address the issue of homelessness in the United States over the past several decades, over 500,000 individuals still experience homelessness on any given night. A large portion of this persistent and high rate of homelessness can likely be attributed to the shortage of affordable housing options, the eviction crisis, and limited financial support for rental assistance found throughout the country. However, administrative burdens may also contribute to the high rate of homelessness being seen.Our study explores this question by examining 28 individuals’ experience of administrative burden when navigating the landscape of homeless assistance services in New …

Cardiovascular Disease Mortality Among Asian American And Pacific Islander Breast Cancer Survivors In The United States By Socioeconomic Status And Rurality, 2000-2018, Katherine Luis Ho

Public Health Theses

Background: Known racial/ethnic disparities in cardiovascular disease (CVD) mortality among breast cancer survivors exist and it is well-documented that non-Hispanic Black (NHB) breast cancer survivors experience higher incidence of CVD mortality compared to NHW women. However, few studies have examined CVD mortality among Asian American, Native Hawaiian, and other Pacific Islanders (AANHPI) survivors, especially with respect to socioeconomic factors and rurality at the county-level. The aim of this study was to describe how county-level factors influence disparities in CVD mortality among AANHPI breast cancer survivors. Methods: Using Surveillance, Epidemiology, and End Results 18 registries, we analyzed a retrospective cohort of …

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 …

Health Care Utilization And Costs For Dementia Patients In China, Fang Ba

Public Health Theses

The number of people in the world living with Alzheimer’s Disease and related dementias (ADRD) continues to rise rapidly, which places a substantial burden on people with dementia (PWD), their families, and the society. Such a burden has been rising faster in low-income and middle-income countries (LMIC) where around two-thirds of PWD live. While prior research documents dementia prevalence in China and indicates its large geographic disparities, no study to date has documented the national pattern of health care utilization, quality and costs in China. The absence of knowledge would largely impede the effective allocation of resources for combating dementia …

United States Long-Term Trends In Adult Bmi From 1959 To 2018 By Income, Education, And Race/Ethnicity, Julia Banas

Public Health Theses

Obesity prevalence has increased dramatically since the 1950s. While cross-sectional comparisons across racial, ethnic, and socioeconomic groups are abundant, there is less work on long-term trends. We assessed trends in average adult body mass index (BMI) in the United States by income, education, and racial/ethnic groups from 1959 to 2018 using the National Health and Nutrition Examination Survey, which assesses repeated cross-sectional, representative samples of the United States population. Height, weight, income, education, and race variables were extracted from raw data files; income data was converted to constant dollars prior to analysis. BMI was calculated from height and weight measurements. …

Assessing Changes In The Epidemiology Of Cutaneous Leishmaniasis In Southwest Colombia Following The Peace Accord With Fuerzas Armadas Revolucionarias De Colombia (Farc), Matthew Stephen Benczkowski

Public Health Theses

The Colombian Conflict persisted for over 50 years, recently coming to an end in November 2016 after the signing of Colombia’s Peace Agreement between the government and FARC guerrilla group. Internal armed conflict is often entangled with the exacerbation of health outcomes, including promoting the spread of infectious diseases like cutaneous leishmaniasis (CL). CL is a vector-borne parasitic disease localized to the human tegument that decreases quality of life through lesions leading to scars and associated stigmatization. This study assessed changes in demographic and clinical characteristics of patients with CL in Southwest Colombia before and after the signing of the …

Effects Of Substance Use Disorder Section 1115 Waivers On Medicaid Population Utilization Of Buprenorphine And Naltrexone, Evangeline Cai

Public Health Theses

Background: In 2015, the Centers for Medicare and Medicaid Services (CMS) issued guidelines for a Medicaid Section 1115 behavioral health waiver with the intention of improving access to treatment for individuals with substance use disorder (SUD). One provision of the waiver allowed states to lift federal guidelines that originally prohibited states from using Medicaid funds to reimburse adults aged 21-64 years old for SUD services that occurred at “institutions for mental disease” (IMDs) with more than 16 beds. As of February 2021, 31 states have an approved the waiver.

Objective: To determine whether the Section 1115 SUD waivers, originally issued …

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 …