Epidemiology Commons^™

Determinants Of Waterpipe Smoking Trajectories And The Effects Of Pictorial Health Warning Label Among Young Waterpipe Smokers In The Us, Prem Gautam

FIU Electronic Theses and Dissertations

In recent years waterpipe tobacco (WPT) smoking has increased among young people in the United States (US). Adequate characterization of the WPT smoking trajectories (initiation, progression, and cessation), their predictors, and examination of the effects of a pictorial health warning label (PHWL) on WPT smokers is essential to guide interventions and policies to curb WPT smoking among young people in the US. Using the Population Assessment of Tobacco and Health Study (PATH) and clinical lab data, this dissertation assessed: 1) prevalence and predictors of WPT smoking initiation and progression among adolescents and young adults; 2) magnitude and predictors of WPT …

Changes Of Harm Perception And Effect Of Health Warnings On Electronic Cigarette Use In Us Youth, Wei Li

FIU Electronic Theses and Dissertations

This dissertation 1) assessed the influence of electronic nicotine delivery systems (ENDS) harm perception on ENDS initiation over time among US youth and young adults; 2) tracked the changes in harm perception of ENDS use and examined their predictors among US youth; 3) conducted a pilot study to address the effectiveness of graphic health warning labels (GHWLs) on important outcomes among US young adult ENDS users. Data from 2013-2018 of the Population Assessment of Tobacco and Health (PATH) study were used for aims 1 & 2. Primary data with 26 participants that were collected from university campus during the year …

Examining The Effects Of Individual And Neighborhood Factors On Hiv Transmission Risk Potential Among People With Hiv, Semiu Olatunde Gbadamosi

FIU Electronic Theses and Dissertations

HIV transmission risk significantly increases in late-diagnosed HIV and at HIV viral load (VL) >1500 copies/mL. The objective of this dissertation was to examine factors associated with HIV transmission risk potential for persons with HIV (PWH) using measures of time from HIV infection to diagnosis and trajectories of VL suppression. Additionally, we sought to determine whether a single yearly VL measure—the current standard to track the HIV epidemic in the United States—is reliable in assessing viral suppression for PWH. The first study estimated the distribution of time from HIV infection to diagnosis in Florida using a CD4 depletion model and …

Examining The Effects Of Neighborhood Factors And Geography On Racial/Ethnic Disparities In Achieving Sustained Viral Suppression, Rahel Dawit

FIU Electronic Theses and Dissertations

Sustained viral suppression (all viral load tests/mL in a year) decreases the risk of HIV transmission and disease progression to AIDS for people with HIV. Racial/ethnic minorities living with HIV are particularly challenged by barriers, including neighborhood factors, to maintain viral suppression. This dissertation examined the contribution of neighborhood and geographic factors on racial/ethnic disparities in achieving sustained viral suppression. A cross-sectional analysis of secondary data collected in 2017 for 6491 clients enrolled in the Miami-Dade County Ryan White Program (RWP) was conducted.

The first study examined the moderating role of neighborhood level factors on the association between race/ethnicity and …

Sociocultural Factors Associated With Hpv Vaccine Uptake Among Hispanic Female Emerging Adults, Tanjila Taskin

FIU Electronic Theses and Dissertations

Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States (U.S.). College students are at high risk of developing HPV-related diseases and play key roles in transmitting the infection. Fortunately, HPV-related cancers can be prevented through HPV vaccination.

A cross-sectional study was designed to collect data from convenience samples of Hispanic emerging adults from Florida International University (FIU) in Miami, Florida, and the University of Houston (UH) in Houston, Texas. Participants who were 18-26 years old, self-identified as Hispanic or Latino/a, able to read English, and enrolled in FIU or UH were included in the …

Identifying Mediators, Moderators And High-Risk Latent Classes Of Preterm Birth And Low Birth Weight Among Pregnant Women In Rural Mysore, India, Sandra Kiplagat

FIU Electronic Theses and Dissertations

This dissertation examined the mediators, moderators, and high-risk latent classes of preterm birth (PTB) and low birth weight (LBW) among pregnant women in rural Mysore District, India. Secondary data analyses of a prospective cohort study conducted between 2011-2014 among 1540 women was performed to complete this dissertation.

In the first study, we examined the association between socioeconomic status (SES) and PTB and LBW. Latent class analysis (LCA) was performed to assess sociodemographic patterns of high-risk pregnant women based on education, income, marital status, primigravida status and number of children. We identified four distinct classes, Class 1 “low SES/early marriage/multigravida/1 child …

Associations Of Sociocultural Stressors With Psychological Distress And Self-Rated Health Among Hispanic Emerging Adults, Abir Rahman

FIU Electronic Theses and Dissertations

Emerging adulthood (18-25 years) is a distinct period of life, characterized by a high level of instability in the matters of romantic life, work, and challenging developmental undertakings. Various events related to these developmental tasks may leave lifelong impacts on emerging adult’s identities and health across adulthood. Further, due to the unstable nature of this period, individuals in this age group are vulnerable to various mental health problems. Hispanic emerging adults may be particularly at risk of experiencing adverse health outcomes, as on top of normative developmental stressors (e.g., increased autonomy, finding employment), they are often exposed to various chronic …

Food Insecurity Is Associated With Nonalcoholic Fatty Liver Disease, Cognitive Impairment, And Immune Activation In People Living With Hiv, Javier A. Tamargo

FIU Electronic Theses and Dissertations

Food insecurity (FI) is a socioeconomic condition characterized by inadequate access to enough food and nutrition to sustain health and wellbeing. Food insecurity is a risk factor for chronic and age-related conditions, raising concerns for the aging population of people living with HIV (PLWH), in whom food insecurity is disproportionately prevalent. PLWH are at increased risk of nutrition-related complications and chronic co-morbidities, thus food insecurity may exacerbate adverse health outcomes in this population. This study investigated whether food insecurity was associated with nonalcoholic fatty liver disease (NAFLD), cognitive impairment, and immune activation among socioeconomically disadvantaged adults living with and without …

Characterizing The Development And Trajectories Of Nicotine Dependence Among A Cohort Of Adolescent Waterpipe And Cigarette Smokers, Mohammad Ebrahimi Kalan

FIU Electronic Theses and Dissertations

Nicotine dependence (ND) is the fundamental reason that people persist in using tobacco products, which kill more than eight million people every year globally. So far, ND research has primarily focused on cigarettes, yet for many youths worldwide, tobacco use, and addiction is maintained by means other than the cigarette including waterpipe (WP) smoking (a.k.a. hookah). It is important to better understand the WP-associated ND trajectories given its unique use features that can influence ND development such as its time-consuming preparation and consumption, intermittent use, and strong sensory and social cues. Hence, using data from 8 waves (2015-2020) of the …

Laboratory And Epidemiological Characteristics Of Zika Virus Infections In Florida, Stephen L. White

FIU Electronic Theses and Dissertations

Until recently, Zika virus (ZIKV) was an obscure virus that rarely caused infections and was unknown to most. In 2015 and 2016, ZIKV came into the public spotlight as Brazil and other countries began to report large increases in infections with ZIKV and reported potential complications with developing fetuses and neurologic manifestations. In 2016, the state of Florida identified and responded to an outbreak of locally acquired ZIKV infections in Miami-Dade County. This dramatic increase in infections demonstrated both its importance as an emerging infectious disease and the paucity of knowledge surrounding ZIKV. This study seeks to utilize the data …

Predictors Of Persistent And Recurrent Bacterial Vaginosis (Bv) Among Young African American (Aa) Women In The United States, Makella S. Coudray

FIU Electronic Theses and Dissertations

Bacterial vaginosis (BV) is a common vaginal dysbiosis among women of reproductive age. Literature presents discordant findings with respect to the predictors of BV and there is a paucity of literature examining the mechanisms by which multiple episodes of BV occur. This dissertation summarized current literature on BV, identified BV incidence patterns over a twelve-month period, and estimated the risk of sexually transmitted infections (STI) among women with episodic and persistent BV. Previously collected randomized clinical trial data were analyzed, where oral metronidazole was the administered treatment. Latent class analysis (LCA) was used to assess BV incidence patterns. Multinomial Logistic …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

Id3, Estrogenic Chemicals, And The Pathogenesis Of Tumor-Like Proliferative Vascular Lesions, Vincent E. Avecilla

FIU Electronic Theses and Dissertations

Tumor-like proliferative vascular lesions manifest in several diseases such as peripheral arterial disease (PAD) and atherosclerosis (AS) after arterial injury. The cause of the vascular cell dysfunction in PAD patients is not known. Our recent novel discovery shows that inhibitor of differentiation 3 (ID3) is highly expressed in intimal lesions of clinical vascular disease samples. The central hypothesis of our study is: estrogenic chemical induced dysregulation of ID3 target genes is involved in the development of vascular disease. NHANES data analysis demonstrated higher geometric levels of all 6 PCB congeners in both PAD diagnosed participants and participants at risk of …

Examining The Influence Of Contextual Factors On Risky Sexual Behavior Among Young Women In Zomba District, Malawi: A Multilevel Analysis, Melissa K. Ward-Peterson

FIU Electronic Theses and Dissertations

The objective of this study was to examine the association between risky sexual behavior and contextual factors related to economic resources, woman’s empowerment, and health facility characteristics among young women in Zomba district, Malawi. Secondary analyses of the Schooling, Income, and Health Risk (SIHR) study were undertaken. Four outcomes related to risky sexual behavior were examined: if participants had ever had sex, consistent condom use, and two scores measuring risk related to partner history and age during sexual activity. Regression models with cluster-robust standard errors and multilevel regression models were used to estimate associations; analyses were stratified by school enrolment …

Examining The Association Between Racial Residential Segregation, Risky Sexual Behaviors, And Sexually Transmitted Infections., Khaleeq J. Lutfi

FIU Electronic Theses and Dissertations

Sexually transmitted infections (STIs) disproportionately impact non-Hispanic blacks in the United States. Racial differences in sexual networks can contribute to these disparities. Racial residential segregation, the separation of racial groups in a residential context, is a community factor known to influence sexual networks and has been associated with negative health outcomes. Our objective was to examine the association between racial residential segregation (henceforth, referred to as segregation), risky sexual behavior, concurrent partnerships, and STI diagnoses among non-Hispanic blacks. Demographic, sexual behavior, and STI diagnosis data for non-Hispanic blacks 15–44 years of age were obtained from the 2006–2010 National Survey of …

Hiv Risk Behaviors, Previous Hiv Testing And Positivity Among Hispanic Women Tested For Hiv In Florida, 2012, Janelle Taveras

FIU Electronic Theses and Dissertations

The prevalence of female adults and adolescents living with diagnosed HIV infection continues to rise. Latina women in the United States (US) are not only disproportionately affected by human immunodeficiency virus (HIV) infection, but also underutilize HIV prevention services, such as HIV testing. Data are limited on the differences in HIV risk among Latinas by country of birth, and opportunities still exist to prevent transmission of HIV and reduce HIV-related disparities. This dissertation describes the risk behaviors, testing behaviors, and test results among women tested for HIV at public sites in Florida. Additionally, it compares these characteristics by HIV testing …