Epidemiology Commons^™

Subsidized Housing, Public Housing, And Adolescent Violence And Substance Use, Tamara Leech

Department of Public Health Scholarship and Creative Works

This study examines the separate relationships of public housing residents and subsidized housing residence to adolescent health risk behavior. Data included 2,530 adolescents aged 14 to 19 who were children of the National the Longitudinal Study of Youth. The author uses stratified propensity methods to compare the behaviors of each group—subsidized housing residents and public housing residents—to a matched control group of teens receiving no housing assistance. The results reveal no significant relationship between public housing residence and violence, heavy alcohol/marijuana use, or other drug use. However, subsidized housing residents have significantly lower rates of violence and hard drug use, …

Exploring Relationships Between Racism, Housing And Child Illness In Remote Indigenous Communities, Naomi Priest, Yin Paradies, Matthew Stevens, Ross Bailie

Aboriginal Policy Research Consortium International (APRCi)

Background Although racism is increasingly acknowledged as a determinant of health, few studies have examined the relationship between racism, housing and child health outcomes. Methods Cross-sectional data from the Housing Improvement and Child Health study collected in ten remote indigenous communities in the Northern Territory, Australia were analysed using hierarchical logistic regression. Carer and householder self-reported racism was measured using a single item and child illness was measured using a carer report of common childhood illnesses. A range of confounders, moderators and mediators were considered, including socio-demographic and household composition, psychosocial measures for carers and householders, community environment, and health-related …

Minimum Description Length And Empirical Bayes Methods Of Identifying Snps Associated With Disease, Ye Yang, David R. Bickel

COBRA Preprint Series

The goal of determining which of hundreds of thousands of SNPs are associated with disease poses one of the most challenging multiple testing problems. Using the empirical Bayes approach, the local false discovery rate (LFDR) estimated using popular semiparametric models has enjoyed success in simultaneous inference. However, the estimated LFDR can be biased because the semiparametric approach tends to overestimate the proportion of the non-associated single nucleotide polymorphisms (SNPs). One of the negative consequences is that, like conventional p-values, such LFDR estimates cannot quantify the amount of information in the data that favors the null hypothesis of no disease-association.

We …

The Handling Of Missing Data In Molecular Epidemiologic Studies, Manisha Desai, Jessica Kubo, Denise Esserman, Mary Beth Terry

COBRA Preprint Series

Background: Molecular epidemiologic studies face a missing data problem as biospecimen data are often collected on only a proportion of subjects eligible for study.

Methods: We investigated all molecular epidemiologic studies published in CEBP in 2009 to characterize the prevalence of missing data and to elucidate how the issue was addressed. We considered multiple imputation (MI), a missing data technique that is readily available and easy to implement, as a possible solution.

Results: While the majority of studies had missing data, only 16% compared subjects with and without missing data. Furthermore, 95% of the studies with missing data performed a …

The Use Of Multiple Imputation In Molecular Epidemiologic Studies Assessing Interaction Effects, Manisha Desai, Denise Esserman, Marilie Gammon, Mary Beth Terry

COBRA Preprint Series

Background: In molecular epidemiologic studies biospecimen data are collected on only a proportion of subjects eligible for study. This leads to a missing data problem. Missing data methods, however, are not typically incorporated into analyses. Instead, complete-case (CC) analyses are performed, which result in biased and inefficient estimates.

Methods: Through simulations, we characterized the bias that results from CC methods when interaction effects are estimated, as this is a major aim of many molecular epidemiologic studies. We also investigated whether standard multiple imputation (MI) could improve estimation over CC methods when the data are not missing at random (NMAR) and …

Implications Of Lifecourse Epidemiology For Research On Determinants Of Adult Disease, Sze Yan Liu, Richard N. Jones, M. Maria Glamour

Department of Public Health Scholarship and Creative Works

Many diseases commonly associated with aging are now thought to have social and physiologic antecedents in early life. Understanding how the timing of exposure to early life risk factors influences later-life health may illuminate mechanisms driving adult health inequalities and identify possible points for effective interventions. Recognizing chronic diseases as developing across the life course also has implications for the conduct of research on adult risk factors for disease. We review alternative conceptual models that describe how the timing of risk factor exposure relates to the development of disease. We propose some expansions of lifecourse models to improve their relevance …

The Pathways To Mental Health Care Of First-Episode Psychosis Patients: A Systematic Review., Kelly K. Anderson, Rebecca Fuhrer, Ashok K. Malla

Epidemiology and Biostatistics Publications

BACKGROUND: Although there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.

METHOD: We searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation …

The Health Of Latinos In Massachusetts: A Snapshot, Dharma Cortés, Rodolfo R. Vega

Gastón Institute Publications

People’s health outcomes are shaped in part by non-biological factors. Most immediately, limited access to health care services can have a deleterious impact on individuals’ health outcomes (Andrulis, 1998). In turn, access to healthcare services is influenced by socioeconomic factors such as whether a person has health insurance or the financial means to pay for their health care. Familiarity with the health care system is another important factor that may influence an individual’s access to healthcare services (Morgan et al., 2008). Language also plays an important role in health outcomes. For instance, individuals with limited English proficiency may find it …

The Efficacy Of Spirometry As A Screening Tool In Detection Of Air Flow Obstruction, Nabeel Manzar, A. Suleman Haque, Bushra Manzar, Muhammad Irfan

Section of Pulmonary & Critical Care

Background/Objectives: In developing countries, spirometry has not been considered a part of routine medical check-up. The purpose of the study was to establish the usefulness of spirometry as a primary screening tool in detecting air flow obstruction (AFO) during routine medical check-up (RMC). Methods: This was a hospital based, retrospective, non-randomized case series study of 3696 participants, who presented to hospital for routine medical check-up. All subjects were assisted at the Pulmonary Medicine Department, from January 2003 till December 2008 who, having met other inclusion criteria, underwent spirometry. Data were analyzed using proportion, group means, standard deviations and …

Concurrent Sexual Partnerships Do Not Explain The Hiv Epidemics In Africa: A Systematic Review Of The Evidence, Larry Sawers, Eileen Stillwaggon

Economics Faculty Publications

The notion that concurrent sexual partnerships are especially common in sub-Saharan Africa and explain the region’s high HIV prevalence is accepted by many as conventional wisdom. In this paper, we evaluate the quantitative and qualitative evidence offered by the principal proponents of the concurrency hypothesis and analyze the mathematical model they use to establish the plausibility of the hypothesis.

We find that research seeking to establish a statistical correlation between concurrency and HIV prevalence either finds no correlation or has important limitations. Furthermore, in order to simulate rapid spread of HIV, mathematical models require unrealistic assumptions about frequency of sexual …

Surrogate Screening Models For The Low Physical Activity Criterion Of Frailty, Sandrah P. Eckel, Karen Bandeen-Roche, Paulo H.M. Chaves, Linda P. Fried, Thomas A. Louis

Johns Hopkins University, Dept. of Biostatistics Working Papers

Background and Aims. Low physical activity, one of five criteria in a validated clinical phenotype of frailty, is assessed by a standardized questionnaire on up to 20 leisure time activities. Because of the time demanded to collect the interview data, it has been challenging to translate to studies other than the Cardiovascular Health Study (CHS), for which it was developed. Considering subsets of activities, we identified and evaluated streamlined surrogate assessment methods and compared them to one implemented in the Women’s Health and Aging Study (WHAS).

Methods. Using data on men and women ages 65 and older from the CHS, …

Growth, Immune And Viral Responses In Hiv Infected African Children Receiving Highly Active Antiretroviral Therapy: A Prospective Cohort Study., Philippa M. Musoke, Peter Mudiope, Linda N. Barlow-Mosha, Patrick Ajuna, Danstan Bagenda, Michael M. Mubiru, Thorkild Tylleskar, Mary G. Fowler

Journal Articles: Epidemiology

BACKGROUND: Scale up of paediatric antiretroviral therapy in resource limited settings continues despite limited access to routine laboratory monitoring. We documented the weight and height responses in HIV infected Ugandan children on highly active antiretroviral therapy and determined clinical factors associated with successful treatment outcomes.

METHODS: A prospective cohort of HIV infected children were initiated on HAART and followed for 48 weeks. Body mass index for age z scores(BAZ), weight and height-for-age z scores (WAZ & HAZ) were calculated: CD4 cell % and HIV-1 RNA were measured at baseline and every 12 weeks. Treatment outcomes were classified according to; both …

Plasma Prekallikrein Levels Are Positively Associated With Circulating Lipid Levels And The Metabolic Syndrome In Children., James A. Mackenzie, Kristen A. Roosa, Brooks B. Gump, Amy K. Dumas, Kestutis G. Bendinskas

Falk College Research Center

Plasma prekallikrein (PK) has been shown to be associated with cardiovascular disease (CVD) and its risk factors, but these associations have not been investigated in children. The present study examined PK activity in relation to well-established cardiovascular risk factors in a cohort of children aged 9–11 years (N = 97). We found a significant and positive association between PK and fasting levels of total cholesterol (p < 0.01), non-high-density lipoprotein cholesterol (p < 0.01), and triglycerides (p < 0.001). In addition, there was a significant association between PK activity and the metabolic syndrome, a clustering of risk factors considered to have an impact on atherosclerosis and CVD mortality. Finally, we found that children with a family history of CVD had significantly elevated PK activity. These novel findings warrant further investigations into the relationship between circulating PK levels and CVD risk factors because PK may be involved in the progression of the disease state. Il est bien connu que la pre´kallicre´ine (PK) est associe´e a` la maladie cardiovasculaire (CVD) et a` ses facteurs de risque, mais ces associations n’ont pas e´te´ ve´rifie´es chez les enfants. Cette e´tude se propose de ve´rifier l’association entre l’activite´ de la PK et les facteurs de risque de CVD aupre`s d’une cohorte d’enfants aˆge´s de 9 a` 11 ans (N = 97). On observe une corre´lation positive significative entre la PK et les variables suivantes : la concentration totale de choleste´rol a` jeun (p < 0,01), les concentrations des lipoprote´ines non a` haute densite´ (p < 0,01) et la concentration des triglyce´rides (p < 0,001). De plus, on observe une corre´lation significative entre l’activite´ de la PK et le syndrome me´tabolique constitue par un ensemble de facteurs ayant un effet sur l’athe´roscle´rose et la mortalite´ due a` la CVD. En dernier lieu, les enfants avec des ante´ce´dents familiaux de CVD pre´sentent une plus importante activite´ de la PK, et ce, de fac¸on significative. Ces premie`res observations sugge`rent d’autres e´tudes sur la relation entre la concentration sanguine de PK et les facteurs de risque de CVD, car la PK pourrait eˆtre implique´e dans la progression de la maladi

Aids Epidemic In The Russian Federation And Policy Reform, Veronika Kiselev

Independent Study Project (ISP) Collection

The AIDS epidemic in the Russian Federation has been a constant struggle for the government and the population since the early 90’s. The epidemic is the most rapidly growing epidemic of HIV/AIDS seen in history and has caused much international attention. The epidemic coinciding with the fall of the Soviet Union and the transition of the Russian government from socialist to democratic state has had a huge impact on the policy and government actions to fight the epidemic. The financial struggles that hit a large portion of the population as a result of the fall of the Soviet Union caused …

Practice Notes: Strategies In Health Education, Lisa D. Lieberman

Department of Public Health Scholarship and Creative Works

Objective: To monitor the progress in the promotion of walkable community initiatives.

Everything's Better In Moderation: Young Women's Gender Role Attitudes And Risky Sexual Behavior, Tamara Leech

Department of Public Health Scholarship and Creative Works

Purpose This study examines the association between gender role attitudes and risky sexual behavior among young women. Previous studies have posed seemingly contradictory arguments: that either traditional attitudes or egalitarian attitudes are associated with riskier behavior. Methods Data are based on the children of the National Longitudinal Survey of Youth, representing 520 sexually active 18–19-year-old women. Propensity radius matching was used to assess differences in rates of multiple sexual partners and sex outside of a committed relationship. Results Relative to moderate gender role attitudes, both egalitarian gender role attitudes and traditional gender role attitudes are associated with higher rates of …

Reinvention Of Depression Instruments By Primary Care Clinicians, Seong-Yi Baik, Junius Gonzales, Barbara J. Bowers, Jean S. Anthony, Bas Tidjani, Jeffrey L. Susman

Publications from Provost Junius J. Gonzales

PURPOSE Despite the sophisticated development of depression instruments during the past 4 decades, the critical topic of how primary care clinicians actually use those instruments in their day-to-day practice has not been investigated. We wanted to understand how primary care clinicians use depression instruments, for what purposes, and the conditions that influence their use.

METHODS Grounded theory method was used to guide data collection and analysis. We conducted 70 individual interviews and 3 focus groups (n = 24) with a purposeful sample of 70 primary care clinicians (family physicians, general internists, and nurse practitioners) from 52 offices. Investigators’ field notes …

Nonparametric Regression With Missing Outcomes Using Weighted Kernel Estimating Equations, Lu Wang, Andrea Rotnitzky, Xihong Lin

Harvard University Biostatistics Working Paper Series

No abstract provided.

The Impact Of Coarsening The Explanatory Variable Of Interest In Making Causal Inferences: Implicit Assumptions Behind Dichotomizing Variables, Ori M. Stitelman, Alan E. Hubbard, Nicholas P. Jewell

U.C. Berkeley Division of Biostatistics Working Paper Series

It is common in analyses designed to estimate the causal effect of a continuous exposure/treatment to dichotomize the variable of interest. By dichotomizing the variable and assessing the causal effect of the newly fabricated variable practitioners are implicitly making assumptions. However, in most analyses these assumptions are ignored. In this article we formally address what assumptions are made in dichotomizing variables to assess causal effects. We introduce two assumptions, either of which must be met, in order for the estimates of the causal effects to be unbiased estimates of the parameters of interest. We title those assumptions the Mechanism Equivalence …

Practice Notes: Strategies In Health Education, Lisa D. Lieberman

Department of Public Health Scholarship and Creative Works

Objective: The purpose of the Be Red Cross Ready Community Outreach Project (BRCR) was to train health education students to provide high-quality, theory-driven community preparedness education in a community on the U.S.-Mexico border. This aim was achieved through an innovative partnership between a community organization, a federal research center, and a university. The ultimate goal of the project was to increase disaster and emergency preparation to protect, promote, and preserve the health of the public.

Hiv Risk Factors Among Moroccan And Turkish Same-Sex Attracted Youth In Amsterdam, Daniel Woznica

Independent Study Project (ISP) Collection

This report is the outcome of a month-long exploratory study on the main HIV risk factors among Moroccan and Turkish same-sex attracted (SSA) youth in Amsterdam. Data was obtained by way of interviews conducted with five experts, categorized as: academics, sexual and ethnic minority activists, and HIV professionals. Five main risk factors were determined: cultural differences; language barriers; stigma and taboo around sexuality and HIV within Islamic communities; socioeconomic marginalization; and lack of a positive term for same-sex sexual behavior and identity among the target group. Recommendations for future research include interviews with Moroccan and Turkish SSA youth themselves. Implications …

Glycemic Control: Risk Factors, Quality Of Life, Workforce Participation, And Mortality Among Us Adults With Type 2 Diabetes, Evelyn P. Davila

FIU Electronic Theses and Dissertations

Despite research showing the benefits of glycemic control, it remains suboptimal among adults with diabetes in the United States. Possible reasons include unaddressed risk factors as well as lack of awareness of its immediate and long term consequences. The objectives of this study were to, using cross-sectional data, 1) ascertain the association between suboptimal (Hemoglobin A1c (HbA1c) ≥7%), borderline (HbA1c 7-8.9%), and poor (HbA1c ≥9%) glycemic control and potentially new risk factors (e.g. work characteristics), and 2) assess whether aspects of poor health and well-being such as poor health related quality of life (HRQOL), unemployment, and missed-work are associated with …

Effects Of Leas And Mecury On The Blood Proteome Of Children, Robert E. Birsall, Michael P. Kiley, Zaneer M. Segu, Christopher D. Palmer, Milan Madera, Brooks B. Gump

Falk College Research Center

Heavy metal exposure in children has been associated with a variety of physiological and neurological problems. The goal of this study was to utilize proteomics to enhance the understanding of biochemical interactions responsible for the health problems related to lead and mercury exposure at concentrations well below CDC guidelines. Blood plasma and serum samples from 34 children were depleted of their most abundant proteins using antibody-based affinity columns and analyzed using two different methods, LC-MS/MS and 2-D electrophoresis coupled with MALDI-TOF/MS and tandem mass spectrometry. Apolipoprotein E demonstrated an inverse significant association with lead concentrations (average being one microgram/deciliter) as …

Recreational Physical Activity And Premenstrual Syndrome In College-Aged Women, Aimee R. Kroll

Masters Theses 1911 - February 2014

It is estimated that up to 85% of premenopausal women experience at least one premenstrual symptom and 15-20% meet clinical criteria for premenstrual syndrome (PMS). PMS has a high morbidity level and reduces the quality of life for many women of reproductive age, with pharmaceutical treatments having limited efficacy and substantial side effects. Physical activity has been recommended as a method of reducing menstrual symptom severity. However, little evidence exists to support a clear relationship between physical activity and PMS. Using a cross-sectional design, we evaluated the relationship between physical activity and PMS and menstrual symptoms among 186 women aged …

Breast Cancer Care In Canada And The United States: Ecological Comparisons Of Extremely Impoverished And Affluent Urban Neighborhoods, Kevin M. Gorey

Social Work Publications

This study examined the differential effect of extreme impoverishment on breast cancer care in urban Canada and the United States. Ontario and California registry-based samples diagnosed between 1998 and 2000 were followed until 2006. Extremely poor and affluent neighborhoods were compared. Poverty was associated with non-localized disease, surgical and radiation therapy (RT) waits, non-receipt of breast conserving surgery, RT and hormonal therapy, and shorter survival in California, but not in Ontario. Extremely poor Ontario women were consistently advantaged on care indices over their California counterparts. More inclusive health insurance coverage in Canada seems the most plausible explanation for such Canadian …

Income And Long-Term Breast Cancer Survival: Comparisons Of Vulnerable Urban Places In Ontario And California, Kevin M. Gorey

Social Work Publications

Effects of socioeconomic status on the long-term survival of 808 women with node-negative breast cancer in Canada and the United States were observed. Ontario and California samples diagnosed between 1988 and 1990 were followed until 2006. Socioeconomic data were taken from population censuses. Compared with their California counterparts, residents of low-income urban areas in Ontario experienced a significant 15-year survival advantage (RR = 1.66 [95% CI: 1.00, 2.76]). In these and other vulnerable, lower-middle- to working-class neighborhoods, significantly more Ontario residents gained access to adjuvant radiation therapy (RR = 1.75 [1.21, 2.53]) which seemed associated with better long-term survival (RR …

Physician Supply And Breast Cancer Survival, Kevin M. Gorey

Social Work Publications

BACKGROUND: This study tested the hypothesis that physician supply thresholds are associated with breast cancer survival in Ontario.

METHODS: The 5-year survival of 17,820 female breast cancer patients diagnosed between 1995 and 1997 was surveilled until 2003 for all-cause mortality. Physician supply densities in 1991 and 2001 were computed for 49 Ontario regions.

RESULTS: There were independent threshold effects for general practitioners (GP; 7.25 per 10,000) and obstetrician/gynecologists (OB/GYN; 6 per 100,000) at or above which women with breast cancer were more likely to survive for 5 years. The respective risk of living in areas undersupplied with OB/GYN and GP …

Automated Detection Of Infectious Disease Outbreaks In Hospitals: A Retrospective Cohort Study, Susan S. Huang, Deborah S. Yokoe, John Stelling, Hilary Placzek, Martin Kulldorff, Ken Kleinman, Thomas F. O'Brien, Michael S. Calderwood, Johanna Vostok, Julie Dunn, Richard Platt

Public Health Department Faculty Publication Series

BACKGROUND:

Detection of outbreaks of hospital-acquired infections is often based on simple rules, such as the occurrence of three new cases of a single pathogen in two weeks on the same ward. These rules typically focus on only a few pathogens, and they do not account for the pathogens' underlying prevalence, the normal random variation in rates, and clusters that may occur beyond a single ward, such as those associated with specialty services. Ideally, outbreak detection programs should evaluate many pathogens, using a wide array of data sources.

METHODS AND FINDINGS:

We applied a space-time permutation scan statistic to microbiology …

Program Evaluation For Tdap Immunization Standing Orders In A Birthing Hospital, Helen Crean Taugher

Doctor of Nursing Practice (DNP) Projects

Newborn infants are vulnerable to pertussis infections. Although the Advisory Committee on Immunization Practices (ACIP) recommends that babies begin their diphtheria, tetanus and acellular pertussis (DTaP) immunization series at two months of age, the minimum age for administration of the vaccine is six weeks of age (Centers for Disease Control [CDC], 2008). Young infants are at risk for whooping cough infection transmitted from parents, siblings and care-givers during the pre-vaccination period in the first two months of life, particularly pertussis transmitted from their mothers. Since the licensure of adult/adolescent formulations of tetanus, diphtheria and acellular pertussis (Tdap) vaccine in 2005, …

The Relationship Between Mosquito Abundance And Rice Field Density In The Republic Of Korea, Erin E. Richards, Penny Masuoka, David Brett-Major, Matthew Smith, Terry A. Klein, Heung Chul Kim, Assaf Anyamba, John Grieco

Journal Articles: Epidemiology

BACKGROUND: Japanese encephalitis virus (JEV), the causative agent of Japanese encephalitis (JE), is endemic to the Republic of Korea (ROK) where unvaccinated United States (U.S.) military Service members, civilians and family members are stationed. The primary vector of the JEV in the ROK is Culex tritaeniorhynchus. The ecological relationship between Culex spp. and rice fields has been studied extensively; rice fields have been shown to increase the prevalence of Cx. tritaeniorhynchus. This research was conducted to determine if the quantification of rice field land cover surrounding U.S. military installations in the ROK should be used as a parameter in a …