Digital Commons Network^™

Distributing Condoms And "Hope": Race, Sex, And Science In Youth Sexual Health Promotion, Chris A. Barcelos

Doctoral Dissertations

This project uses discursive, visual, and ethnographic approaches situated in a critical feminist methodology to understand how ways of knowing about youth sexuality and reproduction influence community health work. I understand the “problem” in this inquiry as the discursive contexts that limit critical ways of knowing about young people’s sexual subjectivities and practices and about the design of policies and programs. Although race, class, gender, and sexuality are understood in the public health literature as important social determinants of health, there is a lack of research that applies a critical, feminist lens to these constructs. I draw on three years …

Gestational Weight Gain And Maternal Health Among Hispanic Women, Megan W. Harvey

Doctoral Dissertations

More than 70% of women do not gain within their target range of gestational weight gain (GWG), as recommended by the Institute of Medicine (IOM) in 2009. Risks associated with inadequate GWG include small-for-gestational age, low birthweight, pre-term birth, and difficulty establishing breastfeeding. Risks associated with excessive GWG include large-for-gestational-age, macrosomia, and delivery complications. There are also long-term consequences for maternal and fetal metabolic processes. Higher pre-pregnancy BMI, lower education level, and higher parity are known risk factors for excessive GWG. There are also possible racial / ethnic differences, and Hispanic women, in particular, may be at high risk for …

Mobile Produce Markets: A Strategy For Increasing Access To Fruits And Vegetables Among Low Income Urban Residents, Bi-Sek J. Hsiao

Masters Theses

Mobile produce markets (MPM) are a community-based strategy to improve produce access in areas with few fruits and vegetables (FV) retail options. The purpose of this thesis is to assess the functionality of MPM in low-income urban neighborhoods. This thesis includes three studies. Study 1 investigates FV availability in areas around MPM locations (n=13). We found limited fresh FV availability in stores, but high prevalence of 100% juice, and canned FV and beans. Study 2 applied questionnaire data from MPM shoppers (n=143) to assess MPM experiences. Chi Square was used to compare shopping behaviors between older (≥ 60) and younger …

A Comparison Of Techniques For Handling Missing Data In Longitudinal Studies, Alexander R. Bogdan

Masters Theses

Missing data are a common problem in virtually all epidemiological research, especially when conducting longitudinal studies. In these settings, clinicians may collect biological samples to analyze changes in biomarkers, which often do not conform to parametric distributions and may be censored due to limits of detection. Using complete data from the BioCycle Study (2005-2007), which followed 259 premenopausal women over two menstrual cycles, we compared four techniques for handling missing biomarker data with non-Normal distributions. We imposed increasing degrees of missing data on two non-Normally distributed biomarkers under conditions of missing completely at random, missing at random, and missing not …

Macronutrients And The Risk Of Premenstrual Syndrome, Serena C. Houghton

Doctoral Dissertations

Premenstrual syndrome (PMS) affects 8-20% of reproductive-aged women, impacting work, family, and social interactions. Limitations in available PMS treatments, including side effects and limited medication efficacy, indicate the need for improved prevention. Modifiable risk factors for prevention of PMS include dietary factors. Several micronutrients have been identified as risk factors, but there has been little evaluation of macronutrients. Thus, the research aim was to examine prospectively whether macronutrient consumption was associated with PMS development among a subset of women enrolled in the Nurses’ Health Study II cohort. Chapter 1 evaluates the association of fat intake and PMS risk. Among 3,638 …

Feasibility Of A Combined Physical Activity And Sleep Education Intervention For Girls Living In A Low Socioeconomic Status Urban Community, Cory J. Greever

Doctoral Dissertations

Declining sleep duration and poor sleep quality is a public health epidemic disproportionately effecting elementary age girls living in low socioeconomic status urban communities. The Girls Dancing and Sleeping for Health (Girls DASH) program was designed to test the feasibility, acceptability, and efficacy of a combined physical activity and sleep education program in this population. In combination with baseline data from a previously conducted intervention in elementary age urban girls living in a low SES community in Springfield, MA, results from a cross-sectional analysis indicated that greater screen time was positively associated with parental reports of child’s sleep quality. Additionally, …

Transformative Learning Facilitated Dialogue: As A Tool For Social Change An Autoethnography, Leslie A. Saulsberry

Doctoral Dissertations

It is my goal, through this autoethnography, to take you through a reflective journey and present to you my personal theory of how facilitated dialogue in the context of transformative learning, critical reflection, systems thinking, shared vision, and holarchy can create a paradigm shift in our personal consciousness, decisions, behaviors, practice, and social policies—social change. My objective is to show how each theory is like a stepping-stone in the path towards social change. The purpose of this living work is to offer an alternative way of creating a healthy and whole society by exploring how facilitated dialogue can lead to …

Sleep Patterns, Urinary Levels Of Melatonin And Subsequent Weight Change In The Women’S Health Initiative Observational Study, Nicole M. Barron

Masters Theses

Results from prospective studies examining associations between sleep duration and weight gain have been mixed. Melatonin has been hypothesized to mediate the association between sleep duration and weight/body composition. In cross-sectional studies, aMT6s has been shown to be inversely associated with weight/body fat percentage. We examined associations between baseline sleep duration, insomnia status, aMT6s levels with weight/body fat percentage through 6 years, utilizing a subset 690 women who participated in a breast cancer case-control study nested within the WHI-OS. Multi-variable and mixed-effects regression was used to calculate beta-coefficients and 95% confidence intervals. Cross-sectional analyses showed urinary aMT6s levels were inversely …

A Comparative Sustainability Study For Treatment Of Domestic Wastewater: Conventional Concrete And Steel Technology Vs. Vegetated Sand Beds (Vsb’S) And Their Relative Differences In Co2 Production, Alicia M. Milch

Masters Theses

Conventional wastewater treatment in the U.S. is an energy dependent and carbon dioxide emitting process. Typical mechanical systems consume copious amounts of energy, which is most commonly produced from fossil fuel combustion that results in the production of CO₂. The associated organic load is also metabolized by microorganisms into CO₂ and H₂O. As the desire to reduce CO₂ output becomes more prominent, it is logical to assess the costs of conventional treatment methods and to compare them to alternative, more sustainable technology. Vegetated Sand Bed (VSB) and Reed Bed (RB) systems are green technologies …

Antidepressant Use And Risk Of Colorectal Cancer In The Women's Health Initative, Jenna F. Kiridly

Masters Theses

Colorectal cancer is the third most common cancer among U.S. women; 63,610 new cases were estimated to have occurred in 2015. Prior studies found a reduced risk of colorectal cancer among antidepressant (AD) users, however, none adjusted for depression, which is itself linked to increased colorectal cancer risk and could confound this relationship. We assessed the relationship between ADs and AD drug classes with risk of colorectal cancer in a prospective cohort of 145,190 women between the ages of 50-79 without a previous history of cancer at enrollment. Current AD use was assessed at baseline. Over an average follow-up of …

The Adoption Of Harm Reduction By Abstinence Program Staff: A Qualitative Analysis, Morgan Coe

Masters Theses

Opioid overdose fatalities have quadrupled in the United States since the turn of the century, and are becoming increasingly recognized as a nationwide epidemic. While naloxone (narcan) has long been the standard treatment for overdose in clinical settings, it has not been issued to opioid users or their family members in the U.S. until relatively recently. As naloxone distribution and overdose training become more widespread, they are being incorporated into more and more abstinence-oriented settings including detoxes, halfway houses, and outpatient methadone and suboxone treatment programs. This qualitative study explored whether the staff at such programs found that training their …

Essays On Household Health Expenditures, National Health Insurance And Universal Access To Health Care In Ghana, Evelyn Kwakye

Doctoral Dissertations

Access to quality health services is essential for maintaining a healthy population and economic development hence the growing global consensus that universal health coverage is necessary. Ghana attempts to expand access by making basic health services free at the point of delivery through its National Health Insurance Scheme (NHIS). Prior studies indicate NHIS increases demand for health services, but questions remain about its impact on out of pocket payments, quality of services, and the financial viability of the program. Hence, this dissertation analyzes the financial risk in health care seeking, the effect of NHIS on out of pocket payments and …

Delays In Antiretroviral Therapy Initiation Among Hiv-Positive Individuals: Results Of The Positive Living With Hiv Study, Krishna C. Poudel, David R. Buchanan, Kalpana Poudel-Tandukar

Health Promotion and Policy Faculty Publication Series

Background: Lack of early initiation of antiretroviral therapy (ART) remains a major health concern due to increased risk of premature mortality and further HIV transmission. This study explored CD4+ cell count monitoring in relation to delays in ART initiation among HIV-positive individuals in the Kathmandu Valley, Nepal, where ART coverage was only 23.7% in 2011.

Design: We recruited a total of 87 ART-naïve, HIV-positive individuals aged 18 to 60 years through the networks of five non-government organizations working with HIV-positive individuals. We collected data on the history of ART initiation, CD4+ cell count monitoring, socio-demographic variables, perceived family …

Pneumococcal Pneumonia In The Older Adult: Increasing Patient Education And Vaccination, Jessica E. Valletta

Doctor of Nursing Practice (DNP) Projects

Background:Pneumococcal disease is a transmitted infectious illness that results in serious complications and death every year in the United States. Given their increased susceptibility to the potential complications of this disease, patients aged 65 and older are considered to be high-risk, but vaccination compliance for this population remain well below state and national goals.

Purpose: The purpose of this project was to increase pneumococcal vaccination rates among adults aged 65 and older in a primary care clinic by increasing patient education.

Methods: An educational intervention was implemented within a large primary care practice located in Central Massachusetts. Educational …

Education Intervention Of Preconception Screening In Primary Care, Tracy Schuler

Doctor of Nursing Practice (DNP) Projects

Problem: The risk of a poor pregnancy outcome among women of reproductive age in Providence, Rhode Island is indicated by the high rates of unintended pregnancies, low multivitamin use prior to pregnancy, obesity, and smoking. Although recommended, health professionals often fail to routinely screen and educate women of reproductive age for preconception risk factors. Purpose: Evaluate the efficacy of an educational intervention on preconception risk factors, lifestyle modifications, and current screening recommendations; and introduce a preconception tool and education sheet among a population of health care providers. Method: Preconception health material and a modified preconception screening tool …

Do Dietary Patterns Explain High Prevalence Of Cardiovascular Risk Factors Among Pakistani Urban Adults? A Cross-Sectional Study, Nilofer F. Safdar, Elizabeth Bertone-Johnson, Lorraine Cordeiro, Tazeen H. Jafar, Nancy L. Cohen

Nutrition Department Faculty Publication Series

Background

The prevalence of cardiovascular disease (CVD) in South Asia is higher than in any other developing countries. The diversity of diets in populations among developing countries may be one explanation for the differences in CVD. This study was carried out to explore the association between dietary patterns and the presence of cardiovascular risk factors among Pakistani low income urban adults.

Methods

Socio demographic, physical activity and dietary information was collected from 1546 Pakistani subjects aged ≥40 years from the Control of Hypertension and Risk Attenuation (COBRA) study. Anthropometric, clinical and biomarker measures were assessed. Cluster analysis was used to …

Associations Between The Patient-Centered Medical Home And Preventive Care And Healthcare Quality For Non-Elderly Adults With Mental Illness: A Surveillance Study Analysis, Jennifer J. Bowdoin, Rosa Rodriguez-Monguio, Elaine Puleo, David Keller, Joan Roche

Health Promotion and Policy Faculty Publication Series

Background

Patient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness, but the extent to which PCMHs are associated with preventive care and healthcare quality for this population is largely unknown. Our study addresses this gap by assessing the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness.

Methods

This surveillance study used self-reported data for 6,908 non-elderly adults with mental illness participating in the 2007–2012 Medical Expenditure Panel Survey. Preventive care and healthcare quality measures included: participant rating of all healthcare; cervical, breast, and …

Improving Hpv Vaccination Initiation And Completion Rates: A Qi Project, Princy M. Varughese

Doctor of Nursing Practice (DNP) Projects

Human papillomavirus (HPV) is a common sexually transmitted infection in the United States and is the cause of most cervical cancers in women, as well as anogenital cancers, oropharyngeal cancer, and genital warts in both men and women (Centers for Disease Control [CDC], 2014b). The HPV vaccine is recommended for preteen girls and boys to protect against HPV infections (CDC, 2011). In line with the goal of Healthy People 2020, the purpose of this evidence-based quality improvement (QI) project was to implement a text message reminder system, and calculate the completion rate of the 3-dose HPV vaccination series among adolescents …