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Bayesian Experimental Design For Control And Surveillance In Epidemiology, Bren Case

Graduate College Dissertations and Theses

Effective public health interventions must balance an array of interconnected challenges, and decisions must be made based on scientific evidence from existing information. Building evidence requires extrapolating from limited data using models. But when data are insufficient, it is important to recognize the limitations of model predictions and diagnose how they can be improved. This dissertation shows how principles from Bayesian experimental design can be applied to surveillance and control efforts to allow researchers to get more out of their data and direct limited resources to best effect. We argue a Bayesian perspective on data gathering, where design decisions are …

Nonlinear Relationships Between The Environment And Health, Levi N. Bonnell

Graduate College Dissertations and Theses

Relationships between the environment and health outcomes are complex and likely nonlinear in nature. However, until recently, most studies used ordinary linear regression to model these relationships. The overall goal of this research was to investigate nonlinear relationships between the environment and health. To accomplish this goal, we used several large, national datasets across varying populations and local environments.

Destination accessibility is an important measure of the built environment that is associated with active transport and body mass index (BMI). In the first study, we sought to determine the relationship between the density of nonresidential destinations (a proxy for walkability) …

How To Analyze Parental Conversation Online: A Computational Stack For Studying Vaccine Hesitancy., Carter Willets Ward

Graduate College Dissertations and Theses

Despite national and international organizations such as the CDC and WHO recognizing the value of vaccines and their importance in addressing public health concerns, there has been a decline in coverage for even the most established vaccines over the past three years. The global COVID-19 pandemic has contributed to this decline via decreases in medical resource accessibility and an increase in vaccine hesitancy. Even before the COVID-19 pandemic, WHO had recognized vaccine hesitancy as one of the top ten threats to public health. In the present work, we introduce a background account of (1) vaccine hesitancy and (2) anti-vax activism, …

Experiences Participating In Federal Nutrition Assistance Programs During The Early Months Of The Covid-19 Pandemic: A Mixed Methods Study In Vermont, Emma Haven Spence

Graduate College Dissertations and Theses

For many Americans, the impacts of the COVID-19 pandemic have extended far beyond its overt health risks, spanning from economic shocks to new social realities. Elevated rates of both novel and continued food insecurity during the pandemic have been well-documented, and this burden has not been equally shared. Examination of food insecurity at the present moment offers a unique opportunity to give voice to those affected during this unprecedented time and understand the ability of existing social services to meet increased needs. This research aims to delve into the experiences of individuals at risk for food insecurity. Specifically, (1) to …

Modeling The Heterogeneous Temporal Dynamics Of Epidemics On Networks, Andrea Joan Allen

Graduate College Dissertations and Theses

Mathematical models of infectious disease are important tools for understanding large-scale patterns of how a disease spreads through a population. Predictions of trends from disease models help guide public health prevention and mitigation measures. Most simple disease models assume that the population is randomly mixed, but real-world populations exhibit heterogeneous patterns in the way people interact. These differences in population structure can be represented by networks. Networks can then be incorporated into disease models by using various interdisciplinary concepts and tools. Yet even network disease models often overlook that populations change over time. In this thesis, two models of infectious …

Understanding The Profiles Of Adolescents Engaged In Intentional Self-Poisoning With Suicidal Intent And The Role Of Primary Care In Early Intervention In Vermont, Rachael Comeau

Graduate College Dissertations and Theses

Suicide prevention is a top public health priority in Vermont. It is a complex issue, requiring a multi-faceted response from many different public and private stakeholders. Because intentional self-poisoning with suicidal intent is rarely lethal, it presents a particularly good opportunity for secondary interventions in the primary care setting. Extensive research has been done on intentional self-poisoning with suicidal intent and its relationship to subsequent risk of death by suicide, but gaps exist in research utilizing poison center data in the primary care setting. This dissertation employs an explanatory sequential mixed method research design to (a) develop a profile of …

Exploring Weight Control Expectancies As A Mediator Of The Relationship Between Fear Of Fat And Nicotine Dependence In Smokers And Vapers, Emily Pomichter

Graduate College Dissertations and Theses

Specific drug-use expectancies are shaped by reports from others about the effects of the drug, by an individual’s own experience with the drug, or by both. The present study hypothesized that, among smokers and e-cigarette users (vapers), an individual’s fear of weight gain would be associated with higher endorsement of appetite and weight control expectancies from nicotine use, which in turn would be associated with self-reported levels of nicotine dependence. The participants were smokers (n = 514) and vapers (n = 412) who responded to a Qualtrics survey advertised via Amazon’s Mechanical Turk platform. As predicted, nicotine’s appetite and weight …

Perceived Addictiveness Of Marijuana, Tobacco And Alcohol Use In Vermont Youth And Young Adults: Associations Between Addiction Perceptions, Sociodemographics, And Substance Use, Julia C. West

Graduate College Dissertations and Theses

Dual and poly-tobacco and substance use are increasingly prevalent in youth and young adults. Current substance use prevention media efforts target addiction perceptions in young people; however, little is known about the perceived addictiveness of multiple substances among young people. The goal of the current study is to examine youth and young adults perceive addictiveness across several substances and the associations between addiction perceptions and substance use. Data were collected in Spring and Summer 2019 (Waves 1 and 2) as part of PACE Vermont, an online cohort study of Vermonters aged 12–25. Latent class analyses grouped participants by responses to …

On The Dynamics And Structure Of Multiple Strain Epidemic Models And Genotype Networks, Blake Joseph Mitchell Williams

Graduate College Dissertations and Theses

Mathematical disease modeling has long operated under the assumption that any one infectious disease is caused by one transmissible pathogen. This paradigm has been useful in simplifying the biological reality of epidemics and has allowed the modeling community to focus on the complexity of other factors such as contact structure and interventions. However, there is an increasing amount of evidence that the strain diversity of pathogens, and their interplay with the host immune system, can play a large role in shaping the dynamics of epidemics.

This body of work first explores the role of strain-transcending immunity in mathematical disease models, …

Association Of Sickle Cell Trait With Exertional Rhabdomyolysis And Atrial Fibrillation., Daniel R. Douce

Graduate College Dissertations and Theses

Sickle cell trait (SCT), sickle cell disease’s carrier status, is a common genetic variant found in many people of African, South Asian, Middle Eastern and Mediterranean descent. While overall considered a benign carrier status, it has been associated with an increased risk of several diseases, including exertional rhabdomyolysis (ER), and chronic kidney disease. While epidemiological evidence links SCT with ER, the actual pathophysiological mechanism less understood. Additionally, while there is an increased prevalence of atrial fibrillation (AF) documented in people with sickle cell disease, studies in individuals with SCT are lacking.

The objectives of this thesis are twofold: The first …

Referral Patterns And Service Provision In Child Protective Services: Child, Caregiver, And Case Predictors, Hannah Mead Holbrook

Graduate College Dissertations and Theses

Child maltreatment, and recurrent maltreatment in particular, occurs at an alarmingly high rate. Frequency of reports to Child Protective Services (CPS) is associated with negative psychological outcomes, and children whose reports are unsubstantiated experience similar risk of behavioral, emotional, and substance use disorders as those whose reports are substantiated. Prior research has demonstrated that children with no CPS reports and children with one CPS report showed no significant differences in rates of maltreatment perpetration or substance use in adulthood, suggesting that prevention efforts after one report may have strong merit in reducing negative outcomes in adulthood. However, patterns and risk …

An Analysis Of Beverage Consumption In The United States Using The National Health And Examination Survey 2007-2017, Sean Morris

Graduate College Dissertations and Theses

Sugar-Sweetened Beverages (SSBs) are liquids sweetened with various forms of added sugar. They are the leading source of calories and added sugar in the American diet (Drewnowski & Rehm, 2014; National Cancer Institute, 2016; Powell, Chriqui, Khan, Wada, & Chaloupka, 2013). The health and nutrition literature has increasingly identified added sugars and SSBs as a key potential contributor to a host of public health issues including obesity, type 2 diabetes, hypertension, and cardiovascular disease (Johnson et al., 2009; Malik, Popkin, Bray, Despres, & Hu, 2010; Vartanian, Schwartz, & Brownell, 2007). Concern about these public health crises has recently animated regional …

Genotypes And Phenotypes Of Staphylococci On Selected Dairy Farms In Vermont, Robert Mugabi

Graduate College Dissertations and Theses

The genus Staphylococcus contains at least 47 species and 23 subspecies. Bacteria in this genus are ubiquitous; many are commensals on human and animal skin and can be opportunistic pathogens. In dairy cattle, staphylococci are the leading cause of intramammary infections (IMI) and mastitis. Mastitis is the inflammation of the mammary gland, and is one of the leading infectious diseases causing production losses in the dairy industry. Based on the ability to clot blood plasma in vitro, members of the genus can be divided into two groups: coagulase positive staphylococci (CPS) and coagulase negative staphylococci (CNS). In the dairy industry, …

Chronic Kidney Disease And The Risk Of Venous Thromboembolism, Katharine Lana Cheung

Graduate College Dissertations and Theses

Chronic kidney disease (CKD) affects more than 30 million adults in the U.S. and is strongly associated with cardiovascular events and mortality. Venous thromboembolism (VTE) is the third leading vascular disease, affects up to 900,000 Americans each year and contributes to as many as 100,000 deaths annually. The relationship of CKD and VTE has been described in patients receiving dialysis, kidney transplants recipients and in nephrotic syndrome, however, data supporting the association of VTE in mild to moderate CKD is conflicted. The overall goal of this research was to study the association of CKD and VTE and to understand the …

21st Century Approaches To Addressing Childhood Diarrhea In Low And Middle-Income Countries: Zinc As A Cornerstone Of New Prevention Strategies, Elizabeth Ross Colgate

Graduate College Dissertations and Theses

During the 20th century, significant strides were made in curtailing the burden of childhood diarrhea, including advances in vaccine research, the advent of antibiotics, improved water and sanitation, and expanded access to health information across the globe. Despite this progress, today diarrhea ranks second only to pneumonia as a leading cause of mortality in children under five years, with a disproportionate burden of 90% of diarrheal deaths in South Asia and Sub-Saharan Africa. Additionally, substantial morbidity due to diarrhea persists in young children, with more than 45 million disability-adjusted life years (DALYs) lost due to diarrhea in 2015. Long-term consequences …

Assessing Community Dynamics And Colonization Patterns Of Tritatoma Dimidiata And Other Biotic Factors Associated With Chagas Disease Prevalence In Central America, Lucia Consuelo Orantes

Graduate College Dissertations and Theses

Chagas disease is caused by the parasite Trypanosoma cruzi and transmitted by multiple triatomine vectors across the Americas. In Central America, the predominant vector is Triatoma dimidiata, a highly adaptable and genetically diverse Hemiptera. In this research, we used a novel reduced-representation DNA sequencing approach to discover community dynamics among multiple biotic factors associated with Chagas disease in Central America, and assess the infestation patterns of T. dimidiata after seasonal and chemical disturbances in Jutiapa, Guatemala. For our first study, we used a hierarchical sampling design to obtain multi-species DNA data found in the abdomens of 32 T. dimidiata …

The Cardiovascular Epidemiology And Genome-Wide Associations Of Biomarkers Of Innate And Adaptive Immunity: Scd163 And Sil2ra, Jon Peter Durda

Graduate College Dissertations and Theses

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in the U.S. and worldwide. Atherosclerosis, the buildup of plaque in the arteries, is a common cause of CVD. For many years, research in atherosclerosis was focused on lipid metabolism and the accumulation of low-density lipoprotein in the arteries. While this research set public health guidelines for lipid management, lipid concentration was not the only factor influencing atherosclerosis and CVD events. Many scientists, as far back as the 1850’s recognized the role of inflammation in the progression of atherosclerotic disease. The continuous low levels of immune activation in the …

An Examination Of Correlation Between Preadmission Indicators Of College Readiness And Clinical Performance Of Nursing Students, Kenneth Allen

Graduate College Dissertations and Theses

A significant body of literature supports the proposition that the development of a culturally competent healthcare workforce is enhanced by diversity in the cohorts of students graduating from post-secondary educational programs related to careers in health and healthcare. However, increasing diversity in these programs is contingent upon increasing acceptance rates of historically disadvantaged students, such as students from racial/ethnic minority groups and/or low socioeconomic status, into highly selective post-secondary institutions, such as state flagship universities, and highly selective majors such as nursing. A significant barrier to increasing enrollment of disadvantaged students at more selective post-secondary institutions is the combined effect …

A New Evolutionary Algorithm For Mining Noisy, Epistatic, Geospatial Survey Data Associated With Chagas Disease, John P. Hanley

Graduate College Dissertations and Theses

The scientific community is just beginning to understand some of the profound affects that feature interactions and heterogeneity have on natural systems. Despite the belief that these nonlinear and heterogeneous interactions exist across numerous real-world systems (e.g., from the development of personalized drug therapies to market predictions of consumer behaviors), the tools for analysis have not kept pace. This research was motivated by the desire to mine data from large socioeconomic surveys aimed at identifying the drivers of household infestation by a Triatomine insect that transmits the life-threatening Chagas disease. To decrease the risk of transmission, our colleagues at the …

Childhood Sexual Abuse Screening And Prevention In The Primary Care Setting: A Survey Of Pediatric Healthcare Providers In The State Of Vermont, Kelley Eileen Groll

Graduate College Dissertations and Theses

ABSTRACT

Background. Childhood sexual abuse (CSA) is a silent, but pervasive concern across the United States, the prevalence of which is often vastly underestimated. Some research indicates that as many as one in four girls and one in six boys become victims of CSA. CSA is classified as an adverse childhood experience (ACE), which has been shown to have serious longstanding negative physical, emotional, and mental health impacts. The pediatric primary healthcare provider is well posed to intervene to detect and prevent the occurrence of CSA.

Objective. The overall goal of this study is to gain an understanding of the …

Childhood Vaccine Perceptions And Practices Among Naturopathic Physicians, Katherine Bloom Whitman

Graduate College Dissertations and Theses

Purpose: Parental decisions to vaccinate their children may be impacted by the advice of health care providers practicing complementary and alternative medicine (CAM). Available literature suggests an association between vaccine delay or refusal and CAM use, decreased vaccination status of naturopathic patients, and increased vaccine hesitancy among naturopathic students. Some naturopathic physicians state that their approach towards discussions about childhood vaccinations may support families in choosing partial vaccination over complete refusal, ultimately contributing to an overall increase in vaccinations.

Methods: Using a modified Health Belief Model as a theoretical framework, this online survey of naturopathic physicians assessed childhood vaccine-related perceptions …

Maternal Hypertension Influences Mortality And Severe Morbidity In Infants Born Extremely Preterm, Carole Anne Mcbride

Graduate College Dissertations and Theses

Worldwide, more than 1 million infants die as a result of premature birth. In the United States, where 1 in 10 births occurs preterm, premature birth is the leading cause of infant mortality. Premature infants have high rates of mortality and morbidity, with the highest rates seen in those infants born extremely preterm -- prior to 30 weeks gestation. Severe morbidity in these infants often contributes to life-long health problems. Maternal hypertension (HTN) is one contributor to preterm birth and also contributes to fetal growth restriction, resulting in birth weights which are small for gestational age (SGA, and generally within …

Long-Acting Reversible Contraceptives In Vermont: A Survey Based Assessment Of Current Knowledge Of Providers Of Women Of Reproductive Age, Erin O'Brien

Graduate College Dissertations and Theses

Unintended pregnancies are a long-standing public health issue nationally, with percentages hovering around 50% for at least the last five years. Vermont is doing slightly better than the national average, but is faced with it's own challenges due to it's rural nature. Agencies and organizations, such as the World Health Organization, March of Dimes and the Vermont Department of Health have made decreasing unintended pregnancies one of their priorities to improve maternal and fetal health outcomes, as well as social and economic opportunities for families. Current evidence-based guidelines call for long- acting reversible contraceptives (LARCs), including intrauterine devices (IUDs) and …

From Dar Es Salaam To Dartmouth: A Case Study Of The Experiences Of Fogarty Aids International Training And Research Program Fellows At Dartmouth College, Lisa Anne Purvis

Graduate College Dissertations and Theses

From Dar es Salaam to Dartmouth: A Case Study of the Experiences of Fogarty AIDS International Training and Research Program Fellows at Dartmouth

Lisa Purvis, EdD Candidate, MPH, MBA

Background

The United States (US) is a major host nation to international college students and scholars who study a variety of disciplines (Farrugia & Bhandari, 2014). Beginning in the last decade, the demand for global health training has risen (Kanter, 2008; Kerry, Ndung'u, Walensky, Lees, Kayanjas, & Bangsberg, 2011).

Since 2000, Geisel School of Medicine at Dartmouth has been one of 26 US universities participating in a global health training program, …

A Comparative Examination Of The Safety Programs At Ucla, Umn, And Uvm In Response To Recent Chemistry Laboratory Incidents, Victoria Carhart

Graduate College Dissertations and Theses

Laboratory safety has recently become more of an imperative in research laboratories than it has ever been in the past. Recent accidents at several universities have escalated the awareness of safety concerns in laboratory workspaces among the general public and created a greater need for a stronger culture of safety in chemistry research overall. Historically, results and publications have been the top priority of most researchers, not laboratory safety.

This thesis discusses a number of laboratory accidents. The first happened in December of 2008 at the University of California, Los Angeles (UCLA) and resulted in the death of a graduate …

Defining Food Agency: An Ethnographic Exploration Of Home And Student Cooks In The Northeast, Maria Carabello

Graduate College Dissertations and Theses

According to popular and academic sources, home cooking is in decline. Nutrition and public health scholars concern that a loss of cooking abilities may diminish individuals' control over their food choices, thus contributing to poor health outcomes. Yet, there are still many unanswered questions. What skills, strategies, and knowledge sets are required to cook a meal on any given occasion? What capacity separates those who cook with ease from those who struggle to incorporate cooking into their daily routines? I propose that this difference is determined by an individual's capacity to employ a range of cognitive and technical skills related …

Meta-Analysis Of Studies Investigation Of The Effect Of Smoking Cessation On Impatience, Miriam Claire Dash

Graduate College Dissertations and Theses

(DSM-IV-TR/) nor in withdrawal scales. However, a related term, "impatience" is listed in some nicotine withdrawal scales. (Hughes J. R., Measurements of the Effects of Abstinence from Tobacco: A Qualitative Review, 2007). Although impatience is not a synonym of impulsivity, both share the synonym "impetuous". Therefore, impatience can be considered a measure of impulsivity. Although some reviews of the effect of smoking cessation on impatience have occurred, we know of no quantitative review of prospective studies of whether smoking cessation increases impatience.

Purpose: To evaluate the effect of smoking cessation on impatience as measured by the Minnesota Nicotine Withdrawal Scale-Revised …