Digital Commons Network^™

Comprehensive Literature Review: Assessing The Impact Of Covid-19 Policies, School Closures And Social Distancing, On The Mental Health Of School Age Children, Fatuma A. Hassan

Capstone Experience: Master of Public Health

Mental health is vital to the well-being of all individuals, especially children. COVID-19 unveiled a significant public health issue with poor mental health during the pandemic. There is limited literature about the mental health implications of COVID-19 policies for children and adolescents and preventive strategies for future pandemics. This comprehensive literature review seeks to further investigate the mental health impacts of school shutdowns and social distancing, which were nonpharmaceutical strategies, on school-aged children, 5-18 years old, and propose recommendations for public health officials to mitigate the mental health impacts for future pandemics. Additionally, the review aims to highlight the potential …

Exploring How Social Determinants Of Health Affects Rates Of Chronic Obstructive Pulmonary Disease (Copd) In The Des Moines Metro, Kyla Winkelman

Capstone Experience: Master of Public Health

Chronic Obstructive Pulmonary Disease (COPD) is consistently in the top ten leading causes of death and most recently ranked fourth in the United States (Heron, 2021). Research on health disparities and SDOH has increased recently as investigators learn their importance in diagnosing chronic conditions. Several studies show that a person’s life and environment can determine their risk of exposure, susceptibility, course, and disease outcome. UnityPoint Health (UPH) clinics were utilized for this project to explore how the social determinants of health and health disparities affect COPD rates in Des Moines, Iowa. Initial data was obtained surrounding COPD statistics in the …

The Association Of Apgar Score Outcomes With The Number Of Midwife Antenatal Care Visits Among Infants Born To Rohingya Refugees In Cox’S Bazar, Bangladesh, Vickie Doss

Capstone Experience: Master of Public Health

A cross-sectional study was conducted at the HOPE Foundation for Women and Children of Bangladesh Field Hospital in Cox’s Bazar, Bangladesh, to examine the relationship between the number of antenatal care visits (ANCV) and Apgar scores. This study aims to explore the association between the number of ANCV and Apgar scores in neonates born to Rohingya refugee women. The medical records at HOPE Field Hospital of 182 post-delivery Rohingya women in the Mhodhurchora refugee camp were collected through a medical chart review to

obtain the number of ANCV and 1-minute and 5-minute Apgar scores. The Apgar scoring system is a …

Food Insecurity And Child Development In Nebraska: The Role Of Income, Home Learning Environment, And Family Socio-Demographic Factors, Marlette Grace Dulcinee Mabiala-Maye

Capstone Experience: Master of Public Health

Food insecurity is a well-known risk factor for delayed child development. Still, the contribution of other factors, such as income, home learning environment (HLE), and family socio-demographic factors, remains to be determined. Therefore, the study aimed to determine the association between food insecurity and child development and assess the role of income, HLE, and family socio-demographic factors in that association. We used secondary data from the Nebraska Early Childhood Study, a cross-sectional study of caregivers of children under five years old in Omaha and Lincoln. Child development, food insecurity, and HLE were measured using a caregiver report of child development. …

A Scoping Review Of The Predictive Values And Use Of The Oraquick In-Home Hiv Test, Mariah Zinn

Capstone Experience: Master of Public Health

The OraQuick In-Home HIV Test was FDA-approved for over-the-counter use for people aged 17 years and older in 2012. The FDA reported on the sensitivity and specificity of the test, which looks at the accuracy of a test relative to a reference standard. However, the predictive values that account for prevalence still need to be thoroughly examined among tests distributed through community-based means. In this review, we looked at the predictive values for the OraQuick In-Home HIV Test for people aged 15 years and older when the test is distributed through community-based means. We calculated the predictive values for each …

Association Between Socioeconomic And Behavioral Characteristics With Urinary Neonicotinoid Levels In The United States, 2015-2016, Komi Nomessi Akliku

Capstone Experience: Master of Public Health

Neonicotinoids are a class of pesticides developed in the 1980s and widely used in agriculture and households. They are sources of health damage in mammals, as identified in experimental studies in rats. The health effects identified were acetamiprid: memory dysfunction, respiratory failure, and digestive troubles; imidacloprid: liver and brain cell necrosis through Nitric Oxide formation: Thiacloprid induces an increase of cytokine proinflammation and causes cell division disturbance and genotoxicity; thiamethoxam is incriminated in reproductive system toxicity and cardiotoxicity; clothianidin is found to be associated with fertility troubles affecting spermatozoids’ motility. They have been said to be associated with thyroid cancer …

Planning A Multiple Myeloma Needs Assessment For Omaha Nebraska, Judith Ngozi Obodougo

Capstone Experience: Master of Public Health

Literature Review

Worldwide, approximately 176,404 people had Multiple Myeloma in 2020, which caused about 117,077 deaths in the same period. Multiple Myeloma is a rare type of blood cancer currently considered a curable malignancy.

Objectives

This public health capstone aims to create a plan for a community needs assessment for multiple Myeloma in Omaha, Nebraska.

Methods

This capstone project modified the Centers for Disease Control and Prevention (CDC) community needs assessment guidelines to create a Multiple Myeloma needs assessment plan for Omaha, Nebraska.

Results

All seven steps outlined in the CDC community needs assessment planning steps were relevant. Omaha, Nebraska, …

Program Evaluation: Utilizing Health Department’S Community Health Needs Assessment Data To Improve Emergency Preparedness Plans, Kathleen Gottschalk

Capstone Experience: Master of Public Health

Public health officials conducting emergency response plans must know how to easily identify the vulnerable populations in their community or jurisdiction. It is beneficial for access and functional needs appendices to include information and resources directed at the identified vulnerable groups before an emergency event to improve health outcomes. Community Health Needs Assessments (CHNA) can provide population-level statistics and information needed to easily identify vulnerable or at-risk groups. This report aims to evaluate the use of the CHNA data to guide the development of inclusive emergency response plans that account for vulnerable populations in local health department jurisdictions. The 2021 …

A Retrospective Analysis Of Rabies Lyssavirus Animal Testing In Nebraska, 2012 Through 2021, Elijah Theye

Capstone Experience: Master of Public Health

Background: Rabies is a zoonotic disease caused by a neurotropic virus that has been a public health issue for over 4,000 years, killing roughly 59,000 humans globally each year. This study examined the seasonality of bat-human exposures, the association between animal-human exposure types and animal rabies positivity, and using skunk monthly positivity rates to predict all non-skunk non-bat animal positivity rates with a lag time of six months, in Nebraska.

Methods: Animal rabies testing data from 2012-21 were extracted from Nebraska’s Electronic Disease Surveillance System. Animal tests that had a valid animal rabies test were included in the analyses. To …

Surviving The Stigma: Incorporating Mental Health Literacy To Increase Help-Seeking In California First Responders, Yvonne C. Newson

Master's Projects and Capstones

First responders are at risk of developing mental health problems due to repeated exposure to traumatic incidents, increasing their chance of developing Post Traumatic Stress Disorder, substance abuse, suicidal ideation, and suicide. Unfortunately, first responders do not recognize that they may have a mental illness and are reluctant to seek help. This paper will discuss the prevalence of mental health problems among first responders and the barriers to their help-seeking. These barriers include the stigma around mental illness within the culture, the assessability of professional help, and the lack of mental health literacy regarding their well-being. Further discussion will focus …

Trust In Southern Nevada Health District By The Southern Nevada Population During The Covid-19 Pandemic, Edom Gelaw

UNLV Theses, Dissertations, Professional Papers, and Capstones

While various studies worldwide investigated trust in relation to health care, government and compliance with public health guidelines, literature remains scarce in relation to the Southern Nevada Health District (SNHD), its population and the services the organization offered during the COVID-19 pandemic. This study helps fill this gap and serves as a foundation for future research and a guide for service evaluations and improvements at SNHD. As trust towards local health districts by the community they serve remains an important component of public health for collaborative work, SNHD saw the need for evaluating trust by its population based on the …

Monte Carlo-Derived 99m Tc Uptake Quantification With Commercial Planar Mbi: Absolute Tumor Activity, Benjamin P Lopez, Srinivas Cheenu Kappadath

Faculty, Staff and Student Publications

BACKGROUND: Molecular breast imaging (MBI) of 99mTc-sestamibi is an emerging adjunct qualitative tool in the detection and diagnosis of breast cancer.

PURPOSE: This work outlines the development and performance evaluation of a methodology to absolutely quantify tumor 99mTc activity uptake using a commercially available dual-headed MBI system by implementing corrections for background, scatter, attenuation, and detector characteristics.

METHODS: A validated Monte Carlo application of a commercial MBI system was used to simulate over 7000 unique acquisitions of spherical and ellipsoidal tumors in breast tissue. Tumor absolute activity was calculated following background, scatter, and attenuation corrections of tumor region of interest …

Qualitative Chemical Analysis Of Elf Bar E-Liquids And Their Effect On Phenotypic Characteristics Of Arabidopsis Thaliana, Genevieve Neuwirth

Undergraduate Theses and Capstone Projects

After their initial market introduction in 2003, the popularity and use of e-cigarettes have exponentially increased. There are three main components that have contributed to this: marketing, ease of access, and emerging flavors. The marketing industry uses claims that ecigarettes are a ‘safer’ and ‘healthier’ alternative to cigarettes as a way to entice previous smokers into using this product. With the increase in popularity, there is also an increase in demand, which has led to the creation of stores designed to target customers and sell e-cigarettes and similar products at convenient locations. Finally, the emerging flavors have enticed many nonsmokers …

Gwas And Meta-Analysis Identifies 49 Genetic Variants Underlying Critical Covid-19, Erola Pairo-Castineira, Konrad Rawlik, Andrew D Bretherick, Ting Qi, Yang Wu, Isar Nassiri, Glenn A Mcconkey, Marie Zechner, Lucija Klaric, Fiona Griffiths, Wilna Oosthuyzen, Athanasios Kousathanas, Anne Richmond, Jonathan Millar, Clark D Russell, Tomas Malinauskas, Ryan Thwaites, Kirstie Morrice, Sean Keating, David Maslove, Alistair Nichol, Malcolm G Semple, Julian Knight, Manu Shankar-Hari, Charlotte Summers, Charles Hinds, Peter Horby, Lowell Ling, Danny Mcauley, Hugh Montgomery, Peter J M Openshaw, Colin Begg, Timothy Walsh, Albert Tenesa, Carlos Flores, José A Riancho, Augusto Rojas-Martinez, Pablo Lapunzina, Genomicc Investigators, Scourge Consortium, Isaricc Investigators, 23andme Covid-19 Team, Jian Yang, Chris P Ponting, James F Wilson, Veronique Vitart, Malak Abedalthagafi, Andre D Luchessi, Esteban J Parra, Raquel Cruz, Angel Carracedo, Angie Fawkes, Lee Murphy, Kathy Rowan, Alexandre C Pereira, Andy Law, Benjamin Fairfax, Sara Clohisey Hendry, J Kenneth Baillie

Faculty, Staff and Student Publications

Critical illness in COVID-19 is an extreme and clinically homogeneous disease phenotype that we have previously shown1 to be highly efficient for discovery of genetic associations2. Despite the advanced stage of illness at presentation, we have shown that host genetics in patients who are critically ill with COVID-19 can identify immunomodulatory therapies with strong beneficial effects in this group3. Here we analyse 24,202 cases of COVID-19 with critical illness comprising a combination of microarray genotype and whole-genome sequencing data from cases of critical illness in the international GenOMICC (11,440 cases) study, combined with other studies recruiting hospitalized patients with a …

A Model For Gastrointestinal Tract Motility In A 4d Imaging Phantom Of Human Anatomy, Ergys Subashi, Paul Segars, Harini Veeraraghavan, Joseph Deasy, Neelam Tyagi

Faculty, Staff and Student Publications

BACKGROUND: Gastrointestinal (GI) tract motility is one of the main sources for intra/inter-fraction variability and uncertainty in radiation therapy for abdominal targets. Models for GI motility can improve the assessment of delivered dose and contribute to the development, testing, and validation of deformable image registration (DIR) and dose-accumulation algorithms.

PURPOSE: To implement GI tract motion in the 4D extended cardiac-torso (XCAT) digital phantom of human anatomy.

MATERIALS AND METHODS: Motility modes that exhibit large amplitude changes in the diameter of the GI tract and may persist over timescales comparable to online adaptive planning and radiotherapy delivery were identified based on …

Utilization Of Community Health Workers In Emergency Preparedness And Response: A Literature Review, Amelia P. Stoltman

Capstone Experience: Master of Public Health

As the frequency and magnitude of disasters worldwide continues to rise, so too does the devastation that follows. This devastation extends to the whole community. In guidance put forward by the Federal Emergency Management Agency (FEMA), emergency preparedness must be represented in and reflective of the whole community, but marginalized groups or segments of the population may be left out of the conversation. Community Health Workers (CHW)s serve as a trusted liaisons and community advocates within the health care landscape. That landscape, as recent events demonstrate, includes emergency preparedness and response. This literature review is designed to assess available publications …

Bladder Mucosal Cystitis Cystica Lesions Are Tertiary Lymphoid Tissues That Correlate With Recurrent Urinary Tract Infection Frequency In Postmenopausal Women, Marianne M Ligon, Brooke Liang, Stacy M Lenger, Priyanka Parameswaran, Siobhan Sutcliffe, Jerry L Lowder, Indira U Mysorekar

Faculty, Staff and Students Publications

PURPOSE: We identify correlates and clinical outcomes of cystitis cystica, a poorly understood chronic inflammatory bladder change, in women with recurrent urinary tract infections.

MATERIALS AND METHODS: A retrospective, observational cohort of women with recurrent urinary tract infections who underwent cystoscopy (n=138) from 2015 to 2018 were identified using electronic medical records. Cystitis cystica status was abstracted from cystoscopy reports and correlations were identified by logistic regression. Urinary tract infection-free survival time associated with cystitis cystica was evaluated by Cox proportional hazards regression. Exact logistic regression was used to identify factors associated with changes to cystitis cystica lesions on repeat …

Identification Of Dietary Supplements Associated With Blood Metabolites In The Hispanic Community Health Study/Study Of Latinos Cohort Study, Robert C Kaplan, Jessica S Williams-Nguyen, Yuhan Huang, Yasmin Mossavar-Rahmani, Bing Yu, Eric Boerwinkle, Marc D Gellman, Martha Daviglus, Aisha Chilcoat, Linda Van Horn, Kim Faurot, Qibin Qi, Heather Greenlee

Faculty, Staff and Student Publications

BACKGROUND: Metabolomics approaches have been widely used to define the consumption of foods but have less often been used to study exposure to dietary supplements.

OBJECTIVES: This study aimed to identify dietary supplements associated with metabolite levels and to examine whether these metabolites predicted incident diabetes risk.

METHODS: We studied 3972 participants from a prospective cohort study of 18-74-y-old Hispanic/Latino adults. At a baseline examination, we ascertained use of dietary supplements using recall methods and concurrently, a serum metabolomic panel. After adjustment for potential confounders, we identified dietary supplements associated with metabolites. We then examined the association of these metabolites …

Advances In The Management Of Menopausal Symptoms, Fertility Preservation, And Bone Health For Women With Breast Cancer On Endocrine Therapy, Matteo Lambertini, Luca Arecco, Terri Lynn Woodard, Audrey Messelt, Kristin E Rojas

Faculty, Staff and Students Publications

In patients with hormone receptor-positive early-stage breast cancer, adjuvant endocrine treatment administered for up to 5-10 years after diagnosis significantly reduces the risk of recurrence and death. However, this benefit comes with the cost of short- and long-term side effects that may negatively affect patients' quality of life (QoL) and treatment adherence. Among them, the prolonged estrogen suppression associated with the use of adjuvant endocrine therapy in both premenopausal and postmenopausal women can induce life-altering menopausal symptoms, including sexual dysfunction. Moreover, a decrease in bone mineral density and an increased risk of fractures should be carefully considered and prevented whenever …

Defining The Genetic Landscape Of Idiopathic Pulmonary Fibrosis: Role Of Common And Rare Variants, Benjamin J Moss, Ivan O Rosas

Faculty, Staff and Students Publications

No abstract provided.

The Impact Of The American Association For Thoracic Surgery On National Institutes Of Health Grant Funding For Cardiothoracic Surgeons, J Hunter Mehaffey, Hanjay Wang, Adishesh K Narahari, Simar S Bajaj, Anirudha S Chandrabhatla, Alexander S Krupnick, Frank W Sellke, Todd K Rosengart, Y Joseph Woo

Faculty, Staff and Students Publications

Objectives: The American Association for Thoracic Surgery, through its annual meeting, pilot grant funding, Scientific Affairs and Government Relations Committee activity, and academic development programs (Grant Writing Workshop, Clinical Trials Course, Innovation Summit), has aimed to develop the research careers of cardiothoracic surgeons. We hypothesized that American Association for Thoracic Surgery activities have helped increase National Institutes of Health grants awarded to cardiothoracic surgeons.

Methods: A database of 1869 academic cardiothoracic surgeons in the United States was created in December 2020. National Institutes of Health grant records from 1985 to 2020 were obtained for each surgeon using National Institutes of …

Commentary: What’S On The Inside Counts, Paige E Brlecic, Todd K Rosengart

Faculty, Staff and Students Publications

No abstract provided.

Vaccines And Therapeutics For Immunocompromised Patients With Covid-19, Shmuel Shoham, Carolina Batista, Yanis Ben Amor, Onder Ergonul, Mazen Hassanain, Peter Hotez, Gagandeep Kang, Jerome H Kim, Bhavna Lall, Heidi J Larson, Denise Naniche, Timothy Sheahan, Nathalie Strub-Wourgaft, Samba O Sow, Annelies Wilder-Smith, Prashant Yadav, Maria Elena Bottazzi, Lancet Commission On Covid-19 Vaccines And Therapeutics Task Force

Faculty, Staff and Students Publications

The COVID-19 pandemic has disproportionately impacted immunocompromised patients. This diverse group is at increased risk for impaired vaccine responses, progression to severe disease, prolonged hospitalizations and deaths. At particular risk are people with deficiencies in lymphocyte number or function such as transplant recipients and those with hematologic malignancies. Such patients' immune responses to vaccination and infection are frequently impaired leaving them more vulnerable to prolonged high viral loads and severe complications of COVID-19. Those in turn, have implications for disease progression and persistence, development of immune escape variants and transmission of infection. Data to guide vaccination and treatment approaches in …

Margetuximab In Her2-Positive Metastatic Breast Cancer, William J Gradishar, Ruth O'Regan, Mothaffar F Rimawi, Jeffrey L Nordstrom, Minori K Rosales, Hope S Rugo

Faculty, Staff and Students Publications

Several anti-HER2 agents are approved for third-line treatment and beyond (after first-line and second-line); however, no specific treatment strategy is recommended for third-line and beyond. Although these agents improve disease outcomes, HER2-positive metastatic breast cancer remains incurable and there is an unmet need for effective therapies in the later line setting. This review focuses on the development of margetuximab-cmkb, a novel, Fc-engineered, anti-HER2 monoclonal antibody, and its role in the systemic treatment of adult patients with metastatic HER2-positive breast cancer who have received two or more prior anti-HER2 regimens, at least one of which was for metastatic disease.

Genetic Susceptibility To Chronic Obstructive Pulmonary Disease And Idiopathic Pulmonary Fibrosis: The Missing Link?, Francesca Polverino

Faculty, Staff and Students Publications

No abstract provided.

Direct Cardiac Reprogramming: A New Technology For Cardiac Repair, Paige E Brlecic, Clark A Bonham, Todd K Rosengart, Megumi Mathison

Faculty, Staff and Students Publications

Cardiovascular disease is one of the leading causes of morbidity and mortality worldwide, with myocardial infarctions being amongst the deadliest manifestations. Reduced blood flow to the heart can result in the death of cardiac tissue, leaving affected patients susceptible to further complications and recurrent disease. Further, contemporary management typically involves a pharmacopeia to manage the metabolic conditions contributing to atherosclerotic and hypertensive heart disease, rather than regeneration of the damaged myocardium. With modern healthcare extending lifespan, a larger demographic will be at risk for heart disease, driving the need for novel therapeutics that surpass those currently available in efficacy. Transdifferentiation …

Associations Between Avocado Intake And Lower Rates Of Incident Type 2 Diabetes In Us Adults With Hispanic/Latino Ancestry, Alexis C Wood, Mackenzie K Senn, Jerome I Rotter

Faculty, Staff and Students Publications

BACKGROUND/PURPOSE: Hispanic/Latinos in the US are at increased risk for type 2 diabetes (T2D). Data suggest that avocado intake is associated with better glycemic control, but whether this translates to protection from T2D has not been studied. The goal of the current analyses was to examine whether consuming avocados at baseline is associated with lower incident T2D over a six-year period, compared to not consuming avocados at baseline.

SUBJECTS/METHODS: Using data from a large population of US adults with Hispanic ancestry, without known or unknown T2D at baseline (N=6,159), participants were classified as avocado consumers (N=983) or non-consumers (N=5,176) based …

Effect Of Quality Of Life On Radiation Adherence For Patients With Cervical Cancer In An Urban Safety Net Health System, Alison K Yoder, Elizabeth Dong, Xiaoman Yu, Alfredo Echeverria, Shelly Sharma, Jane Montealegre, Michelle S Ludwig

Faculty, Staff and Students Publications

PURPOSE: Outcomes for patients undergoing chemoradiation for cervical cancer are dependent on adherence to radiation therapy (RT). In other diseases, quality of life (QoL) is associated with treatment adherence, but the association between QoL and RT adherence for patients with cervical cancer remains unclear.

METHODS AND MATERIALS: This prospective study included patients undergoing RT for cervical cancer from 2017 to 2021 at an urban safety net hospital. The Functional Assessment of Cancer Therapy-Cervical Cancer Version 4 was used to assess QoL based on 5 subscales (physical, functional, social and emotional, and cervical-cancer specific). The survey was administered at radiation consult, …

Investigating Gene-Diet Interactions Impacting The Association Between Macronutrient Intake And Glycemic Traits, Kenneth E Westerman, Maura E Walker, Sheila M Gaynor, Jennifer Wessel, Daniel Dicorpo, Jiantao Ma, Alvaro Alonso, Stella Aslibekyan, Abigail S Baldridge, Alain G Bertoni, Mary L Biggs, Jennifer A Brody, Yii-Der Ida Chen, Joseé Dupuis, Mark O Goodarzi, Xiuqing Guo, Natalie R Hasbani, Adam Heath, Bertha Hidalgo, Marguerite R Irvin, W Craig Johnson, Rita R Kalyani, Leslie Lange, Rozenn N Lemaitre, Ching-Ti Liu, Simin Liu, Jee-Young Moon, Rami Nassir, James S Pankow, Mary Pettinger, Laura M Raffield, Laura J Rasmussen-Torvik, Elizabeth Selvin, Mackenzie K Senn, Aladdin H Shadyab, Albert V Smith, Nicholas L Smith, Lyn Steffen, Sameera Talegakwar, Kent D Taylor, Paul S De Vries, James G Wilson, Alexis C Wood, Lisa R Yanek, Jie Yao, Yinan Zheng, Eric Boerwinkle, Alanna C Morrison, Miriam Fornage, Tracy P Russell, Bruce M Psaty, Daniel Levy, Nancy L Heard-Costa, Vasan S Ramachandran, Rasika A Mathias, Donna K Arnett, Robert Kaplan, Kari E North, Adolfo Correa, April Carson, Jerome I Rotter, Stephen S Rich, Joann E Manson, Alexander P Reiner, Charles Kooperberg, Jose C Florez, James B Meigs, Jordi Merino, Deirdre K Tobias, Han Chen, Alisa K Manning

Faculty, Staff and Student Publications

Few studies have demonstrated reproducible gene-diet interactions (GDIs) impacting metabolic disease risk factors, likely due in part to measurement error in dietary intake estimation and insufficient capture of rare genetic variation. We aimed to identify GDIs across the genetic frequency spectrum impacting the macronutrient-glycemia relationship in genetically and culturally diverse cohorts. We analyzed 33,187 participants free of diabetes from 10 National Heart, Lung, and Blood Institute Trans-Omics for Precision Medicine program cohorts with whole-genome sequencing, self-reported diet, and glycemic trait data. We fit cohort-specific, multivariable-adjusted linear mixed models for the effect of diet, modeled as an isocaloric substitution of carbohydrate …

Predicting E-Cigarette Use Among Emerging Adults Using Perceived Social Norms And Outcome Expectancies, Stephen N. Hanson

Psychology Theses & Dissertations

Despite low rates of combustible tobacco use rates among adolescents and young adults, e-cigarettes continue to gain popularity. A few factors have been shown to be related to e-cigarette use based on prior research. One such example is social enhancement expectancies. Additionally, greater perceptions of harm have been found to be inversely related to e-cigarette use such that those that expect increased risk to their health are less likely to report using e-cigarettes. I hypothesized that social enhancement expectancies would mediate the relationship between perceptions of social norms and e-cigarette dependence. I also hypothesized that perceived harm, such as greater …