Digital Commons Network^™

Measuring The Differential Effect Of Internalized Homonegativity On Hiv Prevention Outcomes By Sexual Orientation Disclosure Status Among Ymsm Across Two Us Cities, Liv Gotte

Public Health Theses

Human Immunodeficiency Virus (HIV) is highly preventable with the right resources. Nonetheless, young men who have sex with men (YMSM) face disproportionately high rates of HIV acquisition, indicating barriers to effective implementation of prevention strategies. To better understand these implementation barriers, this research explores the relationship between internalized homonegativity and HIV prevention outcomes with a focus on the mediating effect of sexual orientation disclosure to healthcare professionals among YMSM. The data used in this research were collected in a previous prospective cross-sectional study that enrolled YMSM seeking HIV prevention care in two U.S. cities ( Nashville, TN and Buffalo, NY) …

Evaluation Of One Health Education Materials: A Scoping Review And Quality Assessment, Sydney Jones

Public Health Theses

The increasing risk of zoonotic spillover, driven by climate change and evolving human behaviors, requires a systematic shift in pandemic prevention strategies towards a One Health approach. Central to this approach is effective health communication intended to translate knowledge into actionable recommendations for the most vulnerable populations. This thesis aims to systematically evaluate the quantity and quality of existing One Health communication materials through a scoping review and two distinct methods of quality evaluation: the CDC Clear Communication Index and content analysis. Among 82 communication materials identified in the scoping review, the median overall CDC Clear Communication Index score was …

Representation In The Endocrinology Literature And The Effect Of Double-Blinded Review, Gal Hodish

Public Health Theses

Background: There is an open question as to whether authorship in peer-reviewed scientific journal articles is representational. Part of this discrimination has been attributed to bias in the review process of manuscripts, with the suggestion that a double-blind review process ensures equitable outcomes due to complete deidentification of both authors and reviewers. Methods: We performed an automated review of 4,191 manuscripts published at three endocrinology journals with comparable impact factor (two single-blind journals; one double-blind journal) in the years 2010-2023; manuscripts were included in the analysis if they were published from institutions based in the United States. Gender and race/ethnicity …

Real-World Rollout Of Injectable Antiretrovirals For Hiv Prevention And Treatment: Understanding Predictors Of Early Adoption, Liza Koshy

Public Health Theses

Background: Data is limited on implementation of long-acting injectable (LAI) HIV treatment (ART) and prevention (PrEP). We sought to characterize “early adopters” of LAI ART and PrEP in terms of social determinants of health, using a health equity lens. Methods: A retrospective cohort included patients prescribed ART or PrEP through a large Northeast urban health system (January 2021-September 2023). Separate analyses used electronic health record data for: 1) prevention (LAI vs. oral PrEP) and 2) treatment (LAI vs. oral ART). Group differences were examined using ANOVA, chi-square tests or Fisher’s exact tests. Bivariate logistic regression modeled associations between LAI ART …

Diagnostic Evaluation For Abnormal Uterine Bleeding At Emergence Departments In The United States, Wanyi Huang

Public Health Theses

Objectives: To examine the pattern of diagnostic evaluation for abnormal uterine bleeding (AUB) in a national sample of women seeking care at emergency departments (ED) and to identify potential influencing factors with a focus on race and ethnicity.

Methods: We identified 1,049 (unweighted, or 7,900,653 weighted) women without previous cancer diagnosis who visited ED for non-pregnancy related AUB from the National Hospital Ambulatory Medical Care Survey during 2014-2021. The primary outcomes were whether an ultrasound was provided/ordered and whether a referral/return for follow-up consultation was recommended. Multivariable logistic regressions were conducted to assess the association of race and ethnicity with …

Concentrating More Than Oxygen: Assessment Of Exposure To Environmental Contaminants Enhanced By Oxygen Concentrators, Andrew Hong

Public Health Theses

Background: Oxygen concentrators concentrate oxygen from ambient air by selectively removing nitrogen. These concentrators are typically for personal use by individuals with chronic respiratory failure from various cardio-pulmonary disorders, including chronic obstructive pulmonary disease (COPD) and heart failure. Such concentrators also could potentially concentrate harmful air pollutants and increase adverse health risks. Understanding the mechanisms of separation in an oxygen concentrator could be used to minimize exposures to harmful pollutants.Objective/Methods: The objective of this thesis was to characterize exposures to environmental contaminants in the air supplied by oxygen concentrators. The performance of oxygen concentrators was investigated, and the levels of …

Exploring Health Equity In Global Community Health Worker Compensation With Cfir Analysis, Mansoorah Kermani

Public Health Theses

IntroductionEquitable compensation of community health workers (CHWs) is fundamental to sustaining and maximizing the impact of CHW interventions worldwide. Despite their pivotal role in promoting health equity especially among underserved populations, CHWs often encounter inadequate and inconsistent compensation, undermining the sustainability and effectiveness of their efforts. This review delves into various CHW compensation models and implications that may improve CHW compensation and performance across diverse patient populations.

MethodsEmploying the Consolidated Framework for Implementation Research (CFIR), this review systematically examines empirical literature to examine six different compensation models: alternative payment methods (value-based, capitation, and shared savings), grant-based, public sector or governmental, …

Polypharmacy Is Associated With Biomarkers Of Cognitive Frailty In Older People With Hiv, Priya Kosana

Public Health Theses

Background: Little is known on the impact of taking multiple medications in older people with HIV (PWH), who have higher rates of medical comorbidities than HIV uninfected individuals. We assessed the prevalence and clinical impact of polypharmacy among a large, mixed gender cohort of PWH, and assessed for the relationship between polypharmacy and clinical and laboratory-based biomarkers of cognitive frailty.Methods: We used data from the AIDS Clinical Trials Group (ACTG) A5322 (HAILO) cohort of PWH aged 40 or older with plasma HIV RNA levels below 200 copies/µL from 2013 to 2014 study visits. We assessed the relationship between polypharmacy ( …

Light At Night And Cancer Incidence: A Gis-Based Study In The Us, Linshuoshuo Lyu

Public Health Theses

Aims: Light at night (LAN) can cause circadian disruption and was found to be a potential risk factor for several cancers. This study aims to confirm the adverse effect of LAN on hormone-related cancers and explore the association between LAN and the prevalence of various cancer types under an ecological study design. Methods: County-level age-adjusted cancer incidence data was obtained from the CDC Cancer Statistics (2016 to 2020), while LAN data (1996 to 2000) was obtained from the satellite imagery of Version 4 Defense Meteorological Satellite Program. Linear mixed effect regression models (LMMs) were performed to assess the relationship of …

Evaluating Knowledge And Attitudes Towards Dengue Fever And Its Vaccination Among Medical Staff In China: A Questionnaire-Based Study, Ip Man Lam

Public Health Theses

Dengue, a mosquito-borne tropical disease caused by the dengue virus, has seen a significant increase in global incidence in recent decades. China has experienced a rapid rise in dengue cases since 2013, posing a serious threat to population health and increased economic burden. This study aimed to evaluate the knowledge and attitudes towards dengue fever and dengue vaccination among medical staff in China. A cross-sectional study was conducted using an online questionnaire survey targeting medical professionals in Zhejiang, Yunnan, and Hainan provinces, which are known endemic areas for dengue virus infection in China. The questionnaire assessed participants' understanding of dengue …

Examining The Impact Of Socioeconomic Status On Relative Excess Mortality During The Covid-19 Pandemic: A Regression Analysis Adjusted For Age, Sex, And Racial/Ethnic Differences, Jiawei Li

Public Health Theses

This study investigates the impact of socioeconomic status, as indicated by education level, on relative excess mortality during the COVID-19 pandemic, while adjusting for age, sex, and racial/ethnic differences. We utilized U.S. mortality data from the National Center for Health Statistics from January 2014 to December 2020 to perform this observational study and employed a multivariate regression model to estimate the relative excess mortality rates from March 2020 to December 2020. Seasonality was assumed to be affected by these selected demographic variables. The results of our analysis were unexpected, suggesting that individuals of higher education levels indeed exhibit higher relative …

Effect Of A Weight-Loss Intervention On Oxidative Stress Biomarkers Among Breast Cancer Survivors In The Lifestyle, Exercise, And Nutrition (Lean) Study, Yiyi Li

Public Health Theses

Introduction: As the number of breast cancer survivors increases, ensuring quality of life during the survivorship period is important. Obesity may induce oxidative stress, which may be relevant mechanistically for adverse health outcomes among breast cancer survivors. Diet, exercise, and weight loss may mitigate oxidative stress, yet few lifestyle trials have investigated if these interventions have impacted oxidative stress. Therefore, we conducted a secondary analysis in a 6-month weight loss randomized controlled trial, the Lifestyle, Exercise, and Nutrition (LEAN) study, among breast cancer survivors with a body mass index (BMI) ≥ 25 kg/m2 to evaluate the effect of the intervention …

Exploring The Use Of Mobile Health Application To Promote Self-Managment Of Cardiovascular Disease: A Study Of Age-Related Differences And Technology Adoption Among Chinese Patients, Yunan Mei

Public Health Theses

Background: Cardiovascular diseases (CVD) are the leading cause of mortality globally, particularly in China's aging population. Mobile health (mHealth) technologies offer a promising avenue to address healthcare disparities and enhance CVD management among the elderly. This study aims to explore the acceptance of mHealth in improving self-management of CVD among older adults in China, focusing on its potential to mitigate accessibility and treatment challenges.

Methods: This cross-sectional study was conducted at the Xinhua Hospital of Shanghai Jiao Tong University. Data were collected using an online Qualtrics questionnaire from 225 participants who met inclusion criteria including being Chinese speakers, diagnosed with …

Emerging Contaminants In Long Island Public Drinking Water, Clare Loughlin

Public Health Theses

Thousands of federally unregulated ‘emerging’ contaminants are entering and persisting in our environment, potentially adversely impacting public health. Drinking water is a major exposure pathway for some of these emerging contaminants. In 2020, New York State set maximum contaminant level (MCL) drinking water standards for three emerging contaminants: 1,4-dioxane: 1 ppb, perfluorooctanoic acid (PFOA): 10 ppt, and perfluorooctanesulfonic acid (PFOS): 10 ppt. Databases of public drinking water exist but generally do not contain comprehensive and ancillary data reported by annual public drinking water reports, or the data may not be aggregated or readily available in a format suitable for data …

U.S. Hospital Readmissions Following Discharge For A Non-Fatal Overdose Among Adolescents, 2016-2020, Gabriela Mendoza Cueva

Public Health Theses

Importance: It is not yet known how many adolescents are readmitted within six months in the U.S. following a non-fatal overdose and the risk factors associated with all-cause readmission. Objective: To examine the risk of 6-month readmission following hospitalization for a non-fatal drug overdose among adolescents and the risk factors for readmission. Design, Setting, and Participants: This retrospective chart analysis utilized the Nationwide Readmission Database (NRD) from 2016 to 2020 to identify nonfatal overdose readmissions among adolescents aged 11 to 19. Exposures: Non-fatal prescription and illicit drug overdose. Main Outcome Measures: The study used weighted state-level discharge data to derive …

Racial Disparities In Metastatic Non-Small Cell Lung Cancer In The Post-Immunotherapy Era, Victoria Mcclare

Public Health Theses

Importance: The approval of immune checkpoint inhibitors (ICI) has improved survival amongthose with metastatic non-small cell lung cancer (mNSCLC). However, it is unclear to what extent existing racial and ethnic disparities in survival outcomes for those with mNSCLC are widening under the new ICI treatment era. Objective: Examine changes in racial and ethnic disparities in mNSCLC survival rates before and after the U.S Food and Drug Administration (FDA) approval of ICI in the United States. Design, Setting, and Participants: This study is a population-based retrospective cohort of patients with NSCLC from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020), …

Analysis Of Mercury Exposures In The United States Reported To The National Response Center (2018-2022), Abigail E. Mcdonald

Public Health Theses

Introduction

The frequency and extent of environmental elemental mercury exposures in the U.S. are unknown. Due to its marked toxicity, elemental mercury has been phased out of many newer commercial products. However, mercury-containing products are still available, and a variety of religious, cultural, decorative, cosmetic, and illicit uses have been reported in the community. Small quantities of mercury can be highly toxic, and mercury toxicity can present nonspecifically and multi-systemically with the potential to be easily missed. Therefore, it is important to characterize the settings where mercury exposures occur and the extent of such exposures. The overall aim of this …

Indoor Air Pollution In Nomadic Himalayan Highlander Communities, Charles Minicucci

Public Health Theses

Indoor air pollution (IAP) from burning solid biomass fuel is a major global health challenge, especially in resource-limited settings without access to electricity or reliable fuel sources. In the Kingdom of Bhutan, where, despite a reported 99% of households having access to electricity, the vast majority of rural households still use biomass fuels for cooking and indoor heating. Given the resource limitations and access challenges associated with Bhutan’s remote highlander and herding communities, few solutions for or details about their exposure to IAP are available – especially during nomadic periods where families may spend months beyond the reach of infrastructure …

Biomarker Profiles And Treatment Patterns In Patients With Advanced Non-Small Cell Lung Cancer: A Real-World Database Analysis, Zijian Niu

Public Health Theses

Background: With the rapidly evolving treatment options for patients with advance-staged Non-Small Cell Lung Cancer (NSCLC), the National Comprehensive Cancer Network (NCCN) offers systematic guidelines on treatment choices based on biomarker profiles and adjunctive information as the reference. This study aim to understand how patient’s biomarker profiles influence the receipt of Guideline-Concordant Treatments (GCTs) and exploring potential prognostic factors that exert such positive impacts on receiving these guideline-concordant therapies.Methods: This retrospective study focused on using the Flatiron Health NSCLC deidentified database, targeting at advanced NSCLC patients with 5 main confirmed actionable biomarker (ALK+, EGFR+, PD-L1 <1%, PD-L1 1%-49%, PD-L1 ≥50%). Patients with five main biomarkers were further described by whether they have undergone first lines of treatment (LOT) GCTs post-confirmation of biomarker status exclusively. Descriptive analysis was used to examine of the frequency distribution of GCTs across out cohort, while the multi-variate logistic regression model was used to identify potential prognostic factors influencing the receipt of NCCN GCTs. Results: 15,221 individuals were aligned with GCTs, underscoring a substantial compliance within the cohort with pre-treatment confirmed biomarker profiles. Descriptive analyses revealed a statistically significant correlation with receiving GCTs across gender, ECOG status, biomarker profiles, histology and smoking history. Strikingly, patients with PD-L1 expression and ECOG status of 2-4 had the highest rates of GCTs than other ECOG subgroups. By adjusting ORs, Asian and patients with PD-L1 expression were more predisposed to receive GCTs. Conclusion: By confirming the importance of biomarker profiles and ECOG status in the receipt of GCTs, results highlighted the necessity of addressing disparities in healthcare accessibility and treatment equity for patients from varied biological and social backgrounds, ensuring that advancements in precision medicine benefit all individuals equally.

Exploring The Connections Between The Arts And Mental Health In The Face Of Climate Change, Marla Joy Minkoff

Public Health Theses

Objective: This study aims to explore how engagement with art may shape emotions related to the climate crisis and expand the conception of art as a mechanism of public health practice.Background: Climate change impacts human health not only physically but also psychologically, manifesting in symptoms of climate emotions (e.g., ecological grief, eco-anxiety, eco-paralysis) that arise as a result of changes to the earth and our relationship to the natural world. These symptoms are among the pressing mental health effects of climate change. Methods: A qualitative approach utilizing the Rapid Assessment Process (RAP) was employed to conduct semi-structured interviews (N=10) with …

A Descriptive Study On The Impact Of Community Health Workers And Medicaid Reimbursement In The United States, Nithya Narayanan

Public Health Theses

Introduction: Community health workers (CHW) may contribute to increased Medicaid enrollment as well as increased uptake of preventative services in states that allow Medicaid reimbursement for CHW services. Reimbursement has been highlighted previously as a useful funding mechanism for CHW positions. This descriptive study aims to examine how CHWs are embedded in healthcare settings and how reimbursement may have altered how CHWs practice.Methods: An exploratory Qualtrics survey was distributed to CHW networks, CHWs, and Medicaid officials (MOs) in the United States from March to April 2024. A total of 58 respondents (50 CHWs and 8 MOs) were sampled and 16 …

Exploring The Association Between The Supplemental Nutrition Program For Woman, Infants And Children (Wic) And Gestational Weight Gain, Oyinlola Obatolu

Public Health Theses

Background: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has been an impactful federal public assistance program that has provided nutrition education and support to millions of low income women and children around the country. Despite its positive impact on perinatal and birth outcomes, the precise mechanisms between WIC and these outcomes remain unclear. Past studies have looked at the relationship between WIC and gestational weight gain (GWG), a potential mediator of the effect of WIC on birth outcomes, but they have mainly focused on city or state level data or Medicaid enrollees. This study aims to …

Sociodemographic And Health Characteristics Of Communities Located Near U.S. Ports: A Distributive Environmental Justice Study, Sophia Mara Ptáček

Public Health Theses

Background:Globalization has spurred substantial growth in international maritime trade, with shipping emerging as the most efficient mode for transporting large quantities of goods. This growth comes at an environmental cost. Maritime transport contributes to local air pollution, with pollutants such as particulate matter (PM2.5 and PM10), black carbon, nitrogen oxides (NOx), sulfur oxides (SOx), volatile organic compounds (VOCs), ozone (O3), and carbon monoxide (CO) disproportionately affecting coastal and port communities. Despite extensive evidence of the adverse health effects of these pollutants, comprehensive analyses of distributive environmental justice related to port communities remain scarce, prompting this study's investigation into the sociodemographic …

“Their Body, Their Choice. Your Body, Your Choice. Your Baby, Your Choice.”: A Reflexive Thematic Analysis Of Vaccine Access And Acceptance Among U.S. Pregnant People On Reddit, Sydney Marie Perlotto

Public Health Theses

Compared to the general population, pregnant people and newborns are at a higher risk of contracting infectious diseases and experiencing worse adverse outcomes. Vaccines delivered during pregnancy, known as prenatal vaccines, represent a critical yet underused form of preventive care for these populations in the United States. Increasing successful prenatal vaccination uptake requires a focus on both access and acceptance, which pregnant people may experience differently than non-pregnant people due to their unique physiological and social state. Given the evolution of vaccine hesitancy following the COVID-19 pandemic, coupled with the recent expansion of the U.S. prenatal immunization schedule, this study …

Determining Optimal Media For Carbapenem-Resistant Enterobacteriaceae Recovery From Hospital Sink Drains: A Prospective Environmental Microbial Study, Eryn Larissa Pawluk

Public Health Theses

Abstract Background: Environmental healthcare-associated pathogens are of particular public health concern, not only as potential contributors to the escalating rates of hospital-acquired infections1 noted during the SARS CoV-2 pandemic, but also as valuable indicators for multidrug resistance2. Their significance extends to infection prevention and control, emphasizing the pivotal role of shaping specific interventions within healthcare settings.

Rationale: The study investigates R2A agar’s efficacy in recovering environmental pathogens, specifically carbapenem-resistant Enterobacteriaceae (CRE), crucial for enhancing infection prevention and control in healthcare settings.

Objectives: In this prospective study conducted within hospital environments, our objective is to identify superior culture methods for recovering …

Greening And Mental Distress: Effect Modification By Housing Tenure, Saira Prasanth

Public Health Theses

Access to high-quality residential greenspace is associated with improved long-term health, particularly mental health. However, many interventions to promote “greening” or increased greenspace in urban areas have been shown through numerous qualitative studies to exacerbate environmental and health inequities, primarily through green gentrification. Our objective was to quantify the association between greenspace and mental distress in the U.S. as well as evaluate whether the association between greenspace and mental distress is modified by housing tenure. We hypothesized that increased greenspace was associated with reduced mental distress, and that this effect was more protective among homeowners than non-homeowners. Mental distress and …

Macronutrient Intake In Us Adults: Race, Gender, Age, Education, Ana Karina Raygoza Cortez

Public Health Theses

Background: The US has seen a consistent increase in obesity rates over the last sixty years across all racial and ethnic groups, with similar trends even among privileged groups. This study examines Macronutrient intake trends in US adults from 1999-2018 and their association with demographic factors: race ethnicity, age, gender, and education.

Methods: We conducted a serial cross-sectional analysis of US adults using 24-hour dietary recall data from 10 NHANES survey cycles (1999-2018). Piecewise regression models identified significant dietary pattern changes over time, by demographic groups. Statistical analysis was done in R and SAS utilizing NHANES sampling weights.

Results: Study …

Hybrid Medical Practices In Malaria Management Among Sao Tome And Principe’S Elderly, Yihan Shi

Public Health Theses

Africa has the global heaviest burden of malaria. Sao Tome and Principe, a low-transmission island nation in the Gulf of Guinea with a population of about 200,000, has entered the malaria elimination phase. Despite this, the prevalence and mortality rates of malaria among the elderly in Sao Tome and Principe remain high compared to high transmission areas. This study employed a mixed-methods approach to explore the association between age and recommended malaria management strategies for adults in Sao Tome and Principe, with a focus on examining samples older than 50 years. All participants (N = 274) completed surveys, with in-depth …

A Climate Change Calamity: Assessing The Impact Of Flooding On Waterborne Disease Burden In Pakistan, Haleigh Schultz

Public Health Theses

Background: Pakistan ranks among the countries most vulnerable to climate change. In 2022, extreme flooding ravaged the country as a result of unprecedented monsoon rains, resulting in widespread environmental and health devastation. As flooding events damage water, sanitation and health (WASH) infrastructure, contribute to disaster conditions, and strain healthcare systems, heavy rains can impact waterborne disease transmission and outbreak events. Extreme flooding events are expected to increase in prevalence, severity, and scope as the climate continues to change in the future. This study aims to assess the impact of monsoon seasons and flooding events on waterborne disease burden in Pakistan …

Behind The Produce Curtain: Exploring Occupational Health Of Connecticut Migrant Farmworkers In A Changing Climate, Nicole-Kristine Limlingan Smith

Public Health Theses

Due to climate change exacerbating high heat days, it is speculated that farmworkers will bear the brunt of this in the fields. High heat is only one of many consequences of climate change but was chosen as the occupational exposure of study due to its lack of literature in northeastern states like Connecticut. This study has three aims. The first aim is to explore the health impacts of extreme and prolonged heat exposure in Connecticut migrant farmworkers. Second, understand the current awareness among health care providers and the intervention methods that are being taken, if any. Finally, understand what barriers …