Digital Commons Network^™

“Recovery Is About Change, So You Have To Change Everything” Exploring The Evolution Of Recovery Capital Among Women In Substance Use Disorder Treatment, Elizabeth Jadovich

Public Health Theses

Recovery capital is an emerging framework in the field of addiction that aims to understand substance use disorder recovery holistically by considering an individual’s access to resources across the four domains of human, physical, social, and community capital. The underrepresentation of women’s experiences in substance use research as well as the limited understanding of substance use disorder treatment’s effect on recovery capital development poses specific challenges to women’s development and maintenance of recovery capital resources while in treatment. This secondary qualitative analysis of data collected from the larger RENEW study explores the experiences of 19 women actively enrolled in substance …

A Systematic Review Of The Effect Of Maternal Circadian Disruption During Pregnancy On Adverse Fetal Outcomes, Siyu Jiang

Public Health Theses

Exposure to a suboptimal pregnant environment can raise the risk of offspring experiencing a variety of diseases in later life. Circadian rhythms play an important role in endocrine system, physiological and psychological functions. Potentially, interruption of the circadian rhythm in pregnant women might impair fetal growth and lead to adverse effects on the children. In the modern world, millions of women experience circadian disruption during pregnancy due to night shift work, excessive light at night, and jet travel across time zones. However, the impact of maternal chrono-disruption during pregnancy on the health of the second generation remains largely unknown. The …

Evaluating Environmental Risk Factors For Community-Associated C. Difficile Infection In New Haven County, Connecticut, 2016-2021, Hannah Liat Litwak

Public Health Theses

Background: Clostridioides difficile infection (CDI) is classified as an urgent threat to public health and has been increasing in incidence and severity. CDI is commonly considered hospital- acquired; however, rates of community-associated CDI (CA-CDI) have been increasing and now make up more than 50% of cases reported. Risk factors for CA-CDI exposure are poorly understood and inadequately studied. This study uses regression to evaluate if community characteristics are associated with CA-CDI incidence at the census tract level in New Haven County. The goal is to determine if where someone lives in proximity to these potential risk factors may contribute to …

Challenges Of Integrating Community Health Workers (Chws) Into Health Systems To Improve Hiv Care Engagement: A Qualitative Study, Yue Hu

Public Health Theses

CHWs provide valuable support to individuals managing chronic diseases, especially populations encountering stigma, discrimination, and other services barriers. CHWs effectively improve HIV outcomes for PLWH, and innovative approaches are needed to maximize their impact on self-management by strengthening their roles as liaisons between clinical services and community resources. Four clinical providers, five community leaders, six CHWs/supervisors in HIV services, and twelve PLWH from St. Louis, Missouri participated in semi-structured interviews, and twelve front-line health workers participated in one of two focus groups. Discussions explored employing CHWs for enhancing HIV care management and retention. Rapid qualitative analysis methods were used to …

A Dna-Extraction-Free Method For The Molecular Detection Of Streptococcus Pneumoniae Carriage In Saliva, Tzu-Yi Lin

Public Health Theses

Pneumococcal carriage is a prerequisite for pneumococcal disease and surveillance of carriage is crucial for evaluating and informing vaccination strategies. In recent years, molecular methods have improved the sensitivity of pneumococcal carriage detection as compared to the gold standard culture-based method. However, nucleic acid extraction from samples collected is resource-intensive, limiting scalability for extensive surveillance, particularly in low-resource settings. We previously developed a saliva-based PCR test for SARS-CoV-2, having identified that nucleic acid extraction can be omitted and replaced with a simple enzymatic lysis or heat treatment step without compromising the accuracy and efficiency of testing. Here, we compared pneumococcus …

Elucidating Metformin As A Scavenger Of 4-Hne, An Endogenously Produced Aldehyde Associated With Alzheimer’S Disease Progression, In Hek293t Cells, Miren Lopez Lascurain

Public Health Theses

Metformin, a first-line therapy for Type 2 Diabetes Mellitus (T2DM), has been shown to have numerous health benefits in neurodegenerative disease progressions, including Alzheimer’s disease (AD). Vasiliou et al. have recently proposed that metformin is able to scavenge endogenously produced aldehydes such as 4-hydroxy-2-nonenal (4-HNE), which are thought to contribute to the progression and development of AD. Preliminary in vitro and in silico studies demonstrate that metformin scavenges 4-HNE leading to adduct formation. Therefore, this study sought to determine if metformin adducts 4-HNE in a living system. We hypothesize that metformin can scavenge 4-HNE in HEK 293T cells and will …

"Hair-Esteem Toolkit For Black Girls": The Development Of A Self-Esteem Toolkit For Black Adolescent Girls Centering Hair As A Tool For Empowerment, Sydney Hussett-Richardson

Public Health Theses

Background: For Black adolescent girls, hair is a strong staple of gender and ethnic identity, influencing intrapersonal and interpersonal interactions. Gendered racism and Eurocentric beauty standards pathologize Black girls and their hair, leading them to experience high rates of hair harassment and discrimination. These experiences negatively impact the self-esteem of Black girls, which has important implications for a host of health behaviors. The purpose of this study was to explore the relationship between self-esteem and hair among Black girls and integrate findings into a culturally relevant digital toolkit to promote and develop hair-esteem and self-esteem among Black girls.Methods: This study …

The Legacy Of Redlining: How Urban Policies Of The Past Shape The Contemporary Food Environment In Buffalo, Ny, Anna Lin-Schweitzer

Public Health Theses

In the 1930s, the Home Owners Loan Corporation (HOLC) graded urban neighborhoods based on their mortgage investment risk, designating whiter wealthier neighborhoods a grade A for “best” and lower-income non-white neighborhoods a grade D for “hazardous.” Despite the fact that this process was outlawed by the 1960s, formerly redlined neighborhoods continue to have less access to resources, including food. The central premise of this paper is that historical housing policies have shaped inequitable distribution of food destinations in the contemporary food environment, and may have implications for food system advocacy and policymaking. Using geospatial analysis and multiple linear regressions, this …

Identifying Aberrant Metabolism And Underlying Biology In Colorectal Cancer Tumors Between Early- And Later-Onset Samples, Allison Paige Janak

Public Health Theses

Early-onset colorectal cancer (EO-CRC) occurring in individuals under age 50 is rapidly increasing globally. In comparison, later-onset colorectal cancer (LO-CRC) incidence has decreased or remained stable over recent years. Despite these increases in EO-CRC incidence, the etiology of EO-CRC is largely unknown. This study aimed to compare the metabolomes of EO-CRC (N=53) and LO-CRC (N=314) patients from a cohort of 367 patients using patient matched samples of stages I-IV tumor and healthy colon tissue. Hydrophilic interaction liquid chromatography mass spectrometry (HILIC-MS) and reversed phase liquid chromatography mass spectrometry (RPLC-MS)-based untargeted metabolomics were applied to identify features present in the samples, …

Drivers Of Global Waterborne Disease Transmission Following Extreme Precipitation Events: A Systematic Review, Claire Latendresse

Public Health Theses

Precipitation events such as hurricanes, typhoons, and heavy rainfall can have devastating impacts on water and sanitation infrastructure around the world and have led to large-scale waterborne outbreaks. As climate change amplifies the frequency and intensity of extreme weather events, it is also triggering an increase in waterborne disease transmission. This master’s thesis consists of a systematic review of academic literature pertaining to extreme precipitation events and the pathways by which they trigger waterborne outbreaks.

A systematic review of the literature in PubMed was conducted to identify waterborne disease outbreaks associated with extreme precipitation. The initial search yielded 3,248 results …

The Ethical And Legal Considerations Of Ai-Driven Healthcare In Infectious Diseases, Natalie Makableh

Public Health Theses

Artificial intelligence (AI) has been rapidly growing in the healthcare sector, with the potential to improve patient outcomes, increase efficiency, and reduce costs. However, as with any technological advancement, AI-driven healthcare presents ethical and legal challenges that must be addressed to ensure the responsible and beneficial use of the technology. To the best of our knowledge this is the first study to examine the ethical and legal considerations of using AI technology in healthcare, with a particular focus on infectious diseases. With the growing use of AI in healthcare, it is crucial to evaluate its potential benefits and challenges in …

Knowledge, Attitudes, And Practices (Kap) About Lassa Fever Prevention And Control: A Survey Of Three Rural Communities In Central Liberia-Epidemiology Of Microbial Diseases, Joseph Gibson Jepru Lewis

Public Health Theses

Introduction: Since the discovery of Lassa fever in 1969 in Nigeria, the disease has become endemic in many West African countries. An estimated 500,000 cases of Lassa fever virus occur each year, leading to approximately 5,000 deaths annually. Liberia continues to record outbreaks almost every subsequent year in regions once considered non-endemic. With no effective vaccines, many studies have underscored the importance for residents in Lassa-endemic regions to have good knowledge and good prevention practices in place to prevent Lassa fever.

Methods: A cross-sectional data extracted from a longitudinal, observational, cohort study conducted using voluntary participant self-reported and study visits …

Variation In First-Line Therapy By Biomarker Expression Status In Patients With Advanced Non-Small Cell Lung Cancer, Yimeng Li

Public Health Theses

Background: Patients diagnosed with advanced non-small cell lung cancer (NSCLC) have a poor prognosis. To inform evidence-based care, this study aims to describe and quantify the first-line treatment variation of patients with NSCLC. Methods: A retrospective cohort study was conducted using Flatiron databases to analyze the treatment patterns of 18,979 patients with advanced NSCLC diagnosed between 1/1/2016 and 6/30/2020. Patients were categorized into groups by biomarker findings and performance status. The first-line treatment variations were measured using the Herfindahl-Hirschman Index (HHI), which provides an indication of the degree of variation in treatment. Bootstrapping was assisted in calculating 95% confidence intervals …

Demographics Of Hospitalized Covid-19 And Influenza Cases In Connecticut During The 2021-2022 Influenza Season: Is There Evidence Of Viral Interference?, Molly Mclaughlin

Public Health Theses

Since the COVID pandemic began in March 2020, the epidemiology of influenza has changeddramatically in the United States. During the 2021-2022 influenza season in Connecticut, only 262 hospitalized influenza cases were recorded in New Haven and Middlesex Counties from October 2021-June 2022, while there are usually well over 1,000 cases in a single season. While the decline in influenza cases could be due to preventive measures adopted early in the pandemic, viral interference could also be to blame. Viral interference is the process by which infection with one virus transiently protects against infection by another virus via a generalized immune …

Assessment Of Environmental Injustice: Spatial Analysis Of Pennsylvania Drilling Waste Facilities And Community Demographics, Avery Naperala

Public Health Theses

Background: Unconventional oil and gas drilling practices have led to the production of technologically-enhanced naturally occurring radioactive materials (TENORM) and chemical waste products, with insufficient toxicological data to understand the health impacts of exposures to these waste materials (U.S. Energy Information Administration, n.d.; US EPA, 2015b; ALNabhani et al., 2016; Elliott et al., 2017). Environmental injustices occur when disadvantaged populations experience a disproportionate burden of exposure to environmental disamenities, such as waste facilities (US EPA, 2015a). This study aims to assess whether disparate exposure to drilling waste facilities is occurring in Pennsylvania based on several socioeconomic factors, as well as …

The Fountain Of Youth?: Calorie Restriction And Its Relationship With Hand Grip Strength As A Marker Of Longevity And Aging, Arion Mete

Public Health Theses

Background and Purpose: Evidence supports a beneficial effect of calorie restriction on longevity within numerous animal models, while data for humans is limited to intermediate biomarkers of aging. The purpose of this study was to determine the association between calorie restriction in humans with respect to hand grip strength, a biomarker of aging and longevity, that has been understudied in relation to caloric restriction. Methods: We analyzed hand grip strength among 184 individuals enrolled in the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE), a 2-year randomized trial of 25% calorie restriction vs. control. Peak hand grip …

The Impact Of The Covid-19 Pandemic On Non-Typhoidal Salmonella Incidence And Exposures In Connecticut, 2015-2022, Adeline Morris

Public Health Theses

Background: During 2020, Salmonella incidence decreased by 22% in the United States.1 At the same time, many common activities were reduced or restricted, including travel and eating food prepared at restaurants or events, which are known risk factors for Salmonella infection. Methods: A descriptive analysis using Salmonella surveillance data collected in Connecticut between 2015 to 2022 was performed to characterize the changes in travel and outside food exposures. Frequencies of exposures were compared before the pandemic, during the pandemic, and after the vaccine was implemented and restrictions eased. Rate ratios of observed to expected cases were calculated to explore trends …

Informal Electrical And Electronics Waste Recycling And Its Health Impacts: Evidence From Developing Countries, Zhen Liu

Public Health Theses

E-waste informal recycling poses severe threats to the environment and public health. This review provides an update to the 2013 and 2021 reviews, which systematically assessed adverse human health impacts associated with e-waste exposure. For this review, e-waste population health studies published between Jan 29, 2020 and Feb 23, 2023 were included. Databases including PubMed, Web of Knowledge, PsycNET, CNKI, Wanfang Data were searched, and the languages were not limited to English. Of the 4097 identified records, 58 studies examined the association between e-waste exposure and health, and are original studies based on population health outcomes. Current studies consistently support …

Early Life Growth Patterns Among Infants Of Mothers With Diabetes, Hedy Ludwig

Public Health Theses

AbstractObjective: Exposure to diabetes during pregnancy increases the risk of insulin resistance, obesity, and cardiometabolic disease in offspring. Limited research exists regarding early postnatal growth patterns among moderate preterm and term infants. This study aims to evaluate growth patterns during the early postnatal period among term and moderate preterm infants of mothers with and without diabetes during pregnancy. Methods: In a prospective longitudinal analysis using data from Yale New Haven Hospital (YNHH), characteristics from term and moderate preterm infants were compared between diabetes exposure groups (n=148). Percent change in weight from birth to hospital discharge was compared between diabetes exposure …

Impact Of The Covid-19 Outbreak On Mental Health And Public Practices In Rural Communities In China, Wenxin Liang

Public Health Theses

Coronavirus disease (COVID-19) has significant impact on people’s mental health. However, no nationwide study has investigated the mental health among rural residents during the COVID-19 outbreak in China. This study was aimed to investigate the impact of the COVID-19 outbreak on the mental health and public practices for controlling and preventing the COVID-19 in rural communities in China. An anonymous online survey was sent to participants through WeChat, the most widely used Chinese social-networking app, from March 2 to 11, 2020. We recruited 4607 individuals from 11 representative provinces in mainland China. The analytical sample was 2159 rural residents. The …

Menopausal Status, Age At Menopause, And Associations With 1-Year Angina Burden Among Women In Recovery From Acute Myocardial Infarction Enrolled In The Virgo Study, Tamara Dorothy Mehta

Public Health Theses

Background: Current knowledge is limited on the association between early age at menopause (AAM) and angina during recovery from acute myocardial infarction (AMI) in young women. We assessed the differences in 1-year angina burden post-AMI among women in pre/peri-menopause phases compared to post-menopausal women stratified by their AAM. Methods: Among patients in the VIRGO study, 1,948 women were categorized into four groups: a reference group of those in their pre/peri-menopause phase (n=917), post-menopausal women who reached AAM at 40 years or younger (n=337), AAM between 41-49 years (n=476), and AAM between 50-55 years (n=218). Angina burden was assessed from Seattle-Angina …

Indirect Effects Of Covid-19 Vaccination Against Sars-Cov-2 Omicron: Rapid Review & Meta-Analysis, Brett Anthony Martini

Public Health Theses

Background: First identified in Wuhan, China in late 2019, the infectious viral disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of lives worldwide and poses the largest public health crisis in the past century. The development and deployment of vaccines have been a key public health measure to mitigate the subsequent harm associated with the viral infection. Despite the mRNA vaccine platform being in development for 15+ years, the mass vaccination campaigns were the first large-scale use of this technology, leaving much to be learned about their effectiveness and longevity. Mass vaccination campaigns influence …

Sexual Show-And-Tell: Correlates Of Sex Communication And Active Modes Of Consent, Samantha Nardella

Public Health Theses

Sexual consent communication is a critical component in ensuring healthy and satisfying sexual experiences. The communication of consent can take many forms and be affected by a variety of factors, ranging from gender and sexual orientation, to type of sexual behavior and familiarity with a partner. The current study sought to examine the ways in which different factors affected how one communicated consent in their last sexual encounter. College students (N = 211) completed an online cross-sectional survey examining engagement in sexual behaviors, feelings in sexual encounters, and aspects of their most recent sexual experience. Individual- and situational-level correlates were …

Epidemiology Of Human Hookworm (Necator Americanus) Infection In Rural Ghana: Investigating Host-Parasite Factors That Mediate Infection, Savanna Randi

Public Health Theses

Abstract

Introduction: Hookworms are soil-transmitted helminths (STHs) that cause significant morbidity in high-risk populations, posing a global health concern in locations of rural poverty [1-5]. While there have been ventures by the World Health Organization to eliminate hookworms in Africa by 2030, there is variability in the effectiveness of current chemotherapy regimens. Studies have shown that benzimidazole anthelmintics have reduced effectiveness, and people living in endemic areas are quickly reinfected [6]. Critical gaps remain in understanding parasite-host interactions within communities, further challenging successful disease control. A study initiated in 2022 investigated the epidemiology of human hookworm infection in Beposo, Ghana. …

Exploring The Experiences Of Intergenerational Trauma And Coping Mechanisms Among African American Women: A Qualitative Study, Esthel Nam

Public Health Theses

This qualitative study aimed to explore the experiences of intergenerational trauma and coping mechanisms among African American women. Semi-structured interviews were conducted among 9 participants, and the “Transactional Model of Stress and Coping” was used to analyze the data. The results revealed complex and interconnected forms of trauma, including historical trauma, adverse childhood experiences, death, and sexual abuse. Participants also utilized a range of coping mechanisms, including spirituality, social support, self-care, and therapy. The identified codes and subthemes provide a comprehensive understanding of the different forms of trauma that participants experienced, and the various strategies they adopted and utilized to …

Missing The Forest For The Trees: The Causes Of The Obesity Epidemic, Acree Mcdowell Cook

Public Health Theses

Arguably the most pressing public health issue in the United States today is the obesity epidemic, which has affected children, adolescents, and adults alike. A lack of longitudinal research on distinct factors related to obesity in different groups has made addressing the epidemic difficult. Many lifestyle and environmental factors, including nutrition, sleep, stress, the gut microbiome, screen time, and marketing, are all related to obesity, but many of these factors are also related to each other. The current study investigates these systemic relationships, presents a hypothesis on the complementary causes of obesity, and contributes to contemporary longitudinal research by investigating …

Antibiotic Prophylaxis For Prevention Of Surgical Site Infections In Orthopedic Surgery, Edwin Ruiz Fuentes

Public Health Theses

Background: In the past decades, there has been an increase in the proportion of orthopedic surgical site infections (SSIs) caused by gram-negative bacilli in various healthcare settings. SSI prevention guidelines suggest that gentamicin can be added to prophylactic antibiotic treatment to target gram-negative bacilli. However, the effectiveness of this strategy remains to be confirmed in orthopedic surgery.

Methods: A retrospective cohort study was conducted to investigate the association between antibiotic prophylaxis with adjunctive gentamicin and SSI rates in orthopedic surgeries. 5,571 patients who underwent hip, knee, spine, and hip fracture surgeries between January 2019 and July 2021 at Yale-New Haven …

A Geospatial Analysis Of Demographic Characteristics And Environmental Burdens In Communities Near Superfund Sites, Long Island, New York, Fintan Mooney

Public Health Theses

Nassau and Suffolk Counties of Long Island, New York, have over 30 federal Superfund sites, which may contribute to increased health inequities in nearby communities due to potential drinking water contamination and air pollutant emissions. We assessed the proximity to Superfund sites on Long Island in relation to community demographics and the presence of other environmental burdens. Data were obtained from the 2022 United States Environmental Protection Agency’s Environmental Justice Screening and Mapping Tool (EJScreen) and included proximity to Superfund sites (operationalized through the EJScreen distance weighting score), presence of other environmental hazards, and sociodemographic variables from the U.S. Census …

Associations Between Patient Sociodemographic Factors And Risk-Aligned Prostate Cancer Clinical Management, Madison Jewel Novosel

Public Health Theses

Although definitive treatment is associated with improved survival for aggressive prostate cancer and is supported by clinical practice guidelines, a significant number of patients do not receive definitive treatment. To identify gaps in practice, we sought to evaluate sociodemographic factors associated with treatment of localized prostate cancer across clinically relevant risk strata. We performed a retrospective study of patients with prostate cancer using the National Cancer Database. A total of 954,591 patients diagnosed with localized prostate (cT1-4N0M0) cancer from 2010 to 2020 were included in the analysis. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with …

Characterizing Populations Living Near Concentrated Animal Feeding Operations: Implications For Health Equity And Environmental Justice, Leah Salzano

Public Health Theses

Current literature has highlighted that concentrated animal feeding operations (CAFOS) are associated with adverse health outcomes among populations living in close proximity to the farms and that, in certain states, vulnerable populations may be disproportionately exposed to CAFOs. However, none of the existing studies have assessed the sociodemographic makeup of areas highly exposed to CAFOs across a diverse geographic range. Using locations of CAFOs across six states with robust operations, we conducted logistic regression models assessing the likelihood of high exposure vs. low exposure at the census tract level for each 10% increase in sociodemographic variables (percent unemployed, percent minority, …