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Primary Care Characteristics And Medication Management Among Patients Receiving Office Based Opioid Treatment With Buprenorphine, Xinxin Du

Yale Medicine Thesis Digital Library

AbstractBackground: Office-based opioid treatment (OBOT) is an evidence-based treatment model for opioid use disorder (OUD) offered by both addiction and general primary care providers (PCPs). Calls exist for more PCPs to offer OBOT. Few studies have been conducted on the primary care characteristics of OBOT patients. Objective: To characterize medical conditions, medications, and treatment outcomes among patients receiving office-based opioid treatment (OBOT) with buprenorphine for OUD, and to describe differences among patients by age and by time in care. Methods: This study is a retrospective review of medical records on or before 4/29/2019 at an outpatient primary care clinic within …

This Place Is A Message: A Case Study Examining The Role Of Emotion, Storytelling, And Interactive Performance Art In Climate Change Communication, Maryanne Rebstock Cosgrove

Public Health Theses

Objectives. This Place Is A Message is a populist performing arts piece created by Faultline Ensembles to explore the relationship between the individual emotional experience and the collective trauma of the climate change crisis. Through personal narratives and emotional appeals, this production seeks to build community solidarity through community-led storytelling and harness participatory theater for climate change communication to be used to find climate solutions in a joint manner. Methods. Data was collected and analyzed using a mixed-methods approach utilizing self-reported surveys, including audience pre-show (N=75) and post-show (N=48) assessments and a survey of cast and crew members (N=14). Additionally, …

Using Community-Based Screening To Quantify The Relationship Between Hiv And Hypertension In A Rural South African Community, Jessica Ainooson

Public Health Theses

Background: Over the past three decades, the prevalence of hypertension has increased in sub-Saharan Africa, paralleling the HIV/AIDS epidemic. The aim of this study is to assess the relationship between HIV status and elevated blood pressure in a rural South African community. Methods: A secondary analysis was conducted from a community-based screening program providing TB/HIV/blood pressure/glucose screening in the rural sub-district of Msinga, KwaZulu-Natal, South Africa from 2011 - 2017. Descriptive analyses were used to characterize the frequency of measured and self-reported hypertension, HIV status, and sociodemographic variables. Multivariable logistic regressions were used to estimate the relationship between HIV status …

Descriptive Characteristics Of Injury Recidivism Among Adults In The Us: Population-Based Study, Mahna Alyami

Public Health Theses

Abstract

Introduction: In the United States (US), injury-related morbidity and mortality is a public health burden in terms of lives lost, healthcare costs, and lost productivity. In 2020, according to the Centers for Disease Control and Prevention (CDC), unintentional injuries were the fourth leading cause of death (200,955) behind heart disease, cancer, and COVID-19. Many of the studies of injury recidivism were limited to demographic data and often focus on a specific type of injury, such as motor vehicle crashes, interpersonal violence, or falls. The aim of this study is to present the descriptive characteristics of injury recidivism among adults …

Association Between Rheumatoid Arthritis Severity And Mental Health In A Prevalent Cohort Of American Adults, 2013-2022, Nicole-Anne Ballesteros

Public Health Theses

Objective/Purpose: The severity of rheumatoid arthritis and its association with depression and anxiety among a prevalent cohort of American adults has been neither well-researched nor backed by real-world data. This investigation seeks to test the hypothesis that there is an association between disease severity and the aforementioned psychological conditions, both of which are commonly observed in patients with rheumatoid arthritis.

Methods: Real-world data from OM1 Inc.’s rheumatoid arthritis registry (2013-2022) was used for this analysis. Disease severity (low, medium, and high), categorized using disease activity scores, was the main exposure, while depression and anxiety were the study’s two primary outcomes. …

Identification And Correction Of Normalized Deviance In Healthcare Systems To Prevent Healthcare-Associated Infections And Improve Patient Outcomes, Elliana Sophia Barbell

Public Health Theses

Introduction: In healthcare, normalized deviance is characterized by the steady transition away from standard practice toward variations in practice behaviors. This deviation presents minorly at first and is accepted to save time and increase efficiency. However, initial evaluations of innocuity do not represent actual safety. While the deviant practice may not cause immediate patient harm, its alignment with additional system weak points has the potential to lead to poor patient outcomes, including the development of healthcare-associated infections (HAI). One behavior that may influence HAI development and patient outcomes is hair removal during preoperative skin preparation.Methods: An observational study of hair …

Women's Beliefs In Gender Equality And Its Association With Gender Based Violence In Conflict Afflicted Regions Of Uganda, Aishwarya Bhattacharya

Public Health Theses

Gender Based Violence such as Intimate Partner Violence and exposure to armed conflict are exacerbated in Conflict settings and can negatively impact health outcomes among women. Although a significant amount of research has looked at how men’s beliefs in gender equity and male stereotypes can impact engagement in violence against women, there is a dearth of research analyzing how women’s beliefs can impact their exposure to armed violence or IPV. We use the adapted version of the Gender-Equitable Men survey in a population of 606 women and adolescent girls in conflict afflicted regions of Northern Uganda to a) look at …

Adverse Childhood Experiences & Breastfeeding - Pakistan, Paola Bojorquez-Ramirez

Public Health Theses

Rationale: Prior studies have found that a history of adverse childhood experiences (ACEs) is associated with breastfeeding, but the evidence is inconsistent. Despite low and middle income countries (LMICs) carrying a disproportionate amount of poor maternal and infant health outcomes, little research has assessed the relative impact of ACEs on breastfeeding initiation and exclusive breastfeeding in LMICs.Objective: The study investigates whether maternal ACEs are associated with breastfeeding initiation and exclusive breastfeeding at 3 and 6 months postpartum among a cohort of women from rural Pakistan. Methods: The cross-sectional analysis included 869 women 18-45 years of age from the Bachpan Cohort …

Trends In Antimicrobial Resistant Non-Typhoidal Salmonella Before And After The Food And Drug Administration’S Guidance For Industry #213, United States 2013-2020, Lily Valentina Carruthers

Public Health Theses

Background: Previous research has shown a potential link between antibiotic use among food-producing animals and antimicrobial resistant enteric pathogens. In late 2016, the Food and Drug Administration completed the implementation of its Guidance for Industry #213, through which growth promotion was removed as an indication for use of medically-important antimicrobials among food-producing animals. This study aimed to describe trends in antimicrobial resistance among human Salmonella isolates from 2013-2020 in the United States before and after the implementation of this regulation.Methods: All non-Typhoidal Salmonella isolates sent to the National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) from 2013-2020 were included …

Caregiver Experiences Of Social Need And Promotion Of Support In The Pediatric Setting: A Qualitative Study, Meghan Patricia Casey

Public Health Theses

Children are vulnerable to the long-term health impacts of unmet family needs within social determinants of health like income, food security, housing, and transportation. Efforts have grown to recognize and respond to these challenges in the pediatric setting through social needs screening and other interventions. Previous research has extensively described the pediatric provider perspective on this work. However, less is known about how caregivers experience interactions surrounding social needs in the healthcare setting and which factors may influence these perceptions. To address these gaps in knowledge, this qualitative study examined semi-structured interviews of 20 caregivers who participated in a pediatric …

United States Immigration Law As A Social Determinant Of Health: A Mixed-Methods Systematic Review, Natalia Castellanos González

Public Health Theses

Background: Rapidly changing immigration policies and anti-immigrant rhetoric have impacted the services available and the health outcomes of undocumented immigrants. Research focusing on the health of noncitizens usually employs a cultural frameworks approach, focusing on individual behaviors or outcomes rather than structural barriers and limitations. This analysis is not adequate for explaining the origins of community-level and structural inequities, and there are existing gaps in research documenting the ways in which policies and changes impact immigrants’ health-seeking behaviors and overall health. Methods: This thesis employed a mixed methods-mixed research synthesis approach to carry out a systematic review. Article selection followed …

Adherence Required On Dolutegravir, Allison Catalano

Public Health Theses

Abstract Background Historical data from a study of non-boosted protease inhibitor-based antiretroviral therapy (ART) regimens have suggested that an average adherence threshold of 95% is the minimum necessary for viral suppression. However, dolutegravir-containing regimens, which are recommended as preferred first-line ART regimens worldwide, may be more forgiving due to their potency and high barrier to drug resistance. Methods We analyzed data from 483 ART-experienced adults in Uganda who were routinely switched from non-nucleoside reverse transcriptase inhibitor-based regimens to tenofovir-lamivudine-dolutegravir (TLD). We compared the proportion virally suppressed (< 50 copies/mL) at 24- and 48-weeks post-enrollment across levels of self-reported adherence using the three-item Wilson adherence scale, with χ2 tests to determine significant differences. We also fit generalized estimating equations (GEE) with viral suppression as the outcome of interest and self-reported adherence as the predictor of interest. Results Median age was 47 (IQR 40-53), and 41% were female. Overall suppression rates were high (>72%). However, we found that those reporting the lowest levels of adherence in …

Breast Cancer Patient Preferences In Patient-Provider Discussions, Lauren Cueto

Public Health Theses

Objectives. To examine breast cancer patient preferences in patient/provider communication methods during prognostic and treatment side effect conversations in an exploratory survey study.

Methods. A sample of 28 breast cancer patients receiving care from Yale New Haven Hospital Smilow Cancer Center completed an in-person, scenario-based survey between February-April 2022. Utilizing Smilow Cancer Center’s breast cancer repository, breast cancer patients who had a routine medical oncologist visit during the study period were recruited. Mann-Whitney U tests, univariate logistic regression, ordinal logistic regression, Wilcoxon Signed-Rank Tests, and qualitative analyses were utilized to determine patient preferences of communication methods that maximize patient understanding …

Circadian Factors And Cancer Survivorship: A Mini Review, Jiaqi Cui

Public Health Theses

Circadian clocks are molecular clocks that govern the temporal control of physiology to preserve homeostasis. The disruption of the circadian rhythm is important in carcinogenesis and aids the development of cancer hallmarks. On the other hand, carcinogenic activities disrupt circadian rhythms directly. In cancer treatment, pharmacological regulation of core clock genes is a novel approach. The use of circadian biology in cancer research opens up new avenues for improving cancer treatment effectiveness. This mini-review provides an overview of relationship between circadian factors including circadian gene expression, circadian genotype, circadian disruption and circadian gene methylation and the cancer survivorship. The review …

The Impacts Of Identity Centrality On Mental Health In Black Americans, Maya Frances Tracey Dennis

Public Health Theses

The relationship between health status and Racial Identity Centrality (RIC) has been determined to be positive and significant among individuals identifying as Black/African American. Racial and sexual minorities face higher rates of stigma-related stress and discrimination that work as a prediction of future health risks such as symptoms of anxiety. The goal of this study was to examine whether sexual or racial identity centrality predicted self-reported symptoms of anxiety in Black Americans. The data used in this study is from the National Couples Health and Time Survey. Ordinary least squares regression predicting self-reported symptoms of anxiety by Racial Identity Centrality …

“She Trusts Us To Love Her, You Know?”: Using A Love Ethic Framework To Explore Faith Navigation And Acceptance Processes Among Mormon Mothers Of Lgbtq+ Individuals, Nandini Milind Deo

Public Health Theses

Parental acceptance is a key factor in bolstering the health and well-being of LGBTQ+ individuals across their lifespan (Needham & Austin, 2010; Ryan, 2010; Jin, 2020; Clark et al., 2021). One factor known to influence parental acceptance is family religiosity, which has typically been associated with conflict and/or rejection (Ryan, 2010; Johns & Hanna, 2012; Roe, 2017). The purpose of this study was to better understand faith navigation and acceptance processes among active Mormon mothers of LGBTQ+ individuals in an effort to inform public health engagement with highly religious parents of sexual and gender minority children. In-depth qualitative interviews were …

On The Same Page? Agreement Between Older Adults And Emergency Clinicians Regarding Desired Outcomes And Its Association With Return Hospital Visits, Hollie Dowd

Public Health Theses

Objectives. To develop a framework for as well as examine the relationship between patient-clinician agreement on what matters to older adults in the emergency department (ED) and 30-day ED return visits.Methods. A sample of 45 emergency department patients aged 70+ and their emergency clinicians were separately asked about the patient’s desired outcomes for their ED visit. Thematic analysis of interview transcripts was conducted and dyadic agreement for each of the identified themes was recorded, then a percent agreement composite score was calculated. 30-day ED return visits were tallied and additional sociodemographic and clinical data was accumulated. Descriptive, bivariate, and multivariate …

Support Or Interference: Relational Influences On Mother’S Exclusive Breastfeeding Practices In Ghana, Georgiana Esteves

Public Health Theses

Childhood malnutrition is a challenge that needs to be understood as a global health threat. Exclusive breastfeeding (EBF) is recognized as the best practice to improve a child’s growth and cognitive development in the first months of life. The World Health Organization recommends EBF until 6 months. Mothers need family support to adhere to EBF practices. This study aimed to understand the interpersonal level relational influences of fathers, grandmothers, and other family members on the mother-child dyad adherence to EBF practices, as well as document community and societal influences on EBF. This study took place in the Central Region of …

Proximity And Parental Interaction: Examining The Relationship Between Proximity Data And Mother-Infant Interaction Among Mothers With And Without Depression, Paige Farrenkopf

Public Health Theses

Background: There is a lack of data on response behaviors among young mothers in low- and middle-income countries. Emerging passive sensing technology has been increasingly allowing researchers to collect this type of day-to-day behavioral data.

Methods: We administered PHQ-9 depression surveys and the Observation of Maternal-Child Interaction (OMCI) measure to young mothers between the ages of 15-25 in the Chitwan region of Nepal, and conducted key informant interviews with all mothers selected for participation.

Results: Among 54 mother-infant dyads, we found that there was no statistically significant correlation between maternal responsiveness and proximity. When we stratified participant groups by depression …

Environmental And Health Impacts Of Biobased Polymers, Liora Fiksel

Public Health Theses

The use of biopolymers is predicted to grow in the coming years as the world searches for solutions to its sustainability problems. Pursuing biobased materials is widely thought of as the sustainable response to moving away from petroleum-based materials and the plastic-waste issue; however, its potential environmental and human health impacts are being questioned. Notably, the controversies related to biopolymers' renewable feedstocks include adding pressure to the food economy, land use, occupational hazards, and environmental pollution with potential human exposure and adverse health effects. Other resource burdens include energy and water. Many biopolymers are designed to biodegrade, compost, or be …

Challenges And Prospects: Reducing U.S. Methane Emissions Via Red Macroalgae (Asparagopsis Taxiformis) Feed Additives To Inhibit Enteric Methane Production From Ruminant Livestock, Rebecca Gillman

Public Health Theses

Approximately 27% of U.S. methane emissions are emitted by the agriculture sector annually, primarily by ruminant livestock as a GHG enteric fermentation bi-product (EPA, 2022). This proposed intervention explores the feasibility of scaling up use of anti-methanogenic ruminant feed additives, to directly reduce U.S. agricultural methane emissions at the source. A careful review of in vitro, in vivo and small-scale pilot studies revealed that the potent, anti-methanogenic bioactive compounds in red macroalgae (Asparagopsis Taxiformis) can both safely and effectively inhibit methanogenesis during enteric fermentation, resulting in up to 90% reduction in methane emissions without adverse risk or consequence to animal …

The Gap Between Attitude And Action: A Mixed Methods Study Of Sexual Self-Stigma As A Predictor Of Consent Behavior, Hannah Carolyn Gorman

Public Health Theses

Introduction: More than 1 in 3 women and 1 in 4 men will experience some type of sexual violence in their lifetimes (NISVS | CDC, 2021). While a significant body of research exists on predictors of reporting behavior after sexual assault victimization, far less research has attended to factors that may contribute to perpetration, such as sexual self-concept. The current study investigates sexual self-concept and its relationship to health behavior and notions of sexual consent in a college student sample. Methods: Quantitative and qualitative data were collected from 160 Yale undergraduates 18 years or older with approval from the Yale …

The Role Of Childhood Trauma In Intergenerational Trauma (Igt), Audrey Huang

Public Health Theses

Emerging research has focused on the intersection of personal and parental trauma within intergenerational trauma (IGT) transmission, specifically offspring adverse childhood experiences due to trauma-related parenting behaviors. However, the role that offspring childhood trauma and its various subtypes may play in moderating or mediating IGT transmission, as well as the impact of caregiver sex, are still remains largely understudied. We examined how the transmission of PTSD between survivors of the 1994 genocide to their offspring might be either (a) mediated by overall and subtypes of offspring childhood trauma, or (b) moderated by overall and subtypes of offspring childhood trauma, and …

Stigma, Cisgenderism, And The Pathologization Of Transness, Baqar Husain

Public Health Theses

Cisgenderism is the culture and system, constituted by both ideology and practice, that denies, denigrates, or pathologizes self-identified gender identities that do not align with assigned sex at birth. Medicine and law are jointly deterministic of the wellbeing of transgender people. This analysis seeks to explore how stigma, operationalized by cisgenderism, manifests in legal and medical structures to negatively impact the wellbeing of transgender people. Thus, this analysis begins with the definition of key terms necessary to understanding concepts related to sex, gender, and gender variance. After delineating how stigma operates, the recent history of transness is outlined and is …

Comparing Dog And Owner Pfas Exposures Using Fresh Air Samplers, Emily Elizabeth Johnson

Public Health Theses

Per- and polyfluoroalkyl substances (PFAS) have gained attention given their prevalence and persistence in the environment and in our bodies. PFAS have been detected in water, food products, and consumer products. Furthermore, companion animals may be exposed to elevated PFAS levels due to sources from pet products as well as household items. A growing number of studies have been conducted to better understand the toxicological and public health impacts of legacy PFAS resulting from ingestion and dermal exposure pathways in both humans and domesticated animals. As alternative replacement PFAS emerge in the market, these compounds are shorter chain which allows …

Understanding The Effects Of Endocrine Disruptors On The Glucocorticoid Signaling Pathway, Dana Norbert Joseph

Public Health Theses

Endocrine disruptors are exogenous chemicals that interfere with the functions of the endocrine system and can cause adverse developmental, reproductive, and neurological effects. Unlike toxic effects that may be evident immediately, disruption to the endocrine system may impact complex signaling pathways that take years or generations to discover. Current toxicology testing does not routinely incorporate endpoints that would identify potential endocrine disruptors. The objective of this study was to evaluate the endocrine disrupting potential of a broad range of industrial chemicals, specifically focusing on four chemicals with predicted activity on the glucocorticoid receptor (GR): 4-nonylphenol, bisphenol A (BPA), butylated hydroxytoluene …

Landlord-Tenant Relationships And The Covid-19 Pandemic: A Qualitative Exploration Of Landlord Power And The Eviction Moratorium, Anna Grazyna Kapolka

Public Health Theses

The COVID-19 pandemic resulted in an economic crisis as well as a public health crisis. The United States experienced the highest unemployment rates in its recorded history, exacerbating the pre-existing affordable housing crisis. Anticipating the impending wave of evictions, policymakers included a ban on evictions in the Coronavirus Aid Relief and Economic Security (CARES) Act, known as the eviction moratorium. When the CARES Act moratorium expired, the Centers for Disease Control and Prevention (CDC) ordered a temporary halt on evictions that was extended several times until August 26, 2021, and many states and localities passed their own eviction moratoria policies. …

Exploring Climate Policy And Health Perspectives In Samoa: A Mixed Methods Study, Erika-Ann Fumiko Kim

Public Health Theses

Background: Greenhouse gas emissions have driven human-induced climate change, bringing several impacts to small island nations in the Pacific. Samoa, a small island developing state located in the south Pacific Ocean, is at disproportionate risk from impacts of climate change such as rising surface temperatures, rising sea levels, increases in frequency and degree of heavy precipitation events, and increases in the frequency of droughts. Simultaneously, Samoan populations possess a high prevalence of non-communicable diseases such as diabetes, heart disease, and hypertension. For multiple decades, the Government of Samoa has framed climate change as a key issue that threatens the lives, …

Oiremos: The Development, Implementation, And Evaluation Of A Holistic Health Curriculum For A Hispanic Youth Enrichment Program, Margaret Cavendish Kellogg

Public Health Theses

In the spring of 2021, as the Covid-19 pandemic continued to exacerbate health inequities and virtual learning dragged on, I developed and implemented an educational health-promotion intervention for a small group of Hispanic youth in collaboration with a New Haven Latinx social services non-profit, Junta for Progressive Action. The bilingual, culturally-responsive health curriculum wove together engaging activities related to physical, emotional, mental, social, and community health, promoting participants’ socio-emotional learning and equipping them with destigmatizing vocabulary and skills they could use to advocate for their needs. The curriculum was grounded in social and behavioral theories and was informed by participants’ …

Mindfulness And Psychological Stress In Black Male Caregivers, Alyssa Misun Kim

Public Health Theses

Background: Mindfulness practices are under-studied in Black communities despite theireffectiveness in improving mental health. When specifically examining Black male caregivers of people living with Alzheimer’s disease or dementia, not much is known about how mindfulness can affect their stress in their role as a caregiver and their identity as a Black male. Therefore, the purpose of this study is to examine mindfulness, self-rated stress, and depressive symptoms among Black male caregivers and non-caregivers and determine whether mindfulness can serve as a protective buffer against psychological stress in each of these groups. Methods: 18 Black male caregivers and 29 non-caregivers completed …