Digital Commons Network^™

Patient Experience During The Covid-19 Pandemic At Smilow Cancer Hospital At Yale-New Haven, Danielle Marie Kline

Public Health Theses

Background: The COVID-19 pandemic has sidelined many elective, as well as non-elective, procedures designed to improve patients’ care experience. Oncology patients are at higher risk of developing and dying from COVID-19 and experience greater difficulties accessing and affording healthcare, compared to patients without cancer.

Objective: To explore the trends in patient experience of outpatient oncology patients in relation to the COVID-19 pandemic.

Methods: We utilized the additional comments section of the Press Ganey survey to ask respondents (n=12,514) about their experiences utilizing care. The survey was administered after each patient visit and analyzed quarterly from January 2020 to February 2021: …

Modeling The Effects Of Climate Factors On The Incidence Of Future Campylobacter Infections In Connecticut, Hannah Lemanske

Public Health Theses

Background & Introduction: Campylobacter is one of the most common foodborne bacteria in the United States, accounting for 48 million infections each year. Campylobacter infections can arise from consuming contaminated food, especially poultry, water, or contact with infected animals. Due to its strong seasonality, cases peaking in the summer and declining in the winter, potential relationships between climate and campylobacter have been analyzed.Methods: Weekly campylobacter surveillance data was obtained from the Connecticut Department of Public Health for 2000 through 2018. Historical and projected temperature and precipitation data were also gathered from the National Oceanic and Atmospheric Administration. A statistical analysis …

How Medical Student Perceptions Of Faulty Interactions Influence Burnout, Meghan Elizabeth Lindsay

Public Health Theses

Objective: To assess the relationship between the perceptions of student-faculty interactions and self-reported burnout scores during professional medical education. Design: Cross-sectional study. Setting: 140 accredited US medical schools by the Association of American Medical Colleges in 2016 and 2017. Participants: 26,464 of 30,651 graduating medical students who completed the Association of American Medical Colleges’ Graduation Questionnaire in 2016 and 2017 and who had complete questionnaires for all aspects of our related measures. Main outcome measures: Exploratory factor analysis was used to identify latent constructs underlying 14 measured students’ perception of faculty interaction variables and develop factor based scales. The association …

A Prediction Model Of Rotavirus Vaccine Performance Based On Meta-Analysis And Variable Selection, Yueqi Li

Public Health Theses

Background: Rotavirus is the leading cause of diarrheal diseases worldwide and is responsible for substantial morbidity and mortality among children younger than 5 years of age. The introduction of national immunization programs against rotavirus has greatly reducedhospital admissions and deaths from rotavirus gastroenteritis, but vaccine efficacy and effectiveness vary substantially between high- and low-income settings. Given the disparity of vaccine performance across countries, we built a model to predict how well the vaccines would work in settings without vaccine introduction. Methods: Data on vaccine performance and relevant predictor variables were extracted from the literature and repositories. We performed a meta-analysis …

Evaluating The Cost-Effectiveness Of Varied Vaccination Strategies For Ebola Virus Disease In The Democratic Republic Of The Congo, Rachel Amanda Lobe-Costonis

Public Health Theses

Introduction: The 2018 outbreak of Ebola virus in the Democratic Republic of Congo was the first to occur in the context of an ongoing complex humanitarian emergency. Despite optimism for an effective response given the efficacious one-dose Merck vaccine (ERVEBO), the immense challenges to public health efforts caused by the ongoing armed conflict posed unprecedented complications to the recommended ring vaccination strategy. In the end, contract tracing efforts for ring vaccination reached only 82% of individuals at best estimate, and the outbreak lasted 89 weeks with a total cost of $734 million. In comparison, transmission dynamic modeling has shown the …

The Politics Of Sexuality Education Policy In Texas, Caroline Alexandra Magee

Public Health Theses

This thesis applies social science research, historical and cultural analysis, and legislative review to understand the relationship between Texas’s school-based sexuality education policies and public health and, in so doing, lay the groundwork for policy change that will better promote sexual and reproductive health, health equity, and health justice in Texas. The thesis first situates Texas state-level sexuality education policy within a larger US political, historical, and legal context, highlighting the key roles of race, class, gender, and sexuality stereotypes and of “morality politics.” It then examines the political history of Texas sexuality education debates within this national context, revealing …

Epidemiology Of Covid-19 Hospitalizations In New Haven And Middlesex Counties, Connecticut, July - September 2021, Caroline Mary Mcwilliams

Public Health Theses

Abstract:Background. This thesis explores the epidemiology of COVID-19 hospitalization among residents of New Haven County and Middlesex County, Connecticut from July - September 2021 with an emphasis on quantifying racial/ethnic and SES disparities. Two previous studies, the first conducted from March - May 2020 and the second conducted from July - December 2020, used COVID-NET Surveillance data from New Haven and Middlesex counties to explore the same questions. This thesis will compare findings with these previous studies to better understand how the epidemiology of COVID-19 hospitalization and racial/ethnic and SES disparities have changed in New Haven and Middlesex counties. Methods. …

Prognostic Effects Of Different Tp53 Mutations In Lung And Pancreatic Adenocarcinomas, Carlos Mauricio Mejia-Arbelaez

Public Health Theses

Cancer patients with similar clinical and pathologic characteristics may have different response to treatments and survival, which may be attributable to distinct molecular properties of their tumor. The most common forms of lung and pancreatic tumors, the adenocarcinomas, often have mutations in the TP53 gene. It is not clear, however, how mutations in this gene may provide prognostic information and/or inform the clinical management of patients with lung adenocarcinoma (LUAD) and pancreatic ductal adenocarcinoma (PDAC). Despite previous studies suggesting that all mutations in TP53 are associated with worse prognosis, it is now known that not all TP53 mutations lead to …

Factors Associated With Failure To Complete Multi-Dose Vaccine Series Among U.S. Children Ages 19–35 Months, National Immunization Survey-Child, 2019, Sarah Yukari Michels

Public Health Theses

Background: Most early childhood immunizations require 3-4 doses to achieve optimal disease protection. Failure to complete multi-dose vaccine series is an important driver of undervaccination. Our objective was to evaluate factors associated with starting but not completing all multi-dose series in the combined 7-vaccine series.

Methods: Using 2019 National Immunization Survey-Child data, U.S. children ages 19-35 months with provider verified vaccination data were classified in one of three vaccination patterns: (1) completed the combined 7-vaccine series, (2) missing ≥1 vaccine series (i.e., selective vaccination), or (3) all series initiated, but did not complete all multi-dose series (i.e., missing ≥1 dose(s)). …

“I Still Have My Sorrows With Me.” A Qualitative Study Exploring How Nepali Adults Engage In Meaning-Making Following Suicide Experiences, Risika Mohanty

Public Health Theses

Background: Of all the global reported suicides, 78% of them occur in low and middle-income countries and 39% specifically occur in the Southeast Asia region. Nepal’s suicide rate was ranked 8th in the world by WHO estimates in 2014, with the third-highest suicide rate for females. While we know of certain suicide risk factors pertaining to Nepal, we have yet to understand how individuals make meaning of life following suicide experiences. Purpose: This study uses a narrative thematic analysis approach to understand how adults with lived experiences of suicide (ALES) navigate their internal and interpersonal lives following their suicide experience. …

Potential Impact Of Covid-19-Related Disruptions To Cervical Cancer Screening On Future Disease Burden: A Modeling Study, Guinevere Oliver

Public Health Theses

INTRODUCTION: Cervical cancer is almost entirely preventable through a combination of vaccination, timely screening, and treatment. There is strong evidence that cervical cancer screening services were disrupted during the COVID-19 pandemic; these disruptions may lead to preventable increases in cases of high-grade squamous intraepithelial lesions of the cervix (HSIL cases), cervical cancer cases, and cervical cancer deaths. OBJECTIVE: The objective of this analysis was to offer insight into possible future trends in HSIL cases, cervical cancer cases, and cervical cancer deaths. METHODS: A model was built to simulate cervical cancer progression and was fit to data on HSIL cases, cervical …

A National Assessment Of Racial And Ethnic Disparities In Cleft Lip Repair, Connor J. Peck

Public Health Theses

AbstractPurpose: This study examined the impact of patient race/ethnicity on the likelihood of experiencing delays to surgery, post-operative surgical complications, and prolonged hospital length of stay (LOS) following primary cleft lip (CL) repair. Methods: Patients who underwent CL repair were identified in the 2006-2012 Kids’ Inpatient Database. Primary outcomes were defined as treatment after 6-months-old, presence of any surgical complication, LOS >1 day, and total hospital charges. Multivariable analyses were performed to adjust for sociodemographic and clinical characteristics that might account for differences in outcomes. Results: There were 5927 eligible patients with cleft lip: 3724 White, 279 Black, 1316 Hispanic, …

Demographics Of Those In Clinical Trials To Treat S. Aureus, William Pelletiers

Public Health Theses

This study aims to identify potential discrepancies between the racial/ethnic demographics of participants enrolled in randomized controlled trials of antibacterials used to treat Staphylococcus aureus and the demographics for those who contract the disease. 115 clinical trials were analyzed for gender, racial, and ethnicity of clinical trial participants. Of the included studies, 95.7% included data on gender, 71.3% included racial data, and 27.0% included ethnicity data. Black/African American individuals were substantially underrepresented in trials when compared to the burden of disease that they share. Black/African American representation in S. aureus clinical trials needs to be ensured in order to properly …

Evaluation Plan For A Mortality Surveillance System In Northwest Syria, Hanna Peterson

Public Health Theses

AbstractIntroduction: Cause-specific population mortality data is one of the most useful metrics used to monitor and evaluate the severity of a crisis. However, the unique context of fragile and protracted armed conflicts creates obstacles for establishing a mortality surveillance system. When CRVS are not feasible, VA can be used to generate high-quality mortality rate estimates. There is currently little documentation of implementation and evaluation of mortality surveillance systems in conflict settings, and guidance for both is extremely limited. This thesis aims to contribute to these two knowledge gaps by providing an evaluation plan for a mortality surveillance system in Northwest …

Exploring Learning Experiences Of Students In An Experiential Community Health Practice Course, Christine Nhu Pham

Public Health Theses

Introduction: Students in their first and second year of their Master of Public Health (MPH) programs worked in teams to collaborate with and assist local community partners in developing solutions to problems immediately relevant to local community health organizations. The course’s unique emphasis on co-generation of knowledge between students and community partners aimed to develop students’ practical skills relevant to working in practice-based community public health agencies as well as enhance their research skills as community-engaged academics. This study aims to identify lessons learned and key elements of the course that were most impactful on students’ learning experiences.Methods: Students were …

The Behavioral Immune System: A Public Health Perspective: How Our Partisan Perceptions Of Sickness Influenced Population Health During The Pandemic, Senyte Pierce

Public Health Theses

Researchers propose that people have a disease-avoidance mechanism called thebehavioral immune system, which is intended to identify and prevent possible interactions with harmful infections. This thesis is intended to explain this phenomenon, one well researched in the fields of behavioral and evolutionary psychology, to public health professionals, who can use its hypothesized components to understand better how to support population health and wellbeing. In addition, the COVID-19 pandemic will serve as a case study to understand the limitations of the BIS as it relates to socio-cultural events and personal political identification. The behavioral immune system keeps individuals healthy by monitoring …

Xylazine In The Drug Supply: Emerging Threat In Connecticut And Lessons Learned From Philadelphia, Thomas A.G. Quijano

Public Health Theses

Background: Xylazine, a sedative analgesic drug approved as an animal tranquilizer but not for human use, has become an adulterant in the supply of heroin/fentanyl.(Greene & Thurmon, 1988) Between 2019 and 2020, prevalence of xylazine in overdose death reports increased by 44.8% nationally.(Friedman et al., 2021) The three jurisdictions in 2020 with the highest prevalence of xylazine were Philadelphia (25.8%), Maryland (19.3%), and Connecticut (10.2%).(Friedman et al., 2021) Not much is known about how xylazine’s impacts on service provider’s practices and the people they serve.

Objectives: Use a multiple methods approach to understand xylazine’s presence and impact in Connecticut, and …

A Qualitative Analysis Of Paternal Perspectives On Breastfeeding Support Among Black Fathers In Connecticut, Jasmine Teresa Rios

Public Health Theses

Background: Despite the persistence of racial and ethnic disparities in breastfeeding in which Black mothers breastfeed at lower rates, little is known about Black fathers’ experiences with breastfeeding and breastfeeding support services (e.g., maternity hospital-based care, lactation specialty care). This thesis reports Black fathers’ perceptions of breastfeeding, influencers of breastfeeding, and breastfeeding support services in Connecticut using a qualitative, community-based participatory approach.Methods: The study’s focus group guide was co-developed with community partners and adapted from the Barrier Analysis Tool to identify breastfeeding facilitators, barriers, and service improvement areas. Per study design, all participants were fathers to a child under three …

Navigating A Patchwork Maze: Individuals’ Experience Of Administrative Burden When Accessing Homeless Assistance Services, Leah Robinson

Public Health Theses

Despite significant efforts to address the issue of homelessness in the United States over the past several decades, over 500,000 individuals still experience homelessness on any given night. A large portion of this persistent and high rate of homelessness can likely be attributed to the shortage of affordable housing options, the eviction crisis, and limited financial support for rental assistance found throughout the country. However, administrative burdens may also contribute to the high rate of homelessness being seen.Our study explores this question by examining 28 individuals’ experience of administrative burden when navigating the landscape of homeless assistance services in New …

Effects Of Depression And Discrimination During Pregnancy On Postpartum Healthcare Utilization Among Women In Detroit, Mi And Nashville, Tn, Janet A. Rojina

Public Health Theses

Objectives: This study seeks to document how both depression and discrimination during pregnancy may impact postpartum healthcare utilization (e.g. attendance of the 6-week postpartum appointment and maternal emergency room (ER) visits within 6 months after birth) among women in Detroit, MI and Nashville, TN. We also investigate how race may be associated in the relationship between depression during pregnancy and healthcare use. Methods: Descriptive, stratified, and logistic regression (univariate and multivariate) analyses were conducted using SAS 9.43. Data was drawn from the Expect with Me (EWM) study, a multisite prospective longitudinal matched-cohort that included 951 pregnant women from Detroit, MI …

Novel Applications Of Music And Digital Media In Global Health Intervention And Education Initiatives During The Covid-19 Pandemic: A Case Study Of Bts And Army, Mariko Fujimoto Rooks

Public Health Theses

The Korean musical group BTS (full name Bangtan Seoyeondan/방탄소년단) is one of the world’s most commercially and artistically successful entertainment acts. BTS is primarily known for their domination of both Western and Korean musical markets, impressive digital media presence, major role in supporting the South Korean economy, and highly mobilized 400,000 member fandom known as ARMY. BTS and their parent company HYBE’s artistic creation and marketing model has long focused on creating “Music and Artists for Healing,” or using music and various forms of primarily digital content to connect with and improve health outcomes for fans. In response, ARMY have …

Evaluating Associations Between Pesticide Use And Kidney Function In The Biomarkers Of Exposure And Effect In Agriculture (Beea) Study: Using Cluster Models To Group Farmers With Similar Pesticide Use, Thomas Shao

Public Health Theses

Pesticides are commonly used in agrarian areas to control for certain forms of undesirable plant or animal life. The widespread use of pesticides and the variety of chemicals that make up this class pose adverse health effects to those exposed to pesticides. Farmers often use multiple pesticides, and their use is often correlated with other pesticides. However, analyses typically examine each pesticide individually and mixture analysis is not as heavily considered. To further evaluate the exposure of pesticide usage, hierarchical clustering methods were used to identify similar questionnaire response patterns. This technique has been used to quantify homogenous exposure estimates …

Prescriptive Faith: Carceral Health Beyond The Prison Walls, Shamar S. Smalls

Public Health Theses

Individuals who are exposed to the carceral system—specifically, solitary confinement are uniquely vulnerable to psychological and physical health conditions. However, the relationship between solitary confinement and physical health conditions are relatively underexamined, compared to mental health disorders. This analysis examines the potential for a risks’ association between solitary confinement and cardiovascular disease risk factors. Additionally, this study examines the relationship between spirituality as a self-efficacious coping measure for health-related outcomes. A cross-sectional analysis of 302 survey participants with a prior history of incarceration in a housing study (New Haven, CT) with a prior history of incarceration from Fall 2017 – …

Covid-19 Infection And Return-To-Work Status Among Workers, Richard Smith

Public Health Theses

ABSTRACTINTRODUCTION: To date, more than 120 million working-age Americans have had COVID-19 infection. Up to 80% of those infected have reported substantial persistent symptoms, known as long COVID. While current research continues to investigate long-term health effects of COVID-19 infections, less information exists on COVID-19’s impact on employment and return-to-work status. This study aims to better characterize the issues related to return-to-work status in those with long COVID. METHODS: Participants were recruited form the Yale Post-COVID-19 clinic. A mixed-methods survey was administered to collect demographic and employment information. Standardized scales were utilized to assess symptoms and functional status. Survey responses …

Using A Dynamic Model To Assess Maintenance Of Deer Tick Virus Via Horizontal Transmission In Ixodes Scapularis Populations, Hannah Jane Sproch

Public Health Theses

IntroductionDeer Tick Virus—a lineage of Powassan Virus—is an emerging tick-borne flavivirus associated with high rates of morbidity and mortality. Although DTV infection is rare, there has been an observed increase in the number of human cases in recent decades, necessitating more public health attention. Ixodes scapularis ticks are known to be the primary vector of DTV. However, the enzootic cycle has yet to be fully characterized and there is evidence that horizontal transmission alone may be insufficient for DTV maintenance; it is hypothesized that vertical and co-feeding transmission are also necessary for sustained transmission.

MethodsA dynamic model was developed to …

Occupational And Socioeconomic Risk Factors Of Noise-Induced Hearing Loss, Rongcan Sun

Public Health Theses

Hazardous noise (>85 dBA) is among the most common occupational exposures and responsible for the majority of noise-induced hearing loss. Noise-induced hearing loss impacts many aspects of a person’s life, including workplace safety, daily routine, economic consequences, and quality of life. However, studies on the relationship between occupational noise exposure and hearing loss were usually done in specific industries rather than the general population. In addition, studies focused on associations between socioeconomic factors and hearing loss rarely take the type of occupation into consideration. In this study, we aim to evaluate both occupational noise exposure and socioeconomic status as …

Nutrition And Hookworm Infection: A Causal Analysis Of The Literature, Mengting Su

Public Health Theses

Hookworm infection is one of the neglected tropical diseases, particularly in low and middle-income countries, but we know relatively little about causal evidence related to malnutrition. This is mainly due to the relatively small research community compared to those investigating the impact of hookworm infection on host nutritional status and disease complications. Causal inference is critical in epidemiology and biomedical research because it can be a powerful tool in enlightening prevention efforts and developing etiology models. The application of causal criteria to address complex epidemiological research questions is indeed helpful in proposing more interventions to improve the health and well-being …

“We Just Need Help”: A Qualitative Study On Information Channels And Knowledge Gaps On Eviction Resources During The Covid-19 Pandemic, Kalla Maxine Pascual Sy

Public Health Theses

BackgroundThe COVID-19 pandemic led to record levels of mass unemployment and wage losses in the United States, placing numerous households at greater risk of housing insecurity. Government bodies and non-profit organizations have responded accordingly by enacting eviction moratorium protections and rental assistance programs to help households in need. However, knowledge gaps pose challenges to successful uptake of eviction moratorium policies and rental assistance programs during the pandemic. Very little is known about tenants’ experience navigating eviction moratorium policies and assistance programs during the COVID-19 pandemic and any knowledge gaps that arose.

ObjectivesTo examine the channels of information for eviction-related resources …

Synergistic Epidemic: A Case Study Of Covid-19 And Substance Use Disorder In New London, Ct, Mary Tate

Public Health Theses

The onset of the COVID-19 pandemic in March 2020, complicated the already ineffectual delivery of health care for historically hard-to-reach populations. Those who face housing insecurity, substance use disorders, unemployment, or uncertain immigration and insurance status were abandoned, as the mainstream U.S healthcare system struggled to cope under the pressure of the novel virus. While parallel public health crises were put on hold to deal with COVID-19, the pandemic collided with and exacerbated the ongoing opioid crisis. Using New London, CT as a case study, this project set out to address a gap in literature on the potential syndemic effect …

Association Between Household Chaos And Childhood Overweight-Obesity: A Cross-Sectional Study Among Young Samoan Children, Ruiyan Michelle Wang

Public Health Theses

AbstractObjective: Household chaos – sustained disorganization, disorder, and hurriedness in the home setting – has been shown to be associated with a variety of adverse health effects for children. The present study examines the relationship of household chaos with childhood overweight and obesity among Samoan children aged 5 to 12 years. Additionally, the present study explores characteristics of the home environment that may be captured by the household chaos measure. Methods: This analysis uses data from the third wave (2019-2020) of data collection in the Ola Tuputupua’e cohort study. Height and weight were used to construct the childhood overweight/obesity outcome …