Digital Commons Network^™

Power Outages And Power-Dependent Home Medical Equipment In The United States: A Spatial Analysis, Phoebe Merrick

Public Health Theses

Background: Extreme weather events pose risks to the power grid, threatening the wellbeing of individuals reliant on electricity to meet their health needs. The aim of this study is to identify geographical locations in the U.S. that have both high risk of power outage impact and high proportions of power-dependent durable medical equipment (DME) users.

Methods: To achieve this, I used the HHS emPOWER historical map dataset from years 2017 to 2022 and overlaid EAGLE-I data with county-level power outage data from the same study years. Using Local Moran’s I, I found spatially significant high-high clusters of each variable and …

Enhancing Disease Surveillance In Conflict Settings: An Ecological Case Study On Cholera In Sudan At The Intersection Of Environmental And Conflict Drivers, Kinsey Medlin

Public Health Theses

Cholera outbreaks are complex and driven by an interaction of environmental circumstances and conflict-related disruptions, yet few studies have integrated both in the context of conflict regions. This ecological study examines cholera transmission dynamics in Sudan from 2016 to 2025, exploring temporal associations using cross-correlation analysis and applying generalized additive mixed models (GAMMs) to analyze the influence of remotely sensed environmental variables (rainfall, temperature, NDVI, NDWI) and conflict indicators (civilian targeting, political violence, demonstrations) on cholera cases. Weekly cholera surveillance data, combined with satellite-derived environmental variables and conflict event datasets, were modeled across two time periods: pre-conflict (2016-2018) and active …

Insights Into Medical Surveillance Among Engineered Stone Countertop Workers In The United States Of America, Tony Huy Nguyen

Public Health Theses

Background: An alarming rise in the number of cases of silicosis, a progressive and incurable lung disease, among engineered stone (ES) workers has prompted concern about the extent of the problem in the U.S. and whether ES can be used safely. Overexposure to high levels of respirable crystalline silica (RCS) during fabrication or installation of ES can increase the risk of developing a more severe case of silicosis. Medical surveillance studies on US ES workers are limited.Aim: The overall objective of this study was to better understand the state of medical surveillance for ES workers using employer surveys and employee …

New Horizons In Hepatitis B Therapy: Antigen Reduction And Immune Modulation Approaches, Yiyun Pan

Public Health Theses

Chronic hepatitis B (CHB) remains a significant global health burden despite advances in antiviral therapy. Current treatments, including nucleoside analogs (NAs) and pegylated interferon (Peg-IFN), effectively suppress viral replication but rarely achieve functional cure, defined as sustained hepatitis B surface antigen (HBsAg) loss. Emerging therapeutic strategies focus on antigen reduction and immune modulation to overcome the limitations of existing therapies.

Antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs) offer promising approaches by directly targeting viral RNA to reduce HBsAg levels. Clinical trials of ASOs such as bepirovirsen and siRNAs such as JNJ-3989 and VIR-2218 have shown substantial HBsAg declines, but …

Characterizing The Genetic Diversity Of Pfrh5 In Plasmodium Falciparum Clinical Isolates From Burkina Faso, Ghana, And Tanzania: A Next-Generation Sequencing Study To Inform Blood-Stage Malaria Vaccine Development, Manuel Emilio Perez

Public Health Theses

The development of a highly effective malaria vaccine is of global health priority, given the persistently high malaria burden in Sub-Saharan Africa (SSA) and growing resistance to antimalarial treatment and vector control measures. P. falciparum reticulocyte-binding protein homolog 5 (PfRH5) has emerged as a leading target among blood-stage malaria vaccine candidates due to its essential role in erythrocyte invasion and initial documentation of limited polymorphisms. However, recent studies have revealed greater PfRH5 genetic diversity than previously believed, raising concerns about potential parasite evasion of vaccine-induced immunity. This study utilized deep targeted amplicon next-generation sequencing to characterize PfRH5 genetic variation in …

Liver Epigenetic Changes In Mice Exposed To 1,4-Dioxane In The Drinking Water: Implications For 1,4-Dioxane Liver Carcinogenicity, Shuya Qiao

Public Health Theses

1,4-Dioxane, a probable human carcinogen and widespread environmental contaminant, has been consistently associated with liver tumor development in rodents. However, limited research has addressed its role in epigenetic dysregulation. This study investigated epigenetic alterations in liver tissue following chronic exposure to 1,4-dioxane. Male mice of wild-type (WT) and glutamate-cysteine ligase modifier subunit knockout (Gclm-KO) genotypes were exposed to 0, 50, or 500 ppm of 1,4-dioxane in drinking water for six months. qPCR, Western blotting, and immunohistochemistry (IHC) were used to assess changes in DNA methylation-related enzyme gene expression, histone acetylation, and SAM (S-adenosylmethionine) distribution. qPCR results showed significant downregulation of …

Disparities In Clinical Trial Representation: Bioethical & Human Rights Violations Against The Global Burden Of Disease And Gender Equity, Kaustubha Reddy

Public Health Theses

This investigative thesis seeks to contribute to the understanding of how disparities in the planning, design, and placement of clinical trials perpetuate global health inequities. It will analyze the misalignment between the global burden of disease and research priorities, examining the systemic factors that determine which diseases are prioritized for trials. It will highlight the bioethical and human rights implications of gender exclusion, particularly the underrepresentation of women with HIV, in clinical research. By addressing both the upstream determinants of clinical trial planning and the downstream consequences of exclusionary practices, this work offers a comprehensive critique of the structural inequities …

A Pilot Rct Of Mhealth & Chw Intervention For Art Adherence, Shivesh Shourya

Public Health Theses

Despite the availability of antiretroviral therapy (ART), only 66% of people with HIV in the U.S. achieve viral suppression, often due to suboptimal ART adherence. Barriers such as limited access to care and forgetfulness impact adherence, which must be ≥95% to prevent viral rebound. Combining community health worker (CHW) support with mobile health (mHealth) technologies may help address these barriers and improve outcomes. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of the remotely delivered Community Health Worker and mHealth to Improve Viral Suppression (CHAMPS) intervention, which combines the WiseApp, CHW support, and the CleverCap smart pill bottle. …

Effectiveness Of Wolbachia Introgression On Dengue Incidence In A Complex Urban Environment, Karthika Satyanarayanan

Public Health Theses

Dengue is an arboviral disease of increasing global public health importance for which more than half the world’s population is at risk. The burden of dengue has increased greatly in the last decade; in 2024, over 14 million cases and 10,000 dengue-related deaths were reported, marking a historical milestone. The endosymbiotic bacterium Wolbachia (wMel strain) offers a promising alternative to traditional control methods through its reduction of Aedes aegypti vector competence and introgression into wild Ae. aegypti populations. This thesis evaluated the dynamics of Wolbachia introgression and its effect on reducing dengue incidence up to 31 months after the completion …

Under-Five Malaria And Malnutrition Syndemic In Rajasthan, Nandini Sinha

Public Health Theses

Background: The syndemic of severe acute malnutrition (SAM) and malaria in under-five children in Rajasthan presents a critical public health challenge. Current SAM and malaria programs are implemented as siloed interventions despite the potential benefits of integrated approaches. A better understanding of the interactions between these factors is important to strengthen the delivery of integrated services.

Objective: This study investigates the relationship between under-five SAM and malaria infections at the block level in Rajasthan to inform targeted, integrated interventions. By running regression analysis, we will identify associations between these co-occurring health threats to guide state-level policy integration. To the best …

A Framework For Icu Culture In Australia & New Zealand, Smriti Sukesh Kumar

Public Health Theses

Organizational culture is increasingly recognized as a fundamental determinant of operational performance and clinical outcomes in healthcare, particularly within high-acuity settings such as Intensive Care Units (ICUs). Despite a growing body of international literature affirming this relationship, there is a paucity of context-specific evidence on the role of organizational culture within ICUs in Australia and Aotearoa, New Zealand. This absence has constrained the capacity of health systems in these regions to design and implement culture change interventions tailored to local realities. In response to this gap, this thesis offers a conceptual framework that maps domains of organizational culture hypothesized to …

Social Media Influences On Youth Substance Use, Sexual Health, And Mental Health In Paterson, New Jersey: A Rapid Qualitative Analysis, Nimisha Srikanth

Public Health Theses

Introduction: Social media use among youth has become a topic of concern among public health professionals and policymakers. Youth have grown to rely on social media for communication and entertainment, but are exposed to negative health behaviors with the potential to model them in their lives. In this study, we investigated youth’s perspectives on social media content and the impact it has on their health and lives.Methods: We conducted a rapid qualitative analysis of individual interviews of youth from Paterson, New Jersey. Among the sample (n=20), the mean age was 16 years, 80% identified as male, and 30% were justice-involved. …

Impact Of Pcv10 On Pediatric Pneumonia In Nepal, Katie Steimel

Public Health Theses

Pneumococcal conjugate vaccines have significantly reduced pneumonia cases, hospitalizations, and deaths worldwide. This study evaluates the impact of 10-valent pneumococcal conjugate vaccine (PCV10) eligibility on pediatric pneumonia hospitalizations in Nepal using administrative hospital data from three major geographically and administratively diverse hospitals. A controlled interrupted time series design was used comparing pneumonia hospitalizations with diarrhea hospitalizations, under the assumption that PCV10 would not influence diarrhea hospitalization rates. A secondary model stratified hospitalizations by age group, assessing differential trends based on vaccine eligibility. Generalized linear models with quasipoisson distributions were used, adjusting for hospital and seasonality.The primary model comparing pneumonia to …

Youth Views On Health Content, Ads, And Messages On Social Media, Christina Tong

Public Health Theses

This study aims to investigate youth perspectives on nutrition and healthism-related content, promotions, and messaging on social media. With the growing usage and impact of social media, especially in younger generations, it is important to recognize how social media may influence types of exposures and messaging of nutrition, weight management, and supplement-related content that youth are exposed to, which can, in turn, influence their perceptions on health and healthy lifestyles. These perspectives can then initiate engagement in helpful or harmful health behaviors. Through a qualitative analysis of focus group and interview responses of 29 Massachusetts teenagers, emerging themes were about: …

Mental Health Stigma As A Barrier To Mental Health Care For Black Youth & Young Adults: A Scoping Review, Sanaa Amaya Walker

Public Health Theses

Mental health stigma presents a significant barrier to mental health care access for Black youth and young adults, contributing to disparities in mental health service utilization in Black communities. This scoping review examines the current literature on mental health stigma as a barrier to care within Black communities, with specific focus on experiences of young Black people aged 25 and under. Review of twelve studies revealed multidimensional stigma manifestations: intrapersonal (characterized by self-reliance tendencies, shame, and secrecy), interpersonal (influenced by peer and caregiver attitudes), and structural manifestations of stigma, and stigma interventions. The findings highlight critical gaps in existing research …

Cross-Sectional Study On The Distribution And Epidemiology Of Plasmodium Ovale Species In Asymptomatic And Symptomatic Individuals In Gulu, Uganda, Xiaohan Xu

Public Health Theses

Despite global progress in malaria control, Plasmodium ovale remains an under-recognized contributor tothe malaria burden in sub-Saharan Africa. Its ability to form dormant liver-stage hypnozoites enables silent, recurrent transmission that often escapes detection by routine diagnostics. This cross-sectional study investigated the prevalence, species distribution, and clinical profile of P . ovale infections in Gulu, Uganda, comparing asymptomatic individuals from the community to symptomatic patients presenting at Gulu Regional Referral Hospital. Molecular diagnostics, including qPCR, nested PCR, and hemi-nested PCR, were used to detect and differentiate P . ovale curtisi and P . ovale wallikeri. Geographic sampling was conducted across 33 …

Risk Factors Of Respiratory Syncytial Virus (Rsv) Infection In Infants: A Study Using New York State Inpatient And Outpatient Databases, Mengjing Yang

Public Health Theses

Respiratory syncytial virus (RSV) infection is the main cause of respiratory diseases in infants, but the sociodemographic differences in RSV risk have not been fully understood for New York State infants within the first two years of life. This study aims to investigate the distribution and risk factors of respiratory syncytial virus infection in infants and young children under 2 years old in New York State.We conducted a retrospective cohort study using the data from the New York State Inpatient Database (SID) and the State Emergency Department Database (SEDD) from 2016 to 2019. Analyze sociodemographic characteristics, including birth weight, gender, …

Temporal Analysis In Connectivity Structure Of Human Disease Co-Occurance Network, Jingxuan Xu

Public Health Theses

Recent research on human disease networks (HDNs) has revealed the importance of jointly analyzing multiple diseasesand their interconnections, yet many existing approaches focus on molecular-based data and do not fully capture non-molecular relationships. Building on the concept of the phenotypical HDN, we leverage Medicare inpatient claims data to construct a comprehensive disease co-occurrence network. In our framework, two diseases are deemed interconnected if their observed probability of co-occurrence significantly deviates from that expected under independence. We adopt the weighted gene co-expression network analysis (WGCNA) framework to build our network, using a ϕ-correlation measure and a hard threshold to ensure a …

Characterization And Survival Outcome Of Missing Ecog Performance Status In A Real-World Cohort Of Advanced Non-Small Cell Lung Cancer Patients, Yuanqing Zhang

Public Health Theses

BackgroundThe Eastern Cooperative Oncology Group (ECOG) performance status (PS) is a critical factor in treatment decisions and prognosis for advanced non-small cell lung cancer (NSCLC). However, documentation gaps exist in clinical practice. The characteristics of patients with missing ECOG PS and the prognostic implications of this missingness are poorly understood. This study aimed to identify demographic and clinical predictors associated with missing ECOG PS documentation and to evaluate whether missing ECOG PS is associated with overall survival (OS) in a large real-world cohort of advanced NSCLC patients.

MethodsThis retrospective cohort study utilized the Flatiron Health electronic health record-derived, de-identified database. …

Dnabert Reveals Tf Motifs Information In Dna With Attention, Zetong Zhao

Public Health Theses

Traditional motif discovery tools often do not capture cooperative interactions between transcription factors (TFs). This study employs DNABERT, a transformer-based deep learning model, to analyze TF binding sites (TFBS) using attention mechanisms and k-mer tokenization. Fine-tuned on ENCODE ChIP-seq data, DNABERT achieved high predictive accuracy and could identify co-binders such as FOS and JUND through motif enrichment analysis. The model inferred position weight matrices (PWMs) aligning with JASPAR motifs and highlighted the regulatory importance of sequences near gene start regions. Comparisons with BPNet showed strong correlations, which validated DNABERT’s ability to capture TF-specific patterns. While constrained by dataset biases and …

Nativity Status And Tobacco Use Among Hispanic Adults In The Us, Siyan Zhou

Public Health Theses

Background: Tobacco use is the leading cause of preventable mortality. Understanding the consumption patterns of cigarettes and e-cigarettes, two of the most prevalent and harmful tobacco products, is important for population health. Furthermore, as the nation's largest racial or ethnic minority group, the Hispanic population faces tobacco-related disparities despite overall low prevalence of tobacco use. Since the Hispanic population is not homogeneous, it is important to disaggregate it by ancestry and nativity status to better guide policy and targeted interventions.

Methods: The 2022 September Tobacco Use Supplement to the Current Population Survey (TUS-CPS) included 37,540 participants in the US. Rao-Scott …

Exploring Harm Reduction In Treatment: A Qualitative Study Of Methods And Perceptions Among People In Substance Use Disorder Care, Carson Francis Ferrara

Public Health Theses

Amidst the ongoing opioid epidemic and rising overdose deaths, substance use disorder (SUD) treatment has historically prioritized abstinence over harm reduction, creating gaps in patient safety. This qualitative study explores harm reduction integration in formal treatment settings and participant perceptions through 48 semi-structured interviews with individuals enrolled in Project RENEW, a larger cohort study examining factors influencing people in treatment for alcohol use across Connecticut and Georgia. Participants (79% inpatient, 51% court-mandated) described their experiences with harm reduction methods and safety strategies while in treatment. Thematic analysis revealed four key findings: 1) inconsistent access to resources like naloxone and fentanyl …

Effect Of The Lifestyle, Exercise And Nutrition (Lean) Weight Loss Intervention On Stress Among Breast Cancer Survivors, Wenxin Gu

Public Health Theses

Background: Stress, experienced by over one-third of breast cancer survivors, not only leads to significant symptoms and mental health issues, but also increases the risk of breast cancer recurrence and impacts survival. While weight loss lifestyle interventions have been effective in helping breast cancer survivors with obesity lose weight and potentially enhance survival, their impact on stress levels has been inconsistent. The aim of the secondary analysis was to evaluate the effects of a 6-month diet and exercise weight loss intervention on perceived stress in breast cancer survivors.Methods: Breast cancer survivors with a BMI of 25.0 kg/m2 or higher (n=151) …

Environmental Justice Dimensions Of Orphaned Oil And Gas Wells In The United States, Grace Marie Hauser

Public Health Theses

Orphaned oil and gas (O&G) wells can leak methane and other hazardous pollutants,contributing to air and water contamination that threatens public health while also imposing financial burdens on local governments and taxpayers for remediation. However, the environmental and public health impacts remain understudied, in part due to limited understanding of the number and location of orphaned O&G wells. In this thesis we aimed to (1) create a national orphaned wells dataset covering years through 2024, (2) estimate the count and distribution of orphaned wells in the United States through 2024, and (3) evaluate the association between community environmental justice (EJ) …

Comparative Effectiveness Of Digital Breast Tomosynthesis And Digital Mammography In Detecting Invasive Lobular Carcinoma And Smaller Tumors Among Older Women, Sida Huang

Public Health Theses

AbstractBackground: Digital breast tomosynthesis (DBT) has demonstrated improved cancer detection and reduced false-positive and recall rates compared with digital mammography (DM) alone in trials of women aged over 50. However, its benefits for older women remain uncertain. We hypothesized that among women aged 67+, breast cancer detected via DBT are more likely to be invasive lobular carcinoma (ILC) and present at a smaller size at diagnosis, and this association persists among women aged 75+. Additionally, we hypothesized that DBT detects ILC at a smaller tumor size. Methods: We conducted a retrospective cohort study of women aged 67+ with screen-detected ER+/HER2- …

Environmental Gentrification And Health: An Exploratory Analysis Of New York City, Joyce Hu

Public Health Theses

Background: Environmental gentrification is an emerging field seeking to understand the integrated effects of environmental improvements and gentrification. To date, we have a limited understanding of how to analyze environmental gentrification with intersecting health impacts. Our exploratory study investigates this relationship in New York City, where environmental improvement policies coincided with gentrification between 2000-2016. Methods: Using a census tract-level index of gentrification and corresponding environmental exposure data on air quality and vegetation, we conducted a clustering analysis to group and label census tracts according to environmental gentrification patterns. We then performed covariate-adjusted multivariable regression analyses to evaluate the association between …

Effect Of The Lifestyle, Exercise, And Nutrition Weight Loss Intervention On Depressive Symptomatology Among Breast Cancer Survivors, Ziyuan Ma

Public Health Theses

Background: Breast cancer patients have up to a five-fold higher risk of depression compared with the general population, with an estimated prevalence of depressive symptoms of 25%. Depressive symptoms among breast cancer patients can affect treatment adherence, quality of life, and mortality. Some studies indicate lifestyle interventions can lower depression symptoms in general population samples; however, few studies have examined changes in depression among breast cancer survivors enrolled in lifestyle interventions. The purpose of this study was to examine the effect of a 6-month diet-and exercise-induced weight loss intervention versus usual care on depressive symptomatology among breast cancer survivors.Methods: 151 …

Respirable Crystalline Silica In Stone Countertop Fabrication, Caitlin Mcgowan

Public Health Theses

Background: Artificial stone, a synthetic product that typically contains >90% silica mixed with resins and dyes, has become highly popular for kitchen and bathroom countertops. Meanwhile, silicosis outbreaks in workers who fabricate and install artificial stone countertops are increasingly being reported worldwide and in the US. Our objective is to better characterize work processes and exposures to respirable crystalline silica (RCS) among these workers in the United States. Methods: In collaboration with the Natural Stone Institute and the International Surface Fabricators Association, both trade organizations that represent the stone industry, an online survey was administered to stone countertop fabrication shops …

Life Satisfaction In Justice-Involved Opioid Users, Cassandra Michel

Public Health Theses

Life satisfaction—an individual’s overall evaluation of their life, including their feelings and attitudes toward it—has been linked to a range of psychological and physical health outcomes. While numerous studies have examined the factors associated with life satisfaction across various populations, such as healthy young and older adults, limited research has focused on individuals with substance use disorders or those involved in the criminal justice system. This study explored the relationship between psychosocial and structural factors and life satisfaction among justice-involved individuals with a history of opioid use disorder. Using cross-sectional survey data from a sample of 372 participants, I conducted …

Influenza Vaccine Coverage, Effectiveness, And Disease Burden Among Pediatric Sickle Cell Patients In Connecticut From 2021-2024: A Test-Negative Case-Control Study, Precious Nchekwube

Public Health Theses

Background: Vaccination is the primary strategy to reduce influenza burden. Limited data exist on the burden of influenza, vaccine coverage, and seasonal influenza vaccine effectiveness (VE) in children and adolescents with sickle cell disease (SCD).

Aim: To evaluate influenza vaccine coverage, effectiveness, and disease burden among pediatric and adolescent patients living with SCD for the 2021-2024 influenza seasons in Connecticut, USA.

Methods: This was a retrospective, test-negative case-control study to estimate influenza VE against laboratory-confirmed influenza infections among children 6 months to 21 years of age across 2021-2022, 2022-2023, and 2023-2024 influenza seasons (August 1, 2021, to July 31, 2024) …