Digital Commons Network^™

Global Routine Immunization Policies For Refugees, Jad A. Elharake

Public Health Theses

BackgroundIn 2020, approximately 26 million refugees resettled in a new country—fleeing their homes due to conflict, persecution, violence, and human rights violations. Refugees often migrate from developing countries with limited access to adequate health care, routine immunizations, and public health resources. Because of low immunization coverage and potentially underlying health conditions, including stress, trauma, overcrowding during transit, poor hygiene and sanitation services, and malnutrition, refugees face a greater risk of contracting vaccine-preventable diseases (VPDs). This presents a key public health challenge and ethical imperative to serve the health needs of refugees resettling each year.

ObjectiveThe purpose of our study was …

Extreme Heat Vulnerability And Spatial Accessibility To Cooling Centers In Connecticut, Nicholas Elton

Public Health Theses

Extreme heat is becoming an increasingly prevalent and prominent environmental health issue under climate change. The goal of this study is to evaluate heat vulnerability at the census tract level in the state of Connecticut and assess the spatial accessibility to cooling centers – an extreme heat intervention. A variety of environmental and sociodemographic variables related to heat and health were identified based on previous literature and used in a varimax-rotated principal component analysis to reduce dimensionality and identify key components that constitute a heat vulnerability score. In addition, cooling center locations were identified based on news media and a …

Sexual Orientation Disclosure And Depression Among Thailand Men Who Have Sex With Men: Associations With Intimate Partner Violence And Social Support, Eduardo Encina

Public Health Theses

Objectives: The analytical goal of this project is to better understand the association of sexual orientation disclosure among different social networks of Thailand men who have sex with men (MSM) and depression. Along with this, we aim to extensively explore the intersectional influence of social support and intimate partner violence (IPV) experiences with each other, with disclosure, and ultimately depression outcomes.

Methods: The secondary dataset for this project was comprised of results from a cross-sectional study. This study utilized a web-based epidemiological and behavioral survey, distributed among young MSM ages 15-24. Self-reported data was provided through collaboration with Mahidol University …

Quantification Of Anesthetic And Analgesic Compounds In E-Liquids And Their Aerosols, Deyri Sugey Garcia

Public Health Theses

The unprecedented rise of vaping has resulted in gaps of scientific understanding of the health hazards this new phenomenon has created, as well as delayed regulations surrounding vape products, including coolants. Coolants are additives that create anesthetic, physical sense-reducing, and/or analgesic, properties that numbs the airways and add a minty flavor to vape products. However, it is unclear how much coolant is added to vape products electronic liquid (e-liquid), and how much of this content carries over into the aerosolized vaped form. To determine compositional analysis and carryover of common synthetic coolants, eugenol in 35 clove e-liquids and menthol, methone, …

How Knowledge, Perception, And Identity Influence Covid-19-Related Concerns In The Built Environment, Abigail Ginader

Public Health Theses

Background: There is increasing research exploring how different diverse and intersecting identities based on race, gender, ability/disability, sexual orientation, and age interact with space to influence an individual’s inclusiveness and comfort in a space. This is particularly salient in the context of COVID-19 which has shown large health inequities and increased risk for certain vulnerable subgroups (e.g., older individuals, individuals of color).Objective: To assess end users’ perception of COVID-19 safety in the built environment of museums. Methods: A cross-sectional study design was used. An electronic survey was distributed between January and February 2021. Repeated measures ANOVA, multivariate Poisson regression, and …

Dreamkit: An Innovative Mobile Health Intervention For Addressing Youth Homelessness, Eva G. Graf

Public Health Theses

Background: Homeless youth experience a variety of barriers to becoming employed and ending their episode of homelessness. DreamKit is a mobile intervention designed to help youth exit their episode of homelessness by paying them to upskill themselves and become more qualified for employment. This thesis explores the feasibility and usability of a mobile application intervention among homeless and housing insecure youth in the greater New Haven area.

Methods: We used a multiple-methods study design that included a formative research phase where we explored whether or not an app would be used by housing-insecure youth; a second pilot phase was included …

Exploring Toddler Sleep Disparities Using Spatial Analytic Methods, Jessica He

Public Health Theses

Introduction: Sleep health is a vital component of childhood health. However, sleep health disparities exist among toddlers from racially/ethnically diverse families living with socioeconomic adversity as early as 12 months of age. There is a gap in the current literature that includes environmental factors that may explain the factors contributing to these differences.Objective: To explore associations between toddler sleep health and environmental and societal factors at the neighborhood level using spatial analysis that may help elucidate factors which contribute to the race/ethnicity differences in toddlers unexplained by socioeconomic variables. Methods: A secondary analysis was performed on data collected from a …

Transcriptomic And Metabolomic Analyses Of Acetaminophen Exposure In Human Ipscs: Potential Mechanisms Explaining Epidemiological Associations Between Prenatal Acetaminophen Exposure And Increased Risk Of Autism Spectrum Disorder, Tristan Furnary

Public Health Theses

Acetaminophen (APAP) is the most common analgesic taken during pregnancy. Indeed, approximately 65% of pregnant women use the drug. Recent epidemiological studies suggest that prenatal exposure to APAP is associated with increased risk of autism spectrum disorder (ASD). Although this neurodevelopmental disorder affects 1 in 54 children in the U.S., no studies have investigated the molecular mechanism by which APAP may increase the risk of ASD. In vitro experiments in cell cultures have shown that high concentrations of APAP induces cell death. Through the use of a systems-level approach in human induced Pluripotent Stem Cells (iPSCs), the present study investigates …

‘I’M Never Saying A Damn Word Again’: Approaches To Community Support And Help Seeking Among Black Youth Experiencing Suicidal Thoughts, Alexis Renee Hopkins

Public Health Theses

Background. Suicidal behavior among Black youth is rising in the United States , yet little is known about how Black Youth engage and navigate suicidality. While we know that suicide ideation and death by suicide is decreasing overall among youth in the U.S., incidences of death by suicide are still rising among Black youth. There is very little understanding of what community support is accessible to Black youth who are experiencing suicidality. The present study examines how Black young adults who experienced suicidality in their youth turned to their social support systems and communities for support. Method. Seventeen semi-structured in-depth …

A Source-Specific Algorithm To Estimate Occupational (1→3)-Β-D-Glucan Exposure For Farmers In The Biomarkers Of Exposure And Effect In Agriculture Cohort, Felicia Hung

Public Health Theses

Background: (1→3)-β-D-glucans, or simply known as glucans, are components of fungal cell walls and are associated with mold. The adverse health effects due to glucan inhalation exposure has not been well studied, but it is known that upper respiratory inflammation has been seen with glucan exposure. Farmers, especially those who work with animals, are exposed to glucans on a daily basis; however, there is no occupational exposure limit to glucans and the full extent of glucan exposure in this population is unclear due to the lack of exposure assessment. This study will utilize decision-rules and a source-specific method to create …

Key Trends In Digital Health And The Future Of Clinical Trials In The Us, Jeannette Jiang

Public Health Theses

With the increasing burden of chronic diseases on the global population, many stakeholders see digital health technologies and devices as potential solutions to improve patient self-management of their disease and offer novel treatment methods. Digital health solutions including mobile apps, web-based programs, texting, and connected devices have been applied to a wide variety of diseases. In recent years, interest in digital health technologies has exploded with almost 200 digital health related articles published in PubMed in 2019 alone. In particular, digital health holds great potential in improving and enhancing the traditional clinical trial by increasing patient recruitment and retention and …

Developing A Cost-Effectiveness Analysis Plan For A Virtual Diabetes Prevention Program, Roujia Jin

Public Health Theses

Background: Diabetes is one of the major health concerns in the US. According to the National Diabetes Statistics Report, about 13% adults in the U.S. had diabetes, and 34.5% of the U.S. adults were categorized as prediabetic. An estimated cost of $327 billion were reported as relevant to diagnosed diabetes in 2017 in the United States by the American Diabetes Association. The virtual Diabetes Prevention Program (vDPP) was designed to address barriers that low social-economic status participants faced when they were enrolled in a diabetes prevention program. It used a digital platform to deliver courses, organize meetings and monitor health …

Psychosocial Mechanisms Of Historical Trauma Transmission In Native American Communities: A Rapid Scoping Review, Rucha Kandlur

Public Health Theses

For centuries Native American communities have been subjected to persistent oppression. The effects of the historical events of colonization have transcended generations and continue to affect the lives of the current generation, removed from direct exposure to the traumatic events. The intergenerational transmission of trauma has widely been studied in Holocaust survivors, with only recent explorations in other marginalized populations incurring similar forms of trauma. Additionally, explorations in intergenerational trauma transmission have largely focused on biological mechanisms rather than the psychosocial mechanisms. The purpose of this study is to examine existing evidence regarding psychosocial mechanisms of intergenerational transmission of historical …

The Impact Of Covid-19 On Backyard Poultry-Associated Salmonella In Connecticut, Laura Kasper

Public Health Theses

Introduction: Salmonellosis is the second leading bacterial foodborne illness in the United States, and is mainly characterized by symptoms of gastroenteritis and their consequences in afflicted individuals. Salmonella accounts for 1.35 million infections, 26,500 hospitalizations and 420 deaths in the United States every year. Live poultry act as a reservoir of Salmonella and causes an annual national outbreak. There has yet to be a published study on the impact of COVID-19 lockdowns on the incidence of Salmonella and on the percentage of cases tied to the national poultry outbreak. Methods: Active public health surveillance of Salmonella in Connecticut is conducted …

The Impact Of Economic Intimate Partner Violence On Women’S Sexual And Reproductive Health In Asia & The Pacific, Marina Katague

Public Health Theses

Intimate partner violence is a human rights violation and serious threat to global public health. Economic intimate partner violence is a unique form of abuse whose effects on health need clarification. Data from the 2011-2012 UN Multi-country Study on Men and Violence, comprised of cross-sectional samples in China, Papua New Guinea, and Sri Lanka were collected on ever-partnered women aged 18-49 years. The sample averaged some (1.14) economic violence exposure across summed behaviors (range 0-12; standard deviation=2.04). Multivariable regressions were run to assess the relationship between severity of IPV abuse types and 14 sexual and reproductive health outcomes. Adjusted analyses …

Factors Associated With Early Childhood Development Outcomes For Children Of Adolescent And Young Adult Mothers In Brazil, Lily Benson Kofke

Public Health Theses

Objectives: A descriptive analysis to explore the risks for early childhood development (ECD) delays among children of adolescent and young adult mothers in Brazil. Methods: A secondary analysis of cross-sectional data of a representative sample of children under age 2 and their mothers from community health centers in Brasília, Brazil. The Denver Developmental Screening Test II was used to assess overall and domain-specific ECD (personal-social, fine motor, gross motor, and language). Mothers were subset into two groups based on age. Bivariate analyses and multivariable logistic regressions were used to examine the associations between maternal age and risk of ECD delay, …

An Exploration Of Race Differences In Network Exposures To Mass Incarceration, Jessica Lee

Public Health Theses

A growing literature suggests that mass incarceration impacts not only the individual who is incarcerated, but also their partners, family members, and children. However, few studies have examined race differences in network exposure to mass incarceration. This study explores associations between race and various measures of network exposure to incarceration: relationships, interactions with the criminal legal system, and housing. We draw on data from the 2017-2018 baseline survey from the Justice, Housing, and Health Study. Descriptive statistics show that Black respondents are more likely to experience each event we examined compared to whites, except for parental incarceration and receiving threats …

The Associations Between Circadian Genetic Factors And Cancer Survival, Bingqing Li

Public Health Theses

The circadian rhythm controls a range of important biological behaviors with a 24-hour cycle. The mammalian biological clock is a layered network of vibrators with a master clock locating in the neurons of suprachiasmatic nucleus (SCN) in the hypothalamus and a set of core and related circadian genes. Several lines of evidence from previous studies suggested the relationships between tumorigenesis and circadian rhythm disruption. However, the effects of circadian genetic factors in cancer survival remains uncertain. Therefore, it is important to review and explore the circadian genetic factors which might be linked to cancer survival. This paper aimed to evaluate …

Gene-Gene Interactions Contributing To Asthma Susceptibility, An Exploration Using Uk Biobank Dataset, Yuyuan Lin

Public Health Theses

Background: Previous studies have attempted to identify gene-gene interactions for asthma. However, most of these studies suffered from lack of replication or insufficient statistical power. In this study, we aimed to explore the gene-gene interactions affecting asthma susceptibility and tried to replicate the results. Both the discovery and replication datasets were nested in UK Biobank data.

Methods: Nested case-control design was used. In the discovery analysis (N= 306,859, cases = 35,483, controls = 271,376), Univariate genome-wide association analysis was performed to prioritize loci for the interaction analysis. Pairwise search for epistasis was conducted among 5,389 SNPs. Replication of the top …

Public Health And Natural Gas Policy In Connecticut, Cheyenne Liberti

Public Health Theses

Due to its adverse impacts on public health via contributions to global climate change and emissions of toxic substances throughout the life cycle, natural gas use should be eliminated as quickly as possible in Connecticut. This project aims to 1) identify the policies and programs concerning all stages of the natural gas life cycle, in and affecting Connecticut; 2) evaluate the capacity of these policies and programs to mitigate public health hazards, promote environmental justice, and achieve rapid elimination of natural gas use; and 3) recommend policy and program alternatives that would accomplish these goals in a more timely manner. …

The Impact Of Ww’S Multi-City Fvrx Program On Children, Damaris Lopez Mercado

Public Health Theses

Introduction and background: Higher F&V intake are associated with healthier BMI in children, but cost of F&V has been found to be a barrier to access for some families. To mitigate this barrier, Wholesome Wave (WW) implemented a six-month F&V incentive program that included a $25 weekly financial incentive for families to spend on F&V in three U.S. cities. The primary objectives of this paper are to assess whether this program significantly impacted child F&V consumption and child anthropometry from baseline to end-of-program and to assess whether F&V intake and food insecurity and end-of-program are significant predictors of healthy child …

Analyzing The Restriction Of Mass Gatherings And School Closures/Reopening In China And Iran During The Covid-19 Pandemic With A Public Health Ethics Framework, Esther Luo

Public Health Theses

The COVID-19 pandemic has undoubtedly elevated the status of public health. Concurrently, public health ethics has been brought to the forefront of the field and its practices in several ways. Over the past year, SARS-CoV-2 has affected nearly every country. In both high and low resource settings, policymakers turned to public health to ease the tension placed on health care systems by COVID-19. Governments implemented measures ranging from lockdown orders to mask mandates, all with the primary goal of curbing the spread of SARS-CoV-2. The effectiveness of these interventions has become a salient topic in public health research, and much …

Determinants For Approval And Reimbursement Of Orphan Products In China, Wenlan Mao

Public Health Theses

Rare disease definition varies among countries/regions. China has published The First National List of Rare Diseases, including 121 kinds of rare diseases in 2018. It was the first time that China has defined rare diseases officially. China has also started releasing a range of encouraging regulations regarding orphan drug development and approval in recent years. Nevertheless, the FDA has introduced Orphan Drug Act in the 1980s, Japan has launched a government-led support initiative in the 1990s, and the European Parliament has adopted the Orphan Regulation in 2000. Among the 121 rare diseases, 58 of them have approved treatments in the …

Co-Distribution Of Ambient Light At Night And Incidence Of Human Cancers And Covid-19, Yidan Meng

Public Health Theses

Introduction and BackgroundThere are increasing concerns about the effects of artificial lights on human health, including hormone-related disease and immune functions. In January 2020, the outbreak of COVID-19 disrupted everyone’s life, and people who infected have various severity. Thus, we want to analyze whether people exposed to different ambient light at night (LAN) levels make them more susceptible to COVID-19 for our summer research. Besides the effects of LAN on immune functions, we also discussed the association of LAN and multiple cancers in seven states of Northeastern U.S. We used similar statistical and geographic analysis methods and separate them into …

Economic Evaluation Of The Preventing Childhood Obesity Through Mindfulness-Based Parent Stress Intervention, Jingyi Meng

Public Health Theses

This study analyzed the intervention cost of a novel early childhood obesity prevention program -- Preventing Childhood Obesity Through a Mindfulness-Based Parent Stress Intervention (PMH+N) conducted by Yale Stress Center. The randomized clinical trial started from 11/01/2018 and will enroll 240 participants in total. Parents were included in the trial if they had: a child in the 2- to 5-year age group, a body mass index (BMI) over 28 kg/m2, high levels of perceived stress as assessed by the Perceived Stress Scale (PSS) (score >25) and were able to read and write in English. For 12 weeks, about 13 parents …

Impact Of Health Care Access On Delayed Or Missed Adolescent Vaccinations For Tdap, Meningococcal, And Hpv Vaccines Among U.S. Adolescents, Nis-Teen 2018, Maura Iko Nakahata

Public Health Theses

Background: Adolescent vaccination coverage varies considerably between Tdap, meningococcal, and HPV vaccines. While evidence suggests that health care access affects vaccination coverage, evidence does not explain whether access drives delayed or no vaccination. This study evaluates whether measures of health care access are associated with delayed vaccination or not being vaccinated by age 17 years for Tdap, meningococcal, and HPV vaccines when controlling for sociodemographic factors as proxies for vaccine hesitancy. The secondary objective assesses whether health care access measures had consistent associations across the different vaccines. Methods: Using current ACIP recommendations, ‘on-time’, ‘delayed’, and ‘missed’ status by age 17 …

(De)Constructing The Grocery Store: An Ethnographic Examination Of Spatial Characteristics And Their Implications For Social Inclusion, Madeline Hoai Chau Nguyen

Public Health Theses

I acknowledge that this research was conducted on land stolen from the Mattabesic, Paugusett, and Schaghticoke tribes which is currently occupied by a Western colonial power.

This study examines the physical characteristics of the interior of New Haven grocery stores and how these are designed to socially include or exclude racial minorities. Drawing upon critical race theory and using ethnographic research methods, I analyze similarities and differences amongst selected independent American and Asian grocery stores and how they communicate their cultural values to various social groups. Even if it is not explicit, white supremacist values are embedded in these spaces. …

Impact Of Covid-19 On Participants Of A Fruit And Vegetable Program, Christabelle Ong

Public Health Theses

Objective: To investigate the impact of COVID-19 on the participants of a multi-city fruit and vegetable incentive program.Design: A six-month cohort study was conducted. Pre-program and post-program data were collected using an online survey platform. Setting: Eight cities across the United States. Participants: A total of 822 individuals were recruited through local site partners to participate in a fruit and vegetable incentive program (n=822; 79.4% women, 20.6% men; median age: 57 years old). Intervention: Participants received $50 monthly fruit and vegetable vouchers, a sneaker gift card or gift basket, and access to a weight loss app. Main Outcome Measures: The …

The Role Of Histone Demethylase Kdm6a In Mouse Coronavirus Infection, Sonam Patel

Public Health Theses

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of acute respiratory coronavirus disease 2019 (COVID-19), a disease that erupted into a global pandemic in March of 2020.2 Recently, a genome wide CRISPR screen was performed on SARS-lineage coronaviruses and two additional recombinant viruses; the screen revealed host genes essential to coronavirus pathogenesis and entry.7 The screen identified KDM6A, a histone demethylase, as an important pro-viral gene.7 Building upon this observation, in this thesis, I explore the role of Kdm6a in murine hepatitis virus (MHV), a type of mouse coronavirus. MHV is the prototypical model for studying SARS-CoV-2 …

An Examination Of The Multilevel Determinants Of Homelessness, Ashley Brooke Roehrig

Public Health Theses

Objectives: This project aimed to explore factors contributing to homelessness within Fairfield County, Connecticut in order to understand how to develop prevention services that best match the population’s needs.

Methods: This project draws on data collected from a qualitative study done by Supportive Housing Works, where researchers conducted 2 focus groups and 44 semi-structured interviews with individuals experiencing homelessness or housing instability in Bridgeport, CT. Participants were recruited by posting flyers, as well as referrals from programs such as Prospect House, and other Opening Doors Fairfield County (ODFC) partner agencies. Eligible participants had to be registered with the Homeless Management …