Digital Commons Network^™

Self-Directed Behavioral Interventions For Health Promotion Among Graduate Students, Chelsea Brett

Public Health Theses

Background: Graduate school environments are recognized for contributing to elevated stress levels among student populations, particularly when compared to their non-academic peers. Graduate school settings can subsequently foster maladaptive coping strategies among students, including self-isolation, poor nutrition choices, engaging with less physical exercise, and substance misuse. Self-stigma related to mental health care may additionally discourage students from seeking mental health treatment. The objective of this study was to explore whether self-directed behavioral interventions, delivered in the context of a course on behavior change, are effective in promoting health among this population. Prior studies have shown that self-directed behavioral interventions can …

Associations Between Campus Bathroom Use And Mental Health Among Gender Minority And Cisgender Students, Antonia Caba

Public Health Theses

Introduction: Gender minority individuals, including university students, experience worse mental health compared with cisgender individuals. Although there are many factors that may shape these mental health disparities, inequitable bathroom access is one known factor. Therefore, the purpose of this thesis is to explore how campus bathroom use influences the mental health of gender minority students compared with cisgender students. Specifically, this study examines how discordance in bathroom preference and bathroom use is associated with mental health.

Method: This was a cross-sectional online study administered across three universities in the United States. Participants (N=120) completed an online survey. Respondents answered questions …

The Health Action For Psychiatric Problems In Nigeria Including Epilepsy And Substances (Happiness) Project: A Preliminary Mixed-Method Evaluation, Casey Jia-Chyi Chu

Public Health Theses

Background: The Health Action for Psychiatric Problems in Nigeria Including Epilepsy and Substances (HAPPINESS) Project is a mental health capacity building intervention based in Imo State, Nigeria that incorporates the World Health Organization’s Mental Health Gap Action Programme (mhGAP). So far, the HAPPINESS Project has trained 36 primary care workers (doctors, nurses, and community health extension workers) in one initial training (covering 5 local government areas) and one refresher training. The goal of this project is to leverage Imo State’s widespread primary care network, to address gaps in access to mental health care.

Objective: To evaluate the impact of the …

Effect Of Antiretroviral Drug Dolutegravir On Mitochondrial Function, Anthony Chui

Public Health Theses

Background: Though antiretroviral therapy (ART) regimens have become progressively less toxic, ART-associated toxicity is still pervasive. Dolutegravir (DTG) is an HIV integrase strand transfer inhibitor (INSTI), a class of antiretrovirals that are generally well-tolerated by patients. However, in the clinic there are reports of unexpectedly high rates of toxicity in cohorts of pregnant women such as neural tube defects, and in older patients’ adverse effects such as neuropsychiatric disorders. We hypothesized that these adverse effects could be due to DTG-induced mitochondrial toxicity in the central nervous system.

Methods: Human neuroblastoma cells were treated with ART regimens that are currently considered …

Household Risk Factors For Malaria Among Children Under 10 In Southwest Burkina Faso, Mckenzie Colt

Public Health Theses

Malaria transmission occurs both indoors and outdoors, and housing and peri-domestic characteristics have been associated with higher risks of malaria. Previous research in Burkina Faso has demonstrated that vector density within households varies greatly, though contributing factors are less clear. In the context of a cluster-randomized trial in a rural region of southwest Burkina Faso, the associations between household structural and behavioral factors with vector density will be presented. General household surveys were completed detailing the external housing characteristics of wall and roof materials, number of individual sleeping rooms, number of individuals in the household, and ITN use. All enrolled …

Use Of Shotgun Metagenomic Sequencing To Determine How The Human Gut Microbiome And Antibiotic Resistome Influence The Risk Of Recurrent Clostridioides Difficile Infection, Maria Alexandra Correa

Public Health Theses

Clostridioides difficile is an opportunistic enteric pathogen that can cause a range of symptoms in humans from diarrhea to pseudomembranous colitis. The risk of recurrence of C. difficile infection after initial treatment with antibiotics is high. Although prior studies have sought to understand the link between the human gut microbiome and the risk of recurrence, none have utilized shotgun metagenomic sequencing methods to establish a relationship between microbiota diversity and recurrence risk. In this study, stool samples were obtained from 47 patients at Yale New Haven Hospital who tested positive for an incident C. difficile infection. Shotgun metagenomic sequencing was …

Personalized Multimedia Videos As Reminiscence Therapy For Persons With Dementia, Julia Rose Donald

Public Health Theses

Reminiscence therapies are an effective intervention in increasing self-esteem, well-being, sense of personhood and even reducing distress and confusion in persons with dementia. There is even evidence that reminiscence therapies can slightly slow the progression of dementia, by enabling a cohesive narrative and sense of identity. This paper will consider relevant literature and explore the potential of using modern technological advances, such as a wealth of digital media and the ability to scan old photos, to create personalized and engaging life narratives. In addition to this paper, this special project will include a concrete example of this type of video …

An Impact Evaluation Of The Rollout Of The Pneumococcal Conjugate Vaccine In Uttar Pradesh State, India. 2017-2019, Elizabeth Edgerley

Public Health Theses

This paper is aimed toward examining whether methods currently being rolled out to administer the Pneumococcal Conjugate Vaccine to children in the Indian state of Uttar Pradesh is effectively reducing morbidity and mortality. The fundamental question regarding this current effort is if it proves to be useful at reducing the prevalence of Streptococcus Pneumoniae and whether the surveillance methods examining the efficacy of healthcare interventions are helpful. Both rural and urban India are troubling areas for public health surveillance to reach, though many diseases of poverty and respiratory illnesses such as pneumonia flourish there. With no true quantification of burden, …

Trends In Cyclosporiasis In Connecticut, 1997—2019, Alexandra Edmundson

Public Health Theses

Introduction: Cyclosporiasis is a foodborne, parasitic infection, causing prolonged debilitating diarrhea, especially in immunosuppressed persons. Exposure to Cyclospora occurs mainly through ingestion of contaminated fresh produce, often during international travel. Nationally, it has been increasing in the United States. Connecticut surveillance data have yet to be systematically analyzed.

Methods: Active surveillance of cyclosporiasis in Connecticut has been conducted since 1997, including follow up of laboratory-confirmed cases by chart review and interview. Data collected include patient demographics, symptoms, severity of illness, and exposures. Data from 1997-2019 were analyzed to identify trends in incidence and changing demographics and sources of exposure.

Results: …

Covid-19 Risk Among Temporary Protected Status Beneficiaries, Diana Estefania Estrada Alamo

Public Health Theses

The current federal response of the United States to the COVID-19 pandemic has created conditions and resulted in unintended consequences that may be disproportionately increasing the risk of COVID-19 infection and sequelae for immigrant populations. This investigative thesis explores whether states with a greater percentage of Temporary Protected Status beneficiaries experience more COVID-19 related deaths as compared to the rest of the United States. Using a multiple linear regression model for statistical analysis, covariates under consideration include the number of COVID-19 confirmed cases, tests performed, hospitalizations reported, as well as the population density of each state and the proportion of …

Association Between Maternal Depressive Symptoms And Hypertension Among African American Mothers In The Intergen Study, Xiaosong Gao

Public Health Theses

Purpose: The purpose of this paper is to examine the association between maternal depressive symptoms and hypertension among African American mothers from the InterGEN study.

Data Source: The Intergenerational Blood Pressure (InterGEN) Study was a longitudinal study which enrolled 250 African American mother-child dyads based in Southwest and Central Connecticut.

Methods: We used logistic regression models to examine the association between depressive symptoms and hypertension, and adjusted for educational level, employment in the past 6 months, and Race-Related Events Score (RRES). We used growth curve modeling to examine the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) …

Ethnic Differences And Risk Of Early-Onset Hodgkin Lymphoma, Connor Ashton Graham

Public Health Theses

Ethnic differences in the risk of early-onset Hodgkin lymphoma (HL) have been understudied. We evaluated potential associations between birth characteristics and early-onset HL in the California Linkage Study of Early-onset Cancers, a population-based case-control study that included a large number of non-Hispanic white and Hispanic subjects. This analysis included 2,819 HL cases (non-Hispanic white: 1651, Hispanic: 1168) diagnosed at the age of 0-37 years in California during 1988-2015 and 140,950 controls matched on race/ethnicity and year of birth. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from multivariable logistic regression models. Among non-Hispanic whites, a birthweight of ≥4,000g …

“Malicious Medicine”: A Qualitative Study Of Medical Mistrust And Prep Perceptions For African American And Hispanic Men And Women In New Haven, Ct, Alexandra Lee Grimaldi

Public Health Theses

Objective: To understand how medical mistrust impacts perceptions of PrEP and willingness to use PrEP for African American and Hispanic men and women in New Haven, Connecticut.

Methods: This qualitative study utilized semi-structured interviews to examine medical mistrust, PrEP awareness, and willingness to use PrEP amongst African American and Hispanic men and women in New Haven, Connecticut.

Results: The majority of participants did not know about PrEP before their first interview of this study and the majority of participants did not decide to use PrEP over the course of this study. For those who are not interested in using PrEP, …

Evaluation Of Pilot Methadone Treatment Programs For Inmates With Opioid Use Disorder In Connecticut Jails, 2014-2018, Alissa Haas

Public Health Theses

Background and Aims. Methadone treatment is underutilized in correctional facilities, despite high prevalence of opioid use disorder in criminal justice settings. In 2013 and 2014, two pilot programs were established by the Connecticut Department of Corrections in the New Haven and Bridgeport Correctional Centers to provide methadone for inmates who had been in medication-based treatment prior to incarceration. We sought to assess post-release outcomes (non-fatal overdose, fatal overdose, recidivism, and resumption of methadone in the community) associated with implementation of methadone treatment in these correctional centers.

Methods. This was a retrospective observational cohort study, linking datasets from the Connecticut Department …

Marketing Of (Bms): Content Analysis Of Breast Milk Substitutes Digital Marketing On Chinese E-Commerce Platforms, Shannon Han

Public Health Theses

Background: China has one of the largest and fastest-growing breast milk substitutes (BMS) industries and a disproportionately low exclusive breastfeeding rate. The rapid penetration of technology and the internet, together with convenience-oriented lifestyles, has led to the dominance of the e-commerce industry in China. Many BMS manufacturers have established e-commerce flagship stores and use them as main retail and marketing channels.

Objective: This study aimed to analyze the BMS retail websites on the largest business to consumer (B2C) e-commerce platform TMall, to characterize the marketing themes and strategies used to target consumers. It was specifically designed to improve our understanding …

Creating An Antibody Digestive Curve In Cx. Quinquefasciatus Mosquitoes, Christina Ann Harden

Public Health Theses

Eastern Equine Encephalitis virus (EEEV) is an endemic arbovirus of increasing importance

in the United States. It is perpetuated via an enzootic cycle between Culiseta melanura

mosquitoes and avian reservoirs. In the northeast, transmission has distinct seasonality

and its overwintering mechanism is unknown. Xenosurveillance has been identified as a

possible way to elucidate viral circulation dynamics in states such as Connecticut that are

experiencing a resurgence of human EEE cases, potentially exacerbated by factors

associated with global climate change. This study sought to experimentally create an

antibody digestive curve for both mammalian and avian bloodmeals in Cx. quinquefasciatus

mosquitoes. Using …

Association Between Opening A Jail And Sexually Transmitted Infections In Rural Counties Across The United States, Tyler Harvey

Public Health Theses

Abstract

Objective

To estimate the effect of openings jail in rural counties on county-level chlamydia, gonorrhea, and syphilis prevalence rates.

Methods

We used county-level data from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (2005-2017) to obtain chlamydia, gonorrhea, and syphilis rates, and the American Correctional Association’s National Jail and Adult Detention Directory (2013-2014) to locate rural jail openings. Using a generalized synthetic control method, we estimated the effect of opening jails in 41 rural counties between 2010 and 2012 across the United States on sexually-transmitted infections.

Results

We found an average treatment effect for chlamydia prevalence …

Analysis Of Medical Device Reclassification: An Evaluation Of The 515 Program Initiative, Tiffany Ning Hu

Public Health Theses

Background: The US Food and Drug Administration (FDA) is in charge of regulating medical devices and one key power the FDA has to ensure safety and effectiveness of these devices is risk reclassification. One example of this regulatory power is the 515 Program Initiative, where the FDA was tasked with reclassifying preamendment devices that had never undergone initial rigorous review before entering the market.

Objective: The objective of this thesis project is to characterize the device types reassessed under this program and determine what characteristics the FDA heavily considers when making a risk classification determination.

Methodology: Data was collected on …

Management Of Opioid Tapering With A Mobile App Among Veterans, Jennifer Villegas Ibarra

Public Health Theses

Objective: The goal of this project is to better understand the Veterans’ perspective on the facilitators and barriers of using a mobile app for opioid tapering.

Methods: Semi-structured interviews were conducted with nine Veteran patients who have experienced opioid tapering at the VA Connecticut Healthcare System in West Haven, CT. Interviews were conducted in-person at the VA Opioid Renewal Clinic (ORC). Each interview lasted approximately 55-70 minutes and participants were compensated with $25. Data analysis was conducted using Grounded Theory to generate findings for this research project.

Results: Findings identified a total of 11 codes, which were categorized as facilitators …

Measuring Tb Stigma In Kampala, Uganda, Amber James

Public Health Theses

Tuberculosis (TB) is one of the leading causes of death worldwide and adversely affects persons living with HIV. TB is a highly stigmatizing disease and has been shown to interfere in household TB contact investigation. The objective of this study was to investigate the severity and characteristics of TB stigma through a multiple methods approach. Quantitative methods involved distributing Van Rie Stigma Scales validated in Southeast to household contacts of Index TB patients during routine household TB contact investigation. Qualitative methods involved interviewing household contacts about their attitudes towards household contact investigation, knowledge of TB transmission and treatment, and perceptions …

Cardiovascular Outcomes In Hypertension As Defined By Proof-Bp Using Nhanes 2015-2016, Kamran Javadi

Public Health Theses

Hypertension is one of the most common medical conditions, affecting nearly one-third of Americans.1 Chronic high blood pressure is the cause of numerous cardiovascular diseases which cost the United States over $100 billion annually.1 The American College of Cardiology and American Heart Association have recently challenged the previous definition of hypertension by suggesting those with a blood pressure of ≥130/80 mmHg now have the disease.2 This new threshold would classify nearly 50% of Americans as hypertensive.2 Establishing a diagnosis of hypertension can be difficult and resource intensive requiring patients to have serial recordings over 24-hours. Until recently there has been …

Blood Dna Methylation As A Surrogate Epigenetic Biomarker In Study Of Night Shift Work And Breast Cancer, Yi Jin

Public Health Theses

Objectives: the objective was to explore the consistency of DNA methylation pattern between peripheral blood and breast tumor tissue, and discussed the potential of using blood as a surrogate epigenetic biomarker to study the relationship between breast cancer and shiftwork.

Methods: systematic review on studies analyzing the concordance or correlation of DNA methylation level between breast tumor tissue and peripheral blood was conducted. The results of eligible studies were summarized to find the specific genes that had consistent methylation pattern in both tumor tissues and blood. Then the blood samples from the well-established Danish cohort were used to perform epigenome-wide …

Development Of A Comprehensive Sexual Education Curriculum For A Private, Independent Day School For Students Pre-K Through 8th Grade, Haja I. Kamara

Public Health Theses

This paper describes the development of a comprehensive sex education (CSE) curriculum for The Country School (TCS), a coeducational, independent school in Madison, CT that serves approximately 200 students in Pre-Kindergarten through 8th grade. CSE describes a wide array of sex education programs and curricula that are scientifically accurate, culturally and age-appropriate, gender-sensitive and life skills-based. The goal for this project is multi-pronged: adapt existing health education programming, build out a new health and wellness program with a distinct scope and sequence for each grade level that includes resources and supports for ongoing parent education and professional development. To inform …

Impact Of A 6-Month Exercise Intervention On Cognitive Function Among Ovarian Cancer Survivors: The Women’S Activity And Lifestyle Study In Connecticut (Walc), Jonica Yu Kao

Public Health Theses

Purpose: Cancer survivors often exhibit symptoms of impaired cognitive abilities after chemotherapy treatment. Physical activity has been shown to be promising in improving cognitive function among survivors for various types of cancer. However, very few studies have addressed this concern among the ovarian cancer patient population specifically.

Methods: The study randomized 111 physically-inactive ovarian cancer survivors into a 6-month exercise intervention (n=59) or an attention-control group (n=52). The FACT-Cog scale was self-reported to understand survivor perceptions of cognitive abilities at baseline and at 6 months. Generalized linear models (GLMs) were executed to examine the effect of the intervention versus attention-control …

Sud Reprocessing- Regulation, Environment Impact Reduction & Cost Savings, Aman Khanuja

Public Health Theses

Healthcare sector is estimated to contribute around 4.6% of the global Green House Gas (GHG) emissions. An estimated 11% of National Health Service GHG emissions are attributable to medical devices. Medical device industry, therefore, has a sizeable carbon footprint. Medical device reprocessing is a validated process used to render a medical device, which has been previously used or contaminated, ready for subsequent use. It is estimated that 2-3% of all medical devices can be safely reprocessed. The Association of Medical Device Reprocessors (AMDR) estimates that the reprocessing activity by its member companies successfully reduced waste generation by 7093 tons, and …

The Hiv Care Continuum And Barriers To Viral Suppression Among Men Who Have Sex With Men In Greater Kuala Lumpur, Malaysia., Lauren Haerin Kim

Public Health Theses

Background: Men who have sex with men (MSM) now account for nearly half of all new HIV cases in Malaysia. There has been little research, however, characterizing the HIV care continuum among MSM living with HIV in Malaysia. This study describes the HIV care continuum and examines factors associated with HIV viral non-suppression among newly diagnosed MSM living with HIV in Kuala Lumpur, Malaysia.

Methods: We enrolled 163 MSM living with HIV who were in care at a major university hospital in Kuala Lumpur, Malaysia. Participants completed a self-administered questionnaire. Electronic medical chart review also provided data on engagement in …

Investigating The Community-Level Variation In Hookworm Prevalence In The Kpandai District, Ghana: A Mixed-Methods Study, Harry Hyunteh Hyunteh Kim

Public Health Theses

Soil-transmitted helminths are a major cause of disability and morbidity in resource-poor settings: over 1.5 billion are estimated to be at risk of infection. Human behaviors and household socioeconomic conditions that facilitate contact with contaminated soil may increase exposure to parasites. The primary objective of the study was to investigate the community-level variation in hookworm prevalence in the Kpandai district of Ghana.

We used a mixed-methods approach to investigate behavioral, societal and environmental risk factors to hookworm exposure. 264 individuals from three neighboring villages (Jagbigbingdo [JG], Takumdo [TK], Wiae Chabor [WC]) were recruited using a convenience sampling strategy. Household questionnaires …

Birth Outcomes Associated With Heavy Metal Exposures In The Surroundings Of A Former Chemical Plant In Târnăveni, Romania, Jenny Wai Kun

Public Health Theses

Heavy metal exposures have long been a public health concern, research on this field may promote policies and regulations to restrict or limit certain industrial practices. This study aims to evaluate potential associations between toxic heavy metal exposures via contaminated environmental media and the frequency of the birth defects in the designated area: Tarnaveni, Romania; historically contaminated by a former chemical plant. In 2018, a pilot investigation conducted on the site demonstrated that chromium (Cr), lead (Pb), and manganese (Mn) are common heavy metal contaminants found. Soil concentrations for all three metals exceeded normal background levels according to Romanian Environmental …

Evaluating The Association Between Severe Acne And Pancreatic Cancer Risk, Rachel Vania Lee

Public Health Theses

Objective: Inflammation is a suggested mediator in pancreatic carcinogenesis. Severe acne may be a proxy of inflammation; however, the association between severe acne with pancreatic cancer is unstudied. Here, we explored the association between self-reported severe acne and pancreatic cancer risk for the purpose of hypothesis generation.

Methods: In a hospital-based case-control study, we used information from personal interviews with 939 confirmed cases of pancreatic adenocarcinoma and 440 controls to assess history of teenage and adult acne. We evaluated the association between severe acne and pancreatic cancer risk by estimating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using …

A Qualitative Analysis On The Transitions Of Afghan Refugee Families To The U.S. And Their Parenting Experiences, Jessica Kung Leung

Public Health Theses

Introduction: Refugee families can face particularly multifaceted challenges during their transition to the U.S. There is currently little research on the experience of parenting during Afghan refugees’ transitions to the U.S. This study seeks to better understand these individuals’ experiences of parenting and their descriptions of their children’s transitions to the U.S. in the context of the greater New Haven area.

Methods: We conducted a secondary analysis on interview data with 19 recently-arrived Afghan refugee parents based in the greater New Haven area; 10 fathers and 9 mothers were interviewed from August 2019 to January 2020. We used thematic analysis …