Digital Commons Network^™

Nicotine Dependence And Alternative E-Cigarette Use Behaviors: Dripping And Vape Tricks, Harmanpreet Bhatti

Public Health Theses

Background: E-cigarette use among youth is concerning due to the risk of exposure to hazardous chemicals and future combustible cigarette use. Alternative e-cigarette use behaviors, or dripping (i.e., applying drops of e-liquids directly onto heated coils) and vape tricks (i.e., blowing shapes or large clouds of visible exhaled aerosol), may also increase this risk. However, little is known about the risk of nicotine dependence among adolescents who engage in these behaviors. Therefore, the aim of this study was to determine the association between these alternative e-cigarette use behaviors and nicotine dependence among adolescents.

Research Design: Cross-sectional data were collected from …

So You Think You Can Exercise: The Gap Between Exercise Confidence And Physical Activity Among Samoan Adults, Diksha Brahmbhatt

Public Health Theses

Samoa is experiencing one of the highest prevalence of overweight and obesity in the world, placing its population at increased risk of developing several noncommunicable diseases including type 2 diabetes and cardiovascular disease. The role of physical activity in reducing the burden of these diseases and overweight is well-established. Exercise self-efficacy or confidence is a predictor, if not determinant, of recreational physical activity. The purpose of this study, therefore, is to assess the relationship between exercise confidence and levels of recreational physical activity among Samoan adults. We confirm that exercise confidence is correlated with time spent exercising. However, despite considerable …

Safety Of Opat In Older Versus Younger Adults, Kaylen Elizabeth Brzozowski

Public Health Theses

Introduction Outpatient parenteral antimicrobial therapy (OPAT) is considered practical, safe, and cost-effective, but roughly 20% of all adult patients on OPAT experience an adverse event (AE). Frequency of AEs and healthcare utilization, defined as emergency department visits and infectious disease office visits, phone calls, and emails, may be greatest in the first two weeks of OPAT. Given that older adults (age ≥ 65) have greater cognitive decline, ADL limitations, and comorbidities than younger adults, we sought to evaluate the frequency and timing of AEs in older adults on OPAT. We examine patients on OPAT at Yale New Haven Hospital (YNHH) …

Postpartum Weight Trajectories In A Cohort Of 127 Samoan Women: Does Breastfeeding Protect Against Postpartum Weight Retention?, Grace Castillo

Public Health Theses

Rising global obesity rates impact every aspect of health, including maternal-fetal health. Samoa has a disproportionate burden of obesity, with more than half of Samoan women entering pregnancy obese. Given Samoan women’s high parity (4), postpartum weight retention (PPWR) may be a significant source of weight gain over women’s lifetimes. Little is currently known about PPWR among Samoan women, so this analysis sought to document PPWR trajectories, assess factors – like breastfeeding -- associated with PPWR. Data of 127 mother-infant dyads from the 2017 Foafoaga O le Ola cohort were used in analysis. Researchers collected demographic and lifestyle data, as …

Attachment Security And Psychological Health In Adult Child Caregivers And Their Parents With Alzheimer’S Disease And Related Dementias, Wei Aiko Chang

Public Health Theses

Objective: Attachment theory is a helpful framework for examining one of the most fundamental needs in parent-child dyads across the lifespan and how attachment security might protect both dyad members’ psychological health, especially in times of crisis. In this study of adult child caregivers and their parents with early stage Alzheimer’s disease and related dementias (ADRD), we examined the associations between both dyad members’ attachment security, the adult child’s depressive symptoms, and quality of life of the parent with ADRD.

Method: Thirty-four individuals (parents) with ADRD and their 34 adult-child caregivers each completed the 12-item Experiences in Close Relationship Scale …

Persistence Of Ebola Virus In Survivors & Risks Of Sexual Transmission: A Systematic Review, Allison Cheung

Public Health Theses

Background: Longitudinal cohort studies of Ebola virus disease (EVD) survivors from the 2014-2016 West African outbreak have found evidence of Ebola virus (EBOV) and EBOV RNA persistence in the bodily fluids of survivors, particularly in semen. This new evidence has raised the possibility of sexual transmission of EBOV by EVD survivors. The current interim guidance issued by the World Health Organization (WHO) recommends safer sex practices for at least 12 months after acute disease onset (ADO). However, based on new evidence, these recommendations may require revision.

Objective: The main aim of this article is to present and evaluate evidence on …

Estimating Mortality After Natural Disasters In Low- And Middle-Income Countries: A Systematic Review, Joseph Clingerman

Public Health Theses

Background

The outcomes of natural disasters produce many complex uncertainties and statistics, many of which have no metrics to assess how accurate they are. In particular, mortality estimates in low- and middle-income countries encompass many variables in their inherently challenging physical, political, and logistical landscapes. Given that there has been no known systematic review of assessing mortality estimation methodologies, the author aimed to provide a systematic review of known methodologies and provide a framework to assess mortality estimation methodologies.

Methods

The author performed a systematic search of electronic databases from the past two decades up to January 2019. In addition, …

Exposure To Atmospheric Metals Using Moss Bio-Indicators And Neonatal Health Outcomes In Portland, Oregon, Saskia Comess

Public Health Theses

Background: Exposures to certain metals are associated with adverse birth outcomes, including inhibited fetal growth and congenital defects. Previous studies focused on metals such as lead and arsenic, and primarily assessed exposure using biological monitoring, which does not provide insights into sources. Examining exposure to metals via atmospheric pathways is challenging due to a lack of high-resolution air-pollution data. We applied a unique map of atmospheric metal pollution, derived from bio-indicator moss samples, as a screening tool to study neonatal health risks of atmospheric metal pollution in Portland, Oregon, a city of 640,000 people with several metal-emitting industrial sources.

Methods: …

The Contribution Of The Residential Environment To Indoor Air Pollutants, Jessica Deslauriers

Public Health Theses

Rationale: Little is known about the home environment and associated indoor exposures to brown carbon and black carbon, components that make up fine particulate air pollution.

Objective: Identify how features of the residential environment contribute to indoor measurements of brown and black carbon.

Methods: Between November 2012 and December 2014, 125 veterans who were part of a COPD cohort were recruited for this study. At roughly 3 month intervals, participants received a particle sampler to measure air pollutants in their home for a 1-week period. The filters within the samplers were analyzed for levels of black and brown carbon using …

Quantifying Influenza Exposure Within Hospitals And Nursing Homes, Drew Taylor Dickinson

Public Health Theses

Abstract

Background: Influenza acquisition in hospitals and nursing homes (NHs) highlights the need for infection prevention to protect patients from contagious diseases while under the care of a healthcare facility. We quantified influenza exposure in both settings and compared facility-onset influenza rates in order to determine if risks of acquiring influenza differed by type of healthcare facility since infection prevention practices are less standardized and less rigorous in NHs.

Methods: We conducted a retrospective cohort study of California hospital and NH inpatients during the 2015-2016 influenza season, defined as the peak influenza month, plus the two adjacent months, using claims …

Using Host Response For Respiratory Virus Discovery And Surveillance, Amelia Erin Hanron

Public Health Theses

INTRODUCTION: In 2015 lower respiratory infections (LRI) were the fifth leading cause of

death and the leading cause of death for children under five years old. Despite increasing advances in viral detection technology, etiology is never established for a large portion of viral respiratory infections. The most recent of such advancements- next-generation sequencing (NGS)- has greatly improved the ability to discover and/or identify rare or novel viruses. However, NGS platforms are still not feasible in a clinical laboratory due to cost, complexity, personnel, etc. The ability to screen for unknown viruses using technology that is already present in most clinical …

Proximity To Nearest Major Road And Time To Pregnancy In The Early Pregnancy Study, Nina Hatch

Public Health Theses

Purpose: Current literature suggests that air pollution may affect reproductive outcomes, but little research has evaluated the association between air pollution and fertility. Our aim is to further examine the relationship between distance to major roadway, a proxy for traffic-related air pollution, and fecundability.

Methods: Our analysis was conducted within the North Carolina Early Pregnancy Study (n=221). Our outcome was pregnancy attempt time, an estimate of fecundability, or the per cycle probability of conception. Our primary definition of conception included early pregnancy loss, spontaneous miscarriage, ectopic and molar pregnancy, and singleton or twin pregnancies. In a secondary analysis, we defined …

Gaps In Mental Healthcare Use And Perceived Quality Between Privately Insured Lgb And Heterosexual Individuals In The United States, Yuki Hayashi

Public Health Theses

Previous research has identified significantly heightened levels of mental health issues and psychological distress among lesbian, gay, and bisexual (LGB) individuals in the U.S., as well as greater mental health service utilization among this population. Using a nationally representative sample of privately insured adults in the U.S., we investigate differences in mental healthcare utilization, characteristics of mental healthcare received, and perceived quality of care between LGB and heterosexual individuals. Key results find that privately insured LGB men and women are significantly more likely than their heterosexual counterparts to have used outpatient mental healthcare as well as out-of-network (OON) outpatient mental …

Multi-State Analysis Of Unconventional Oil And Gas Development And Rates Of Sexually Transmitted Infections In The United States, Nicholaus Peter Johnson

Public Health Theses

Background

Advances in unconventional oil and gas development (UOGD), including hydraulic fracturing and horizontal drilling, have helped position the United States as a world leader in the production of both crude oil and natural gas hydrocarbons. This significant increase in production would not have been possible, however, without the assemblage of a workforce that is predominantly young, male, and mobile. This is significant given that a number of studies have associated similar types of mobile workforces – especially those employed by resource extractive industries – with impacts on the sexual health of the host communities in which these workers operate …

Perspectives Of Type 2 Diabetes Patients On Their Interactions With Providers, Marleen Z. Jones-Pool

Public Health Theses

Effective patient-provider communication has been shown to help achieve optimal health results, particularly in patients with diabetes. While previous studies have identified patient-perceived barriers in communicating with their providers, this study highlights factors in the patient-provider interaction that may contribute to effective health communication. As part of a larger mixed-methods study, 10 semi-structured interviews were conducted with patients with self-reported diabetes at a primary health center. These interviews sought to understand patient-perceived communication factors that influenced their interactions with their providers. Interviews were recorded and transcribed verbatim. Interview transcripts were then coded and analyzed utilizing a grounded theory approach. Findings …

The Association Between Self-Reported History Of Experiencing Violence & Mental Health Status Among Urban Refugees And Asylum Seekers In Malaysia, Rayne Soyoung Kim

Public Health Theses

Background: In displaced populations, studies have shown that there are significant associations between exposure to violence and reporting mental illness. There is little known regarding this relationship in countries like Malaysia, which serves as a transitional point where refugees wait to be resettled.

Objective: To assess the cross-sectional association of exposure to violence with mental health status in the urban refugee and asylum-seeking population in Malaysia.

Methods: 286 self-identified refugees and asylum seekers, recruited by using time-location sampling, were given interviewer-administered surveys, including questions regarding exposure to violence and mental health symptoms. Multivariable logistic regression analyses were performed to evaluate …

Evaluating The Feasibility And Effectiveness Of Self-Monitoring Of Health – A Pilot Study Among Samoan Women, Erica Kocher

Public Health Theses

Background:

Samoa, like many low- and middle-income countries, faces a high burden of obesity and non-communicable disease. Self-monitoring technologies to help individuals track their health have proven effective in high-income countries, but have not generally been tested in low-income settings. To investigate the feasibility and potential effectiveness of using step-counters and digital scales in Samoa, we conducted a pilot randomized controlled trial.

Methods:

The trial enrolled 44 Samoan women (31-40 years) without chronic conditions (non-hypertensive, non-diabetic, etc.) and who reported motivation to become more active. After a 1-week baseline period to measure physical activity in the absence of any feedback, …

Nonmydriatic Fundus Photography In A High-Risk Population Of Samoans With Diabetes: The Soifua Manuia Eye Screening Program, Lauren Carmela Lamonica

Public Health Theses

IMPORTANCE Novel methods of detecting eye disease are needed due to the challenges associated with service delivery in resource-limited settings.

BACKGROUND The objective of this study is to determine whether clinically gradable fundus images can be obtained using a low-cost, handheld non-mydriatic fundus camera by a non-ophthalmic provider in a remote setting.

DESIGN Cross-sectional study

PARTICIPANTS Two-hundred and six individuals (412 eyes) in the Pacific Island nation of Samoa with pre-diabetes and diabetes (HbA1c ≥5.7% or FBG ≥110 mg/dl).

METHODS Participants underwent non-mydriatic fundus photography with the PanOptic iExaminer System, along with an assessment of near vision, medical, and ophthalmic …

Older Adult Spouses’ Emotional Responses To Reminiscing About Their First Encounter: Associations With Mental Health, Marital Satisfaction, And Cardiovascular Reactivity, Hanzhen Lan

Public Health Theses

Objectives: While there has been growing interest in how close relationships affect older adults’ health, not much research has examined how emotional experiences in older married couples’ positive interactions relate to individual and relational well-being and physical health. The present study hypothesizes that positive emotional responses to older couples reminiscing about first encounter are associated with each spouse’s higher marital satisfaction, fewer depressive symptoms, and healthier cardiovascular reactivity (blood pressure and heart rate variability).

Method: One hundred and one couples completed a background questionnaire at home and then participated in a laboratory session in which they discussed how they first …

Association Between Engagement In A Community-Based Home Visitation Program And Birth Spacing Between First And Second Children, Hing Ting Connie Li

Public Health Theses

OBJECTIVE: To identify patterns in engagement in the Connecticut-based home visitation program, Nurturing Families Network (NFN), and to determine whether associations exist between various engagement patterns and birth-to-pregnancy intervals between first and second children.

METHODS: Repeated measures latent class analysis was employed to identify patterns in program engagement among 5,248 families enrolled in NFN with available home visit information. Maternal socio-demographic characteristics were examined to identify potential predictors of engagement patterns. Propensity score matching was used to identify firstborn children of families in Connecticut with comparable eligibility and tendency to enroll in NFN. Survival analysis was conducted to assess the …

What Does It Meme? A Qualitative Analysis Of Adolescents’ Perceptions Of Tobacco And Marijuana Messaging, Jessica Liu

Public Health Theses

With increasing popularity of e-cigarettes and legalization of marijuana, messaging from online sites and platforms are shaping product perceptions and use. Quantitative studies have examined social media statistics of posts; however, there is a lack of research explaining the aesthetic appeal of these advertisements from the adolescents and young adults (AYA) perspective.

Twenty-four participants were recruited from a larger study of adolescents' perceptions and tobacco use (N=772 high school students). Participants were grouped by whether or not they had used tobacco or marijuana products before, with N=8 non-users and N=16 users. Data were collected through individual semi-structured interviews, where participants …

Associations Between Cannabis Use, Medication Status And Panic-Anxiety Disorder Symptoms Among Us Adults, Diane Tran Ma

Public Health Theses

The existing body of literature focuses on the onset of panic disorders or other side effects as an association with cannabis use, but does little to address how possible concomitant cannabis use affects symptom presentation in already-diagnosed patients. The present project aims to take a closer look at adults with a lifetime history of DSM-5 diagnosed anxiety disorders, their prescribed (non-cannabis) medication use, cannabis use frequency, and associated symptom severity.

In general, we find that cannabis use is associated with higher panic-anxiety symptom severity across panic disorder without agoraphobia, generalized anxiety disorder, and people with combined anxious-distress diagnoses, after controlling …

Wholesome Wave Communities Market Approach, Nikita Mehta

Public Health Theses

In 2017, approximately 1.2 million residents, or 14.4% of the population, in New York City were identified as food insecure, which is higher than the national rate of 11.8%. Wholesome Wave is a non-profit organization based in the Northeastern region of the United States that develops programming for consumers to make healthier food choices through increases in affordable access to healthy, locally and regionally grown foods. Wholesome Wave makes fruits and vegetables affordable through their Wholesome Communities initiative which includes the SNAP Double Value Program and the FVRx. This report builds a strategic go-to-market approach by identifying key funders, partners, …

Predictors Of Intense End-Of-Life Care Among Children And Young Adults With Advanced Hematologic Malignancies, Sophia Mun

Public Health Theses

Background: Studies suggest that children, adolescents, and young adults (AYAs) with advanced cancer receive intense end-of-life (EOL) care. This is particularly true for patients with hematologic malignancies. Yet, it is unclear who is at highest risk for receiving intense care.

Methods: We used the Premier Healthcare Database to perform a population-based analysis of patients aged 0-39 years at death with hematologic malignancies who died between 2010-2017. We defined intense EOL care as: receipt of cardiopulmonary resuscitation (CPR), intubation, hemodialysis, or tracheostomy within the last 30 days of life; more than one emergency room (ER) visit within the last 30 days …

Assessing The Effect Of The Fto (Rs9939609) Gene On Weight Loss Among Breast Cancer Survivors Enrolled In The Lifestyle, Exercise, And Nutrition (Lean) Study, Hien Thai Nguyen

Public Health Theses

Abstract: Background: A single nucleotide polymorphism (SNP) of the Fat, Mass, and Obesity associated (FTO) gene, rs9939609, is significantly associated with obesity and individual variability in weight loss achieved by diet/lifestyle interventions. However, study results on the effect of the FTO gene on weight loss remains inconsistent. This study aims to examine the moderating effects of the FTO SNP rs9939609 on weight loss achieved by a lifestyle intervention in breast cancer survivors. Methods: Breast cancer survivors with a body mass index (BMI) > 25 kg/m2 were randomized to the LEAN 6-month intervention, which included eleven 30-min counseling sessions focused on reducing …

The Effects Of Rurality And Cost Of Transportation On Time Of Evolution And Disease Complexity At Diagnosis For Cutaneous Leishmaniasis In Colombia, Miguel Paredes

Public Health Theses

Patients in Colombia affected by cutaneous leishmaniasis (CL) face significant geopolitical and socioeconomic barriers to accessing diagnosis and treatment. This study aimed to understand how the geosocial characteristics of a patient’s area of residence affect time to medical consultation and disease status at consultation. An observational cross-sectional study was performed of individuals with CL who consulted at a local clinical referral center (CIDEIM) in Cali and Tumaco, Colombia. Descriptive, bivariate, and multivariable simple and ordinal logistic regression analyses were done to examine how area of residence (urban or rural) and cost of transportation to the nearest urban center may influence …

Quantifying The Burden Of Contact Precautions Of Carbapenem-Resistant Enterobacteriaceae (Cre) In Hospital Settings, Carolyn Park

Public Health Theses

Carbapenem-resistant Enterobacteriaceae (CRE) are a group of multi-drug resistant organisms (MDROs) that is currently considered an important and urgent public health concern due to their high mortality rates, antibiotic resistance, and their potential for rapid transmission. These pathogens are more commonly seen in healthcare-associated infections with some also occurring in the community. This study focused on distinguishing CRE into two distinct groups based on resistance mechanism: carbapenemase-producing CRE (CP-CRE) and non-CP-CRE. In order to determine if testing for carbapenemase can be useful in infection prevention, we aimed to quantify the total hospitalization in days per patient within a 90-day follow-up …

Randomized Trial Of Weight Loss On Ghrelin Levels Among Breast Cancer Survivors, Leah Puklin

Public Health Theses

Purpose: Obesity is associated with increased breast cancer risk and mortality. Ghrelin is a hormone that participates in a negative feedback loop to regulate body weight. Understanding the impact of an individualized, sustainable, dietary and exercise weight-loss intervention on circulating ghrelin levels could provide insight on weight control mechanisms among overweight and obese breast cancer survivors.

Methods: The Lifestyle, Exercise, and Nutrition (LEAN) randomized controlled trial was a 6-month weight loss trial conducted to examine the effect of a weight loss intervention versus usual care on outcomes in 151 breast cancer survivors with BMI ≥ 25 kg/m2. Fasting blood samples …

Associations Between Mindful Eating Techniques And Gestational Weight Gain, Yuqing Shang

Public Health Theses

Abstract

Objective: To investigate the extent to which the use of mindful eating techniques is associated with gestational weight gain among a clinic-based sample of pregnant women.

Methods: Four hundred and forty-eight pregnant women in their second trimester of pregnancy participated in the Expect With Me group care study and were selected for this secondary analysis. Sociodemographic and general health data was collected at baseline. Mindfulness practice was measured based on frequency of performing mindful thinking and mindful eating techniques in the third trimester. The main outcome was excessive average weekly gestational weight gain, which was determined using the guidelines …

Analysis Of Entomological Surveillance Data To Predict West Nile Virus Cases In Connecticut, Lena Marie Tayo

Public Health Theses

INTRODUCTION: Since 1999, West Nile Virus (WNV) has been identified in a wide variety of mosquito species. Seasonal epidemics occur in the summer in all regions of the United States, with varying degrees of intensity and spread. In Connecticut, the state mosquito surveillance system for WNV has been conducted since 2000, collecting entomological and site data, and acting as an early warning system for potential human disease risk.

AIMS: Re-analysis of the epidemiology of WNV in Connecticut after years of established endemicity will be conducted using recent mosquito surveillance and human case data. A predictive model will also be developed …