Digital Commons Network^™

Evaluating Clinical Outcomes And Cost-Effectiveness Of Aspirin And Clopidogrel Versus Factor Xa Inhibitors And Clopidogrel For Treatment Of Patients With Peripheral Arterial Disease After Lower Extremity Revascularization, Uday Dhanda

Public Health Theses

Introduction and Objective: Antithrombotic treatment plays a critical role in managingperipheral arterial disease (PAD) and reducing the risk of major adverse limb events (MALE) and major adverse cardiovascular events (MACE) after revascularization. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is the most commonly used regimen for medical management to prevent cardiovascular events following revascularization. Still, emerging studies suggest that dual antithrombotic pathway inhibition (DAPI), which combines a Factor Xa inhibitor with clopidogrel, may offer enhanced protection. This study evaluates the clinical outcomes and cost-effectiveness of DAPI compared to DAPT in patients undergoing lower extremity revascularization (LER).

Methods: A retrospective …

Crowned In My Confidence: The Impact Of Self-Perceptions Of Black Hair & Ethnic Identity On The Mental Health Of Black Teen Girls, Olivia Francis

Public Health Theses

Introduction: Black girls’ mental health is significantly affected by the intersection of racism and sexism, leading to higher rates of anxiety, depression, and psychological distress. Ethnic identity can serve as a protective factor, fostering resilience and self-esteem, but difficulties with identity formation can increase vulnerability to mental health challenges. This paper explores the connection between ethnic identity, self-perceptions of Black hair, and mental health outcomes. Methods: Utilizing survey data from the Dreamer Girls project, which included a sample (N= 201) Black girls between the ages of 13-18 (M= 16), the study explores hair-esteem, ethnic identity, anxiety, depression, and suicidality. Hair-esteem …

Secondhand Smoke Exposure And The Risk Of Tuberculosis In Children: A Systematic Review And Meta-Analysis, Cenyun Guan

Public Health Theses

ABSTRACT

Introduction: Tuberculosis (TB) remains one of the leading causes of death globally, with children and young adolescents having a significant burden of the disease. Smoking is a well-established risk factor for TB, but the association between secondhand smoke (SHS) exposure and TB remains inconclusive. Pediatric populations are commonly exposed to SHS due to living with smokers in their households. Inconsistencies in the findings of previous systematic reviews on the associations between SHS exposure and TB status (infection and disease) highlight the need for an updated systematic review to better establish these associations and provide evidence-based guidance for reducing the …

Swift: Strong-Signal Weighted Prs Integration For Fine-Tuning, Yikai Dong

Public Health Theses

Polygenic risk scores (PRS) hold immense promise for personalized medicine but suffer from reduced accuracy in non-European populations, hindering equitable application. We introduce SWIFT (Strong-signal Weighted PRS Integration for Fine-Tuning), a novel framework to enhance cross-population PRS prediction by optimally combining base scores from diverse ancestries using only GWAS summary statistics. SWIFT employs a GWAS subsampling technique based on data fission to generate internal training and tuning sets, circumventing the need for external validation cohorts. A key innovation is its focus on strong genetic signals (p < 0.1) for estimating robust combination weights via cross-validation, which mitigates overfitting and significantly reduces computational burden. We evaluated SWIFT across 22 complex traits using data from five populations (EUR, AFR, AMR, EAS, SAS) and independent validation cohorts (UK Biobank, All of Us). Applied to state-of-the art base methods (PRS-CSx, X-Wing, JointPRS), SWIFT achieved predictive accuracy comparable or superior to the recent LEOPARD integration method and baseline implementations. Crucially, SWIFT demonstrated a 3.5- to 9.5-fold reduction in computational runtime compared to LEOPARD and exhibited robust performance even when using a single, unified LD reference panel. SWIFT provides an efficient, robust, and practical approach to improve the accuracy and applicability of PRS across diverse populations, representing a significant step towards more equitable genomic medicine.

Present Tense Love: How To Stay Close Amidst A Changing Mind, Brit Fleck

Public Health Theses

This thesis examines how long-term partners sustain intimacy when one partner lives with dementia. Through an Appreciative Inquiry (AI) workshop with four couples from the Empowering Partnership Network—a joint initiative of the Yale Social Gerontology Lab and the Livewell Institute—this research explores how relationships adapt and endure amidst cognitive change. Drawing on Irene Smith’s Touch Awareness methodology and theories of relational autonomy, the study challenges dominant deficit-based narratives by highlighting the enduring capacity for meaningful connection. Participants described intimacy as grounded in embodied practices, daily rituals, and what they called the “third body”—a shared relational space that transforms rather than …

Empowering Mothers In New Haven: Evaluating The Impact Of A Maternal Health Program For New And Expecting Black And Brown Mothers, Ethelia Holt

Public Health Theses

The U.S. maternal mortality rate has surpassed that of other high-income countries, with mental health conditions now among the leading causes of perinatal death. These challenges disproportionately affect Black and Brown women, who are less likely to receive adequate follow-up care. The Maternal Health Program for New & Expectant Black and Brown Mothers aimed to improve maternal mental health through psychoeducation, skill-building, financial literacy, and connection to local resources.

A mixed-methods evaluation was conducted using pre- and post-program survey data (N = 7) to assess changes in mental health symptoms, knowledge, self-care, and financial habits. Descriptive statistics were the primary …

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) …

Empowering Mothers In New Haven: Evaluating The Impact Of A Maternal Health Program For New And Expecting Black And Brown Mothers, Ethelia Holt

Public Health Theses

The U.S. maternal mortality rate has surpassed that of other high-income countries, with mental health conditions now among the leading causes of perinatal death. These challenges disproportionately affect Black and Brown women, who are less likely to receive adequate follow-up care. The Maternal Health Program for New & Expectant Black and Brown Mothers aimed to improve maternal mental health through psychoeducation, skill-building, financial literacy, and connection to local resources.

A mixed-methods evaluation was conducted using pre- and post-program survey data (N = 7) to assess changes in mental health symptoms, knowledge, self-care, and financial habits. Descriptive statistics were the primary …

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) …

Black Lives Matter Paterson’S Harm Reduction Center Program Evaluation, Shreya Jadhav

Public Health Theses

BackgroundThe Substances and Sexual Health (SASH) Lab at the Yale School of Public Health conducts much of its work in Paterson, New Jersey. As part of a community partnership, the lab collaborated with Black Lives Matter (BLM) Paterson to conduct a program evaluation of BLM Paterson’s Harm Reduction Center. BLM Paterson, founded in 2016, offers harm reduction through a wide range of services including survival resources, referrals to treatment, and a touchpoint with the healthcare system, all within a safe, non-judgmental space for individuals to decompress and find support. Evaluation Methods This formative program evaluation assesses the impact of BLM …

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 …

Association Between Greenspace And Weight-Related Outcomes In Later Adulthood: A Longitudinal Study Using Uk Biobank Data, Jun Jiang

Public Health Theses

Overweight and obesity are escalating global health concerns, greenspace may support healthierweight, and air pollution may mitigate the effect, but its effects across population subgroups and over time remain underexplored. According to the longitudinal analysis, this study found that greenspace exposure within 300 m was more strongly associated with lower BMI and overweight risk than exposure within 1000 m; for example, the presence of greenspace within 300 m reduced the odds of overweight (OR = 0.791, 95% CI: 0.672–0.933), while the same measure within 1000 m was associated with higher odds of obesity (OR = 1.275, 95% CI: 1.08–1.505). Stratified …

Cost-Effectiveness Of Active Surveillance, Radical Prostatectomy, And Radiotherapy For Patients With High-Risk Non-Metastatic Prostate Cancer, Nathan Lai

Public Health Theses

Background: Current standards of care guide patients with high-risk prostate cancer (T3a or Gleason score 8–10 or PSA >20 ng/ml) toward treatment options such as radical prostatectomy (RP), or radiotherapy (RT) regardless of their life expectancy. These interventions are often invasive, costly, and may offer limited benefit compared to active surveillance (AS). While previous cost-effectiveness analyses have established that active surveillance in low-risk prostate cancer patients (T1–T2a, Gleason score ≤6, and PSA <10 ng/ml) is a cost-effective initial strategy, its role in the management of high-risk patients, especially those with limited life expectancy, remains unclear. This study aims to extend previous cost-effectiveness modeling to the high-risk population to inform decision makers on the most appropriate strategy of care considering a 10-year time horizon.

Methods: This retrospective cost-effectiveness cohort study using the Veterans Affairs Cohort Study (VACS) dataset, which contain electronic health records of men with high-risk prostate cancer. Patients included in …

The Evolution And Effectiveness Of Sterile Insect Technique For Vector Control: A Historical And Modern Analysis, Katerina Karaiskos

Public Health Theses

Sterile Insect Technique (SIT) has emerged as an important tool in the control of vector-borne diseases, providing an alternative to traditional chemical insecticides. Initially based on the irradiation of insects to induce sterility, SIT has proven effective in eradication campaigns, including the cases of the screwworm and tsetse fly. SIT’s primary strengths lie in its species specificity, environmental safety, and the avoidance of pesticide resistance. However, “classic” irradiating SIT is limited by high operational costs, reduced mating competitiveness of sterilized males, and difficulties in addressing high-density vector populations. Recent advancements in genetic-based SIT methods, such as the Release of Insects …

Barriers And Facilitators To Covid-19 Vaccination Access Among Older Adults: A Comprehensive Needs Assessment To Enhance Vaccination Strategies, Jiye Lee

Public Health Theses

Objective: To identify system-specific barriers and facilitators to COVID-19 vaccination among older adults (≥65 years) within a large academic healthcare system and to inform future strategies to enhance vaccine uptake.

Methods: This mixed-methods study included six semi-structured interviews with healthcare leaders and staff, a large-scale survey of 42 clinical leaders across 52 ambulatory sites (20 responses), and analysis of administrative data from Yale New Haven Health (2020–2024). Interviews and survey responses were thematically analyzed. Quantitative data on vaccination rates for COVID-19 and influenza were analyzed by age group and year using descriptive statistics and t-tests.

Results: The semi-structured interviews with …

Assessing The Cross-Species Vaccine Potential Of Pfripr Using Transgenic Chimeric Plasmodium Knowlesi Models, Peiqi Li

Public Health Theses

Malaria remains a major global health burden, with an estimated 263 million cases and597,000 deaths reported in 83 countries in 2023 (1). While P. falciparum is responsible for the most severe cases, non-falciparum species such as P. vivax, P. ovale curtisi, P. ovale wallikeri, P. malariae, and P. knowlesi also pose significant public health risks, particularly in co-endemic regions. Current malaria vaccine efforts mainly focus on P. falciparum which is reasonable because over 90% of the global malaria-related morbidity and mortality are caused by P. falciparum (2). However, laying emphasis on targeting P. falciparum leaves a critical gap in cross- …

Prevalence And Correlates Of Antipsychotic Use Without An Indicated Diagnosis Among Long-Stay Residents In Nursing Facilities In Massachusetts, Hongyi (Sophie) Liu

Public Health Theses

Background: In 2012, the Centers for Medicare & Medicaid Services (CMS) implemented initiatives to reduce unnecessary antipsychotic medication use in elderly nursing home residents to ensure quality of care. While antipsychotic use among long-stay nursing home residents has decreased nationwide, Massachusetts still exceeds the national average and ranks 6th in the U.S. This study aims to evaluate and identify both facility-level characteristics and resident-level correlates of antipsychotic use without an indicated diagnosis among long-stay residents in Massachusetts nursing homes. Methods: The study examined 30,857 long-stay residents across 345 nursing facilities in CY2023, using data from the Minimum Data Set (MDS), …

Global Perspectives On 1,4-Dioxane: Environmental Persistence, Detection Strategies, And Policy Frameworks, Haoyu Lyu

Public Health Theses

1,4-Dioxane is a persistent environmental contaminant present in industrial activities, pharmaceutical manufacturing, and consumer items, particularly challenging to manage due to its high solubility in water and resistance to traditional water treatment processes. Although some countries have implemented stringent regulatory measures, there is a lack of consistent detection and remediation of 1,4-Dioxane in the environment, potentially leading to unregulated contamination in areas with insufficient monitoring capabilities.

In this literature review, studies that have already been published focusing on 1,4-dioxane pollution in China, South America (including Brazil, Argentina, and Peru), and Europe (Germany and the Netherlands) will be evaluated against relevant …

Universal School Meal Programs At The State-Level: Assessing The Next Iteration Of Child Nutrition Policy For A New Generation Of Students, Grace V. Manes

Public Health Theses

BackgroundEight states have passed legislation to codify universal school meal programs (USMPs) for public and nonprofit schools. These programs provide free school breakfasts and lunches to all students with no exclusions. A strong link exists between health, education, and social outcomes and the presence of subsidized school meal programs, and these outcomes are often used to advocate for such programs. This study assesses the prevalence of other state policies passed to address health, education and social outcomes (Medicaid expansion, universal pre-k, and state child tax credits) among states which have also passed USMP policies. We hypothesized that USMP passage would …

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 …

Exploring The Chemistry Of Wildfire Smoke: Leveraging High-Resolution Mass Spectrometry Approaches To Detect Chemical Signatures, Aline Grace Friesen Maybank

Public Health Theses

Background: Wildfire smoke is an increasingly important public health concern. While regulatory monitoring emphasizes fine particulate matter (PM2.5), wildfire smoke is composed of complex mixtures of volatile and semi-volatile organic compounds (VOCs and SVOCs), many of which are harmful to human health but are understudied.

Methods: Fresh Air Clips, passive chemical samplers, were deployed in Kamloops and Kelowna from March to September 2024 to measure VOC and SVOC concentrations before, during, and after the wildfire season. Chemical samples were analyzed using high-resolution mass spectrometry. PM2.5 concentrations, wildfire perimeters, wind direction and speed data, and HYSPLIT back-trajectories were integrated to classify …

Joint Realities: Prevalence, Frequency, And Modality Of Cannabis Use By Sexual Identity In A Multi-State Brfss Sample (2022–2023), Meredith Audrey Rose Mcgee

Public Health Theses

Cannabis use has increased substantially among U.S. adults, yet disparities by sexual orientation and sex remain underexplored, particularly regarding frequency and consumption modality (Hammond et al., 2022; Dyar, 2022). Leveraging 2022–2023 Behavioral Risk Factor Surveillance System (BRFSS) data from eight U.S. states, this study examined patterns of past-month cannabis use among U.S. adults, stratified by sexual orientation–sex group (e.g., bisexual women, gay men).Guided by minority stress theory and prior research (Dyar, 2022; Meyer, 2003; Poole et al., 2021; Schofield et al., 2023), we hypothesized that sexual minority adults, especially bisexual individuals across both sexes, would report: (1) higher prevalence of …

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 …

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 …

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) …

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 …

Stage-Specific Disruption Of Cancer Cell Metabolism By Pfas: Connecting “Forever Chemicals” To The Growing Public Health Challenge Of Colorectal Cancer, Hannah O'Halloran

Public Health Theses

Per and polyfluoroalkyl substances (PFAS), termed “forever chemicals” for their persistence in the environment, are under investigation for their carcinogenic effects, but their specific impacts on colorectal cancer (CRC) progression remain largely unexplored. This study uses untargeted metabolomics to examine the effects of PFAS exposure on cells of CRC stages 2, 3, and 4, and identify state-specific alterations in important metabolic pathways. Later stage cells exhibit a greater response than early stage cells, suggesting increased susceptibility to PFAS effects in cells of more advanced cancer. PFOS had a greater effect on the metabolism of the cell lines compared to PFOA, …

Evaluating The Implications Of Class And Regional Stereotypes On Attributions Of Blame During Hurricane Helene: A Reflexive Content Analysis Of Tiktok, Abby Ong

Public Health Theses

Background and Objectives: Hurricane Helene devastated entire towns across the Southern and Appalachian U.S. Following the hurricane, people who lived in impacted regions were derided for their perceived failures in evacuating. Utilizing Bernard Weiner’s attribution theory of social motivation, this study sought to analyze potential implications of regional stereotypes on how people blamed or supported disaster victims. Primary objectives were to: (1) to analyze content regarding residents’ decisions to evacuate or not evacuate during the storm, (2) to document attributions of blame or support and how those experiencing the disaster and outside observers responded to these attributions, and (3) to …