Digital Commons Network^™

Real-World Rollout Of Injectable Antiretrovirals For Hiv Prevention And Treatment: Understanding Predictors Of Early Adoption, Liza Koshy

Public Health Theses

Background: Data is limited on implementation of long-acting injectable (LAI) HIV treatment (ART) and prevention (PrEP). We sought to characterize “early adopters” of LAI ART and PrEP in terms of social determinants of health, using a health equity lens. Methods: A retrospective cohort included patients prescribed ART or PrEP through a large Northeast urban health system (January 2021-September 2023). Separate analyses used electronic health record data for: 1) prevention (LAI vs. oral PrEP) and 2) treatment (LAI vs. oral ART). Group differences were examined using ANOVA, chi-square tests or Fisher’s exact tests. Bivariate logistic regression modeled associations between LAI ART …

Exploring Health Equity In Global Community Health Worker Compensation With Cfir Analysis, Mansoorah Kermani

Public Health Theses

IntroductionEquitable compensation of community health workers (CHWs) is fundamental to sustaining and maximizing the impact of CHW interventions worldwide. Despite their pivotal role in promoting health equity especially among underserved populations, CHWs often encounter inadequate and inconsistent compensation, undermining the sustainability and effectiveness of their efforts. This review delves into various CHW compensation models and implications that may improve CHW compensation and performance across diverse patient populations.

MethodsEmploying the Consolidated Framework for Implementation Research (CFIR), this review systematically examines empirical literature to examine six different compensation models: alternative payment methods (value-based, capitation, and shared savings), grant-based, public sector or governmental, …

Evaluating Knowledge And Attitudes Towards Dengue Fever And Its Vaccination Among Medical Staff In China: A Questionnaire-Based Study, Ip Man Lam

Public Health Theses

Dengue, a mosquito-borne tropical disease caused by the dengue virus, has seen a significant increase in global incidence in recent decades. China has experienced a rapid rise in dengue cases since 2013, posing a serious threat to population health and increased economic burden. This study aimed to evaluate the knowledge and attitudes towards dengue fever and dengue vaccination among medical staff in China. A cross-sectional study was conducted using an online questionnaire survey targeting medical professionals in Zhejiang, Yunnan, and Hainan provinces, which are known endemic areas for dengue virus infection in China. The questionnaire assessed participants' understanding of dengue …

Exploring The Connections Between The Arts And Mental Health In The Face Of Climate Change, Marla Joy Minkoff

Public Health Theses

Objective: This study aims to explore how engagement with art may shape emotions related to the climate crisis and expand the conception of art as a mechanism of public health practice.Background: Climate change impacts human health not only physically but also psychologically, manifesting in symptoms of climate emotions (e.g., ecological grief, eco-anxiety, eco-paralysis) that arise as a result of changes to the earth and our relationship to the natural world. These symptoms are among the pressing mental health effects of climate change. Methods: A qualitative approach utilizing the Rapid Assessment Process (RAP) was employed to conduct semi-structured interviews (N=10) with …

“Their Body, Their Choice. Your Body, Your Choice. Your Baby, Your Choice.”: A Reflexive Thematic Analysis Of Vaccine Access And Acceptance Among U.S. Pregnant People On Reddit, Sydney Marie Perlotto

Public Health Theses

Compared to the general population, pregnant people and newborns are at a higher risk of contracting infectious diseases and experiencing worse adverse outcomes. Vaccines delivered during pregnancy, known as prenatal vaccines, represent a critical yet underused form of preventive care for these populations in the United States. Increasing successful prenatal vaccination uptake requires a focus on both access and acceptance, which pregnant people may experience differently than non-pregnant people due to their unique physiological and social state. Given the evolution of vaccine hesitancy following the COVID-19 pandemic, coupled with the recent expansion of the U.S. prenatal immunization schedule, this study …

Determining Optimal Media For Carbapenem-Resistant Enterobacteriaceae Recovery From Hospital Sink Drains: A Prospective Environmental Microbial Study, Eryn Larissa Pawluk

Public Health Theses

Abstract Background: Environmental healthcare-associated pathogens are of particular public health concern, not only as potential contributors to the escalating rates of hospital-acquired infections1 noted during the SARS CoV-2 pandemic, but also as valuable indicators for multidrug resistance2. Their significance extends to infection prevention and control, emphasizing the pivotal role of shaping specific interventions within healthcare settings.

Rationale: The study investigates R2A agar’s efficacy in recovering environmental pathogens, specifically carbapenem-resistant Enterobacteriaceae (CRE), crucial for enhancing infection prevention and control in healthcare settings.

Objectives: In this prospective study conducted within hospital environments, our objective is to identify superior culture methods for recovering …

A Climate Change Calamity: Assessing The Impact Of Flooding On Waterborne Disease Burden In Pakistan, Haleigh Schultz

Public Health Theses

Background: Pakistan ranks among the countries most vulnerable to climate change. In 2022, extreme flooding ravaged the country as a result of unprecedented monsoon rains, resulting in widespread environmental and health devastation. As flooding events damage water, sanitation and health (WASH) infrastructure, contribute to disaster conditions, and strain healthcare systems, heavy rains can impact waterborne disease transmission and outbreak events. Extreme flooding events are expected to increase in prevalence, severity, and scope as the climate continues to change in the future. This study aims to assess the impact of monsoon seasons and flooding events on waterborne disease burden in Pakistan …

Examining The Relationship Between Pcv13, Respiratory Viruses, And Invasive Pneumococcal Disease In Massachusetts Children, Kaitlin Soden

Public Health Theses

The landscape of the burden of invasive pneumococcal disease (IPD) in Massachusetts children has been shaped by both the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in 2010 as well as the relationship with respiratory viruses, like influenza and COVID-19. The implementation of non-pharmaceutical interventions (NPIs) and dramatic decline in non-COVID circulating respiratory viruses during the initial waves of the COVID-19 pandemic provided a unique opportunity to evaluate the relationship between respiratory viruses and IPD in Massachusetts children. Using weekly surveillance data for IPD, influenza, and COVID-19 in Massachusetts children 5 years of age and younger from the Massachusetts …

Assessment Of Suicide Risk In Emergency Department Settings For Adults In Nepal: Validation Of The Nepali Ask Suicide-Screening Questions, Pei Wang

Public Health Theses

Objectives: Suicide is a severe public health crisis around the globe. Low-middle-income countries (LMICs) bear 77% of the global suicide burden. Screening is a significant component of suicide prevention, but there is a dearth of suicide screening tools, especially in LMICs. This study focused on validating the Ask Suicide-Screening Questions (ASQ) within an adult Emergency Department (ED) population in Nepal. Although the validation occurred in an ED setting, the Nepali ASQ is designed with the flexibility to be useful in a variety of healthcare contexts, extending its applicability beyond just emergency care.Methods: We systematically translated and adapted the 4-item ASQ, …

Cost-Effectiveness Analysis Of Alternative Infant And Neonatal Rotavirus Vaccination Schedules In Malawi, Catherine Wenger

Public Health Theses

Rotavirus is the leading cause of cases and deaths related to diarrhea-related hospitalizations among children under five worldwide, especially in low- and middle- income countries. Although vaccination is proven to be the best strategy for preventing rotavirus, its impact has been suboptimal in LMICs.

The primary aim of this study was to evaluate the impact of and cost- effectiveness of the current Rotarix rotavirus vaccine, two alternative vaccine delivery schedules, and the next-generation vaccine (RV3-BB) in Malawi.

The cost-effectiveness of rotavirus vaccine strategies in Malawi was evaluated using moderate-to-severe and non-severe rotavirus cases derived from a mathematical model ofrotavirus transmission …

The Impact Of The Covid-19 Pandemic On Cancer Prevention Behaviors In Selected Gen Z Population (Ages 18-25), Lan Zhang

Public Health Theses

Background: The COVID-19 pandemic has resulted in negative changes in health behaviors related to cancer. Recent studies in adults have identified factors leading to harmful/unhealthy lifestyle changes during the pandemic. However, little is known about the factors that predict worse cancer-related health behaviors among young adults.

Methods: The data used for this analysis were from a cross-sectional online survey conducted in Connecticut in 2021 regarding participant’s lifestyle behaviors during the COVID- 19 pandemic. Participants were recruited through social media networks of community partners and organizations within the Yale Cancer Center (YCC) catchment area. Participants included local minority and low socioeconomic …

Do Rental Assistance Programs Relieve Overcrowding In U.S. Children?, Frank Zhu

Public Health Theses

Introduction: Crowded living conditions are associated with many negative health outcomes, with significant implications for children, as they are particularly shaped by their home environment and more likely to live in crowded conditions, given their larger household size. How rental assistance programs may shape and improve household crowding has not been previously explored. Methods: This study leveraged data from NHANES linked with HUD administrative rental assistance records. We examined changes in crowding measures in U.S. children using linear and logistic regression models stratified by different rental assistance program types. Results: There was a statistically significant 40 percentage point reduction in …

Exploring The Role Of Bacteroidales In Human Health: A Comprehensive Literature Review On Their Associations With Selected Diseases, Tingyue Wang

Public Health Theses

Bacteroidales are a vital group of gut bacteria that significantly contribute to human health by maintaining gut balance. However, their abundance is often altered in various diseases, indicating a strong association with disease progression and immune responses. This review categorizes Bacteroidales into clusters based on metabolic phenotypes, suggesting similarities in their metabolic pathways.

To explore the relationship between Bacteroidales species and human health, we conducted a comprehensive literature review. We compiled a list of 16 Bacteroidales species and performed targeted searches in PubMed using keywords related to inflammation and immunity. This process helped us identify relevant diseases, focusing on those …

Influence Of Stigma On Retention In Hiv Care And Adherence To Antiretroviral Therapy In Specialized Hiv Clinics Targeting Men Who Have Sex With Men And Transgender Women In Lima, Peru, David Oliveros Oliveros

Public Health Theses

HIV stigma is a social determinant of health that can influence adherence to antiretroviraltherapy (ART) and engagement in HIV care that impacts viral suppression levels for people with HIV (PWH). In Peru, a country which lags behind 95-95-95 targets for HIV outcomes, LGBTQ-affirming clinics have the potential to mitigate these negative health effects of stigma and discrimination among men who have sex with men (MSM) and transgender women (TGW), two populations that continue to be disproportionately affected by HIV. Using a validated HIV stigma scale and multivariate logistic regression models, this study assessed the magnitude and types of stigma present …

Intersectoral Responses To Climate Change And Waterborne Diseases In The Caribbean Region: Current Actions And Pathways Forward Using The One Health Framework, Sydney A. Steel

Public Health Theses

The Caribbean exists on the frontlines of climate change, and many climate-related threats are already felt throughout the region and projected to worsen in the coming decades. A critical climate-related threat is that of waterborne diseases, as extreme weather events, sea level rise, and temperature increases are shown to contribute to potable water inaccessibility and a more favorable environment for pathogen proliferation and transmission. The complexity of this challenge calls for increased regional and inter-sectoral collaboration in both preparedness and response efforts. Countries and territories across the Caribbean are currently displaying variable yet marked interest in One Health, yet there …

Does Environmental Testing Of C. Difficile Predict Whether A Patient Is Positive With C. Difficile?, David Caccese

Public Health Theses

Clostridioides difficile is a major public health threat and frequent cause of healthcare-associated infections. Hospitals have struggled to control C. difficile due in part to the challenge of identifying asymptomatic C. difficile carriers and because of C. difficile’s ability to survive on environmental surfaces for long periods. Asymptomatic carriers and environmental surfaces can contribute to C. difficile transmission. Screening of all patients for C. difficile upon hospital admission is not feasible and asymptomatic patients may not be accepting of surveillance testing. Thus, this study examines whether sampling the patient’s room environment once they have been admitted can indicate a patient …

Subcutaneous Lesions And Systemic Infections: A Scoping Review Of The Clinical Implications Of Illicit Xylazine Use, Fatimah Maiga

Public Health Theses

Xylazine, a clonidine analog, is a potent alpha-2 adrenergic agonist used as an analgesic sedative in veterinary medicine. Known to people who inject drugs (PWID) as “tranq”, xylazine has recently infiltrated the U.S. illicit opiate drug supply and has been associated with severe, necrotic lesions, sedation, and respiratory depression. Unlike opiates, xylazine has no human reversal agent or standardized withdrawal treatment protocol and its effects are unclear.

The objective of this study was to conduct a scoping review synthesizing the available clinical research and reporting on xylazine associated subcutaneous lesions and systemic infections. The study also sought to identify gaps …

Barriers To Help-Seeking For Minority College Students During The Covid-19 Pandemic, Jasminder Bains

Public Health Theses

Background: The COVID-19 pandemic has profoundly impacted US college student mental health, but it is unclear how racial/sexual/gender minority students have specifically been affected. Traditional barriers to help-seeking such as mental health stigma do not necessarily hold the same influence in college student populations, and there is mixed evidence on what barriers are the most significant in this population. Therefore, the present study aims to ascertain the effects of the COVID-19 pandemic on the mental health outcomes of racial/sexual/gender minority college students and identify the largest barriers to care for college students.

Methods: Data were obtained from the 2020-21 Healthy …

Social Vulnerability And Viral Respiratory Infections In Connecticut (2018-2021): A Modeling Approach To Identify Salient Measures, Sarah C. Katsandres

Public Health Theses

The social vulnerability index (SVI) measure was developed by the Centers for Disease Control and Prevention to characterize a community’s vulnerability level. Recently, SVI has been used to predict risk of COVID-19, in order to understand which communities may be most vulnerable. This analysis aims to understand what factors are driving the relationship between census tract-level vulnerability and risk of hospitalization with a viral respiratory pathogen. A statistical analysis and modeling study of surveillance data was conducted, analyzing the incidence of hospitalization with influenza, respiratory syncytial virus (RSV), and COVID-19, by census tract, in two counties in Connecticut between 2018–2021. …

Scoping Review On Gonorrhea Vaccines, Linyang Li

Public Health Theses

Gonorrhea infection is caused by Neisseria gonorrhoeae and it is the second most common bacterial sexually transmitted infection around the globe. Although gonorrhea infection is treatable with antibiotics, the level of antimicrobial resistance continues to increase and has become a major public health concern. As options of available treatments are reduced by the emergence of AMR, it has become urgent to develop effective vaccines against gonorrhea infection. The purpose of this scoping review is to describe existing epidemiological evidence in support of gonorrhea vaccine development, to discuss the current vaccine candidates in clinical stages, and to evaluate the theoretical impact …

Shiga Toxin Producing Escherichia Coli (Stec) In Connecticut, Usa, 2017-2021, Angelo Raymond Lodato

Public Health Theses

Introduction: Shiga-toxin producing Escherichia coli (STEC) is a common foodborne pathogen known to cause significant gastrointestinal illness in humans and often results after contact with animals and/or consumption of food that has been contaminated. STEC is a major contributor of foodborne outbreaks in the US. Understanding major contributors of infection is important to improving prevention. Methods: Cases of STEC reported in routine Connecticut FoodNet surveillance were included. Trends in demographic features, serotypes, and exposure histories were used to assess whether there was variation among cases between 2017 and 2021, and pre (2017-2019) and post (2020-2021) COVID-19 pandemic. CT respondents of …

Cost-Effective Analysis Of Rotavirus Vaccination In Dhaka, Bangladesh Using A Dynamic Model Of Rotavirus Transmission, Anher Pinky

Public Health Theses

Background: Despite the global introduction of rotavirus vaccinations across countries, Rotavirus infections continue to be a

leading cause of severe, dehydrating gastroenteritis in children under the age of 5 (Crawford et al., 2017). Bangladesh

experiences an extremely high burden where rotavirus infections contribute to 6,000–14,000 deaths each year in children <5

years of age (Rahman et al., 2007). A cost-effective analysis can aid decision-makers in determining the pros and cons of

introducing a rotavirus vaccination program in limited-resource countries.

Objective: A cost-effectiveness analysis was developed to evaluate the potential benefits of introducing rotavirus vaccination.

The analysis performed aims to inform key …

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State, Anna Grace Preston

Public Health Theses

Background: Despite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the …

The Undercurrents Of Disease In Armed Conflict: An Analysis Of Aggregate National Dstb And Mdr/Xdr Tb Screening & Diagnosis Trends During The 2022 War In Ukraine, Sakina Erika Reames

Public Health Theses

​​Tuberculosis (TB) is the second leading cause of death by an infectious disease worldwide after COVID-19. Extensive efforts have been made for decades to tackle this disease through bolstering healthcare systems especially in countries experiencing a disproportionate burden of TB. Ukraine is considered by the WHO to be one of the 30 high burden countries in the world with a notably high burden of MDR TB. In addition, Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia as well as the fifth largest number of extensive drug resistant cases in the world. Ukraine has made extensive …

Developing And Using Cholera Models In Northwest Syria, Emily Rose Tobik

Public Health Theses

Researchers have utilized transmission dynamic modeling to determine interactions between hosts and pathogens in many humanitarian settings. However, modeling for the cholera outbreak in Northwest Syria (NWS) has yet to be completed. This thesis presents a path towards cholera model building in NWS by investigating the current cholera outbreak, outlining how to create a compartmental model in this region given its complexities, and determining ways potential cholera models could be utilized in NWS. Intricacies involving the region's ongoing civil war, significant internally displaced persons (IDP) population, and the February 2023 earthquake add complexities to modeling in this region. For the …

A Deeper Dive Into Food Insecurity Among Women Involved In The Criminal Justice System, Jessica Robles

Public Health Theses

Background: The U.S. has the highest incarceration rate globally and a recent study found that 91% of formerly incarcerated individuals report being food insecure. Given that, women have become the fastest-growing segment in the incarceration system. Women who are involved in the criminal justice system (WICJ) are more at risk for experiencing food insecurity and chronic diseases. Therefore, this study aims to contribute to existing knowledge on the overall health of WICJ by assessing the prevalence of food insecurity and the social determinants of health (SDOH) that may contribute to food insecurity.Objective: To provide information on the overall health of …

Chagas Disease Screening: Awareness, Practices And Perceived Barriers Among Health Care Providers In Connecticut, Erica J. Rayack

Public Health Theses

Background: An estimated 288,000 people in the United States are infected with Chagas disease. Despite published recommendations for health care providers, the neglected nature of this disease persists, in part due to gaps in knowledge and low levels of Chagas disease awareness among health care providers. A survey was emailed to health care providers to assess knowledge, screening practices and provider-perceived barriers to screening for Chagas disease.

Methods: The survey link was emailed to healthcare providers and department heads. Providers answered a series of questions categorized either as knowledge (K), practice (P), or perceived barriers (B), which were then scored …

Towards A Saliva-Based Pcr Test For The Detection Of Mpox, Russell J. Thomas

Public Health Theses

Current recommendations for the diagnosis of mpox (monkeypox) rely on lesion-swabs as the gold-standard specimen type even though many patients experience symptoms prior to lesion-onset. Earlier detection could bolster the mpox response by mitigating transmission and facilitating access to antiviral treatments. In this study, we validated five PCR assays and compared their detection of mpox virus DNA extracted from 30 saliva specimens collected into Spectrum SDNA-1000 tubes. We found the Logix Smart™ Mpox (2-Gene) RUO assay (Co-Diagnostics, Inc., Salt Lake City, UT) performed statistically significantly better than the other assays. Next, we tested five raw (unsupplemented) known-positive saliva samples in …

A Robust Bayesian Model Averaging Method For Basket Trials With Different Endpoints, Xueting Wang

Public Health Theses

Oncology drug research in the last few decades has been driven by the development of targeted agents. In the era of targeted therapies, basket trials are often used to test the antitumor activity of a novel treatment in multiple indications sharing the same genomic alteration. As patient population are further fragmented into biomarker-defined subgroups in basket trials, novel statistical methods are needed to facilitate cross-indication learning to improve the statistical power in basket trial design. Here we propose a robust Bayesian model averaging (rBMA) technique for the design and analysis of phase II basket trials. We consider the posterior distribution …

Hiv Treatment Patterns Across A Us Data Network: 2012-2021, Raechel Elizabeth Davis

Public Health Theses

IntroductionOnce-daily combination antiretroviral therapy is recognized as the standard treatment for people living with Human Immunodeficiency Virus (HIV) in the United States.1,2 Treatment strategies for HIV have changed substantially over the years, influenced by individual and clinical factors, new medication options, and changing clinical guidelines.1–3 Observational data sources provide a unique opportunity to characterize populations and provide insight into medication usage under real-world conditions that differ systematically from controlled trial scenarios.3,4 Methods We evaluated the treatment patterns and characteristics of 12288 individuals diagnosed with HIV and continuously treated with antiretroviral medications across four, US-based observational databases using the Observational Health …