Digital Commons Network^™

Cost-Effectiveness Of New Monoclonal Antibody And Maternal Immunization For The Prevention Of Respiratory Syncytial Virus (Rsv) Disease In Infants: A Systematic Review, Yuwei Che

Public Health Theses

AbstractIntroduction: Respiratory syncytial virus (RSV) remains a major cause of morbidity and mortality among infants and young children worldwide. Given the lack of specific therapeutic treatments for RSV that are suitable for universal use, the development of effective prevention strategies is of paramount importance. Previously, palivizumab was utilized for long-term prophylaxis of RSV infections; however, it was only recommended for specific populations due to its high cost and limited overall effectiveness. In 2023, the U.S. FDA approved RSVpreF maternal vaccine (Abrysvo™, Pfizer), and nirsevimab (Beyfortus™, Sanofi and AstraZeneca) for the prevention of RSV to newborns. Two newly developed interventions have …

Assessing Impact Of Maternal Proximity To Unconventional Oil And Gas Wells On Neonatal Birthweight In Ohio: A Retrospective Cohort Study (2010–2017), Alan Cao

Public Health Theses

AbstractBackground: Unconventional oil and gas development (UOGD) has expanded rapidly in the United States, particularly in states like Ohio, which is home to approximately 5,000 horizontal shale wells and more than 80,000 hydraulically fractured wells since 1952. Although oil and gas extraction has occurred in Ohio for over 60 years, the recent surge in UOGD activity has raised renewed public health concerns about environmental exposures during pregnancy. While previous studies have linked maternal proximity to UOGD with adverse birth outcomes, evidence remains limited regarding its association with birthweight and fetal growth indicators in high-production states such as Ohio.

Methods: We …

The Village Determinants Of Self-Rated Health And Mental Health: A Multilevel Analysis Of Environments In Rural Honduran Villages, Marnen Elizabeth Decker

Public Health Theses

I investigated the associations of village structural, behavioral, and social environments with self-rated health and mental health among adults residing in remote rural villages in the mountainous Copán region of Honduras. I estimated nested multilevel logistic models with 17,318 adults in 174 villages. All models controlled for individual characteristics to distill true village-level effects, and nested structure was employed to facilitate direct comparison across models. Both poor self-rated health and mental health were inversely associated with village size and positively associated with coffee cultivation. Poor self-rated health was also positively associated with friend/adversary tie ratio, and poor self-rated mental health …

How To Increase The Public’S Awareness Of Car-T Therapy? A Pilot Mixed Methods Study, Pei-Chun Cha

Public Health Theses

Background: Chimeric Antigen Receptor (CAR) T-cell therapy is a combination of antibody and T cell receptor (TCR), which allows T-cells to recognize and attack cancer cells. It has shown effectiveness in treating hematological malignancies, but has been less effective for solid tumors. Clinically, it is the first FDA-approved gene therapy as it uses lentivirus to modify the genome of T cells that are infused back into patients. Preclinically, laboratory research is being conducted to enhance this treatment through multiple genetic modifications. Concurrently, integrating community research to understand the public’s awareness of CAR-T is essential for making this therapy more widely …

Assessing The Costs Of Illness Attributable To Leptospirosis, Alyssa Chetrick

Public Health Theses

Leptospirosis, caused by the spirochetes of the genus Leptospira, is a zoonotic bacterialdisease endemic to tropical regions and lower middle income countries (LMICs). Leptospirosis causes an estimated 1 million cases and more than 58,900 deaths annually.(Costa et al., 2015; Torgeson et al., 2015) In addition to human health, leptospirosis significantly impacts animal health and the livestock industry, particularly through reproductive losses, increased treatment costs, and decreased milk production, which exacerbates global insecurity.(Bennet, 2015; Torgeson et al., 2015) The estimated global cost loss to productivity due to disease is estimated at Int$ 29.3 billion. (Agampodi et al., 2023) Because of its …

Scale-Up Of Access To Medication For Opioid Use Disorder For People Who Inject Drugs On Parole In Ukraine: A Modeling Analysis, Brendan Caver

Public Health Theses

Background: Human Immunodeficiency Virus (HIV) and opioid-use disorder have long beendescribed as a syndemic; the two health issues go hand-in-hand to exacerbate each other (Perlman & Jordan, 2018). While the HIV pandemic has improved greatly in many regions such as the United States over the past several decades, it continues to become worse in Eastern Europe and Central Asia. HIV prevalence and opioid dependence are particularly high in carceral settings, but access to opioid agonist therapy (OAT) is extremely limited. This paper shows the results of a modeling analysis undertaken to see the impact of opioid agonist therapy (OAT) scale-up …

The Impact Of Climate Change On Japanese Encephalitis Trends In China, Jiayi Du

Public Health Theses

Japanese encephalitis (JE) is a mosquito-borne viral disease that poses a significant public health threat across Asia, including China. Climate change has been increasingly recognized as a key driver of JE transmission dynamics, influencing mosquito vector distribution and virus proliferation. This study aimed to assess how climatic variables affect the ecological suitability for Japanese encephalitis virus (JEV) transmission, using species distribution modeling with MaxEnt.

Using climate data from WorldClim and JE incidence data from published sources, we applied the MaxEnt model to identify the key environmental predictors of JE transmission and project future risk areas under changing climatic conditions. The …

Association Between Primary Covid-19 Vaccine Type And Booster Uptake Among Incarcerated People In Connecticut: A Retrospective Cohort Study, Michael Condon Elhardt

Public Health Theses

Importance: Booster doses of the COVID-19 vaccine are critical for maintaining protection against SARS-CoV-2, especially in high-risk settings such as correctional facilities. Understanding how initial vaccine type influences booster uptake can inform vaccination strategies in these and other underserved populations.Objective: To assess whether the type of COVID-19 vaccine received for the primary series—either viral vector (Janssen/Jcovden) or mRNA (Moderna/Spikevax or Pfizer-BioNTech/Comirnaty)—was associated with timing or likelihood of booster completion among incarcerated individuals. Design: Retrospective cohort study using survival analysis methods. The study period spanned from February 2, 2021, to May 31, 2023. Setting: Connecticut Department of Correction (DOC) facilities, including …

Exploring Harm Reduction In Treatment: A Qualitative Study Of Methods And Perceptions Among People In Substance Use Disorder Care, Carson Francis Ferrara

Public Health Theses

Amidst the ongoing opioid epidemic and rising overdose deaths, substance use disorder (SUD) treatment has historically prioritized abstinence over harm reduction, creating gaps in patient safety. This qualitative study explores harm reduction integration in formal treatment settings and participant perceptions through 48 semi-structured interviews with individuals enrolled in Project RENEW, a larger cohort study examining factors influencing people in treatment for alcohol use across Connecticut and Georgia. Participants (79% inpatient, 51% court-mandated) described their experiences with harm reduction methods and safety strategies while in treatment. Thematic analysis revealed four key findings: 1) inconsistent access to resources like naloxone and fentanyl …

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 …