Medicine and Health Sciences Commons^™

Exploration Of The Complex Relationship Among Multilevel Predictors Of Prep Use Among Men Who Have Sex With Men In The United States, Kristina M. Rodriguez

Dissertations and Theses

Background: Men who have sex with men (MSM) remain the group most heavily affected by HIV in the United States (US), with MSM of color further disproportionately represented. In July 2012, the US Food and Drug Administration (FDA) approved the use of tenofovir disoproxil fumarate plus emtricitabine (TDF-FTC, Truvada) for use as pre-exposure prophylaxis (PrEP) in HIV-negative adults who are at high-risk of HIV infection. Despite its effectiveness, PrEP prescriptions are reaching only a small proportion of those who could benefit from the drug and prescription rates vary both by race and geographic region. The goal of this dissertation was …

Pandemics And Methodological Developments In Epidemiology History, Alfredo Morabia

Publications and Research

No abstract provided.

Leveraging Technology To Blend Large-Scale Epidemiologic Surveillance With Social And Behavioral Science Methods: Successes, Challenges, And Lessons Learned Implementing The Unite Longitudinal Cohort Study Of Hiv Risk Factors Among Sexual Minority Men In The United States, H. Jonathon Rendina, Ali J. Talan, Nicola F. Tavella, Jonathan Lopez Matos, Ruben H. Jimenez, S. Scott Jones, Brian Salfas, Drew Westmoreland

Publications and Research

The use of digital technologies to conduct large-scale research with limited interaction (i.e., no in-person contact) and objective endpoints (i.e., biological testing) has significant potential for the field of epidemiology, but limited research to date has been published on the successes and challenges of such approaches. We analyzed data from a cohort study of sexual minority men across the United States, collected using digital strategies during a 10-month period from 2017 to 2018. Overall, 113,874 individuals were screened, of whom 26,000 were invited to the study, 10,691 joined the study, and 7,957 completed all enrollment steps, including return of a …

Hypertension And Hiv In An Urban Slum Setting, Port-Au-Prince, Haiti, Olga Tymejczyk

Dissertations and Theses

Background: Rapidly growing urban slum settings increasingly face co-occurring communicable and non-communicable health crises, against the backdrop of extreme poverty, and social and environmental vulnerability. In Haiti, sparse data suggest a growing burden of hypertension and cardiovascular disease (CVD), along with substantial prevalence of HIV, increasingly recognized as a major CVD risk factor. As life-saving antiretroviral treatment (ART) is extended to more people living with HIV (PLWH), their risk of CVD increases with longer life expectancy and possibly cumulative ART exposure. Pregnant HIV-positive women may face additional cardiovascular vulnerability, due to the risk of gestational hypertension and pre-eclampsia. Integration of …

Trends In The Timeliness Of Hiv Diagnosis And Antiretroviral Treatment Initiation Before, During And After The “Treat All” Recommendation – New York City, 2006 - 2015, Mckaylee Robertson

Dissertations and Theses

BACKGROUND: Voluntary HIV testing followed by immediate antiretroviral treatment (ART) initiation (universal testing and treatment) has become an integral part of strategies to eliminate HIV and control the HIV/AIDS epidemic. Minimizing the time from HIV infection to ART initiation is essential for universal test and treatment to be optimally effective. In New York City, an epicenter of the HIV epidemic, the ‘treat all’ recommendation, immediate treatment for all people diagnosed with HIV, was made in late 2011, and efforts to ‘treat all’ were contemporaneous with large scale HIV testing initiatives in NYC. The overarching goal of this dissertation was to …

Extreme Obesity Among Adults In The United States: Spatial Variation And The Association With Mortality, Carrie Mills

Dissertations and Theses

Objectives: The purpose of this dissertation was to create small area estimates to describe and explore the county-level spatial variation of extreme obesity among adults in the United States and to assess the county-level association and spatial variation of extreme obesity and mortality.

Methods: The Behavioral Risk Factor Surveillance System was used in conjunction with data from the Census Bureau to estimate county-level model-predicted prevalence of extreme obesity using multilevel regression and poststratification. Spatial dependence of estimates was assessed using global Moran’s Index, and local Moran’s Indices were used to identify clusters of higher and lower rates of extreme obesity …

Using Marginal Structural Models To Control For Time-Dependent Confounding And Detect Effect Modification In A Randomized Control Trial With A Time-Varying Exposure, Non-Adherence And Missing Data, Elizabeth A. Lancet

Dissertations and Theses

Background: Unlike traditional regression used in the Intention to Treat (ITT) approach, Marginal Structural Models (MSM) can account for joint effects of baseline and subsequent treatments as well as the presence of time-dependent confounding influenced by prior treatment and selection bias due to censoring. In addition, MSMs have been theorized to be able to assist investigators in determining the overall benefit of a drug in the total population as they are able to provide a summary effect size across all strata of an effect modifier which cannot be done via tradition regression techniques. The overall goal of this dissertation is …

Comorbidities And Medication Adherence Among Older Individuals Living With Hiv In The United States, Amanda M. Kong

Dissertations and Theses

The number of people living with HIV (PLWH) ≥65 years old is increasing in the United States (US) as PLWH live longer. In 2015, there were nearly 1 million people living with diagnosed HIV in the US and under 10% were age ≥65. By 2035, the proportion of PLWH in this age group is projected to be 27%. Like the general population of elderly individuals, as they age, PLWH face age-related comorbidities, many of which require routine medical care and daily medications, in addition to daily antiretroviral therapy (ART) for treatment of HIV. Previous research has found that PLWH develop …

A Mendelian Randomization Study Of Coronary Artery Disease And Three Amino Acids: Alanine, Glycine, And Glutamine, Allan Uribe

Dissertations and Theses

Cardiovascular disease is the leading cause of death worldwide. Coronary Artery Disease (CAD) accounts for the majority of those deaths. Observational studies have identified risk factors that have been helpful in lowering the death rate, including hypertension, high cholesterol, diabetes, smoking, physical inactivity and poor diet. The effects of these risk factors on CAD remain unclear. To clarify the effect of three amino acids, alanine, glutamine, and glycine on CAD I applied a two sample Mendelian randomization analysis to extensively genotyped observational data. In a sample with up to 184,000 individuals and approximately 60,000 controls, SNPs that reached genome wide …

Determination Of Anxiolytic And Antidepressant Medicines In New York City Wastewater Samples, Jasmine J. Gayle

Student Theses

Wastewater-based epidemiology (WBE) provides information about a population’s exposure to certain chemical agents, such as drugs of abuse and medicines, by the analysis of human biomarkers, also known as excretion products, in wastewater samples. Although this is a growing field worldwide, mainly in Europe, Oceania, and Asia, limited data from the US are currently available. We developed and validated an analytical method to quantitatively and qualitatively determine the presence of commonly prescribed drugs to treat anxiety (alprazolam, buspirone, clonazepam, lorazepam, and propranolol) and depression (bupropion, citalopram, clomipramine, duloxetine, fluoxetine, imipramine, paroxetine, sertraline, and venlafaxine) in wastewater using liquid chromatography tandem …

Burden Of Lipohypertrophy Among Insulin Dependent Diabetes Mellitus Patients In China: An Analysis Of Outcomes And Impact Of Pen Needle Reimbursement Policy, Arthi Chandran

Dissertations and Theses

Background

Diabetes is a global epidemic and with an aging population accompanied by rapid urbanization China ranks highest in disease prevalence and associated burden. Independent of diabetes type, insulin is an eventual and costly requirement for disease management. The consequences of insulin administration however are poorly understood. Lipohypertrophy (LH) is one such consequence. It is hypothesized that method of insulin delivery and poor delivery technique are significant risk factors for this condition which is believed to alter insulin pharmacodynamics. Subsequently, insulin pen needles are a critical component of care however access to pen needles varies across China.

Objective

The objective …

Changing Neighborhoods And Residents’ Health Perceptions: The Heart Healthy Hoods Qualitative Study, Paloma Conde, Marta Gutiérrez, Maria Sandin, Julia Díez, Luisa N. Borrell, Jesús Rivera-Navarro, Manuel Franco

Publications and Research

Cities, and therefore neighborhoods, are under constant change. Neighborhood changes may affect residents’ health in multiple ways. The Heart Healthy Hoods (HHH) project studies the association between neighborhood and residents’ health. Focusing on a middle–low-socioeconomic neighborhood in Madrid (Spain), our aim was to describe qualitatively its residents’ perceptions on the urban changes and their impacts on health. We designed a qualitative study using 16 semi-structured interviews including adult residents and professionals living or working in the area. Firstly, we described the perceived main social and neighborhood changes. Secondly, we studied how these neighborhood changes connected to residents’ health perceptions. Perceived …

Obesity, Type 2 Diabetes, And Dietary Acculturation Among Foreign-Born Blacks In New York City, Margrethe F. Horlyck-Romanovsky

Dissertations and Theses

Background: Black immigration to the US quadrupled between 1980 and 2000, and between 2000 and 2013 it further increased by 56%. The US Census estimates that by 2060, 16.5% of the US Black population will be foreign-born. Half of all foreign-born Blacks (FBBs) in the US, or more than 1.9 million people, are from the Caribbean, and of those, 682,000 were born in Jamaica alone. Besides the Caribbean, there are 1.36 million immigrants from sub-Saharan Africa. In New York City, non-Hispanic black Caribbean and West African immigrants constitute 19% and 4%, respectively, of the total foreign-born population. Research is limited …

First Trimester Medication Abortion Practice In The United States And Canada, Heidi E. Jones, Katharine O'Connell White, Wendy V. Norman, Edith Guilbert, E. Steve Lichtenberg, Maureen Paul

Publications and Research

We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, n = 703) and Canada (n = 94) to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time of fielding, mifepristone was not approved in Canada. 383 (54.5%) US and 78 (83.0%) Canadian facilities participated. In the US, 95.3% offered first trimester medication abortion compared to 25.6% in Canada. While 100% of providers were …

Public Health Research Priorities To Address Us Human Trafficking, Emily F. Rothman, Hanni Stoklosa, Susie B. Baldwin, Makini Chisolm-Straker, Rumi Kato Price, Holly G. Atkinson

Publications and Research

In this Perspective, HEAL Trafficking, the nation's leading public health anti-trafficking organization maps out a national research agenda to tackle the problem of human trafficking. Given the paucity of research on trafficking, HEAL Trafficking engaged its membership in a consensus development process throughout 2016 to develop its national research agenda. HEAL Trafficking proposes five priorities that public health researchers should focus on in the decade ahead to make meaningful progress on preventing and responding to human trafficking in the Unites States.

Incorporating Place And Space: A Hierarchical Spatial Approach To Exploring Preventable Congestive Heart Failure Hospitalizations In New York City, Rachael Weiss Riley

Dissertations and Theses

Background: Faced with rising medical care costs, increasing prevalence, and widening health disparities, preventing congestive heart failure (CHF) hospitalizations is a central public health concern. Despite evidence of geographical clustering in preventable CHF admissions, there is a lack of research designed to examine spatial patterning of CHF and the local area neighborhood determinants that contribute to this variability. This study sought to assess and evaluate the importance of both space and place in analyzing preventable CHF hospitalizations and readmissions by applying appropriate statistical techniques, clarifying the assumption inherent in each method, and interpreting the findings within the context of existing …

The Role Of Socioeconomic Context In The Association Between Educational Attainment And Morbidity And Mortality, Jennifer Brite

Dissertations and Theses

Although the association between educational attainment and health is one of the most studied in the social science, little is known about the role of social and economic context. Fundamental Cause Theory suggests that the education-health gradient will be weakest in contexts where the better educated are unable to leverage their resources to achieve better health. This dissertation tests several different factors that may moderate the association between educational attainment and morbidity and mortality: 1. Demographic characteristics, including race, immigration status, and gender, 2. Status consistency (defined as education equivalent to that required for current occupation), 3. Unemployment rates at …

Quantitative Analysis Of Opioids And Cannabinoids In Wastewater Samples, Alethea Jacox

Student Theses

Wastewater-based epidemiology is an innovative approach that uses the analysis of human excretion products in wastewater to obtain information about exposure to drugs in defined population groups. We developed and validated an analytical method for the detection and quantification of opioids (morphine, oxycodone, hydrocodone, oxymorphone and hydromorphone), and cannabinoids (9-tetrahydrocannabinol, 11-nor 9-carboxy- tetrahydrocannabinol (THCCOOH) and THCCOOH-glucuronide) in raw influent wastewater samples by ultra-high performance liquid chromatography-tandem mass spectrometry. Method validation included linearity (5–1 000 ng/L for opioids, 10–1 000 ng/L for cannabinoids), imprecision (<21.2%), accuracy (83%–131%), matrix effect (from –35.1% to –14.7%) and extraction efficiency (25%–84%), limit of detection (1–5 ng/L) and quantification (5–10 ng/L) and auto-sampler stability (no loss detected). River, sewage overflow and wastewater samples were collected in triplicate from different locations in New York City and stored at -20 C until analysis. River water samples were negative for all the compounds. Water from sewage overflow location tested positive for morphine (10.7 ng/L), oxycodone (4.2–23.5 ng/L), oxymorphone (4.8 ng/L) and hydromorphone (4.2 ng/L). Wastewater samples tested positive for morphine (133.0– 258.3 ng/L), oxycodone (31.1– 63.6 ng/L), oxymorphone (16.0–56.8 ng/L), hydromorphone (6.8–18.0 ng/L), hydrocodone (4.0– 12.8 ng/L) and THCCOOH (168.2– 772.0 ng/L). This method is sensitive and specific for opioids and marijuana determination in wastewater samples.

Research Methods In Occupational Health Psychology, Irvin Sam Schonfeld, Chu-Hsiang Chang

Publications and Research

http://www.springerpub.com/occupational-health-psychology.html

Occupational Health Psychology (OHP) is a rapidly expanding interdisciplinary field that focuses on the science and practice of psychology in promoting and developing workplace health- and safety-related initiatives. This comprehensive text for undergraduate and graduate survey courses is the first to encompass a wide range of key issues in OHP. It draws from the domains of psychology, public health, preventive medicine,nursing, industrial engineering, law, and epidemiology to focus on the theory and practice of protecting and promoting the health, well-being, and safety of individuals in the workplace and improving the quality of work life.

The text addresses key psychosocial …

The Effects Of Health-Related Fitness On School Attendance In New York City 6th-8th Grade Youth, Emily M. D'Agostino

Dissertations, Theses, and Capstone Projects

Background: Only 42% of youth ages 6-11 in the United States meet the World Health Organization’s recommendation for ≥60 minutes of daily moderate to vigorous physical activity. Estimates for adolescents ages 12-19 are even lower, ranging from 8-17%. Literature suggests low levels of youth health-related fitness (fitness) may negatively impact attendance, potentially due to reduced physical and psychosocial wellness. Nationally, 10-15% of (5-7.5 million) students are chronically absent, meaning that they miss ≥10% of the school year (or ≥20 days of school per year). Moreover, 20-30% of students in high-poverty, urban school districts do not attend school regularly (≥6 days …

The Impact Of Foster Care On Depression: An Examination Of Placement Type And Mental Health Service Utilization Among Children And Adolescents, Kisha Cummings

Dissertations, Theses, and Capstone Projects

Background: Children and adolescents in foster care with a history of complex trauma such as neglect, emotional, physical, and sexual abuse have a greater odds of being clinically diagnosed with depression in adulthood compared to children and adolescents without such a history. The current study examines the prevalence of depression in a national sample of children and adolescents aged 7 to 17 years. This study asks whether a) foster care is associated with a greater prevalence of depression among children and adolescents in foster care compared to children and adolescents not in foster care; b) there is an association between …

Multilevel Analysis Of Individual, Neighborhood, And Health Care Facility Characteristics Associated With Achievement And Maintenance Of Hiv Viral Suppression Among Persons Newly Diagnosed With Hiv In New York City, Ellen W. Wiewel

Dissertations, Theses, and Capstone Projects

Objective

To investigate the effect of individual, health care facility, and neighborhood characteristics on achievement and maintenance of HIV viral suppression, among New York City residents aged 13 years and older diagnosed with HIV between 2006 and 2012.

Methods

I used individual-level data from the New York City HIV surveillance registry and Case Surveillance-Based Sampling, facility-level data from the surveillance registry, and neighborhood-level data from the U.S. Census and American Community Survey. The outcomes of interest were first viral suppression after diagnosis (Aims 1 and 3; ≤400 copies/mL) and virologic failure after first suppression among persons who achieved suppression (Aim …

Monitoring Prevalence, Treatment, And Control Of Metabolic Conditions In New York City Adults Using 2013 Primary Care Electronic Health Records: A Surveillance Validation Study, Lorna E. Thorpe, Katharine H. Mcveigh, Sharon Perlman, Pui Y. Chan, Katherine Bartley, Lauren Schreibstein, Jesica Rodriguez-Lopez, Remle Newton-Dame

Publications and Research

Introduction: Electronic health records (EHRs) can potentially extend chronic disease surveillance, but few EHR-based initiatives tracking population-based metrics have been validated for accuracy. We designed a new EHR-based population health surveillance system for New York City (NYC) known as NYC Macroscope. This report is the third in a 3-part series describing the development and validation of that system. The first report describes governance and technical infrastructure underlying the NYC Macroscope. The second report describes validation methods and presents validation results for estimates of obesity, smoking, depression and influenza vaccination. In this third paper we present validation findings for metabolic indicators …

Effect Of The New York City Overdose Prevention Program On Unintentional Heroin-Related Overdose Death, 2000-2012, Anne Elizabeth Siegler

Dissertations, Theses, and Capstone Projects

Background: Drug overdose mortality is the leading cause of injury death in both the United States (US) and New York City (NYC). Heroin-related overdoses make up the majority of overdoses in NYC. Since 2006, when a law was passed that allowed for layperson administration of naloxone, an opioid antagonist, heroin-related overdose deaths have decreased in NYC. No studies to date have investigated a possible association between the implementation of this intervention and heroin-related overdose mortality.

Objectives: To investigate the possible association between overdose prevention programs (OPPs) and heroin-related overdose mortality in NYC, using interrupted time series and geospatial analytic …

Housing And The Environment: Smoking Triggers And Tobacco Smoke Exposure, Shannon Farley

Dissertations, Theses, and Capstone Projects

Background: Despite decades of smoking prevalence declines and more recent smoke-free indoor and outdoor air laws, smoking causes 400,000 preventable deaths and secondhand smoke (SHS) exposure leads to 40,000 deaths from respiratory and cardiovascular disease among non-smokers annually. Built and social environment factors linked to smoking include tobacco retailer density and neighborhood poverty. Housing environments including multiunit housing are linked to SHS exposure and adverse health outcomes.

Objectives: To investigate possible associations of different environmental factors with smoking, SHS exposure, and SHS-related health outcomes.

Methods: Many data sources were used: New York City Community Health Survey, Department of Consumer Affairs, …

Diagnostic Procedures Using Radiation And Risk Of Thyroid Cancer: Causal Association Or Detection Bias? An Examination Of Population Cancer Trends And Data From The Nyc Fire Department, Rachel Zeig-Owens

Dissertations, Theses, and Capstone Projects

Background: Thyroid cancer (TC) is a common cancer diagnosis in the United States, whose incidence is increasing. Disaster and radiation treatment studies show high doses of radiation can cause TC. Some diagnostic procedures, whose use is increasing, expose individuals to low-dose radiation but can also incidentally detect subclinical TC. Evidence regarding low-dose radiation risk is limited.

Objectives: To investigate the possible association of greater use of diagnostic procedures with TC, either causally through radiation exposure or via incidental detection.

Methods: Two data sources were used: National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) data and Fire Department of the …

Risk Factors And Costs Influencing Hospitalizations Due To Heat-Related Illnesses: Patterns Of Hospitalization, Michael T. Schmeltz

Dissertations, Theses, and Capstone Projects

The objective of this dissertation was to identify individual and environmental risk factors, investigate outcomes and hospital resource use, including costs, and document the pattern of heat-related illness hospitalizations in the United States. The main data source for the study population was the 2001-2010 Nationwide Inpatient Sample (NIS). The study population for heat-related illnesses (HRIs) consists of patients in the NIS with at least one diagnosis of a heat-related illness (ICD-9 codes 992.0 - 992.9) from 2001 to 2010. Outcome analysis included a study population of patients who had primary or secondary diagnoses of diabetes, cardiovascular diseases, respiratory illnesses, nephritic …

Intra- And Intergenerational Effects Of Migration And The Role Of The Psychosocial Environment In The Development Of Perinatal Depression, Hannah R. Simons

Dissertations, Theses, and Capstone Projects

Background: Perinatal depression is a significant public health issue that affects women and their families. Studies conducted outside of the United States (US) have found a higher prevalence of perinatal depression in immigrant compared to native-born women. US studies have been less consistent but have relied on convenience samples and lacked appropriate comparison groups.

Objectives: To characterize the relationship between migration to the US and risk for perinatal depressive symptomatology and to examine the role of the post-migration psychosocial environment on the occurrence of perinatal depressive symptoms.

Methods: The dissertation used two data sources, the NYC Pregnancy Risk Assessment Monitoring …

The Revolving Door Pattern Of Jail Incarceration And Homelessness And Its Influence On Mortality And Morbidity Among New York City Adults, Sungwoo Lim

Dissertations, Theses, and Capstone Projects

Objectives

The purpose of this dissertation study was to identify timing and sequencing of jail incarceration and homelessness by utilizing sequence analysis and to test whether a particular trajectory contributes to mortality risk and discontinuity of HIV care.

Methods

The main data source was an existing matched dataset, constructed using administrative data from the New York City (NYC) Departments of Health and Mental Hygiene, Correction, and Homeless Services. The study cohort consisted of 15,620 NYC adults with recent histories of both jail incarceration and homelessness. Monthly experiences of jail incarceration, homelessness, and community-dwelling in 2001-03 were summarized into trajectory groups …

An Argument And Plan For Promoting The Teaching And Learning Of Neglected Tropical Diseases, Kevin M. Bonney

Publications and Research

Neglected tropical diseases constitute a significant public health burden, affecting over one billion people globally, yet this group of diseases is underrepresented in the appropriation of both monetary and intellectual capital for developing improved therapies and public health campaigns. The topic of neglected tropical diseases has been similarly marginalized in the biology classrooms of our nation’s high schools and colleges, despite offering an opportunity to teach and learn about a diverse area of microbiology with far-reaching public health, social, and economic implications. Discussed herein is an argument for increasing the representation of neglected tropical diseases in microbiology education as a …