Medicine and Health Sciences Commons^™

Frequency Of Colonoscopy Surveillance In Average-Risk Adults Relative To Guideline Recommendations, Meng-Han Tsai

Theses and Dissertations

Colorectal cancer (CRC) is the third leading cancer in the United States with an estimated 132,700 new cases and 49,700 deaths in 2015. Well-performed screening colonoscopies prevent cancer by allowing visualization of the entire colon and removal of precancerous polyps (adenomas). Persons with high-risk polyps at screening are therefore advised to undergo periodic surveillance colonoscopy. Screening and surveillance colonoscopy guidelines were updated by the U.S. Multi-society Task Force (USMSTF) in 2006, which emphasized risk stratification by polyp features at screening colonoscopy.

This is a retrospective cohort study of patients with screening colonoscopy at an endoscopy center in South Carolina between …

Sleep Disruption And Cancer Incidence In A Southeastern Veteran Population, Alexandria F. Delage

Theses and Dissertations

Sleep disruption influences biological processes that can facilitate carcinogenesis. However, studies examining the relationship between sleep disruption and cancer risk have been inconclusive. This retrospective cohort study used de-identified data from the Veterans Administration (VA) electronic medical record to test the hypothesis that sleep disorder diagnoses among Veterans seeking care in the Southeast United States Service Network are associated with increased risk for cancer of the prostate, breast, colorectum, or total cancer (1999-2010, N=663,869). Sleep disorders were defined as patients with an in- or out-patient diagnosis as specified by the International Classification of Sleep Disorders. Cancer cases were defined as …

Low-Intensity Physical Activity And Cardiometabolic Risk Factors Among Older Adults With Multiple Chronic Conditions, Yueyao Li

Theses and Dissertations

Introduction:

Cardiovascular disease (CVD) is the leading cause of death among older adults in the Unites States and is driven largely by cardiometabolic risk factors including elevated blood pressure and blood glucose. Studies have found the protective effect of moderate intensity physical activity (MIPA) and vigorous intensity physical activity (VIPA) on cardiometabolic risk factor; however, the association between light physical activity (LIPA) and cardiometabolic risk factor among older adults is not clear.

Objectives:

1. Examine the association between LIPA and cardiometabolic risk factors.
2. Examine whether the association between LIPA and cardiometabolic risk factor is moderated by multiple chronic conditions. …

Bayesian Semiparametric Quantile Regression For Clustered Data, Xin Tong

Theses and Dissertations

Traditional frequentist quantile regression makes few assumptions on the form of the error distribution and thus is able to accommodate non-normal errors. However, inference on the quantile regression models could be challenging for the unknown error distribution, though asymptotic or resampling methods were developed. Bayesian literature on quantile regression with random effects is relatively limited. The quantile regression approach proposed in this dissertation is founded on Bayesian probabilistic modeling for the underlying unknown distributions. By adopting the error density with a nonparametric scale mixture models, we developed Bayesian semiparametric models to make an inference on any quantile of interest and …

Job Satisfaction And Intent To Quit Outcomes Among Home Health Aides In Home Health Care Industry Of The United States: A Multilevel Study, Seokwon Yoon

Theses and Dissertations

Backgrounds: Home health aides’ job satisfaction and intent to quit have been attributed to organizational and community level factors. The objective is to determine the effects of individual-, organizational-, and community-level factors on job satisfaction or intent to quit among home health aides.

Methods: This research used data from two subsets of the 2007 National Home and Hospice Care Survey and the 2007 National Home Health Aides Survey, sampling six eligible workers across the agencies in the Unites States. As another data source, the present study uses Area Health Resource File. The author used hierarchical linear modeling technique for handling …

Molecular Cues Of Pattern-Recognition-Receptor Pathways In Redox-Toxicity-Driven Environmental Nafld, Suvarthi Das

Theses and Dissertations

With the pandemic proportions of obesity and a correlative increase in fatty liver disease, there was a dire need to explore the missing link between the changed environment and progression of NAFLD in obesity. My research implies that environmental toxin bromodichloromethane induces early liver lesions in obesity, and is mediated by the synchronous insult of oxidative stress and increased levels of the adipokine leptin. In a two-pronged approach to investigate the molecular cues, I looked at the role of Purinergic receptor X7 and Toll 4 receptor. Both rodent models and cell-based systems were used. Also, in order to validate my …

Effectiveness Of Community-Based Eibi Treatment: A Longitudinal Analysis Of Adaptive Behavior And Language Outcomes, John Kuntz

Theses and Dissertations

Autism spectrum disorders (ASDs) are a group of lifelong, neurodevelopmental disorders characterized by deficits in social interaction, communication, relationship development and by the presence of repetitive or stereotypical behaviors including restricted interests. Continued advances in understanding treatment outcomes and broadening access to effective treatment is critical to improving the quality of life of children with autism and their families and minimizing the cost associated with care. The overall aim of this study is to assess the effectiveness of a community-based implementation of an Early Intensive Behavioral Intervention (EIBI) treatment program through a large-sample, longitudinal secondary analysis of administrative data. Additionally, …

Conversations About Sexuality On A Public University Campus: Exploring Perspectives From Campus Ministry Leaders And Students, Charis Rebecca Davidson

Theses and Dissertations

Since the 1800s, religious organizations have been a presence on public universities. However, there is limited research on the influence these organizations may have on student health communication and behaviors. Prior research on campus ministries has focused primarily on the culture of individual organizations. In this study, researchers explored the goals and experiences of USC leaders related to communication around sexuality with their students, as well as student perceptions of these messages, and how students incorporate religious messages about sexuality into their lives. The present study had four aims:

1. Assess whether students participating in campus ministries at USC differ …

Examining Crowdsourced Social Media Platforms And Their Association With College Students' Alcohol Consumption, Perceived Risk, And Behaviors, Danielle Gentile

Theses and Dissertations

Introduction: High-risk alcohol use by U.S. college students remains a significant threat to individual health and community well-being. Newly-emerging social media platforms and apps which relay information about alcohol-related law enforcement serve as an intriguing addition to college alcohol-use environments. The purpose of this study was to examine the information delivered to users by the local social media platform @Drinking Ticket (DT), determine which types of information were then relayed to others, and clarify how this information influences alcohol use, perceived risk, and alcohol-related risk behaviors among college students. Methods: One year of DT tweets (n=854 tweets) were qualitatively coded …

Smoking-Related Stigma: A Public Health Tool Or A Damaging Force ?, Paula A. Lozano

Theses and Dissertations

Cigarette smoking is the leading cause of preventable death in the world. In an effort to address the tobacco epidemic, the World Health Organization’s Framework Convention on Tobacco Control (FCTC) has formulated a number of policies that are thought to reduce cigarette consumption by making smoking socially unacceptable. It is possible that tobacco control policies that aim to make smoking socially unacceptable may also result in the stigmatization of smokers. Social factors such as social norms and socioeconomic status may also influence the development of smoking-related stigma. While some researchers suggest that smoking-related stigma may be an important public health …

Examining Infant Health Outcomes Impacted By South Carolina's Regionalized System Of Perinatal Care, Michael Grady Smith

Theses and Dissertations

Perinatal regionalization systems have been shown to reduce the risk of neonatal mortality when very low birth weight infants are delivered in Level III hospitals with neonatal intensive care units, sub-specialist staffing, and adequate experience caring for high-risk pregnancies and neonates. However, studies to date examining the association between delivery in Level III hospitals and neonatal mortality have not accounted for censoring due to fetal deaths. Furthermore, studies of perinatal regionalization to date have not adequately assessed the association between delivery hospital level of care and the infant’s hospital length of stay. This dissertation examined 8,594 very low birth weight …

A Comparison Of Health Care Systems In The Western World, Katherine Regan Lawall

Senior Theses

This senior thesis evaluates the health care systems of the Netherlands, Belgium, Switzerland, and Denmark, before looking at how their approaches could be adapted to the U.S. system. I picked these specific countries due to their similarity in geographic location, demographic, religious affiliations, and population size but have different styles of health care systems (public, mixed, and private) that are set up in varying ways. Additionally, these populations have similar health issues to one another, such as aging-populations, and to the U.S. as well like the top causes of death. However, these four western European countries have longer life expediencies …

Implementation And Evaluation Of A Social Media Campaign To Promote Cervical Cancer Prevention And Control, Kelsie Nicole Dirksing

Senior Theses

Background: Cervical Cancer-Free South Carolina (CCFSC) is a member state of the Cervical Cancer-Free Coalition focused on eliminating cervical cancer through screening, follow-up care, HPV vaccination, and education. CCFSC utilizes social media to help spread awareness about cervical cancer prevention and control.

Purpose: The purpose of this thesis was to develop, implement, and evaluate a social media campaign for CCFSC during Cervical Health Awareness Month in January 2016.

Methods: Two social media plans – one for CCFSC use and another for CCFSC partner use – were developed for use during Cervical Health Awareness Month in January 2016. The CCFSC posts …

Sustainability Of Food And Nutrition Security Policies During Presidential Transitions: Integrating Socio-Political And Nutritional Sciences, Jessica Liana Escobar-Alegría

Theses and Dissertations

Presidential transitions are uncertain periods in which relationships among power, accountability, and electoral support of a democratic process do not hold. Transitions challenge collaboration towards implementing policies contributing to food and nutrition security (FNSP). Sustaining these policies during transitions is critical for reaching long-term goals. Knowledge gaps remain on how to perform strategic multisectoral work during transitions to maximize FNSP sustainability.

This study aimed to examine what determines FNSP sustainability during presidential transitions and responded to the questions: How do policy actors define sustainability? What are the mechanisms determining policy sustainability? What are the implications of terminal logic behavior (TLB) …

The Association Between Physical Activity And Serum Immunoglobulin G (Igg) Antibodies Against Periodontal Bacteria, A. Paige Anderson

Theses and Dissertations

The purpose of this study is to add more research and evidence to the mechanisms surrounding periodontal disease, periodontal microorganisms, and physical activity. The main objective of this study is to evaluate and explore the association between physical activity and serum IgG antibodies, which are grouped into four distinct clusters, formed from species specific 19 periodontal antibody titers. This cross sectional study divided physical activity into three categories: adequately physically active, inadequately physically active, and inactive based on MET scores. Certain models were adjusted for confounders including age, sex, race/ethnicity, income-to-poverty ratio, years of formal education, smoking, alcohol intake, BMI, …

Depression Among Pregnant Latinas In South Carolina, Andrew Fogner

Theses and Dissertations

The aim of the study was to determine the prevalence of depression among pregnant Latinas. To bring to light the importance of prenatal depression prevention, we assessed the effect of the quality of healthcare providers among South Carolina Latinas (n=171). Women answered a validated CES-D and were categorized as depressed (score >16). In multivariate analyses, good perception of quality of healthcare was more likely among women who were not depressed; adjusted odds ratio of 0.75, 95% confidence interval 0.37 – 1.55. The findings show the need for tailoring healthcare to Latinas with prenatal depression prevention. It is imperative to understand …

The Roots Of Perspective In The American Context: News Media Discourse And Stakeholder Perspectives About The Supplemental Nutrition Assistance Program, Nicholas Younginer

Theses and Dissertations

The Supplemental Nutrition Assistance Program serves 46 million people but is controversial. The media is positioned to influence political and public opinions about SNAP policy. This study identifies the SNAP media discourse and investigates perspectives of SNAP participants and frontline workers about the program.

I employed a mixed-methods design with two aims. Aim 1 gathered 295 articles across six news outlets, semi-inductively coding the articles for characters, assignment of responsibility, and framing of the article. I then ran chi-square tests for difference between employed frame and responsibility and employed frame and political ideology.

Aim 2 collected a sample of 20 …

Demand And Supply Factors Affecting Maternal Healthcare Utilization Pattern In Nigeria, Dumbiri Joy Powell

Theses and Dissertations

Given poor maternal services utilization and associated high maternal mortality risk in Nigeria, we document policy-amenable supply and demand factors impacting women’ use of skilled ANC and institutional delivery services. Using a cross-sectional design, we analyzed data from the Nigeria State Health Investment Project health facility and household surveys on 418 health facilities and 3,726 women with a pregnancy within 24 months prior to survey living in 241 geographic wards of two states. Logistic regression was used to study associations of women’s use of each maternal service with ward facilities’ ANC outpatient satisfaction, healthcare staff job satisfaction, surveyorverified facility infrastructure, …

Quality Over Quantity: Positive Interactions During Family Meals In Food-Insecure Households Compensate For The Negative Impacts Of Household Chaos On Child Emotional Well-Being, But Not Diet Quality, Tiara Nicόl Rosemond

Theses and Dissertations

Family meals are important family activities that have many positive nutritional and emotional benefits for children. Positive family meal experiences may provide opportunities for children to strengthen emotional bonds, leading to a sense of security and, fostering improved children’s self-regulation of healthier food intake and emotional well-being. Unfortunately, children in food insecure households experience higher amounts of chaos, lower diet quality, and worry about having enough to eat compared to children in food-secure households, all of which may affect both family meal frequency and interpersonal quality. Yet, the relationships between food insecurity, household chaos, and family meal frequency and interpersonal …

A Qualitative Study Of How Communities Think About And Act Upon Hunger In The Presence Of A Food Banking System, Eliza Miriam Fishbein

Theses and Dissertations

Hunger is often addressed by providing food directly to those experiencing symptoms of food insecurity and hunger. Even with the availability of government food assistance programs, food insecurity and hunger rates continue to rise. Many local community organizations (e.g., small food banks, faith-based organizations, schools) across the country have come together to create and implement a variety of nongovernment food programs. Although there is no evidence these programs lower food insecurity and hunger rates, community organizations appear to be strongly committed to sustaining these programs. Little is known about the basis for this commitment, i.e., “ the will to act …

Healthcare Utilization And Expenditure Patterns Among Older Adults With Functional And Medical Decline, Ashley Shields Robertson

Theses and Dissertations

Purpose. As the aged population of this country grows, the U.S. healthcare system will face increased pressure to provide long-term care services and supports to increasing numbers of elderly Medicare beneficiaries. Studies have indicated that unmet long-term care need can lead to increased, unnecessary utilization of the healthcare system, thus further taxing the Medicare system. Little is known about how type of long-term care, as well as how long-term care policies—specifically payment policies—affect health care utilization. The objective of this original dissertation research was to examine the effects of place of residence (community versus residential long-term care facility) and …

The Influence Of Prenatal And Early Life Factors On Bmi Z Scores And The Risk Of Being Obese In Early Childhood, Junxiu Liu

Theses and Dissertations

Childhood obesity is a serious public health challenge. The underlying causes behind the rising levels of childhood obesity might be driven by prenatal and early life factors. Recently, several studies have examined the association between gestational weight gain (GWG) and the risk of obesity in the pediatric population. Findings on the association of both inadequate and excessive GWG with offspring obesity are inconsistent and vary by maternal prepregnancy body mass index (BMI) status. Inconsistent findings also exist for the association of GWG and BMIZ as a continuous outcome. Nevertheless, existing studies mainly focus on the BMIZ upper centiles using logistic …

Social Capital And Social Networks: The Importance Of Social Ties For Health Among Residents Of Disadvantaged Communities, Stephanie Child

Theses and Dissertations

Access to social capital via social networks is important for health and may be linked with chronic disease, including obesity and hypertension. Socioeconomic status (SES) may influence access to social capital and social network characteristics, and may also moderate the relationship between social capital, social networks, and health. Yet few studies have explored relationships between social capital, social networks, and chronic disease among resource poor individuals.

Respondent-driven sampling was employed to recruit participants (n=430) from low-income communities in the US South for a household survey as part of the Greenville Healthy Neighborhoods Project. The survey collected information about participants’ SES …

Spatio-Temporal Analysis Of The Occupational Fatal Victimization Of Law Enforcement Officers In The Us, Xueyi Xing

Theses and Dissertations

The models with constant coefficients of the covariates across space and time are commonly used in spatio-temporal analyses. However, the associations between risk factors and the outcome could have locally differential temporal trends in many cases. In this study, a Bayesian latent cluster modeling strategy is employed to identify potential spatial clusters in which locally specific sets of temporally varying coefficients of covariates are allowed. A state-level panel data of police officers occupational fatal victimization for the years 1979-2010 is used. To accommodate overdisperson and excess zeros, a negative binomial model and zero-inflated Poisson/negative binomial models are also utilized. A …

Examining The Relationship Among Patient-Centered Communication, Patient Engagement, And Patient’S Perception Of Quality Of Care In The General U.S. Adult Population, Jumee Wang

Theses and Dissertations

Introduction: Patient-centered care is a major focus of healthcare organizations, policy makers, and researchers. Patient-centered communication by the provider and patient engagement are important components of patient-centered care. Despite increasing attention to these topics, we do not fully understand how patient-centered communication and patient engagement relate to perceived quality of care as reported by patients. This study takes some initial steps in exploring these relationships. The study also identifies patient-related factors such as sociodemographic, health-related, and health system factors that are associated with patient-centered communication, patient engagement, and perceived quality of care.

Method: This study used survey data …

Relationships Of Chronotype, Social Jetlag, Sleep, Physical Activity And Diet With Mood, Perceived Stress, Obesity, Blood Pressure And Prostate Cancer, Daria M. Mcmahon

Theses and Dissertations

Background: Chronotype, social jetlag, poor sleep, proinflammatory diet, and low physical activity have been associated with increased risk of chronic diseases: obesity, diabetes, cardiovascular disease, depression and cancer. Yet the relationships between these factors have not been extensively investigated in prospective studies.

Methods: Two studies were conducted. The first study followed 390 healthy men and women ages 21-35 for two years. Social jetlag [SJL] and sleep measures (total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO]), sleep efficiency [SE]), were derived from physical activity personal (armband) monitoring. The participants wore the armband for 4-10 …

Progesterone-Only Oral Contraceptive Pill, Breast Cancer, Heart Disease, And Stroke, Marsha Ema Samson

Theses and Dissertations

There is evidence from earlier studies that oral contraceptive pills may be a risk factor for certain chronic diseases, including heart disease, stroke, and breast cancer. Previous studies mainly focus on the estrogen component of combined (estrogen+ progestin) oral contraceptives (COCs) due to their popularity. This focus limits our understanding of progestin-only contraceptives and its relationship to commonly occurring chronic diseases. To provide insight into alternative methods of oral contraception, this dissertation explores the relationship between progestin-only oral contraceptive (POC) pills and heart disease, stroke, and breast cancer. We hypothesize that women using POCs are less likely to have certain …

Contextualizing Multilayered Sexual Subjectivities Of Heterosexual Black Female Undergraduate Students At A Predominantly White Institution In The South, Amarachi Rossana Anakaraonye

Theses and Dissertations

This study uses an intersectional theoretical framework to examine Black college women’s sexual health by focusing on how they engage in sexual decision making within their social contexts. This qualitative study analyzed 20 individual in-depth interviews of Black female undergraduate students, ages 18-22, who attend a predominantly white institution (PWI) in the Southeastern United States. The themes that emerged from qualitative data analysis include Black female undergraduate students’ perceptions of the sexual culture of their campus and the protective strategies they employ to navigate the sexual culture in order to achieve and/or maintain physical, emotional, and social well-being. Key findings …

Influence Of Thyroid Disorders On Pregnancy Outcomes, Brittany Sullivan

Theses and Dissertations

Objective: The objective of this thesis is to investigate the effects of maternal thyroid dysfunction on maternal pregnancy outcomes.

Setting and Participants: The NICHD Consecutive Pregnancy data set contains information on a total of 114,679 pregnancies from 51,086 women who delivered ≥ 20 weeks of gestation. The data come from 20 different hospitals throughout the state of Utah and were collected between the years of 2002 to 2010.

Main Outcomes: Main outcomes of interest included: breech presentation, chorioamnionitis, gestational diabetes, gestational hypertension, hemorrhage, inductions, placental abruption, placental previa, preterm birth, premature rupture of membranes (PROM), preeclampsia, and …

Sleep Disorder Trends, Epigenetic Markers, And Genetic Variation Of Circadian Genes In Adenomatous Polyp Formation, Melannie Alexander

Theses and Dissertations

Introduction: Sleep disturbances and sleep quality have fluctuated over time in the United States (US). Virtually every physiological process follows a circadian pattern, and cellular processes (i.e., cell proliferation, DNA damage response, and apoptosis) are often disrupted by sleep disturbances and other factors, potentially giving rise to adverse health outcomes such as cancer. Additionally, both genetic variation and epigenetic patterns within clock genes, which may affect sleep quality, also may increase one’s risk for developing cancer. The role of sleep disturbances in the formation of adenomas, precursor lesions to colorectal cancer (CRC), has been explored previously; however, little is …