Effect Of Body Mass Index, Testosterone, And Insulin On Breast Cancer: A Mendelian Randomization Study And Investigation Of Selection Bias, Kezhen Fei

Dissertations and Theses

BACKGROUND: Female breast cancer is the most studied cancer, and the second leading cause of cancer death in women, whose aetiology is still not completely clear. The parallel increase of incident obesity and breast cancer in women worldwide raises the question of the role of adiposity, measured by body mass index (BMI), and of major anabolic hormones, such as insulin and testosterone, on breast cancer. Observational studies are open to confounding making it difficult to clearly demonstrate causal effects. Several mendelian randomization (MR) studies have shown inverse association of BMI with breast cancer. To assess selection bias in MR …

Radiation Isolation And The Impact Of Care: Nursing Knowledge And Perception Of Radiation Risks, Bae P. Chu

Dissertations and Theses

Background: The safety challenges encountered when employing ionizing radiation to treat patients and manage radiation exposure and contamination have been well established in previous research. However, little is known about nurses’ understanding of the risks associated with ionizing radiation and how they respond to their own perceptions of risk. Although a wealth of literature shows an association between radiation treatment and negative patient experiences, there remains a lack of understanding of the basis of these perceptions among nurses. Increased ionizing radiation diagnoses and treatment means that nurses are at a higher risk of radiation exposure today than thirty years ago. …

Assessment Of Spatial And Temporal Trends Of Exposure To Ambient Fine Particulate Matter And Ozone In New York/New Jersey Metropolitan Area, Subraham Singh

Dissertations and Theses

Background. Exposures to fine particulate matter (PM_2.5; particles with diameter less than 2.5 μm) and ozone (O₃) affect premature respiratory and cardiovascular mortality, morbidity and contribute to the development and progression of sub-clinical and clinical disease. Climate change affects air quality directly by modifying the thermodynamic properties of formation mechanisms and transport patterns, and indirectly, through increased emissions of PM_2.5 and O₃ precursors. The resultant changes in air quality influence human health outcomes through mechanisms of varying scale, timing, and complexity. PM_2.5 and O₃ levels have been declining due to the implementation …

Neighborhood Predictors Of E-Cigarette Retailer Density In New York City, Laena Orkin-Prol

Dissertations and Theses

Background: The rampant expansion of the e-cigarette market over the last decade in the U.S. is a threat to the health of the public—due to the e-cigarette’s appeal to young people, addictiveness, and harms of consumption. It is vital to study the distribution of e-cigarette retailers of different types in major urban centers, such as New York City (NYC), to identify if certain neighborhoods are overburdened with retailers and if intervention is required. The current research on the e-cigarette retailer environment is limited in its scope and methods used.

Objective: To investigate neighborhood attributes associated with e-cigarette retailer density in …

Factors Related To Contraceptive Use And Family Planning Decision-Making In The South Asian Community Residing In New York City, Nandini Shroff

Dissertations and Theses

Introduction: Currently, there are approximately 5.4 million South Asians residing in the United States (U.S.). The limited literature illustrates that contraceptive use is underutilized among Asians and Asian sub-groups, including South Asian Americans, compared to other racial and ethnic groups. Using Los Angeles County Health survey data, one study found that 22% of Asian Americans reported always using condom in the past 12 months compared to 37% of African Americans, 27% of Whites, and 27% of Hispanics. A study among New Jersey women revealed that compared to non-South Asian women, South Asians (SAs) were less likely to have used ever …

Investigation Of The Association Of Exposures To Fire-Related Hazards With Pulmonary Function Of Firefighters, David G. Goldfarb

Dissertations and Theses

Background. Firefighters are habitually exposed to hazardous toxicants which place them at an elevated risk for numerous adverse health outcomes. An example of this is the associations observed in other works between inhalation of combustion byproducts from urban structural fires and both acute and chronic pulmonary dysfunction. To-date, the characterization of firefighters’ exposures to dangerous chemicals in smoke from non-wildfire incidents, both directly through personal monitoring and indirectly from work-related records is scarce. Prior works investigating the association between routine firefighting and pulmonary function have relied on crude metrics such as years of service and numbers of responses to …

The Global Implementation Of Dolutegravir For Hiv Treatment, Matthew L. Romo

Dissertations and Theses

Background
Dolutegravir, an integrase strand transfer inhibitor, is now recommended by international guidelines as part of preferred antiretroviral therapy (ART) regimens for people living with HIV. In low- and middle-income countries (LMICs), HIV treatment programs are transitioning from non-nucleoside reverse transcriptase inhibitors (NNRTIs) to dolutegravir because of its superior efficacy and tolerability, and high genetic barrier to HIV drug resistance. Along with the optimism surrounding widespread dolutegravir use, key questions regarding its implementation have emerged. In this dissertation, I sought to achieve the following specific aims: Aim 1: Characterize dolutegravir uptake in LMICs and identify potential disparities related to sex …

Assessing Psychosocial Factors That Influence Water, Sanitation, And Hygiene Behavior In The Amhara Region Of Ethiopia, Kimberly Kamara

Dissertations and Theses

Background: The absence of potable drinking water from an improved source combined with inadequate sanitation and hygiene contributed to an estimated 1.9% of the global burden of disease in 2016. The estimated number of diarrheal deaths in 2016 was 1.4 million, of which 829,000 could have been prevented through improved drinking water and sanitation services, and hand-washing with soap. Despite the clear link between poor water and sanitation access and hygiene practices, 785 million people do not have access to water and two million do not have access to basic sanitation services. However, access does not automatically result in increased …

Episode Based Payment Models And The Hospital Safety-Net: An Evaluation Of The Center For Medicare And Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program, John A. Gravina

Dissertations and Theses

Episode Based Payment Models and the Hospital Safety-net: An Evaluation of the Center for Medicare and Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program

By John Anthony Gravina

Advisor: Alexis Pozen, Ph.D.

Introduction: Payments for Healthcare services are increasingly being tied to clinical quality, patient experience, health outcomes, and efficiency through value-based payment arrangements (VBP). VBP presents a potential opportunity to reduce healthcare expenditures by requiring providers to take on financial risk associated with the cost and quality of care, therefore aligning payment incentives with the goals of providing higher quality and efficient care. As of 2020, 80 percent of …

The Associations Between Diabetes, Cardiovascular Disease And Occupational Hearing Loss In A Cross-Sectional Analysis Of Department Of Energy Nuclear Workers, With A Mendelian Randomization Of Publicly Available Data To Enhance Observational Findings, Jonathan Corbin

Dissertations and Theses

Title: The Associations between Diabetes, Cardiovascular Disease and Occupational Hearing Loss in a Cross-sectional analysis of Department of Energy Nuclear Workers, with a Mendelian Randomization of Publicly Available Data to Enhance Observational Findings

Author: Jonathan Corbin

Advisor: Ghada Soliman, MD, PhD, R.D., CDN

Introduction: Occupational Hearing Loss (OHL) is the most common workplace health condition, and the overall impact of hearing loss (HL) on health is underappreciated. Diabetes and cardiovascular disease (CVD) are two of the most common causes of death and are largely preventable and treatable. Previous research has evaluated associations between OHL and …

Fortunate People In A Fortunate Land: Dwelling And Residential Alienation In Santa Monica's Rent-Controlled Housing, Lauren E.M. Everett

Dissertations and Theses

The importance of safe and stable housing for individual and community wellbeing is widely acknowledged. However, for the one third of Americans who rent their homes, housing-related stress and precarity (residential alienation) may undermine stability and a sense of home. Rent control is perhaps the most well-known tenant protection policy in the United States, but it remains highly controversial and its efficacy has been debated for decades. This research is the first academic inquiry to examine the policy through the experience of residents of rent-controlled housing. In academic discourse dominated by quantitative inquiry from the discipline of economics, this study …

Factors Associated With Racial And Ethnic Disparities In Cesarean Delivery Among Women With Low-Risk Pregnancies At New York City Hospitals, 2012-2017, Ellen Brazier

Dissertations and Theses

BACKGROUND: While Cesarean delivery is a life-saving procedure when certain complications arise, it is associated with increased risks of maternal mortality and morbidity, as well as neonatal and childhood morbidities, and increased risks for women during subsequent pregnancies. Stark and persistent racial/ethnic disparities in Cesarean delivery that are not explained by clinical risks raise concerns about overuse of the procedure, as well as the contribution of potentially avoidable Cesareans to disparities in maternal mortality and morbidity. Understanding the extent to which disparities in Cesarean delivery may be attributable to differences in care during labor is critical for addressing these disparities. …

Assessing The Association Among Hospital Ownership Penalties Assessed Under The Hospital Readmissions Reduction Program And 30-Day Risk Standardized Mortality Rates For Selected Conditions, 2016-2018, Jennifer Carmona

Dissertations and Theses

Background: The Hospital Readmissions Reduction Program (HRRP) is an aspect of Patient Protection and Affordable Care Act (ACA) of 2010. HRRP requires Medicare to reduce payments to hospitals with relatively high readmission rates. While the implementation of the program has been accompanied by reductions in readmission rates, some have expressed concerns about unintended consequences, including harm to patient care and even death. Under HRRP, hospitals serving a high proportion of socioeconomically disadvantaged patients, like public hospitals, have been more likely to receive financial penalties, potentially impeding their ability to invest resources in improving patient outcomes. There is previous research …

Contraceptive Use And Sterilization Among People With Disabilities, Gabrielle Y. Defiebre

Dissertations and Theses

Background

Approximately 20% of individuals in the United States (US) have a disability, with 1 in 4 adult women above the age of 18 having a disability. People with disabilities include individuals who may experience difficulties with mobility, cognition, independent living, vision, hearing, and/or self-care. Disabled people face physical/environmental barriers, provider-level barriers, and system-level barriers in accessing health care, including sexual and reproductive health care, and are more likely than people without disabilities to have unmet medical needs. Four recent studies have indicated that those with disabilities are more likely to have received female sterilization as a family planning service …