The Associations Of Out-Of-Home Placement With Penile-Vaginal Intercourse, Age Of Sexual Debut And Pregnancy Among Child Welfare Involved Youth: A Cross-Sectional Study Using The National Survey Of Child And Adolescent Well-Being (Nscaw) Ii, Gabriela S. Betancourt

Dissertations and Theses

Background: Studies of youth in out-of-home (OOH) care and adults with histories of OOH placements have found evidence of poorer sexual and reproductive health (SRH) compared with their counterparts in the general population, including inconsistent use of male condoms and contraceptives, higher prevalence of adolescent pregnancy, and history of unwanted sexual debut. However, within the population of youth involved in child welfare, the effects of OOH placement on SRH have been difficult to establish. The overall goals of the current study were to compare SRH indicators (ever having penile–vaginal intercourse; early age of sexual debut; reported pregnancy) among youth involved …

Aligning Food Environments With Institutional Values: A Mixed Methods Study Of Oregon Health Care Organizations, Elizaveta Walker

Dissertations and Theses

A major driver of the obesity epidemic is obesogenic food environments, characterized by nutrient-poor and energy-dense foods that saturate the collective physical, economic and sociocultural conditions that influence nutritional status. Food environments in organizations such as hospitals and public health agencies warrant special consideration given their health-focused mission. Improving food environments within health care settings has been highlighted by the Centers for Disease Control and Prevention (CDC) as one of seven key strategies to prevent obesity. However, most of the refereed literature examining healthy food environment policies (HFEPs) within hospitals focuses on the inpatient dietary environment, leaving a paucity of …

Smoking Behaviors In Patients Offered Lung Cancer Screening, Sara Elizabeth Golden

Dissertations and Theses

In the United States, smoking causes preventable diseases, including lung cancer, which is the leading cause of cancer deaths. Improving smoking cessation rates is important to decrease lung cancer deaths. Health care visits with a discussion about lung cancer screening (LCS) may help in increasing prevalence of smoking cessation. Importantly, insurers now require clinicians to have a shared decision-making discussion with patients that includes discussion of smoking abstinence before they can receive an LCS scan (i.e., a low-dose computed tomography scan). This discussion may represent a unique opportunity to encourage smoking cessation since it may prompt positive smoking behavior change. …

Inclusion For Speech-Language Pathology Minority Graduate Students, Teresa Michelle Roberts

Dissertations and Theses

Speech-language pathologists provide assessment and intervention for communication, cognition, and swallowing disorders for individuals across the lifespan in educational, medical, and private practice settings. The demographics of professionals in the field do not reflect those of the general public in regard to race and ethnicity, gender, socioeconomic status, LGBTQ+, and disability. Lack of representation of minorities limits research, policy, and services designed to serve diverse populations. Although initiatives have sought to address lack of diversity of speech-language pathologists, limited research on the graduate training experience for minority students is available. Since a master's degree is required to become a speech-language …

Implicit Learning Of Children With And Without Developmental Language Disorder Across Auditory And Visual Categories, Wanchi Yu

Dissertations and Theses

The current study examined implicit sound- and visual-meaning-mappings of children with and without Developmental Language Disorder (DLD).

One child with DLD and 29 children with typical language development (TLD) were included in the study, based on results from a hearing screening and standardized assessments of cognitive and expressive language skills. Participants completed two computer-based experiments, which were designed to investigate: 1) sound discrimination (pitch and duration), implicit mapping of sound stimuli to objects; 2) visual discrimination, implicit mapping of visual stimuli to objects.

The current study showed that children with TLD who implicitly learned pitch categories showed better mapping of …

Plasma Proteins That May Cause Parkinson’S Disease And Multiple Sclerosis: A Mendelian Randomization Study, Brigid A. Staley

Dissertations and Theses

Multiple sclerosis (MS) and Parkinson’s disease (PD) are progressively disabling neurologic disorders that profoundly affect quality of life and shorten life expectancy. There is no cure for either disease, and current treatments only alleviate symptoms and may cause serious side effects. The causes of MS and PD are not well understood. Previous epidemiologic studies have documented numerous environmental risk factors for both diseases. However, these studies are inherently prone to bias from confounding which may generate spurious results. The lack of unbiased evidence on environmental causes of MS and PD has been a critical barrier to fully understanding their pathophysiology. …

The Impact Of The Deficit Reduction Act Of 2005 On The Length Of Hospital Stay, Honamattie Dabydeen

Dissertations and Theses

ABSTRACT

Introduction

Hospital-acquired infections (HAIs) are the most common complications of hospital care in the United States, and at least 1 in 10 patients admitted to the hospital will develop one. These unnecessary complications lead to about 99,000 premature deaths per year and add approximately $35–$45 billion of direct costs. Most of the cost increase is due to increases in hospital length of stay (LOS). This study examines the effect of a federal policy change on LOS among people with an HAI using the Donabedian quality of health care model as a framework. Specifically, this study examines the effect of …

Hiv Viral Suppression Among Hiv Positive Women Of Color In The United States, Amanda J. Nace

Dissertations and Theses

Background: As of 2020, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) remains a serious public health problem in the United States (U.S.). There are more than 1.1 million people living with HIV/AIDS (PLHIV) in the U.S. in 2020. While HIV predominately affects men in the U.S., women are less likely to achieve viral suppression than men. Among the women living with HIV, women of color (WOC) have borne a disproportionate burden of the HIV epidemic in the U.S. for decades. A wealth of evidence has demonstrated the importance of viral suppression as a tool for controlling the …

An Examination Of Hiv Risk, Testing And Prevention Intervention Participation Among Vulnerable Youth, Bianca V. Lopez

Dissertations and Theses

Background: Young gay, bisexual and other men who have sex with men (YGBM) of color are disproportionately affected by HIV and bear the burden of the disease in the United States. Gay and bisexual men – referred to in surveillance systems as men who have sex with men (MSM) – continue to be the risk group most severely affected by HIV in the United States. The dissertation study explored factors related on HIV prevention intervention participation, HIV testing and sexual risk behaviors among YGBM ages 13-29 in the Bronx. Additionally, this dissertation endeavored to study the concept of “intervention fatigue”, …

Impact Of 2012 Spanish Health Care Reform On Hiv-Positive Immigrants: A Mixed Methods Approach, Megi Gogishvili

Dissertations and Theses

Background: The financial crisis of 2008 hit Spain hard. As a consequence, the government took multiple austerity measures, including reforms in the healthcare system in 2012. Specifically, the government reduced the budget for health and social services by 13.7% in 2012.The reduction was further followed with structural changes via the 2012 Royal Decree Law (RDL) and Royal Decree (RD).The 2012 RDL and RD entailed broad areas of action,but most importantly the Spanish National Health System (SNS) no longer covered undocumented immigrants. The 2012 RDL and RD excluded approximately 500,000 undocumented immigrants from SNS.

The number of immigrants in Spain has …

Proximity To Comprehensive Emergency Obstetric Care And The Utilization Of Facility-Based Delivery Services Across Six Low-And-Middle Income Countries, Chioma T. Amadi

Dissertations and Theses

Background: More than 90% of maternal deaths occur in low-and-middle-income countries (LMICs) and are largely attributed to preventable pregnancy-related causes. Comprehensive emergency obstetric care (EmOC), also known as signal functions, is the most effective life-saving intervention for managing obstetric and newborn emergencies. Health facilities offering delivery services are generally classified as having either comprehensive, basic or less than basic EmOC capacity based on their obstetric resources. Multiple EmOC methods are regularly utilized in characterizing facility obstetric capacity and this introduces inconsistencies that pose significant public health and policy implications for access to delivery care among women within a service environment. …

The Role Of Strategic Governance In Reducing Infant Mortality Under Crisis Conditions, Lynn Christine Finley

Dissertations and Theses

The infant mortality rate (IMR) in some developing countries has decreased faster than the global average even though these countries lack strong economic growth, good governance, and democracy (often acknowledged precursors to improved health outcomes). What accounts for the improvement of the IMR in the absence of these traditional pathways to health gains? Some scholars suggest that the concept of "strategic governance" might help direct attention to intermediary factors that reduce neonatal deaths in countries that experience crisis conditions. The main objective of this dissertation is to investigate the set of governance practices that have reduced IMR in two such …

The House We Built In Challenging The Status Quo: House And Ballroom Community Leadership And Health Justice, Jennifer Lee

Dissertations and Theses

Background: The House Ballroom Community (HBC), an underground queer subculture, has been leading actions in large urban cities throughout the Unites States to address health inequities exacerbated by stigma, systemic neglect, and economic disparities, such as the HIV/AIDS epidemic. The HBC is an inventive and dynamic space that posits new leadership paradigms for health equity and health justice, where collective actions and their resulting social impact center the embodied knowledge of their members to create social change.

Methods: Community-based participatory research (CBPR) was a fundamental method and framework for each of the studies (Aims 1, 2, and 3). The meaningful …

The Role Of Agency In Early And Unwanted Adolescent Pregnancy: A Multi Country Analysis, Katharine Mccarthy

Dissertations and Theses

Purpose. The agency to decide one’s reproductive future is paramount, yet an estimated 75 percent of adolescent girls in the United States (U.S.) and 49 percent of those in low and middle-income countries experience mistimed or unwanted pregnancy. This dissertation characterized empirical representations of agency over the course of adolescence and investigated the relationship between agency and early and unwanted pregnancy and childbearing using data from three countries (India, Zambia and the U.S.).

Methods. Using latent class and latent transition analysis, multi-dimensional profiles of adolescent agency were assessed using data from: (1) a state representative cross-sectional cohort study of adolescents …

Agnostic Search For Metabolites Causally Implicated In Alzheimer's Disease, Sal P. Leggio

Dissertations and Theses

This paper uses two sample Mendelian randomizations to conduct an agnostic search of the metabolic GWAS published by Tao Long and co-workers. GWAS for AD from IGAP and from UK Biobank were used for outcomes. The author uses two sample Mendelian randomization (MR) to test for causal relationships between common blood metabolites and Alzheimer’s disease (AD). First, estimates for a set of 22 metabolites which are statistically significant for both outcome GWAS are determined. Egger regression, Mendelian Randomization Pleiotropy Residual Sum and Outlier (MRPRESSO), and weighted median regression are used as sensitivity checks. AD shares risk factors with both heart …

Medical Cannabis In New York State, David Steven Younger

Dissertations and Theses

Background: In July 2014, New York State became the 23rd state to legalize marijuana (“cannabis”) for medical consumption under the New York State Medical Marijuana Program (“Program”). Three years later, during his Executive budget address, the NYS Governor, Honorable Cuomo, directed the Department of Health in consultation with other NYS agencies, to evaluate the experience, consequences and effects of legalized marijuana in neighboring states and territories, and to review the health, criminal justice and economic impacts of regulating marijuana use. That report concluded that the positive effects of a regulated marijuana market outweighed the potential negative impacts.

Objective: This dissertation …

Factors Affecting Clinical Research Enrollment Among Individuals With Alzheimer's Disease And Related Dementias, Nicole Grace Bouranis

Dissertations and Theses

The need to increase ADRD research participation has become more pressing as the prevalence of ADRD increases. Nearly 70,000 Oregonians and 7 million people in the United States live with ADRD, and this number is expected to increase by 200% by 2050 without identification of an intervention to halt its increase. Developing mechanisms for effective care and treatment depends on implementing research with numerous participants. Historically, ADRD research programs have had difficulty recruiting and enrolling individuals into studies for a variety of reasons. Given low recruitment rates, the interest in researching and evaluating effective strategies to recruit specifically for ADRD …

The Social Construction Of Deservedness In Medicaid Eligibility Design: A Qualitative Content Analysis Of State Policy Responses To The Affordable Care Act, Carmina Bernardo

Dissertations and Theses

When the U.S Supreme Court in 2012 ruled that the federal government could not withhold Medicaid funding from states that did not expand Medicaid to low income, non-disabled adults under the Affordable Care Act (ACA), Medicaid expansion became a state option. By the end of 2015, nineteen states had not expanded Medicaid, excluding about 2.5 million individuals from affordable health coverage and access to care. Prior research explored the reasons certain states expanded or did not expand Medicaid, but state decisions did not always result in one of these binary outcomes. There were four policy responses to the ACA’s Medicaid …

Psychosocial Impacts And Employment Preparedness Of Participating In An Hiv Peer Program: Implications For Tailoring A Vocational Counseling Model For Plwh, Erin R. Mckinney-Prupis

Dissertations and Theses

Background:

Medical advancements in HIV care should have reduced barriers to employment for PLWH, yet in 2017 only 47.7% of PLWH reported being employed, as compared to 62.9% in the general population. Employment is a significant social determinant of health, it impacts a variety of factors related to health, including earned income, access to healthcare, and social connectedness. Quantitative and qualitative studies have identified several concerns PLWH have about entering the workforce; the most pressing being fear of losing benefits. Targeted work readiness programs for PLWH is an important approach to help PLWH overcome their unique barriers to work, such …

An Evaluation Of A Web-Based Tool To Improve Feeding Practices And The Home Environment Among Parents Of Low-Income Minority Preadolescents At-Risk For Childhood Obesity, Katrina F. Mateo

Dissertations and Theses

Background: Web-based/mHealth interventions may be an engaging approach to promote positive dietary-related behaviors among parents of youth at-risk for childhood obesity. Importantly, childhood obesity research highlights the role of parents as a key support mechanism in improving child dietary outcomes. Intervention INC is a childhood obesity intervention that comprises a unique, interactive web-based child nutrition comic aimed at improving dietary behaviors among urban Black/African American (AA) and Latino preadolescents, and also weekly online parent newsletters (with feeding tips, healthy printable recipes, links to coupons to support healthy eating/feeding and health-promoting local/community events, and access to the child nutrition comic) to …

Sexual And Reproductive Health Outcomes In Women By Dimensions Of Sexual Orientation: An Examination Of 2011-2017 National Survey Of Family Growth Data, Lauren Porsch

Dissertations and Theses

Background: Sexual minority women experience disparities in sexual and reproductive health outcomes including higher rates of certain STIs, lower engagement in preventive sexual health behaviors, and higher rates of unintended pregnancy compared to their non sexual minority counterparts. Much prior research on sexual minority women’s health has been limited by incomplete or inconsistent definitions of sexual minority status, and has failed to consider sexual orientation branchedness as a risk factor.

Method: Using pooled National Survey of Family Growth data, survey cycles 2011-2013, 2013-2015, and 2015-2017, we performed bivariate and multivariable logistic and multinomial regression analyses to estimate the independent associations …

Investigating The Impact Of The Nursing Practice Environment (Npe) On Central Line-Associated Bloodstream Infections (Clabsi) Among Older Adults In The Intensive Care Unit (Icu), Kristen A. Cribbs

Dissertations and Theses

Background: Health care–associated infections, resulting from treatment received for medical or surgical conditions in a health care setting, represent a critical public health and patient safety issue, exacting substantial medical, social, and economic costs. The costliest among the leading causes of preventable health care-associated infections is central-line associated bloodstream infections (CLABSI), to which older adults (age 65 years and older) are particularly susceptible, especially during intensive care unit (ICU) stays. A rich body of research has empirically linked the quality of the nursing practice environment (NPE) in hospitals to both positive and negative patient outcomes; yet, surprisingly few studies have …

Impacts Of Rift Valley Fever Virus: A One Health Approach To Assess Burden And Inform Prevention And Control Options, Catherine Machalaba

Dissertations and Theses

Background: Rift Valley Fever (RVF) is a climate-sensitive emerging zoonotic disease associated with large-scale livestock production losses and human disease burden in Sub-Saharan Africa and the Middle East. While recognized as a key One Health issue based on its transmission dynamics involving human, animal and environmental determinants, there has been poor coordination between sectors to reduce the risk and impact of RVF. Efforts to counter the disease remain largely reactive, presenting an ongoing threat to local and global health security. The intent of this dissertation was to improve understanding of the burden of RVF across society and to identify entry …

An Assessment Of Potential Causal Pathways Between Two Autoimmune Diseases: Mendelian Randomization Studies Of Rheumatoid Arthritis And Crohn’S Disease; And A Phenome-Wide Association Study To Assess Potential New Targets For Tocilizumab, An Interleukin-6 Inhibitor, Staci Abramsky Risman

Dissertations and Theses

Background

Rheumatoid arthritis (RA) and Crohn’s disease (CD) are two among a group of immune-mediated inflammatory diseases (IMIDs). These diseases are common, collectively affecting as many as two million Americans and as many as 28 million people worldwide. They have different clinical presentations but may have a common pathogenesis. An over-expression of tumor necrosis factor (TNF) and interleukin-6 (IL-6) have been proffered as a causal factor for IMIDs. These and other IMIDs may co-occur in patients, and it has been shown that patients with one IMID may have an increased risk of another IMID. What is not clear is whether …

An Evaluation Of Respiratory Exacerbation In New York City Given Current Trends In Climate Variability And Predictive Sociodemographic Factors, Sarah L.R. Kuril

Dissertations and Theses

Background: Within the last century, the massive increase in emissions due to economic growth has made climate variability a major problem for many of the industrialized countries and an emerging problem for the rest of the world. With an increasing number of extreme weather events, such as heat waves, cold fronts, floods, heavy rain, and storms, individuals with Chronic Obstructive Pulmonary Disease (COPD) and asthma remain a vulnerable population, placing them at highest risk of respiratory exacerbation. This dissertation aims to contribute to our understanding of how climate variability, which can influence patterns of rainfall, temperature and other variables on …

The Reproductive Health And Academic Impact Of The New York City School-Based Health Center Reproductive Health Project For Adolescents, Michelle Silverio

Dissertations and Theses

Background: Gaining an understanding of how school reproductive health policies impact adolescent sexual health and academic outcomes is a public health priority in the United States (U.S.) since it has the highest rates of adolescent pregnancy and sexually transmitted infections among developed nations. Adolescence is a critical developmental period and influences in this period affect reproductive health and social well-being over a person’s entire lifespan. Almost all adolescents spend the majority of their time in school settings; therefore local school reproductive health policies may have substantial lifetime impacts. Policies such as providing comprehensive sexual health education and contraceptive access in …

Development Of A Hospital Readmission Reduction Program For Patients Discharged To Skilled Nursing Facilities: An Application Of Artificial Intelligence And Machine Learning Techniques, Anna Stachel

Dissertations and Theses

Background

Hospital readmissions within 30 days after discharge have drawn national policy attention as they are a reflection of suboptimal patient care. Readmissions are costly, accounting for more than $17 billion in potentially avoidable Medicare expenditures - nearly 78% of readmissions may be avoidable. Rich electronic data from medical records, growing computing capacities, and open source machine learning algorithms offer new opportunities to predict patients at high risk for readmission and prevent readmission through focused interventions. Prediction models might also serve to provide a more nuanced context of patient characteristics that lead to variations in readmission rates. Furthermore, transitional care …

What’S For Lunch? Examining The Factors Associated With Food Choices And Food Insecurity Among Cuny College Students- A Mixed Methods Study, Rachel G. Taniey

Dissertations and Theses

Background: The growing rates of food insecurity in college students points to the need to examine food choices within the context of a socio-ecological framework with an emphasis on the contribution of financial constraints and limited food access on food-based decisions.

Methods: A mixed-methods study design using both primary and secondary data analysis was developed for this dissertation. Primary data examining undergraduate college students was collected on three CUNY campuses including: semi-structured in-depth interviews (N=33), computerized 24-hour dietary recalls using the ASA24 program (N=45), three focus groups (N=26) with students who utilize on-campus food assistance programs, and key informant interviews …

Using Short Chain Fatty Acids To Inactivate Pseudomonas Aeruginosa Biofilms, Stephen Lee

Dissertations and Theses

Abstract

Using Short Chain Fatty Acids to Disinfect Pseudomonas Aeruginosa Biofilms

by

Stephen Lee

Background

The study of bacteria typically focuses on the planktonic or free-living single-cell state that is purely cultured in a laboratory for subsequent growth with appropriate media. Although this traditional way of growing bacteria has been paramount to the understanding of bacterial behavior, physiology, and pathogenesis, bacteria rarely exist as pure cultures of planktonic growth forms in the natural habitat. Bacterial contamination of environmental surfaces, in the form of biofilms, is a prime public health problem and causes numerous infections within the general public. Biofilms are …

Individual And Community Supports That Impact Community Inclusion And Recovery For Individuals With Serious Mental Illnesses, Rachel Elizabeth Terry

Dissertations and Theses

The current dissertation presents two published manuscripts and discusses a third study that explored the role of social support in promoting community participation for individuals with serious mental illnesses. The first manuscript investigated sense of community as a potential mediating factor between community participation, psychological distress, and mental health functioning utilizing quantitative methods. The results indicated that sense of community acted as a partial mediator between community participation and psychological distress, as well as mental health functioning. The second manuscript is a literature review that explored the influence of social support on community integration for individuals with serious mental illnesses. …