Medicine and Health Sciences Commons^™

Comparing Hpv Vaccination Uptake In Democrat And Republican Us States Using Presidential Elections Voting Patterns In 2016 And 2020, Omar Guerrero

Public Health Theses

Abstract Objective: To investigate the association between state-level voting patterns and Human Papillomavirus (HPV) vaccination coverage in teenagers in the US. Methods: States were categorized as either Democratic or Republican based on the 2016 and 2020 Presidential election results. A paired t-test was conducted to examine the difference between vaccination coverage between the two groups. A multivariable linear regression model was conducted to examine how state-voting patterns are associated with HPV vaccination coverage after adjusting for confounding (percentage of people living in poverty, percentage of uninsured people, percentage of non-white population, and the percentage of people living in rural areas …

Evaluation Of One Health Education Materials: A Scoping Review And Quality Assessment, Sydney Jones

Public Health Theses

The increasing risk of zoonotic spillover, driven by climate change and evolving human behaviors, requires a systematic shift in pandemic prevention strategies towards a One Health approach. Central to this approach is effective health communication intended to translate knowledge into actionable recommendations for the most vulnerable populations. This thesis aims to systematically evaluate the quantity and quality of existing One Health communication materials through a scoping review and two distinct methods of quality evaluation: the CDC Clear Communication Index and content analysis. Among 82 communication materials identified in the scoping review, the median overall CDC Clear Communication Index score was …

Diagnostic Evaluation For Abnormal Uterine Bleeding At Emergence Departments In The United States, Wanyi Huang

Public Health Theses

Objectives: To examine the pattern of diagnostic evaluation for abnormal uterine bleeding (AUB) in a national sample of women seeking care at emergency departments (ED) and to identify potential influencing factors with a focus on race and ethnicity.

Methods: We identified 1,049 (unweighted, or 7,900,653 weighted) women without previous cancer diagnosis who visited ED for non-pregnancy related AUB from the National Hospital Ambulatory Medical Care Survey during 2014-2021. The primary outcomes were whether an ultrasound was provided/ordered and whether a referral/return for follow-up consultation was recommended. Multivariable logistic regressions were conducted to assess the association of race and ethnicity with …

Effect Of A Weight-Loss Intervention On Oxidative Stress Biomarkers Among Breast Cancer Survivors In The Lifestyle, Exercise, And Nutrition (Lean) Study, Yiyi Li

Public Health Theses

Introduction: As the number of breast cancer survivors increases, ensuring quality of life during the survivorship period is important. Obesity may induce oxidative stress, which may be relevant mechanistically for adverse health outcomes among breast cancer survivors. Diet, exercise, and weight loss may mitigate oxidative stress, yet few lifestyle trials have investigated if these interventions have impacted oxidative stress. Therefore, we conducted a secondary analysis in a 6-month weight loss randomized controlled trial, the Lifestyle, Exercise, and Nutrition (LEAN) study, among breast cancer survivors with a body mass index (BMI) ≥ 25 kg/m2 to evaluate the effect of the intervention …

Exploring The Use Of Mobile Health Application To Promote Self-Managment Of Cardiovascular Disease: A Study Of Age-Related Differences And Technology Adoption Among Chinese Patients, Yunan Mei

Public Health Theses

Background: Cardiovascular diseases (CVD) are the leading cause of mortality globally, particularly in China's aging population. Mobile health (mHealth) technologies offer a promising avenue to address healthcare disparities and enhance CVD management among the elderly. This study aims to explore the acceptance of mHealth in improving self-management of CVD among older adults in China, focusing on its potential to mitigate accessibility and treatment challenges.

Methods: This cross-sectional study was conducted at the Xinhua Hospital of Shanghai Jiao Tong University. Data were collected using an online Qualtrics questionnaire from 225 participants who met inclusion criteria including being Chinese speakers, diagnosed with …

U.S. Hospital Readmissions Following Discharge For A Non-Fatal Overdose Among Adolescents, 2016-2020, Gabriela Mendoza Cueva

Public Health Theses

Importance: It is not yet known how many adolescents are readmitted within six months in the U.S. following a non-fatal overdose and the risk factors associated with all-cause readmission. Objective: To examine the risk of 6-month readmission following hospitalization for a non-fatal drug overdose among adolescents and the risk factors for readmission. Design, Setting, and Participants: This retrospective chart analysis utilized the Nationwide Readmission Database (NRD) from 2016 to 2020 to identify nonfatal overdose readmissions among adolescents aged 11 to 19. Exposures: Non-fatal prescription and illicit drug overdose. Main Outcome Measures: The study used weighted state-level discharge data to derive …

Indoor Air Pollution In Nomadic Himalayan Highlander Communities, Charles Minicucci

Public Health Theses

Indoor air pollution (IAP) from burning solid biomass fuel is a major global health challenge, especially in resource-limited settings without access to electricity or reliable fuel sources. In the Kingdom of Bhutan, where, despite a reported 99% of households having access to electricity, the vast majority of rural households still use biomass fuels for cooking and indoor heating. Given the resource limitations and access challenges associated with Bhutan’s remote highlander and herding communities, few solutions for or details about their exposure to IAP are available – especially during nomadic periods where families may spend months beyond the reach of infrastructure …

Exploring The Association Between The Supplemental Nutrition Program For Woman, Infants And Children (Wic) And Gestational Weight Gain, Oyinlola Obatolu

Public Health Theses

Background: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has been an impactful federal public assistance program that has provided nutrition education and support to millions of low income women and children around the country. Despite its positive impact on perinatal and birth outcomes, the precise mechanisms between WIC and these outcomes remain unclear. Past studies have looked at the relationship between WIC and gestational weight gain (GWG), a potential mediator of the effect of WIC on birth outcomes, but they have mainly focused on city or state level data or Medicaid enrollees. This study aims to …

“Their Body, Their Choice. Your Body, Your Choice. Your Baby, Your Choice.”: A Reflexive Thematic Analysis Of Vaccine Access And Acceptance Among U.S. Pregnant People On Reddit, Sydney Marie Perlotto

Public Health Theses

Compared to the general population, pregnant people and newborns are at a higher risk of contracting infectious diseases and experiencing worse adverse outcomes. Vaccines delivered during pregnancy, known as prenatal vaccines, represent a critical yet underused form of preventive care for these populations in the United States. Increasing successful prenatal vaccination uptake requires a focus on both access and acceptance, which pregnant people may experience differently than non-pregnant people due to their unique physiological and social state. Given the evolution of vaccine hesitancy following the COVID-19 pandemic, coupled with the recent expansion of the U.S. prenatal immunization schedule, this study …

Greening And Mental Distress: Effect Modification By Housing Tenure, Saira Prasanth

Public Health Theses

Access to high-quality residential greenspace is associated with improved long-term health, particularly mental health. However, many interventions to promote “greening” or increased greenspace in urban areas have been shown through numerous qualitative studies to exacerbate environmental and health inequities, primarily through green gentrification. Our objective was to quantify the association between greenspace and mental distress in the U.S. as well as evaluate whether the association between greenspace and mental distress is modified by housing tenure. We hypothesized that increased greenspace was associated with reduced mental distress, and that this effect was more protective among homeowners than non-homeowners. Mental distress and …

Macronutrient Intake In Us Adults: Race, Gender, Age, Education, Ana Karina Raygoza Cortez

Public Health Theses

Background: The US has seen a consistent increase in obesity rates over the last sixty years across all racial and ethnic groups, with similar trends even among privileged groups. This study examines Macronutrient intake trends in US adults from 1999-2018 and their association with demographic factors: race ethnicity, age, gender, and education.

Methods: We conducted a serial cross-sectional analysis of US adults using 24-hour dietary recall data from 10 NHANES survey cycles (1999-2018). Piecewise regression models identified significant dietary pattern changes over time, by demographic groups. Statistical analysis was done in R and SAS utilizing NHANES sampling weights.

Results: Study …

Hybrid Medical Practices In Malaria Management Among Sao Tome And Principe’S Elderly, Yihan Shi

Public Health Theses

Africa has the global heaviest burden of malaria. Sao Tome and Principe, a low-transmission island nation in the Gulf of Guinea with a population of about 200,000, has entered the malaria elimination phase. Despite this, the prevalence and mortality rates of malaria among the elderly in Sao Tome and Principe remain high compared to high transmission areas. This study employed a mixed-methods approach to explore the association between age and recommended malaria management strategies for adults in Sao Tome and Principe, with a focus on examining samples older than 50 years. All participants (N = 274) completed surveys, with in-depth …

Child And Adolescent Exposure To Environmental Chemicals And Mental Health Outcomes: A New Haven Study, Yunyue Shi

Public Health Theses

Child and adolescent mental health disorders, including anxiety, depression, and behavioral problems, contribute significantly to the global health burden. Exposure to toxic air contaminants such as semi-volatile organic compounds (SVOCs)—especially polycyclic aromatic hydrocarbons (PAHs) and phthalates—during critical developmental periods can have detrimental impacts on children’s brain development and function. This study aimed to identify potential associations between children and adolescents’ chemical exposure and mental health outcomes. The objectives were: 1) to characterize the distribution of individual environmental chemical exposures among children and adolescents using Fresh Air samplers and 2) to determine the association between chemical exposures, particularly PAHs and phthalates, …

Long-Term Exposure To Ambient Pm2.5 & Intentional Self-Harm, Caroline Elise Sutton

Public Health Theses

A growing body of literature is finding that air pollution exposure may contribute to disease onset of certainbrain disorders, including mental disorders such as depression, through mechanisms of neuroinflammation and oxidative stress1. However, even as there is increasing attention on the impacts of air pollution and mental illnesses, most studies focus on mental illness outcomes that might not represent severe or life-threatening symptoms (such as self-harm)2–7 , while a majority of studies focused on intentional self-harm assess the relationship between short-term air pollution exposure (as opposed to chronic and cumulative exposure) and self-harm outcomes8–13 . Given the barriers to treatment …

“I Don't Work For The Prison. I Don't Work For The Hospital Either. I’M Yours. Who Else Here Is Yours?” A Qualitative Analysis Of Facilitators And Barriers Of Launching Enhanced Perinatal Programs In Seven State Prisons, Karenna Thomas

Public Health Theses

The United States incarcerates women at the highest rate globally (Fair & Walmsley, 2022), while simultaneously failing to provide incarcerated individuals with adequate reproductive health care. Perinatal programs, including a combination of one-on-one and group prenatal and postpartum education, labor and birth support with a doula, separation support, and lactation care have been implemented as an alternative to standard care in around 21 states (Wilson et al., 2022). While the efficacy of these programs among incarcerated individuals has been established (Bard et al., 2016; Barkauskas et al., 2002; Schroeder & Bell, 2005; Shlafer et al., 2018; Shlafer, Saunders, Boraas, et …

Cost-Effectiveness Of Helicobacter Pylori Screenings In Asian Americans In The United States, Qin Wang

Public Health Theses

Background: Gastric cancer remains a significant public health concern, particularly for Asian Americans in the United States, who are at higher risk. Helicobacter pylori (H. pylori) infection is a known risk factor for gastric cancer (GC) and peptic ulcer disease (PUD), and its eradication has proven effective in preventing both conditions. Due to the lack of clinical standards in H. pylori screening for this high-risk group of Asian Americans, we explore whether population-based screening using carbon-13 urea breath test (C-UBT) and/or endoscopy is cost-effective in the United States for Asian Americans. Methods: We built a cohort state-transition Markov model to …

Birth Characteristics, Outdoor Artificial Light At Night, Ambient Air Pollution And The Risk Of Hepatoblastoma In Young Children, Peiyi Wang

Public Health Theses

Objective: The etiology of hepatoblastoma, the predominant malignant liver tumor in infancy and early childhood, is unclear. We assessed possible associations between birth characteristics, outdoor artificial light at night (ALAN), ambient air pollution (measured by particulate matter PM2.5), and the risk of hepatoblastoma.

Methods: Leveraging a population-based linkage of statewide birth records and cancer registry data in California, we conducted a case-control study that included 356 hepatoblastoma cases diagnosed at the age of 0-6 years during 1988-2015 and 17,800 controls frequency-matched by birth year. Restricted cubic spline transformation was employed to evaluate non-linear associations. Multivariable logistic regression models were used …

Assessment Of Suicide Risk In Emergency Department Settings For Adults In Nepal: Validation Of The Nepali Ask Suicide-Screening Questions, Pei Wang

Public Health Theses

Objectives: Suicide is a severe public health crisis around the globe. Low-middle-income countries (LMICs) bear 77% of the global suicide burden. Screening is a significant component of suicide prevention, but there is a dearth of suicide screening tools, especially in LMICs. This study focused on validating the Ask Suicide-Screening Questions (ASQ) within an adult Emergency Department (ED) population in Nepal. Although the validation occurred in an ED setting, the Nepali ASQ is designed with the flexibility to be useful in a variety of healthcare contexts, extending its applicability beyond just emergency care.Methods: We systematically translated and adapted the 4-item ASQ, …

Cost-Effectiveness Analysis Of Alternative Infant And Neonatal Rotavirus Vaccination Schedules In Malawi, Catherine Wenger

Public Health Theses

Rotavirus is the leading cause of cases and deaths related to diarrhea-related hospitalizations among children under five worldwide, especially in low- and middle- income countries. Although vaccination is proven to be the best strategy for preventing rotavirus, its impact has been suboptimal in LMICs.

The primary aim of this study was to evaluate the impact of and cost- effectiveness of the current Rotarix rotavirus vaccine, two alternative vaccine delivery schedules, and the next-generation vaccine (RV3-BB) in Malawi.

The cost-effectiveness of rotavirus vaccine strategies in Malawi was evaluated using moderate-to-severe and non-severe rotavirus cases derived from a mathematical model ofrotavirus transmission …

Randomized Trial Of Exercise Vs. Usual Care On Inflammatory And Metabolic Biomarkers In Women With Breast Cancer Taking Aromatase Inhibitors, Lingxiao Zhang

Public Health Theses

ABSTRACT

Background: The Hormones and Physical Exercise (HOPE) study demonstrated efficacy of exercise in reducing AI-associated arthralgia in breast cancer survivors. Yet, the underlying mechanism for this relationship remains unclear. Prior research among breast cancer survivors highlights improvements in metabolic and inflammatory biomarkers related to exercise. This secondary analysis of HOPE examined the potential role of metabolic and inflammatory biomarkers in mediating the effect of exercise vs. usual care on AI-associated arthralgia.

Methods: Our analysis included 80 participants (42 exercise arm, 38 usual care) enrolled in the HOPE study. The intervention was a year-long exercise program that included both supervised …

Do Rental Assistance Programs Relieve Overcrowding In U.S. Children?, Frank Zhu

Public Health Theses

Introduction: Crowded living conditions are associated with many negative health outcomes, with significant implications for children, as they are particularly shaped by their home environment and more likely to live in crowded conditions, given their larger household size. How rental assistance programs may shape and improve household crowding has not been previously explored. Methods: This study leveraged data from NHANES linked with HUD administrative rental assistance records. We examined changes in crowding measures in U.S. children using linear and logistic regression models stratified by different rental assistance program types. Results: There was a statistically significant 40 percentage point reduction in …

The Menstrual Cycle In Psychotherapy: Interventions, Therapist Engagement, And Blind Spots, Rozita Alaluf

Dissertations and Theses

There is a dearth of literature on psychotherapy and menstruation, except for the treatment and diagnosis of issues associated with premenstrual distress. This study aimed to bridge this gap by investigating the frequency and context of discussions about the menstrual cycle, the factors influencing therapists’ engagement with this topic, and the therapeutic approaches utilized to address the menstrual cycle within psychotherapy.

In phase 1, 118 psychotherapists from various theoretical backgrounds completed a survey on menstruation in clinical practice. The data was analyzed using descriptive statistics. In phase 2, semi-structured interviews were conducted with 7 psychotherapists, primarily identifying their theoretical orientation …

The Shadow Of Grief: Understanding Grief Among Ethnoracially Diverse Young Adults, Rona R. Tarazi

Dissertations and Theses

Background: Complicated grief, characterized by prolonged and intense mourning, presents unique challenges for individuals grappling with loss, as it is shaped by a multitude of factors influencing the grieving and mourning processes. While the literature has identified several factors that significantly impact complicated grief, such as post-loss symptom severity, stigmatization, the quality of the relationship to the deceased, and grief-related avoidance, this two-part study aimed to expand on existing findings by shedding light on the landscape of grief among a sample of ethnoracially diverse young adults. Part 1 of the study examined whether previously identified factors remain significant in this …

Harnessing Antagonistic Pleiotropy: Tolc-Dependent Coliphages Can Drive Reduced Antibiotic Resistance In E. Coli, Cooper Mckenna

CMC Senior Theses

The rise of multidrug-resistant (MDR) bacterial pathogens has been a growing concern in healthcare around the world, and bacteriophage (phage) therapy is a promising method to combat MDR infections. One defense mechanism of E. coli against antibiotics is the TolC-AcrAB efflux pump. At the same time, some phages use TolC as a surface receptor to infect the cell. This puts TolC at a crossroads in which it is beneficial to the bacteria to protect against antibiotics but harmful by allowing phage infection, creating the potential for evolutionary trade-offs. Previous research has identified only three TolC-dependent phages and shown phage-resistant E. …

Traditional Chinese Medicine: Employing Integrative Medicine As An Approach To Treat Cancer, Jade Hudson

CMC Senior Theses

This thesis explores the history of Traditional Chinese Medicine (TCM) through its depiction in the four classics of TCM and examines the evolution of the field to date. The five categories of TCM treatments analyzed in this paper include acupuncture, dietary therapy, herbal medicine, moxibustion, and physical exercise. Research highlights significant positive outcomes in cancer patients who incorporate TCM alongside modern cancer treatments, such as reduced nausea, vomiting, fatigue, anorexia, pain, and improvements in quality of life and overall well-being. However, notable risks associated with TCM herbal medicine and moxibustion underscore the need for further research into these practices before …

Gut Dysbiosis Correlates With Covid-19 Severity, Ednita Escobar

CMC Senior Theses

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) impacts not only respiratory but also gut and oral microbiomes, influencing the manifestations of COVID-19. Each person’s unique microbiome consists of microorganisms such as bacteria, fungi, and viruses, some of which are symbiotic and others potentially harmful. Alterations in the gut microbiome, specifically, can affect the severity and symptoms of COVID-19. A review of studies indicate a pattern of gut dysbiosis in COVID-19 patients characterized by a decrease in beneficial microbiota and/or an increase in opportunistic pathogens. This gut imbalance correlates with disease severity, suggesting that the gut microbiome plays a significant role …

Sex Differences In The Effects Of Cortisol On Muscle Characteristics: A Meta-Analysis, Natalie Bitetti

CMC Senior Theses

Background: Cortisol plays a central role in both muscle breakdown and growth. These effects are highly dependent on dose and interactions with other hormones. It is known that men and women show considerable differences in their muscle structure and physiology, which are largely driven by hormonal differences. Cortisol release patterns may also vary between the sexes, with current research showing considerable disagreement. The interplay between cortisol and muscle, two highly variable and sexually dimorphic factors, may prove to have different effects in males versus females.

Objective: This meta-analysis integrates existing research on sex differences in cortisol-muscle physiology with existing research …

Driven By Change: The Impact Of Macroeconomic Shifts And Covid-19 On New Vehicle Sales, Jackson Aldrich

CMC Senior Theses

This paper examines the impact of macroeconomic factors and the COVID-19 pandemic on new vehicle sales. In order to address these two topics, a two-pronged approach was used with separate regression models. The macroeconomic variables include monthly supply of new homes, CPI for urban public transportation, unemployment rate, disposable personal income, inflation expectation, consumer sentiment, average gas prices, and total vehicle miles traveled which were regressed on total vehicle sales from 1978-2022. The regression results confirmed and supported current literature and highlighted the importance of the housing market and unemployment rate on new vehicle sales. The COVID-19 pandemic model variables …

The Emergence Of Aedes Aegypti In California: Implications For Ecosystems And Public Health, Jose Ruiz

CMC Senior Theses

This literature review delves into the emergence and impact of Aedes aegypti, the yellow fever mosquito, in Southern California. My investigation begins with an exploration of the physical characteristics, historical background, and its significance as a vector. Notably, Aedes aegypti's historical role as a vector for yellow fever during the 19th century shapes the foundation for understanding its effectiveness in disease transmission and demonstrates the potential of its negative impact on Southern California residents. I examined the habitat preferences and behaviors of Aedes aegypti, emphasizing its adaptability to urban environments and its effect as a daytime feeder with a limited …

Effect Of Dopamine-2-Receptor Manipulation On Social Interaction And Social Decision-Making In Juvenile Fish, Kiren Kanazawa

CMC Senior Theses

Animals interact in intricate social networks. Social behavior is imperative in shaping relationships, in communication, and adapting to changing environments. Despite its profound effects on individual fitness and health, neural-molecular mechanisms behind social behavior and social decision-making continue to be identified. In the present study, we focused on the regulation of social behavior by the Dopamine-2-Receptor (D2R), based on its role in context-dependent social behavior. We used juvenile African cichlid fish, Astatotilapia burtoni, to investigate the effect of dopamine signaling manipulation on their aggressive, territorial, and affiliative behaviors. We hypothesize that D2R manipulation affects social decision-making in juvenile A. burtoni. …