Public Health Commons^™

Effects Of The U.S. Veterinary Feed Directive Final Rule On The Prevalence Of Violative Antibiotic Residues And Antibiotic-Resistant Bacteria In Animal Products, Md Shamim Sarkar

Doctoral Dissertations

Antibiotic-resistant is a public health concern. The dissertation objective was to assess the effect of the implementation of the Veterinary Feed Directive (VFD) rule changes on the prevalence of violative antibiotic residues and antibiotic-resistant bacteria in food-animal tissues, retail meats, and cecal samples from food animals compared to the pre-VFD rule change period in the U.S. To understand the effect of implemented VFD rule changes on violative antibiotic residues in food-animal tissues, inspector-generated sampling (IGS) data from the U.S. National Residue Surveillance Program (NRP) was analyzed. An important observation was that implementing VFD rule changes was associated with the decreased …

Impact Of Child/Parent Characteristics On Ultra-Processed Food Intake In Preschool-Aged Children, A Latent Class Analysis Of Obesity-Related Factors And Obesity Risk, And The Qualitative Impact Of 9-11 Year Old's Perception Of Unhealthy Food Marketing, Jennifer E. Carroll

Doctoral Dissertations

Childhood overweight/obesity is an epidemic in the US. Modifiable risk factors, such as intake of foods that are highly processed, are heavily marketed to children. Exposure to food advertisements, along with home environment factors, family meal styles, and digital media habits shapes children’s preferences, tastes, and habits. Predictors of ultra-processed food (UPF) intake in children are unclear and the potential effect of ad exposure on UPF intake is unknown. It is also unknown if there are distinct response patterns among a collection of potentially obesity-related factors, and if distinct groups affect child BMI. Additionally, more qualitative research is needed to …

Spatial Epidemiology Of Prediabetes And Diabetes In Florida, Md Marufuzzaman Khan

Doctoral Dissertations

The burden of diabetes and diabetes-related Emergency Department (ED) visits has increased in Florida. However, Diabetes Self-management Education (DSME) Program participation remained considerably low. Little is known about disparities of DSME participation, diabetes complications, and ED use by diabetes patients in Florida and yet this information is important for guiding health programs aimed at reducing diabetes burden. Therefore, the objectives of this study were to investigate: (a) disparities of diabetes prevalence and DSME participation; (b) disparities of diabetes-related ED visit risks; and (c) prevalence and predictors of stroke among persons with prediabetes and diabetes.

Behavioral Risk Factor Surveillance System and …

Healthcare Service Utilization And Life Satisfaction In South Africa, Tamara Chavez-Lindell

Doctoral Dissertations

South Africa has achieved improvements in many health measures over the past 30 years, yet significant disparities in healthcare utilization and health outcomes persist. There is evidence that healthcare utilization has a strong influence on health outcomes and life satisfaction. Unfortunately, rural areas tend to have poorer accessibility and utilization of health services, leading to disparities in health outcomes. In rapidly urbanizing countries such as South Africa, identification of disparities and predictors of public healthcare utilization and life satisfaction may provide information that can be used to guide development of programs aimed at improving population health outcomes, quality-of-life, and overall …

Perinatal Health In North Dakota: Emerging Issues, Grace N. Njau

Doctoral Dissertations

Preterm birth, newborn screening refusal, and postpartum depression represent three emerging areas of concern that have not been previously investigated in North Dakota. Their potential impact creates significant social, behavioral, and economic burdens. Although various studies have investigated preterm birth and postpartum depression, to the best of my knowledge, newborn screening refusal in the United States has not been previously investigated. In alignment with the role of Title V of the Social Security Act (Maternal and Child Health) Programs to conduct ongoing statewide needs assessments, the objectives of this study was to investigate and identify predictors of preterm birth, newborn …

Interplay Of Environmental Pollutants And Folate In The Etiology Of Autistic Traits Analysis Using Multipollutant Approaches, Michael T. Mascari

Doctoral Dissertations

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by a spectrum of communication deficits and repetitive behaviors. The challenges in learning, thinking, and problem-solving abilities of people with ASD can be debilitating. There is currently no cure for ASD. Many environmental pollutants are suspected to contribute to the etiology of ASD and its associated traits, whereas folate and folate supplements have been shown to exhibit both protective and adjuvant roles. Little is known about the interplay of multiple environmental pollutants and folate in the etiology of ASD. Additionally, statistical approaches that consider the effects of pollutant mixtures instead …

The Impact Of A Lifestyle Intervention On Risk Factors Of Cardiovascular Disease And Type Ii Diabetes Among At-Risk Hispanic Women, Kathryn A. Wagner

Doctoral Dissertations

Cardiovascular disease and type 2 diabetes are global epidemics affecting approximately 127 and 21 million people in the U.S., respectively. Women who are overweight, obese or who develop glucose intolerance during pregnancy represent high-risk groups for the development of cardiovascular disease and type 2 diabetes. Hispanic women are both more likely to begin their pregnancies as overweight or obese and have a higher prevalence of type 2 diabetes, compared to non-Hispanic whites. However, prior lifestyle interventions have largely been limited to non-Hispanic whites. Therefore, this research assessed how culturally tailored lifestyle modification may affect cardiovascular disease and type 2 diabetes …

Endocrine Disrupters And Adverse Health Outcomes Among Post-Menopausal Women, Gabriela Vieyra

Doctoral Dissertations

Globally, chronic diseases that require ongoing medical attention, and limit daily living activities, are the leading cause of disability and mortality. The older population in the U.S. is rapidly growing, and the risk of chronic diseases is higher in this population, specifically older women. In 2018, 51.3% of women compared to 41.8% of men had two or more chronic conditions. Thus, the Women’s Health Initiative (WHI) study, Chapter 1, focused on preventing leading causes of death, disability, and frailty in older women. Phthalates are synthetic industrial compounds, Chapter 2, commonly added to daily used consumer goods, nutritional and dietary supplements, …

Elucidating Mechanisms Influencing Maternal Postpartum Health: The Protective Benefits Of Breastfeeding And Associations With Allostatic Load, Experiences Of Stress, And Resiliency, Bi-Sek J. Hsiao

Doctoral Dissertations

Research has established breastfeeding as protective of maternal health, but little is known about the ways breastfeeding interacts with chronic stress pathways and interfaces with stressors such as discrimination and neighborhood deprivation, which are salient in the experiences of many marginalized communities. This research addresses these knowledge gaps through secondary analyses of prospective cohort data generated by the Community Child Health Research Network through Community Based Participatory Research processes. Analytical samples were derived from 2510 postpartum women from five regions in the U.S. who self-identified as Black, Hispanic, or White. Study 1 investigated and found an inverse association between breastfeeding …

Factors Associated With The Perception Of Diet Quality: Analysis Of The National Health And Nutrition Examination Survey (Nhanes) 2007-2018, Kiara Y. Amaro-Rivera

Doctoral Dissertations

Perceived diet quality is a potential modifiable factor that could explain dietary choices. Research has shown that some individuals tend to misperceive the healthfulness of their diet, rating it more or less healthy than it actually was when compared to dietary recommendations. In particular, overestimation of diet quality has been associated with lower intention to change dietary behaviors. Using the National Health and Nutrition Examination Survey (NHANES) dataset, this dissertation explores factors associated with the perception of diet quality among U.S. adults. In Chapter 1, we derived dietary patterns using latent class analysis and explored their association with perceived diet …

An Epidemiologic Study Of Vaccination Exemptions And Pertussis Risk, Corinne B. Tandy

Doctoral Dissertations

The incidence of pertussis, a vaccine-preventable disease that can have severe complications in infants, has been increasing in the United States over the past three decades. Vaccine hesitancy and refusal have also increased and are associated with vaccination exemptions, which in turn are associated with outbreaks of vaccine-preventable diseases, including pertussis. Understanding attitudes towards vaccinations and identifying geographic disparities of vaccination exemptions and pertussis risks is useful for guiding control programs. Therefore, the objectives of this study were to: (i) investigate attitudes towards vaccinations; (ii) identify county-level geographic disparities and sociodemographic predictors of vaccination exemptions in Florida; (iii) investigate county-level …

Applied Infectious Disease Forecasting For Public Health, Graham Gibson

Doctoral Dissertations

Infectious disease modeling has emerged as a powerful data driven tool for monitoring outbreaks, assessing intervention strategies, and allocating public health resources. This thesis addresses a variety of challenges faced in real-world infectious disease forecasting. We first present methods for aggregating forecasts made at different spatial scales, where explicitly modeling the spatial dependency would be computationally prohibitive. We then extend the mechanistic model framework to create an operational forecasting model capable of handling real-world COVID-19 surveillance system issues. Finally, we propose a new framework for merging mechanistic and statistical approaches to infectious disease forecasting. This framework allows modelers to construct …

High-Dimensional Feature Selection And Multi-Level Causal Mediation Analysis With Applications To Human Aging And Cluster-Based Intervention Studies, Hachem Saddiki

Doctoral Dissertations

Many questions in public health and medicine are fundamentally causal in that our objective is to learn the effect of some exposure, randomized or not, on an outcome of interest. As a result, causal inference frameworks and methodologies have gained interest as a promising tool to reliably answer scientific questions. However, the tasks of identifying and efficiently estimating causal effects from observed data still pose significant challenges under complex data generating scenarios. We focus on (1) high-dimensional settings where the number of variables is orders of magnitude higher than the number of observations; and (2) multi-level settings, where study participants …

Sleep, Reproduction, And Pregnancy, Joshua R. Freeman

Doctoral Dissertations

Sleep, and particularly sleep timing, prior to conception may be important for reproductive and pregnancy health. Evidence of a biological mechanism relating sleep to reproductive health from laboratory studies suggests that sleep may influence the hypothalamic-pituitary-ovarian (HPO) axis. The role of sleep in the HPO axis may also impact many reproductive outcomes including reproductive hormones, ovulation, pregnancy, live birth, pregnancy loss, and adverse pregnancy outcomes. However, epidemiological evidence for associations between sleep, especially sleep timing, and these reproductive health endpoints is limited with most studies typically assessing shift work, and not sleep patterns directly. To address these gaps, we evaluated …

Mental Health And Adiposity: The Effects Of Racial Discrimination And Social Relationships, Nicole D. Fields

Doctoral Dissertations

Excess adiposity is associated with increased risk of cardiovascular disease, type 2 diabetes, and premature mortality. It is well-documented that Black women are disproportionately affected by excess adiposity. Research has focused on lifestyle factors, such as diet and physical activity, to explain the higher prevalence of obesity among Black women compared to white women; however, there is much less research on the association between psychological distress and adiposity, which may be important for understanding racial disparities. To date, no studies have examined the social context by which mental health and physical health are related. Black women in U.S. society live …

Policing And Health: Police Encounters As A Fundamental Cause Of Racial Health Disparities, Richard S. Carbonaro

Doctoral Dissertations

Structural racism has taken many forms throughout American history and to this day continues to drive social, economic, and health inequalities. Mass incarceration is a modern tool of social marginalization with well documented and deep-rooted racial inequalities. Research has continually shown that mass incarceration negatively impacts the health of disadvantaged communities. Even police stops, the most common and mundane form of criminal justice contact has been linked with deleterious health outcomes at the individual and community level. In this dissertation, I identify specific social and biological mechanisms connecting encounters with the police and health outcomes. In the first chapter, I …

Prevalence Of Rats And Rodent Borne Pathogens Across Post-Katrina New Orleans, Bruno Marco Ghersi

Doctoral Dissertations

Disasters are happening at an increasingly higher rate and intensity a trend that is expected to continue as more humans migrate to coastal urban areas. Disasters, and as importantly, disaster recovery can affect how native and pest populations will recover. My aim was to improve understanding of disease risk by evaluating the socioecological conditions that have shaped commensal rat recovery and distribution, as well as the pathogens they carry, across New Orleans after Hurricane Katrina. I first estimated relative abundance and distribution of commensal rats from rodent trapping conducted between mid-2014 and early-2017 across 96 sites in 10 areas of …

Emerging Zoonotic Pathogens At The Human-Wildlife Interface In Protected Areas: Game In The Southeastern United States And Bushmeat In Northern Uganda, Breeanna M. Dell

Doctoral Dissertations

The emergence of zoonotic pathogens through contact with animal reservoirs is a well-documented phenomenon and growing concern for public health. Particularly in light of the ongoing Ebola epidemic in the Democratic Republic of the Congo and the coronavirus pandemic, the need to understand mechanisms of contact and disease transmission at the human-wildlife interface and to understand which infectious agents may reside within wildlife reservoirs crucial. In this project, we investigated the potential introduction of zoonotic cestode Echinococcus canadensis to public lands in Tennessee subsequent to elk translocation effort and aimed to identify whether a transmission cycle was established in this …

Social Determinants Of Cardiometabolic Disease Control: An Ecosocial Approach, Cristina Huebner Torres

Doctoral Dissertations

Cardiovascular disease (CVD) is the leading cause of death in the United States. Diabetes mellitus, hypertension, and dyslipidemia are three primary risk factors for CVD. Each is disproportionately distributed in the population by race/ethnicity. Social determinants of health (SDoH) research indicate that social and environmental factors upstream of individual behaviors can impede an individual’s chronic disease control. Guided by Michael Marmot’s SDoH theoretical framework and by an ecosocial approach, this study used data from a cross-sectional mixed methods study conducted in Western Massachusetts at a federally qualified health center from 2014 to 2018 (RxHL) to examine the association between SDoH—food …

Phthalates, Embryo Development, And Sperm Dna Methylation, Haotian Wu

Doctoral Dissertations

Infertility affects 15% of all couples and presents a major public health issue. Animal and human data indicate that epigenetic dysregulation in sperm is associated with poor male reproductive health and extensive epigenetic reprogramming during spermatogenesis presents a window of vulnerability for environmentally-induced epigenetic dysregulation. Phthalates is a class of ubiquitous environmental contaminant and global health concern. Phthalate exposure in humans has been associated with diminished male fertility, adverse birth outcomes, and altered offspring development. In order to facilitate additional research on this topic, we aimed to developing a higher throughput method of sperm nucleic acid extraction. In addition, this …

Vitamin D, Calcium, And Dairy Consumption And Risk Of Early Menopause, Alexandra C. Purdue-Smithe

Doctoral Dissertations

Early menopause, defined as the cessation of ovarian function before the age of 45, affects roughly 10% of women in Western populations. Current research suggests that women who experience early menopause are at increased risk for cardiovascular disease and other adverse health outcomes. Early menopause may also have substantial financial and psychological consequences for family planning, particularly as women increasingly delay childbearing into the later reproductive years. Emerging research suggests that modifiable lifestyle factors such as diet may play an important role in ovarian aging. According to our review of the current biologic and epidemiologic literature in Chapter 1, vitamin …

Hormonal Contraceptive Use Among Active Duty Army Servicewomen. Trends And Implications For Risk Of Musculoskeletal Injury., Melanie K. Hosker

Doctoral Dissertations

Almost 40% of servicewomen use hormonal contraception every year, and 60% will use a contraceptive method in their military career. Rates of contraceptive use and musculoskeletal injury are higher among servicewomen as compared to civilians. Gender differences in rates of musculoskeletal injury have led investigators to question the role of sex hormones, including contraception. Recent studies suggest that hormonal contraceptives may decreased risk of anterior cruciate ligament (ACL) injury, potentially decreasing early onset osteoarthritis (OA). We utilized the Total Army Injury and Health Outcome Database, which prospectively captured demographics, clinical and pharmacy records on over 5.6 million Army soldiers since …

Investigations Of The Role Of Acculturation In Cancer Screening And Phthalates In Breast Cancer Risk And Weight And Body Mass Index Change, Mary V. Diaz Santana

Doctoral Dissertations

INVESTIGATIONS OF THE ROLE OF ACCULTURATION IN CANCER SCREENING AND PHTHALATES IN BREAST CANCER RISK AND WEIGHT AND BODY MASS INDEX CHANGE MAY 2018 MARY V. DIAZ SANTANA, B.S., UNIVERSITY OF PUERTO RICO RIO PIEDRAS CAMPUS M.S., UNIVERSITY OF PUERTO RICO MEDICAL SCIENCE CAMPUS Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Katherine Reeves Phthalates, endocrine-disrupting chemicals, are hypothesized to increase obesity and, as a result, risk of obesity-related cancers, such as breast cancer. However, findings are not consistent across studies. Identifying whether phthalates impact obesity is critical for understanding the pathways by which phthalates may affect cancer risk. Experimental …

Micronutrients, Inflammation And Depression Among Women Of Reproductive Age From The National Health And Nutrition Examination Survey 2005-2008, Joycelyn M. Faraj

Doctoral Dissertations

Depression is the leading cause of disease burden among women. Recent evidence indicates that inflammation is associated with depression, and factors that contribute to inflammation can be addressed through nutritional and lifestyle interventions. Vitamins B₆ and D have been linked with depression and have established roles in inflammation, yet their associations with depression in the presence of low-grade inflammation remain unknown. The purpose of this research was to investigate how high sensitivity C-reactive protein (hs-CRP), a biomarker of inflammation, contributes to different dimensions of depression and to determine to what degree inflammation affects the association between vitamins B_{6 …}

Gestational Weight Gain And Maternal Health Among Hispanic Women, Megan W. Harvey

Doctoral Dissertations

More than 70% of women do not gain within their target range of gestational weight gain (GWG), as recommended by the Institute of Medicine (IOM) in 2009. Risks associated with inadequate GWG include small-for-gestational age, low birthweight, pre-term birth, and difficulty establishing breastfeeding. Risks associated with excessive GWG include large-for-gestational-age, macrosomia, and delivery complications. There are also long-term consequences for maternal and fetal metabolic processes. Higher pre-pregnancy BMI, lower education level, and higher parity are known risk factors for excessive GWG. There are also possible racial / ethnic differences, and Hispanic women, in particular, may be at high risk for …

Macronutrients And The Risk Of Premenstrual Syndrome, Serena C. Houghton

Doctoral Dissertations

Premenstrual syndrome (PMS) affects 8-20% of reproductive-aged women, impacting work, family, and social interactions. Limitations in available PMS treatments, including side effects and limited medication efficacy, indicate the need for improved prevention. Modifiable risk factors for prevention of PMS include dietary factors. Several micronutrients have been identified as risk factors, but there has been little evaluation of macronutrients. Thus, the research aim was to examine prospectively whether macronutrient consumption was associated with PMS development among a subset of women enrolled in the Nurses’ Health Study II cohort. Chapter 1 evaluates the association of fat intake and PMS risk. Among 3,638 …

Impact Of Exercise During Pregnancy On Maternal Outcomes Among A High-Risk Population, Carrie Nobles

Doctoral Dissertations

Prior observational research has suggested an association between increased physical activity during pregnancy and improved maternal outcomes including a reduced risk of gestational diabetes mellitus (GDM). Despite this, randomized controlled trials of prenatal exercise are sparse and only one had been conducted in a high-risk population. Therefore, we examined the association between physical activity during pregnancy and risk of adverse pregnancy outcomes in the Behaviors Affecting Baby and You (B.A.B.Y.) Study, a randomized controlled trial of a 12-week exercise intervention among a diverse group of inactive pregnant women at high-risk for GDM. The first project examined the effect of participation …

Population Modeling For Resource Allocation And Antimicrobial Stewardship, Jason Bintz

Doctoral Dissertations

This dissertation contains two types of population models with applications in conservation biology and epidemiology. In particular, it considers models for resource allocation and antimicrobial stewardship.

In a population model with a parabolic differential equation and density dependent growth, we study the problem of allocating resources to maximize the net benefit in the conservation of a single species while the cost of the resource allocation is minimized. The net benefit is measured in terms of maximizing population abundance and the goal of maximizing abundance is divided between the goal of maximizing the overall abundance across space and time and the …

The Effects Of Menopausal Vasomotor Symptoms And Changes In Anthropometry On Breast Cancer Etiology, Victoria Hart

Doctoral Dissertations

One of the strongest predictors of breast cancer risk is mammographic density; however, incomplete understanding of the mechanisms relating density to risk has limited its use as a marker for breast cancer susceptibility. Hormone fluctuations during the menopausal transition may influence declines in mammographic density and may also trigger the onset of menopausal vasomotor symptoms (VMS), which have been associated with lower breast cancer risk. The effects of hormone changes on density, VMS, and breast cancer risk are complicated by external factors such as changing body mass and hormone therapy use during the menopausal transition. We evaluated the association between …

Stress And Depression During Pregnancy Among Hispanic Women: Risk For Adverse Birth Outcomes And The Role Of Physical Activity, Kathleen Szegda

Doctoral Dissertations

Preterm birth and low birth weight are among the leading causes of infant mortality and morbidity in the United States. Puerto Rican women are at increased risk for these adverse birth outcomes and elevated levels of depression and psychosocial stress during pregnancy when compared to non-Hispanic Whites. Therefore, it is important to understand whether these psychological factors increase risk for these adverse birth outcomes and mechanisms to prevent/reduce depression in this high-risk population. The first study of this dissertation examined associations between perceived stress during pregnancy and preterm birth, low birth weight, and birth of a small-for-gestational age infant (SGA) …