Public Health Commons^™

Personalized Estimation And Causal Inference Via Deep Learning Algorithms, Yuanyuan Liu

Dissertations and Theses (Open Access)

Personalized approaches have shown great potential to transform modern medicine. As challenging as it may sound, we are making tremendous progress with the help of data sciences and machine learning. Two fundamental tasks in data sciences are prediction and inference. In this dissertation, I proposed to address these two tasks using deep learning approaches in the setting of personalized medicine. First, I developed a novel framework to estimate individualized treatment effects (ITE), which quantified the variation in response to the same treatment among patients with heterogeneous profiles. The ITE estimation has the potential to replace the one-size-fits-all average treatment effects …

Using Technology To Reduce Barriers In Community Health: An Intersection Between Broadband Access, Ehr & Telehealth Adoption In Federally Qualified Health Centers, Renita Madu

Dissertations and Theses (Open Access)

While Federally Qualified Health Centers (FQHCs) provide affordable, high quality, accessible and cost–effective primary health care to all individuals regardless of their inability to pay, patients continue to have difficulty accessing affordable primary care as well as broader specialty services that other patients may receive living near larger health systems and hospitals. Health information technology (HIT) serves as a cost-effective means to overcome barriers related to accessing care, particularly for individuals living in rural and remote areas. We examined if the key influencers of an FQHC’s structure, broadband access and/ or state and federal policies impacted the utilization of telehealth …

Estimating Means And Distributions Of Count Data From Surveys Invoking Complex Sampling Designs: Application To Measuring Cross-Sectional And Lifetime Alcohol Intake From Nhanes And Nlsy, Elysia A. Garcia

Dissertations and Theses (Open Access)

It is often of interest to measure the distribution (i.e. mean and percentiles) of count outcomes from national survey data to assess population consumption and guide public health efforts for substances such as alcohol, cigarettes, marijuana, and other illicit or licit drugs. Currently available methods for estimating the distribution of dietary intakes do not immediately lend themselves to estimating the consumption of substances measured as counts, nor do they accommodate the complex design elements – strata, cluster, and weight – characteristic of national surveys. We introduce an accurate methodology, called the Survey Adjusted Count (SAC) method, and an associated SAS …

Understanding Factors That Impact Health Behaviors And Access To Healthcare Among Youth Experiencing Homelessness, Kathryn Rosales Gallardo

Dissertations and Theses (Open Access)

Youth experiencing homelessness (YEH) have a high risk of adverse health outcomes and their utilization of healthcare services is low. This dissertation aims to further understand factors that impact YEH’s health behaviors and access to healthcare services. This dissertation is in the form of three manuscripts that each contribute to the overall aim. In manuscript 1, we examined the rates and correlates of human papillomavirus (HPV) vaccination initiation and completion among a sample of YEH in seven U.S. cities using logistic regression models. We found that HPV vaccination completion is low among male (19%) and female (37%) YEH. Among male …

A Mixed- Methods Examination Of The Healthcare, Social Support, And Religious Needs Of Sexual And Gender Minority (Sgm) Older Adults In Texas, Jennifer Lynn Holcomb

Dissertations and Theses (Open Access)

Shared historical and social contexts influence a generational group’s needs, risk factors, and resiliency mechanisms. Sexual and gender minority (SGM) older adults have experienced structural exclusion and systematic discrimination throughout their lifetime. The minority stress model posits that SGM individuals experience stressors, like discrimination, unique to their social status which affect physical and mental health. SGM older adults experience worse physical and mental health outcomes than their heterosexual peers suggesting unique needs for SGM older adults. Research also points to resiliency mechanisms that offset the impact of stressors on SGM older adults. The examination of these needs and resiliency mechanisms …

Trends In Injection Drug Use In Texas Treatment Facility Admissions, Cara Dahlhausen

Dissertations and Theses (Open Access)

This is a serial cross-sectional secondary analysis of drug treatment admissions records from the TEDS-A from years 2013-2017. The prevalence of injected drug use was calculated for each year and analyzed across the five-year period using a chi-square test to determine the presence of significant change in injection drug use from 2013 to 2017. Prevalence of injection drug use also will be calculated for each year by drug type (heroin, methamphetamine, and cocaine), age, sex, ethnicity and race, and will be analyzed for trends using a chi-square test.

Consider Us: Analysis Of National Mammography Screening Recommendations On African American Women, Gayla M. Ferguson

Dissertations and Theses (Open Access)

Breast cancer is the second most common cause of cancer related death in women in the United States with one in eight women expected to develop the disease in their lifetime. Unfortunately, breast cancer is the leading cause of cancer related death among African American women. African American women are four times more likely to die from breast cancer that Caucasian women. Mammography screenings are the most effective method of reducing breast cancer mortality in African American women. This study aimed to determine if the changes made to the mammography screening recommendations put forth by the U.S. Preventive Services Task …

The Role Of Dna Methylation In White Matter Hyperintensity Burden: An Integrative Approach, Yunju Yang

Dissertations and Theses (Open Access)

Cerebral white matter hyperintensities (WMH) on MRI are an indicator of cerebral small vessel disease, a major risk factor for vascular dementia and stroke. DNA methylation may contribute to the molecular underpinnings of WMH, which are highly heritable. We performed a meta-analysis of 11 epigenome-wide association studies in 6,019 middle-aged to elderly subjects, who were free of dementia and stroke and were of African (AA) or European (EA) descent. In each study, association between WMH volume and each CpG was tested within ancestry using a linear mixed model, adjusted for age, sex, total intracranial volume, white blood cell count, technical …

Social Work Involvement In Hurricane Harvey Relief Efforts, Claire Crawford

Dissertations and Theses (Open Access)

Hurricane Harvey brought 33 trillion gallons of rainfall to Texas and Louisiana and damaged more than 100,000 homes in August 2017. Social workers worked during and after the storm to provide services to those affected. The primary research question guiding this dissertation was: What were social workers’ experiences as they were involved in relief efforts during and immediately after Hurricane Harvey? The study group comprised 39 participants (35 female, 4 male); of these, 19 were masters-level social workers who volunteered at shelters in Houston following Hurricane Harvey, 14 were masters-level social workers who worked at a pediatric children’s hospital on …

Exploration Of Breastfeeding As A Protective Factor For Breast Cancer In South African Women: A Nested Case-Control Study, Booker S. Quiera

Dissertations and Theses (Open Access)

Background. South African’s (SA) breast cancer incidence rate is continually increasing (39 per 100,000 (2012) versus 46.2 per 100,000 (2018) with trends towards later-stage diagnosis. In previous literature, breastfeeding has been assessed as a protective factor for breast cancer; however, the SA population experiences inconsistent breastfeeding trends, rates, and support services. Therefore, this study will evaluate the inverse association between breast cancer and breastfeeding history. Methods. Cases (breast cancer) and controls (mastalgia) were matched 1:1 on clinical visit from May-August 2019 at Groote Schuur Hospital (GSH) in Cape Town, Western Cape, South Africa. Breastfeeding history, breast carcinoma diagnosis, and clinically …

The Influence Of Sodium And Potassium On Blood Pressure Genetics In The Population Architecture Using Genomics And Epidemiology Study, Cynthia S. Bell

Dissertations and Theses (Open Access)

Multiple polymorphisms have shown associations with blood pressure (BP) levels and hypertension status, but the overall genetic effect on BP has been small and accounts for only a small fraction of the variation in population-wide BP characteristics. These weak associations of BP with genotype may not be attributable to the examining the “wrong” single nucleotide polymorphism (SNP) but may instead be the result of noisy BP phenotypes based on mmHg alone. Adding information from the underlying mechanisms of nutritional intake, reuptake, and excretion on BP may produce more informative BP phenotypes to study. To explore this complex relationship between diet, …

Estimating Children’S Health Risks From Recreational Beach Play Following An Oil Spill, Tanu K. Altomare

Dissertations and Theses (Open Access)

Environmental contamination from marine oil spills can have damaging impacts on ecosystems and human health. In 2010, an explosion of the Deepwater Horizon (DWH) oil drilling platform resulted in approximately 1,728 km of shoreline oiling. Existing research characterizes health risk from exposure to oil spill chemicals (OSCs) for adults; however, data on impacts to child health are limited. One objective of the Beach Exposure And Child HEalth Study (BEACHES), funded by the Gulf of Mexico Research Initiative, is to estimate health risks to children between walking and six years of age from exposure to OSCs in a post-oil spill scenario …

Measuring Cultural Humility Of Community Health Workers, Nayeema Ahmed

Dissertations and Theses (Open Access)

This study examined cultural humility of community health workers (CHWs) in ambulatory clinical settings. Cultural humility has been defined as an attitude, or process that incorporates openness, power-balance, and critical self-reflection when interacting with people of cultural differences. It differs from the more well-known concept of cultural competence in that cultural humility is not culture specific and reflects provider attitudes and an orientation towards recognizing differences rather than specific knowledge about another culture. As such, cultural humility may lend itself to improving the care process across diverse patient populations. The literature on cultural humility and its relationship with CHWs is …

The Association Between Assorted Hormonal Contraceptive Methods And Advanced-Stage Epithelial Ovarian Cancer: A Systematic Review, Cheng Cheng

Dissertations and Theses (Open Access)

Epithelial ovarian cancer, the most lethal of the gynecological cancers, is typically diagnosed at advanced stages. Women diagnosed with advance-staged (i.e., stage III and IV according to the International Federation of Gynecology and Obstetrics) epithelial ovarian cancer are more likely to have recurrent episodes within 18 months17. According to a 2012 2016 case analysis conducted by the surveillance, epidemiology, and end results, or SEER program, the incidence of ovarian cancer was 11.4 per 100,000 women in all races per year with the highest incidence in non-Hispanic whites, of 11.9 per 100,000 women and the lowest incidence in Asians / Pacific …

Depression, Anxiety, And Social Anxiety As Predictors Of Help – Seeking Behavior Among U.S. University Students, Priya B. Thomas

Dissertations and Theses (Open Access)

Depression and anxiety are the top two mental health issues frequently cited by university students. Furthermore, the majority of students fail to seek professional help and may not find treatment useful. Many studies do not address the multiple factors that inhibit help seeking behaviors. This study aims to examine the associations between mental health issues and specific sociodemographic factors that may predict which students find seeking mental health treatment useful and are likely to seek help for their mental health issues over two semesters. Data from this study can be used to help develop strategies that help students maximize the …

Using S-Predixcan To Identify Associations Of Genetically Determined Gene Expression Levels With Carotid Intima Media Thickness, Andy Bryan A Castaneda

Dissertations and Theses (Open Access)

The aim of the study was to identify associations between predicted gene expression levels using S-PrediXcan and carotid intima media thickness (cIMT) in order to elucidate the etiology of atherosclerosis. Further, we wanted to compare our results to those from a transcriptome wide association study (TWAS) that used actual gene expression levels in whole blood. For our analysis we used summary statistics from a GWAS of cIMT from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, tissue-specific gene expression profiles from the GTEx project, and S-PrediXcan prediction models. The TWAS of cIMT that we compared our …

Treatment Outcomes Associated With Implementation Of An Express Sti Testing Model In A Prep Clinic In Austin, Texas, Diane Chau

Dissertations and Theses (Open Access)

It is unknown whether express STI testing is as effective as comprehensive STI testing. The research aims of this study are: (1) to describe the patients who obtained a STI testing at the Kind Clinic between February 01, 2019 to January 31, 2020; (2) to determine the association between STI testing type and sociodemographic factors, clinically-relevant factors, and treatment outcomes; (3) to visualize time-to-treatment among STI type and testing types for comparison on a diagnosis-level and a patient-level. Electronic medical records were abstracted for 2,201 patients that received an STI test during February 01, 2019 and January 31, 2020 at …

Exploration Of Breastfeeding As A Protective Factor For Breast Cancer In South African Women: A Nested Case-Control Study, Quiera S. Booker

Dissertations and Theses (Open Access)

South African’s (SA) breast cancer incidence rate is continually increasing (39 per 100,000 (2012) versus 46.2 per 100,000 (2018) with trends towards later-stage diagnosis. In previous literature, breastfeeding has been assessed as a protective factor for breast cancer; however, the SA population experiences inconsistent breastfeeding trends, rates, and support services. Therefore, this study will evaluate the inverse association between breast cancer and breastfeeding history. Methods. Cases (breast cancer) and controls (mastalgia) were matched 1:1 on clinical visit from May-August 2019 at Groote Schuur Hospital (GSH) in Cape Town, Western Cape, South Africa. Breastfeeding history, breast carcinoma diagnosis, and clinically relevant …

Raft-Versus-Host Disease Occurrence Among Cord Blood Transplantation Recipients In Relation To Human Leukocyte Antigen Match Grade, Sarah Chowdhury

Dissertations and Theses (Open Access)

Umbilical cord blood (UCB) transplantation has been consistently found to have low rates of graft-versus-host disease (GVHD), high rates of engraftment, and faster turnaround times in terms of finding suitable donors. In addition, it serves as a viable option for individuals with no matched donor options especially due to its flexible human leukocyte antigen matching criteria. Despite its advantages, there has been an overall decrease in UCB transplantation. However, its advantages emphasize the need for further research and investment in resources such as cord blood banking especially since pediatric populations are most likely to benefit from continued research due to …

Statistical Evaluation Of An Extension Of Linear Discriminant Analysis In Multiclass Settings With An Application For Detection Of Cervical Neoplasia, Frances A. Brito

Dissertations and Theses (Open Access)

Although a pathologists’ review of Papanicolaou smear cell samples has been successful in decreasing cervical cancer incidence, it is often costly and time-consuming. Quantitative cytology is a promising semi-automated method that measures cell features for further analysis or classification. There have been several advancements in classification algorithms, but many do not account for the nested data structure seen in quantitative cytology. Further, histologic diagnoses are separated into five or more classes, yet, multiclass classification has not been investigated. Here, we compare the predictive performance of macrolevel discriminant analysis (MDA) to traditional discriminant analysis methods in multi-class settings on cervical quantitative …

The Health And Wellness Characteristics Of Food And Beverage Service Industry Workers In Austin, Texas: A Participatory Cross-Sectional Survey, Alexandria Abbott

Dissertations and Theses (Open Access)

Food and beverage service industry workers are prone to tobacco use, alcohol abuse, illicit drug use, and mental health conditions. These workers are also highly likely to not have health insurance. Despite the poor health outcomes that stem from these conditions, little to no empirical evidence currently exists to explain the factors that contribute to the poor health condition of the service industry workforce. This study used a cross-sectional online survey to gather preliminary information on the health and wellness condition of service industry workers over the age of 18 in Austin, Texas. Survey respondents revealed high rates of alcohol …

Follow Up Care, Cancer Treatment Summaries And Patient Centered Communication, Ashleigh Gil

Dissertations and Theses (Open Access)

The adolescent and young adult (AYA) age group is the cohort of individuals who have been diagnosed with and/or are survivors of cancer. It is recommended they receive lifelong follow up care to prevent or mitigate late health effects associated with cancer and treatment. However, AYAs are caught between the pediatric and adult healthcare systems and they may not be able to fully advocate for their healthcare needs. Some factors that may be associated with AYAs survivorship care are treatment summaries and where they receive follow up care. This study aimed to identify if receipt of a treatment summary and …

Effects Of Latinx Parental English Proficiency On Stress, Maria Alvarez Pineda

Student Research Posters

In the United States, patients who have Limited English Proficiency (LEP) report having more problems communicating with their children’s doctors (Eneriz-Wieme et al., 2014) and experiencing more discrimination (Zhang et al., 2012) which can lead to increased psychological distress (Torres et al., 2012). The goal of this study was to determine if level of English Proficiency is related to stress levels and discrimination among Latinx parents. Participants consisted of 22 Latinx parents (86.4% Mexican and 90.9% female) in the San Francisco Bay Area. The Acute Stress Appraisals scale (Mendes, et al., 2007) measured parents' stress levels before and after an …

The Effectiveness Of Implementing A Collaborative Mental Health Approach On Quality Of Life For Individuals Of Low Socioeconomic Status, Tyler Z. Tooley

Graduate Theses/Dissertations

The ultimate purpose of this study is to provide insight and education to mental health clinicians, politicians and the general public of the numerous effects poverty has on mental health, in addition to the most beneficial ways to combat those insidious effects. The specific barriers met by individuals of low socioeconomic status severely affect psychological and physical health, as well as social and environmental relationships, which therefore diminish overall quality of life. The aim of this study is to examine the effectiveness of implementing a collaborative mental health approach for low income individuals on length of engagement in services and …

Managing Stress In A Constantly-Changing Workforce, Lorri Burch-Hubbard

Electronic Theses and Dissertations

When staffing reductions occur in the workplace, staff left behind may face increased stress, may not be given the support they need to manage the feelings caused by the reduction. This study was conducted to evaluate the impact of stress caused by staffing reductions has on medical technologists (MT), medical technicians (MLT) and respiratory therapists (RT), and to identify any common methods of stress management used by those staff who remain in the organization.

Literature research showed the negative impact stress can have on individuals when it is not addressed, such as decreased work performance, health issues, and even the …

Preferences In Information Processing, Marginalized Identity, And Non-Monogamy: Understanding Factors In Suicide-Related Behavior Among Members Of The Alternative Sexuality Community, Robert J. Cramer, Jennifer Langhinrichsen-Rohling, Andrea R. Kaniuka, Corrine N. Wilsey, Annelise Mennicke, Susan Wright, Erika Montanaro, Jessamyn Bowling, Kristin E. Heron

Psychology Faculty Publications

Suicide-related behavior (SRB) is a mental health disparity experienced by the alternative sexuality community. We assessed mental health, relationship orientation, marginalized identities (i.e., sexual orientation minority, gender minority, racial minority, ethnic minority, and lower education), and preferences in information processing (PIP) as factors differentiating lifetime SRB groups. An online cross-sectional survey study was conducted in 2018. Members of the National Coalition for Sexual Freedom (NCSF; n = 334) took part. Bivariate analyses identified the following SRB risk factors: female and transgender/gender non-binary identity, sexual orientation minority identity, lower education, suicide attempt/death exposure, Need for Affect (NFA) Avoidance, depression, and anxiety. …

An Interdisciplinary Study To Understand Treatment Seeking Behavior Among Female Survivors Of Anorexia Nervosa, Meaghan Victoria Tipton

Graduate Theses and Dissertations

This study was done to examine what psychosocial factors influence treatment seeking behavior among female survivors of eating disorders. This study uses a mixed methods survey consisting of open-ended item questions regarding treatment experience and social environment, and close-ended items to measure constructs from the Health Belief Model. Fourteen participants were recruited for this study to retrospectively detail their experiences of treatment during their eating disorder. All fourteen participants identified as Caucasian, thirteen identified as female, one identified with other gender, each with a history of medically diagnosed anorexia nervosa. The mean of age of current participants was 29.46, and …

Community Psychology's Impact On Public Health And The Experience Of Marginalization, Katie Hudick

Richard T. Schellhase Essay Prize in Ethics

Vulnerable and marginalized populations face a series of risks and dangers throughout their daily lives. This is not simply limited to explicit forms of discrimination and hatred, but systemic forms of oppression and discrimination which limit those not belonging to more privileged and affluent socioeconomic or sociocultural groups. Community psychology operates as a means of analyzing how environmental and social factors impact specific demographic groups within a larger population and by extension the experience of mental health specific to these groups (Townley, Brown, & Sylvestre, 2018). In the application of this field, it is critical to understand the dynamics of …

Greater Social Cohesion Is Associated With Lower Body Mass Index Among African American Adults, Adolfo G. Cuevas, Ichiro Kawachi, Kasim Ortiz, Mariam Pena, Lorraine R. Reitzel, Lorna H. Mcneill

Publications and Research

Obesity remains a public health issue, especially for Blacks (or African Americans). Obesity is thought to reflect a complex interaction of socioenvironmental, biological, and cognitive factors. Yet, insufficient attention has been given to psychosocial factors like social cohesion within the African American community. Using multivariable linear regression, we examined the association between social cohesion, measured by the Social Cohesion and Trust scale, and body mass index (BMI) with cross-sectional data (n = 1467) from a cohort study (2008–2009). Greater social cohesion was associated with lower BMI (b = -0.88; 95% CI: −1.45, −0.32) in an unadjusted model. The association was …

Spring 2020

Scientia

From the Dean: Forward Motion; Strategic Plan Summary: Make No Little Plans; Alumnus Profile: Principled Prescription - William McDade is making medicine more diverse nationally: Living Our Mission: A Just World - For Mark Potosnak, concern for the environment isn't just a job, it's a moral obligation; One Peace at a Time: Psychology professors LaVome Robinson and Leonard Jason are working to prevent violence in schools; Impactful Inquiry: Real-world opportunities give undergraduate students a head start on their career paths; Lab Notes