Public Health Commons^™

No More Loosies: A Mixed-Methods Study On The Implementation And Enforcement Of The Loose Cigarette And Bidi Sale Ban In India, Mayank Sakhuja

Theses and Dissertations

Background: Sale of loose cigarettes and bidis (loosies) is widely accepted as a key factor in promoting the tobacco epidemic in India. This mixed-methods study aimed to broaden understanding around the sale and purchase of loosies addressed three aims: 1) To determine the prevalence and correlates of loosies purchase in India; 2) To examine the association between purchase behavior and health warning labels (HWLs) exposure and responses, and 3) To conduct a stakeholder analysis regarding the ban on the sale of loosies in India. Methods: Data from the 2018-19 Tobacco Control Policy (TCP) India survey (643 current cigarette users and …

Social Network Attributes Associated With Conversations About Smoking And Cessation And Differences By Socioeconomic Status, Victoria Catherine Lambert

Theses and Dissertations

Conversations about smoking and cessation in response to cessation messages appear to encourage quit attempts, yet there is some evidence that smokers with lower income and education have these conversations less often than their counterparts with higher income and education. No research has investigated the social network characteristics that encourage smokers to have these conversations or the mechanisms for SES differences in these conversations. Because social factors play a role in SES disparities in smoking and cessation as well as other health behaviors and outcomes, social network characteristics likely explain some SES differences in conversations about smoking and cessation. The …

Nutrition Facts Label Use Among U.S. Adolescents, Jennifer Beth Mandelbaum

Theses and Dissertations

Despite the promise of Nutrition Facts label (NFL) use as a population-level intervention with broad reach, few studies have examined determinants of adolescents’ NFL use, and how this label use may be associated with nutrition behaviors. This study used data from the International Food Policy Study, an online cross-sectional survey of trends in dietary patterns and policy-relevant behaviors in the U.S. and five other countries. First, this study examined 1) whether NFL use was associated with healthy eating efforts and 2) whether there were sociodemographic differences in NFL use among U.S. adolescents. Results demonstrated that NFL use was positively associated …

Greenspace Across The United States: Exploring Equity And Associations With Physical Activity, Obesity, And Health-Related Quality Of Life, Ellen W. Stowe

Theses and Dissertations

Neighborhood greenspace is important for health and well-being but may not be equitably present in neighborhoods across the United States. Also, many adults are physically inactive, have obesity, and report poor health-related quality of life. Greenspace has been tied to these health conditions, but with mixed findings. The purpose of this study was to 1) use an environmental justice perspective to examine variations in 11 measures of greenspace by neighborhood race/ethnicity, income, and rurality in block groups across the contiguous United States and 2) examine 11 greenspace measures in connection to physical activity, obesity, and health-related quality of life in …

Hiv-Related Stigma, Sexual And Gender Minority-Related Stigma, And Health Outcomes Among Msm Living With Hiv: Measurement, Impact, And Intersectionality, Tianyue Mi

Theses and Dissertations

Background: Many men who have sex with men (MSM) living with human immunodeficiency virus (HIV) experience suboptimal health outcomes compared to nonMSM males living with HIV, including a faster decline in CD4 count before initiating antiretroviral therapy (ART), slower immune recovery after initiating ART, more mental health problems, suboptimal ART adherence, and lower retention in care. MSM living with HIV are often exposed to multiple layered stigmas, including, but not limited to, stigma related to being infected with HIV and stigma related to sexual and gender minority (SGM) status. Although various scales of HIV-related stigma have been frequently used for …

Food Insecurity Resilience Of Refugee Families In The United States: A Qualitative Study, Maryam Suliman Alhabas

Theses and Dissertations

Refugee families living in the United States often encounter a number of challenges while trying to build a new home and maintain their household food security. Refugee families at high risk of experiencing food insecurity in the resettlement country. Food insecurity among US refugee families is a major public health concern as it adversely impacts their health and wellbeing, since it affects dietary intake and mental health and associated with illness, poor nutrition, and obesity. Little is known about what happens when refugee families face food insecurity experience, and the role of their social contexts in that experience. The objective …

Living With Ulcerative Colitis: Exploring Dietary Inflammatory Intake, Physical Activity, And Methods To Manage The Burden Of Illness, Kelli E. Dubois

Theses and Dissertations

Ulcerative Colitis (UC) is a chronic illness under the umbrella of Inflammatory Bowel Disease (IBD). IBD is becoming a global health issue as incidence rates are rising throughout the world. UC is characterized by chronic inflammation and ulcerations in the colon’s mucosal lining due to abnormal inflammatory and immune system responses. Patients with UC experience a range of gastrointestinal and extraintestinal symptoms as well as psychosocial challenges throughout the course of illness that generate a significant burden on daily life. Periods of active disease, or flares, present exacerbations of disease symptoms and the greatest burden on daily functioning, yet disease …

Exploration Of The Role Of Neighborhood Residential Segregation By Race And Ethnicity In Obesity Risk Among School-Aged, Melissa L. Fair

Theses and Dissertations

Youth obesity prevalence remains high, despite decades of intervention. Grounded in the social ecological model, neighborhoods and schools are important settings in addressing the complex systems that influence obesity. Contributing to disparities, by race/ethnicity, Black and Hispanic youth are more likely to live in segregated neighborhoods and attend segregated schools, which are also more likely to have high rates of poverty and are less likely to have high quality nutrition and built environments. Leveraging data from local school district (district and state department of education) and national datasets (ACS, Childhood Opportunity Index 2.0), this study examined the associations between school …

Perspectives About Food Safety In Diverse Low- And Middle-Income Countries, Sejla Isanovic

Theses and Dissertations

Concerns about unsafe food influence food choice, and consumption of unsafe foods increases morbidity and mortality, particularly in low- and middle-income countries. Actions to ensure safety of food are dominated by mitigation of biological and chemical hazards through supply-side risk management, disregarding individuals’ experiences and perspectives of food safety. We aimed to identify and categorize perspectives about food safety in five countries. Five Drivers of Food Choice projects provided transcripts from 17 focus groups discussions and 303 interviews in Kenya, Ghana, India, Guinea, and Vietnam. We analyzed transcripts using a priori and emergent codes. Individuals constructed meaning about food safety …

Homestead Vegetable And Poultry Production And Related Practices: An Assessment In Nepal, Shiva Bhandari

Theses and Dissertations

Consumption of nutrients-rich foods like diverse vegetables, eggs, and meat throughout a year remains a challenge in low- and middle-income countries due to poor availability, accessibility, and affordability. One important way to overcome the challenge is to promote households’ own production of these foods and encourage individuals to consume. Improving household production of the foods necessitates understanding whether active participation and performance of frontline workers in the communities and performing improved production-related practices can translate into improved production of nutrients-rich foods. This study had two specific aims. The first aim was to examine demographic, socio-economic, and programmatic determinants of active …

Food Choice Decision-Making Among School-Going Adolescents Amidst The Nutrition Transition In Urban Accra, Ghana, Krystal Krsna Rampalli

Theses and Dissertations

Like many countries of the world, Ghana is experiencing a nutrition transition and rising non-communicable diseases. Adolescents are susceptible to diet-related health risks as they experience significant physical and psychological changes, which are happening in tandem with food environment changes, including widespread proliferation of large portion and package sizes of energy-dense, nutrient-poor foods. Both local and multinational food and beverage companies have encouraged consumption of their products through various marketing tactics targeted directly to adolescents. Some of these tactics include the use of characters or celebrity endorsement, promotional discounts, and appeal to sociocultural values, including messages about body size preferences. …

Pre-Exposure Prophylaxis (Prep) Knowledge, Willingness To Use & Uptake Among Black Heterosexual Men, Akeen Lowell Hamilton

Theses and Dissertations

INTRODUCTION: Pre-exposure prophylaxis (PrEP) is a pill, taken orally, that has been shown to be effective at reducing the chance that someone who is HIV-negative and at-risk for HIV will contract the disease during sexual intercourse with someone who is living with HIV. One demographic group that has been under-researched is Black heterosexual men. This dissertation presents research on evaluating the heterosexual Black men’s awareness of, prior use, and network of friends/family’s perceived interest in learning more about PrEP.

METHODS: Two-hundred and six Black heterosexual men living in Brooklyn, New York City, were surveyed about their sexual behaviors and PrEP …

Evaluating The Health Impact Of Centeringpregnancy Program Versus Traditional Prenatal Care In Midland Obstetric Clinics And Validating Selected Item On Birth Certificate, Oluwatosin A. Momodu

Theses and Dissertations

The primary focus of this dissertation is to evaluate the health impact of the CenteringPregnancy (CP) program versus traditional prenatal care (TPNC) on important maternal outcomes of pregnancy. This is looked at in two outcomes-gestational weight gain (GWG) and pregnancy induced hypertension (PIH). The specific aims are to examine the: (1) effects of CenteringPregnancy program versus traditional prenatal care on gestational weight gain (GWG); (2) effects of CenteringPregnancy program versus traditional prenatal care on pregnancy induced hypertension (PIH).

Birth certificate (BC) data were linked to hospital discharge records of women who delivered in midland’s obstetric clinics of South Carolina between …

A Contextual Evaluation Of The Fresh Fruit And Vegetable Program In South Carolina And Related Child Health Behaviors, Kathryn Irene Hoy

Theses and Dissertations

Children in vulnerable communities are at increased risk for poor diet.1,2 The Fresh Fruit and Vegetable Program (FFVP) is a United States Department of Agriculture (USDA) child nutrition program that increases vulnerable children’s access to and consumption of fruits and vegetables.3,4 FFVP is inherently flexible,5 has few regulations, and helps identify and develop best practices for individual schools to increase fruit and vegetable consumption among low-resource children.6 Flexibility built into the FFVP at the federal level naturally results in a variation of program adoption and implementation at both the state and school-levels.7 These variations affect outcomes in complex health promotion …

Neighborhood Socioeconomic Status, Green Space, And Walkability And Risk For Falls And Fracture Among Postmenopausal Women: The Women’S Health Initiative, Marilyn Elizabeth Wende

Theses and Dissertations

The purpose of this study was to assess whether neighborhood socioeconomic status (SES), walkability, and green space impacts fall and fracture incidence among postmenopausal women, and to assess important modifiers for these relationships, such as fall history, physical activity, physical impairment, race/ethnicity, and rurality. Data from the Women’s Health Initiative study from 1993 to 2012 (N=161,808) was used.

SES had a significant relationship with falling after adjustment (intermediate vs low SES OR=0.99, p=0.0309; high vs low SES OR=0.99, p=0.1192). Study arm participation and fall frequency at baseline significantly modified this relationship. Walkability had a significant relationship with falling incidence after …

Applying Health Stigma Framework To Examine The Mechanisms Of Hiv-Related Stigma On Clinical Outcomes, Chengbo Zeng

Theses and Dissertations

Background: HIV clinical outcomes including CD4 count, viral suppression, and health-related quality of life (HRQoL), are important indicators reflecting immunologic functioning, treatment efficacy, and overall health quality. However, due, in part, to HIV-related stigma, many people living with HIV (PLWH) experience suboptimal clinical outcomes. The Health Stigma Framework introduced the potentially distinct mechanisms underlying internalized, anticipated, enacted stigma and health outcomes through psycho-behavioral pathways. Based on this framework, this dissertation investigated the impacts and mechanisms of HIV-related stigma on clinical outcomes among PLWH in Guangxi, China from a longitudinal perspective. Methods: Data at baseline, 6-, 12-, 18- month follow-ups …

Evaluation Of A Clinic-Based Peer Navigation Program (Pnp) For African Americans Living With Hiv In South Carolina, Kimberly Butler Willis

Theses and Dissertations

Peer navigation programs have been identified as a potential motivator in care engagement and retention for patients living with HIV, although the data is inconsistent. HIV management requires important disease management considerations and innovative approaches for patient care. Medication advancements and technology have drastically improved care for most patients living with this chronic disease; yet African Americans contract, live with, and die because of HIV-related complications at disproportionately higher rates compared to their White peers.The purpose of this exploratory mixed-methods outcome evaluation is to: (1) determine if peer navigation is a viable intervention to improve three key HIV care metrics: …

Package Warning Labels For Communicating Relative Risks Of Cigarettes, Heated Tobacco Products, And E-Cigarettes, Yoo Jin Cho

Theses and Dissertations

Package warning labeling policy is a fundamental public health strategy for communicating about tobacco product risks. The rapidly growing markets for novel tobacco products, such as heated tobacco products (HTPs) and e-cigarettes (ECs), make it critical to determine the characteristics of effective warning label policies for these products, which have lower levels of risk compared to cigarettes according to available evidence. Whether warning labels can communicate information about a continuum of risk across tobacco products is unexplored.

This dissertation investigated two warning label systems for communicating the relative risks of cigarettes, HTPs, and ECs: (1) varying warning sizes as a …

Examining The Organizational Capacity Of Public Libraries That Offer Obesity Prevention Programs, Olivia Whitt

Theses and Dissertations

Supplemental Nutrition Assistance Program Education (SNAP-Ed) is a federally funded grant program that helps SNAP-eligible populations make healthy choices, like those outlined by the Dietary Guidelines for Americans and the Physical Activity Guidelines for Americans. Together with implementation agencies (IAs) and local sites, SNAP-Ed provides direct nutrition education and facilitates policy, systems, and environmental strategies (PSEs) such as farmers markets and community gardens. This qualitative research investigated two specific aims: 1.) Understand the elements of organization capacity that influence a public library’s ability to implement obesity prevention programs and 2.) Evaluate the need for library staff public health knowledge …

Determinants Of Nutrition Agenda Setting In The Context Of The Double Burden Of Malnutrition In Tamil Nadu, India, Shilpa Vimalananda Constantinides

Theses and Dissertations

The double burden of malnutrition is increasing in low- and middleincome countries, with economic, social, and health consequences. Policies and programs to address malnutrition at the national and subnational levels reflect the priorities and framing of the problem by the stakeholder community. Previous studies have examined if and how nutrition-related NCDs have been included into national nutrition policy agendas that have historically focused on reduction of undernutrition, but little is known about if or how this process occurs at the subnational level where policies are translated and implemented according to local contexts, priorities, and frames of nutrition-related NCDs.

We aimed …

Does Marriage, Employment And Having Children Matter? A Secondary Analysis On Physical Activity Levels, Leisure Time Physical Activity, And Social Roles Among Women In The United States, Tramaine Paul Mcmullen

Theses and Dissertations

Background: Social roles, such as being married, employed, or having children, have been shown to have independent negative relationships with moderate to vigorous physical activity (MVPA) levels among women. Increasing the number of women with children that meets physical activity guidelines is critical to reduce chronic disease and early mortality in this population. However, few studies have examined the relationship between holding multiple social roles, MVPA, and leisure-time physical activity (LTPA) among women with children. The study had two aims: 1) to determine the relationship between objectively measured MVPA by social roles and 2) to examine the frequency of specific …

Understanding The Role Of Political Commitment And Coherence Across Sectors And Across National And Sub-National Levels In Enabling Improvements In Nutrition In Rwanda, Elyse Iruhiriye

Theses and Dissertations

Reducing undernutrition is on the political agendas of many low- and middle-income countries. There is general consensus that to improve nutritional outcomes involves actions across the different sectors that influence both the immediate and underlying determinants of optimal nutrition and an enabling environment to support the political and policy processes. Despite renewed attention over the last 15 years, addressing nutrition in a multisectoral way was previously promoted in the 1970’s but failed to have sustained political commitment due to its organizational complexities to plan and implement strategies across sectors.

We conducted an in-depth retrospective case study to understand how Rwanda, …

Influences On Parents’ Food Shopping For Children’S Consumption In South Carolina, Nazratun Nayeem Monalisa

Theses and Dissertations

Background: The diets of children in the United States typically do not meet dietary guidelines. Energy-dense nutrient-poor (EDNP) foods dominate children’s diets, contributing excessive energy, sugar, sodium, and fat intake. Home is the major source of children’s energy intake. Parents oversee household food purchases including foods for children.

Objectives: This research aimed to 1) identify parents’ food and beverage purchases for their household and for 6-11-year old children; 2) understand how parents made food purchase decisions by adjudicating among different values; 3) understand children’s food choice construction, strategies to influence parents for desired items, and extent of children’s influence.

Methods: …

Rethinking The Customer Experience: An Empirical Comparison Of Airbnb And Hotels, Jing Li

Theses and Dissertations

Experience is at the heart of the tourism and hospitality industry. One of the fundamental objectives of this sector is to create memorable customer experiences. For years, the sharing economy has been an essential industry phenomenon. Distinct from the traditional sector, Airbnb emerged as a disruptive innovation and a dominant online sharing-economy platform and has had a significant impact on the traditional industry. Despite growing interest in customers’ experiences in tourism and hospitality, limited research has provided insight into what constitutes the customer experience with Airbnb, how it can be conceptualized, and how it should be measured. In addition, Airbnb …

Social Networks, The Local Food Environment, And Maternal Food Choice For Children Ages 1 To 5 Years Old In Rural Mexico, Ligia Ivette Reyes

Theses and Dissertations

Children’s nutrition is largely determined by the food choices their primary caregivers make. Food choice for children has important implications for nutrition, development, and the dietary habits and preferences that are formed during early life food exposure. Little is known about the food environments in which food choices are made and the role of social networks in maternal food choice during habit- and preference-forming years in contexts undergoing nutrition transitions and facing the double burden of malnutrition. The overall objective of this study was to gain an indepth understanding about how mothers, as primary caregivers, make food choices for their …

Women’S Socio-Economic Empowerment And Uptake Of Hiv Testing In Ethiopia, Dawit Alemu

Theses and Dissertations

Introduction: Sub-Sahran Africa constitute two-thirds of all people living with HIV in the world. HIV infection rate is high in the continent with women comprising 56% of new HIV infections among adults 15 and older. Women 15 to 24 are the most affected constituting 66 % of new infections occurring among this age group. The purpose of this study was to examine how gender power relations between men and women affect health seeking behavior, particularly HIV testing, among Ethiopian women age15 to 49.

Methods: The Ethiopian Demographic and Health Survey (EDHS) from 2016 served as the data source for …

Experience Of Persistent Pain Among Military Service Members Participating In An Interdisciplinary Intensive Outpatient Program, Barbara Katarzyna Bujak

Theses and Dissertations

Persistent pain is one of today’s most complex issues in healthcare. In the U.S. military, persistent pain affects close to half of the service members who have deployed overseas and up to 73.2% of service members and veterans experiencing persistent pain. Interdisciplinary pain management, considered one of the most effective ways to manage persistent pain, utilizes the biopsychosocial model that illustrates the dynamic interaction between the physiological, psychological and social factors involved in the experience of persistent pain. Effective interdisciplinary programs address all components of the model and result in better coping skills to self-manage persistent pain, decreased fear of …

Pre-Exposure Prophylaxis (Prep) For Hiv Prevention: A Mixed-Methods Study Of Sexual Risks And Knowledge, Perceptions, And Willingness Of Prep Use Among African American Women In The South, Jamie Troutman

Theses and Dissertations

There are approximately 1.1 million people living with HIV in United States, with nearly 40,000 new diagnoses annually. Significant regional and racial disparities are associated with HIV diagnoses — with the South experiencing the greatest burden of HIV and African American women accounting for 60% of new diagnoses among women. Pre-exposure prophylaxis (PrEP) has been designated as an effective tool to prevent HIV transmission among individuals who may be at risk of HIV infection. Earlier PrEP research has focused mainly on at-risk groups such as men who have sex with men (MSM). Previous PrEP research involving African American women included …

Evaluating Impacts Of A Multilevel Resilience-Based Psychosocial Intervention On Mental Health Of Children Affected By Parental Hiv In China, Yanping Jiang

Theses and Dissertations

Background: Children affected by parental HIV are commonly exposed to multiple risk factors, including parental illness and death, other traumatic life events, HIV stigma, and poverty, all of which in turn put them at elevated risk of experiencing poor mental health outcomes. Previous research has suggested the promise of psychosocial interventions in improving mental health for children affected by parental HIV through an integrated and multilevel resilience-based approach. However, there are few multilevel resilience-based interventions for this group, and the efficacy of such interventions on mental health outcomes has not been fully examined. Furthermore, very few studies have examined whether …

Social Networks, Social Support, And Contextual Factors That Affect Blood Glucose Control Among Individuals With Type 2 Diabetes Mellitus In Urban Ghana, Marian O. Botchway

Theses and Dissertations

This study used primary data from Kumasi, Ghana, to examine whether social networks, social support, diabetes-related stigma, religion, and traditional medicine affected blood glucose (HbA1c) control among adults with type 2 diabetes mellitus (T2DM). First, the study evaluated whether three social network characteristics (kin composition, household composition, and network density) were directly or indirectly (via social support) associated with HbA1c. Kin composition and household composition were significantly associated with social support. Neither network characteristics nor social support were associated with HbA1c, which suggests that social network characteristics may operate through mechanisms other than social support to affect HbA1c among study …