Public Health Commons^™

The Role Of Paraprofessionals In The Mental Health Structure Of India, Amy Abraham

Senior Theses

The mental health treatment gap in India is part of a growing public health crisis, with over 95% of those in need of services never receiving them. Over 197 million Indians suffer from at least one diagnosable mental health disorder, and this number continues to grow given the treatment gap. The treatment gap is a result of four major factors: lack of government support, stigma, limited treatment facilities, and the dearth of professionals able to provide treatment. The current study aimed to analyze several factors of paraprofessional led mental health interventions including setting, treatments delivered, treatment models, and client outcomes. …

Maternal Preventive Dental Services Utilization: The Role Of Preconception Oral Health Counseling In And The Association With Birth Outcomes: Evidence From South Carolina Prams, Monique Johnette Williams

Theses and Dissertations

ABSTRACTThe purpose of this study is to examine maternal preventive dental services utilization by analyzing the role of preconception oral health counseling in utilization of dental cleaning services before or during pregnancy and the association of utilization with preterm birth (<37 weeks) and small for gestational age (SGA) (same sex newborns having birth weight for gestational age below the 10th percentile of the reference population as defined by the World Health Organization (WHO)). Studies suggest that unfavorable maternal oral conditions have significance in birth outcomes, specifically periodontal disease (periodontitis), an oral inflammatory condition which is shown to be a risk factor for preterm birth and low birth weight (Dortbudak et al., 2005; Guimarães et al., 2012; Tejada et al., 2012). Dental cleaning before and during pregnancy is effective in the prevention of oral disease including gingivitis and periodontitis (Johnson et al., 2006; Kurien et al., 2013; Steinberg et al., 2013).

Cross-sectional 2012-2015 data from the South Carolina Pregnancy Risk Assessment Monitoring System (SC PRAMS) survey, a population-based surveillance system on prenatal, perinatal and postpartum experiences of resident mothers who recently delivered a live-born infant, were analyzed using weighted analyses in SAS. Analyses included demographic univariate analyses, Rao-Scott Chi-squared tests of significance to study differences between groups, and multivariate logistic …

An Analysis Of How Stress Impacts Dietary Habits In First-Year Students, Matthew Telfer

Senior Theses

The majority of students will experience stress during their first year at college. Stress can have many ill effects on the well-being of a first-year student and can even be a significant factor in weight gain – hence the term “The Freshman 15”. Sixty seven first-year students at the University of South Carolina were recruited to participate in a sixteen-item questionnaire focused on analyzing the relationship between stress and dietary habits. It was hypothesized that first -year students who had higher levels of stress would have significantly more unhealthy eating habits than first-year students who had lower levels of stress. …

Examining Parental Perceptions And Decisions To Uptake Child Influenza Immunizations: Assessing Pandemic And Policy Impacts On Vaccination Rates Following The H1n1 Pandemic, And The Acip Laiv Preferential Recommendation Revocation, Amir H. Mehrabi

Theses and Dissertations

Introduction

2009 H1N1 Pandemic: The historical 2009 H1N1 Influenza pandemic, which had a CDC estimated accrued disease burden of 100.5 million illnesses, 936,000 hospitalizations, and 75,000 deaths from 2009 to 2018, resulted in a declared state of emergency nationally, with ensuing diminished vaccine confidence and amplified fears of infection, prompting some to pursue flu vaccination, and others to forego. Although the Centers for Disease Control and Prevention (CDC), and its Advisory Committee on Immunization Practices (ACIP) recommend an annual flu vaccine for individuals 6 months of age and older as the “first and best” defense against influenza, a low percentage …

Effect Of Lifestyle, Medical School Culture And Income On Medical Students' Decision To Pursue A Primary Care Career In Saudi Arabia, Ahmed Abdullah Alhussain

Theses and Dissertations

This study aims to examine the relationship of medical school students who select primary care as their career specialty. Based on extensive literature review, we focused on the three main factors that influence students to consider career specialty: lifestyle, income, and medical school culture. With a paper questionnaire of a cross-sectional study survey at ten medical schools, we were able to collect 1,006 participants from fourth and fifth year students. The clear majority of students considered lifestyle characteristics to be a significant influence in their career decision (PP<.05). Also, we found there was a significant relationship between students’ specialty choices and income variables. The result showed us that medical school culture played a notable role in terms of forming the students’ decisions in different ways. First, specialty characteristics were strongly correlated with career consideration. Second, having advising and mentoring within the medical school enhanced the probability of choosing primary care specialty. Finally, the effect of the primary care course was significant and closely related to the choice of the primary care specialty. In conclusion, the study demonstrated the impact of lifestyle, income, and medical school culture on student career selection. These results are in parallel with previous studies conducted in many countries around the world.

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 …

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 …

Association Between Urinary Enterolignans As A Marker For Gut Microbiome Diversity And Depression In Nhanes, Marie Knoll

Theses and Dissertations

Depression is a chronic disease which inflicts functional and emotional impairment that has been a growing issue in the United States (US). Depression is the most prevalent mental disorder in the US and is the leading cause of disability in the world. By 2030, It is projected that major depressive disorder will be the second largest contributor to global burden of disease. Causes of depression are still largely unknown and treatments are often expensive, time consuming, and only available to certain populations. Treatment often requires a combination of medicines and therapy to be effective. In recent years, the gut microbiome …

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, …

Correlates Of Maternal Health Service Use And Women’S Experiences Using Antenatal Care In Ghana: A Mixed-Methods Study, Anna Cofie

Theses and Dissertations

The pace of improvements in maternal mortality has been slow in Ghana. While Ghana’s maternal mortality ratio (MMR) decreased from 635 per 100,000 live births to 319 per 100,000 live births between 1990 and 2015, the country failed to meet the 75% reduction target set by Millennium Development Goal (MDG) goal 5A, to reduce maternal mortality ratio by 75% between 1990 and 2015. Antenatal care (ANC) is critical to improving maternal morbidity and mortality and child deaths. In 2003, Ghana introduced the National Health Insurance Scheme to ensure that all pregnant women have access to free maternal care, and in …

Effectiveness Among Community Health Center Governing Boards: An Assessment Of The Different Governing Board Members’ Perspectives, Brandi L. Wright

Theses and Dissertations

Governing boards of Community Health Centers were created with the anticipation that majority of its members be patients (users) of the Community Health Center they served. This study assessed South Carolina Community Health Center governing board members’ perception and understanding of what they believe their roles and responsibilities are, and their perceived overall effectiveness. It provides a framework for understanding the governance structure of Community Health Centers, based on examining three characteristic areas (Board Function, Board Performance and Board Development) of Community Health Centers located in South Carolina.

This study invited 234 governing board members to obtain members perceptions. Key …

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 …

Effectiveness And Experience Of An Integrated Maternal Mental Healthcare Intervention In Private Clinics And Public Health Facilities In Pakistan, Syeda Somyyah Owais

Theses and Dissertations

Maternal depression is often undetected or undertreated at the primary care level. Despite the growing high prevalence of depression among women of childbearing age, the usual primary care practice in Pakistan does not include depression screening. Two facility-based cluster randomized control trials, including a maternal depression intervention component, were conducted within two healthcare settings, private and public primary care facilities in Rawalpindi and Lahore. This study aimed to estimate the effectiveness of each trial in reducing maternal depression among mothers in the intervention arm compared to the control by analyzing the change in PHQ-9 (Patient Health Questionnaire-9) scores from baseline …

Aging With Hiv In The United States: Trends And Impact Of Hospital Stays On Inpatient Resource Utilization, And Costs Of Care, 2003-2015, Khairul Alam Siddiqi

Theses and Dissertations

Background:

Due to advances in Antiretroviral Therapy (ART), people living with HIV (PLWH) live longer in the United States. Aging prolongs exposure to HIV and antiretroviral drugs, which could lead to an elevated risk of developing multiple age-related comorbidities [HIV Associated Non-AIDS (HANA) conditions], earlier for PLWH. Higher comorbidity burdens among older PLWH may require greater use of inpatient care, i.e., higher hospitalization, inpatient resource utilization, and costs. This study examined the trends and characteristics of comorbidities, resource utilization, and costs of hospital stays with HIV (HSWH) compared to hospital stays without HIV (HSWOH). We also assessed trends for resource …

Intracranial Atherosclerotic Stenosis And Its Association With Inflammation And Meditarrenean Diet, Tushar Trivedi

Theses and Dissertations

Intracranial Atherosclerotic Stenosis (ICAS) is associated with 8 to 10% of all strokes in the U.S. Although there is some evidence that in the Asian population inflammation plays a role in asymptomatic ICAS, it has not been shown in the U.S. population. Prior studies have shown associations between diet and regulation of inflammation. Mediterranean dietary pattern has been associated with lower levels of inflammation and cardiovascular disease (CVD). In light of the important role of inflammation in intermediate stroke risk factors including atherosclerotic disease, and potential role of diet in modulating inflammation, understanding individuals’ diets according to their inflammatory properties …

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 …

Associations Between County-Level Socioeconomic Status And Opioid Overdose Rates In Northern New England, Samuel Godfrey

Theses and Dissertations

Background – The opioid epidemic persists as a significant concern to public health as the proliferation of fentanyl presents additional risks for illicit opioid users. States such as Maine and New Hampshire experience far greater opioid overdose rates compared to the overall US opioid overdose rate. Many studies on the opioid epidemic use socioeconomic and macroeconomic factors individually but few use a composite index of multiple of these measures. Limited attention has been paid to the need for a composite index of socioeconomic status at the small area (county) level designed to quantify the impact of socioeconomic status on the …

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 …

Influenza Vaccination Coverage In Pediatric Patients With Inflammatory Bowel Disease, Kelly Brown

Senior Theses

Background: Children with chronic health conditions, including inflammatory bowel disease (IBD), are at especially high risk for influenza infection and complications. The Crohn’s & Colitis Foundation and American College of Gastroenterology recommend that IBD patients should receive annual influenza vaccination. The aims of this study were to evaluate influenza vaccination coverage over time and identify predictors of flu vaccination in pediatric IBD and non-IBD patients.

Methods: We utilized longitudinal data (2000 to 2016) from South Carolina Medicaid to conduct a matched cohort study. The primary exposure of interest was IBD diagnosis based upon ICD-9/10 diagnosis codes. Children with IBD were …

Is Vaping Related To Other Health Risk Behaviors Among Adolescents?, Alvina Emran

Senior Theses

Vaping (smoking a vaporized liquid with an active ingredient) has had an upward trend in high school populations (ages 13-18) within the last decade, mainly due to misinformation and targeting from companies that sell e-cigarettes (142, 7). The most common substances that are vaped in teens are nicotine and tetrahydrocannabinol (THC, the active ingredient in marijuana) (147). Nicotine and THC bind to NAchR and CB1 receptors that affect certain parts of the dopamine reward pathway, such as the prefrontal cortex, the ventral tegmental area, and the ventral striatum in the brain (44,106). Dysfunction within these pathways have been associated with …

The Role Of A Community-Driven, Structured Exercise Program On Children's And Adolescent's Quality Of Life, Padgett Singley Powe

Senior Theses

Childhood obesity is a long-standing epidemic in the United States as of 2020, and the problem is continuing to worsen. Childhood obesity has been shown to have many unhealthy effects, such as increasing prevalence of cardiovascular disease, depression, and social anxiety, which all can contribute to a worsened quality of life. Research suggests that summer is the most critical time period to combat childhood obesity is because children’s lives are less structured over the summer, which can lead to increased unhealthy behaviors, obesity, and a decrease in quality of life. The current study, the Skybrook Swim Team Study, aimed to …

The Impact Of Psychosocial, Clinical, And Neighborhood Factors On Inflammatory Outcomes Among African American Women, Malcolm Seth Bevel

Theses and Dissertations

Inflammatory-related chronic diseases are disparagingly prevalent among African Americans in the United States, particularly in the Southeastern region. Access to community gardens shows promise in mitigating chronic disease outcomes, despite multiple barriers to physical activity and diet among underserved populations. We seek to determine if psychosocial or clinical factors mediate the association between the treatment effect of a healthy lifestyle intervention and inflammatory biomarker levels among African American women, respectively. We also seek to analyze the relationship between residing in a food desert/swamp and inflammatory biomarker levels, while gaining a qualitative perspective about community garden access among African American women. …

Contraceptive Education In South Carolina Women's Jails, Sarah B. Johnson

Senior Theses

Women in jail, which is currently a growing population, are at risk of unplanned pregnancy due to their potential exposure to alcohol and drug use, history of living in an abusive environment, and potential practice of prostitution(Clarke et al., 2012; Clarke et al., 2006; Kelly, 2012). The majority of female inmates are between the ages of 17-30, the peak reproductive age, which increases the importance of jails providing education to improve inmates’ reproductive health (Hale et al., 2009). Many females arrested will be released from jail back into society, making jails an opportune place to provide information to improve the …

Relation Of Flt-1 And Endothelial Function In Women Soon After Delivery: Effect Of Physical Activity And Sedentary Behavior, Chloe W. Caudell

Senior Theses

Adverse pregnancy outcomes (APOs) are believed to be caused by poor placental formation. APOs can be characterized by elevated levels of a circulating Fms-like tyrosine kinase biomarker called Flt-1, produced by the placenta when its blood vessels are shallow or inadequately formed. Flt-1 acts directly on the maternal endothelium to impair vascular function during pregnancy and contributes to maternal features of APOs. This study aimed to evaluate the relation of Flt-1 and endothelial function in women soon after delivery. This study also aimed to evaluate the relation of Flt-1 and physical activity and sedentary behavior in women during and soon …

Treatment Of Chronic Pain In U.S. Veterans: The Effectiveness Of Interdisciplinary Programs, Morgan L. Compton

Senior Theses

Chronic pain is a prevalent issue amongst US veterans. Experts suggest that interdisciplinary pain treatment is the most effective method of treating chronic pain, specifically due to targeting functioning and quality of life. These programs combine cognitive behavioral therapy and physical therapy by utilizing a variety of exercise and education regimens. The pain department at Columbia VA Health Care System offers both a comprehensive interdisciplinary treatment, Outpatient Interdisciplinary Pain Program (OIPP), and a flexible, multidisciplinary option (OIPP-Lite) for veterans suffering from chronic pain. The goal of this program is to improve knowledge for coping with chronic pain and to create …

Differences In Food Spending On Groceries And Eating Out Between Two Dietary Groups: The New Soul Study, Carly Fassler

Senior Theses

Background: Heart disease is now the leading cause of death for both men and women in the United States. Obesity, high blood pressure, and high cholesterol are all risk factors for heart disease. Research has shown that increasing consumption of plant-based foods may be effective in reducing risk factors for chronic disease, especially heart disease. A plant-based diet consists of nutrient-dense plant foods and minimizes the consumption of processed animal products. High costs of eating a healthier diet are a commonly cited barrier that prevents individuals from making dietary changes that could potentially decrease their chronic disease risk.

Objective: To …

The Impact Of Perceptions About Influenza And The Yearly Influenza Vaccine On Vaccine Behaviors Among Undergraduate Students At The University Of South Carolina, Julia G. Fuller

Senior Theses

Background: Undergraduate students are at an increased risk for developing respiratory infections as a result of the proximity in which they live, study, and eat. Despite being a target population for the Centers for Disease Control and Prevention’s yearly flu vaccine, several studies of undergraduate populations have found vaccine uptake to be much lower than other at-risk populations. This study aims to understand how perceptions about influenza and the influenza vaccine affect University of South Carolina undergraduate students’ vaccine behavior. Methods: A cross-sectional study was completed using survey data from 165 undergraduate students at the University of South Carolina. The …

An Examination Between Neighborhood Characteristics And Alzheimer’S Disease And Related Dementias And Caregiver Mental Health In South Carolina, Dana Mahmoud Alhasan

Theses and Dissertations

Research has examined the relationship between neighborhood environments and cognitive decline, yet few have investigated the role of neighborhood characteristics specifically on incident Alzheimer’s disease and related dementias (ADRD), on severity of Alzheimer’s disease (AD) including neuropsychiatric symptoms (NPS), and on caregiver mental health including depressive symptoms. This dissertation aimed to 1) ecologically examine the geographic distribution of ADRD and investigate ecologic associations between census-tract neighborhood characteristics and diagnosed ADRD case incidence from 2010-2014 in the South Carolina (SC) Alzheimer’s Disease Registry; 2) estimate the cross-sectional association between neighborhood characteristics and NPS among those with AD in 2010 in SC; …

First Aid And Emergency Preparedness: Improving Health Outcomes Among Aging Adults, Anna J. Kulangara

Senior Theses

As the United States population demographic shifts and the baby boomer population enters seniority, the health sector must adjust and prepare to provide efficient and adequate healthcare to the people. The Silver Tsunami, a metaphor for the expected wave of aging adults, will inevitably strain healthcare professionals and can be partly relieved by promoting risk-minimizing behavior in baby boomers before severe conditions develop. Through this effort, a health education course, titled First Aid and Emergency Preparedness, was developed and taught twice at a local senior center to target senior citizens and promote proactivity and healthy behaviors. Course development founded largely …

Vaccine Confidence, Coverage, And Hesitancy Worldwide: A Literature Analysis Of Vaccine Hesitancy And Potential Causes Worldwide, Jordan Hammond

Senior Theses

Vaccines are one of the world’s most impactful medical therapies. They are cost-effective, successfully proven, and one of the quickest treatment options available today (Clark et al., 2016). They save millions of lives every year and have eliminated certain diseases on a national and international level. However, millions of people worldwide still remain unvaccinated. In developed nations, mainly The United States (U.S.) and the European countries, many of the unvaccinated are a result of rising vaccine hesitancy of parents in conjunction with the anti-vaccination movement. Vaccine hesitancy is defined as “a delay in acceptance or refusal of vaccines despite availability” …