Public Health Commons^™

The Influence Of Brand Equity On Prescriber Behaviour In A Multisource Drug Market, Wanjiku Kariuki

Dissertations and Theses (Open Access)

When a patent expires, innovator (brand-name) drugs lose their monopoly status and new generic competitors are free to enter the market. Theoretically, free market entry and exit should lead to a drop in the price of the innovator drug as per the tenets of perfect competition. Yet instead of prices decreasing, innovator drug prices are often minimally impacted by generic competition and the innovator continues to maintain both market power and market share – a phenomenon labelled the generic competitor paradox (Scherer, 1993) That the expected supply and demand dynamic is less pronounced in multisource drug markets, suggests that non-price …

Development Of A Culinary Nutrition-Based Training For Dietitians And A Clinic-Based Nutrition Intervention To Improve Health Outcomes Among Low-Income Minority Patients, John Wesley Mcwhorter

Dissertations and Theses (Open Access)

Substantial evidence demonstrates the relations between a healthy dietary pattern rich in fruits, vegetables, and whole grains and a lower risk of chronic diseases including type 2 diabetes. Despite well supported studies, programs, and public health campaigns presenting the health benefits of consuming a healthy dietary pattern, most Americans fall far short of the recommendations. Further, the compounding effects of food insecurity and the consumption of energy-dense and nutrient-deficient foods disproportionately affect low income minority populations. Culinary medicine (CM) and food prescription programs are gaining popularity as tools for (1) decreasing food insecurity; (2) increasing personal agency; (3) promoting healthy …

The Intersection Of Diet, Health And The Environment: Plant Based Diets And Public Health, Christine E. Jovanovic

Dissertations and Theses (Open Access)

Both globally and within the United States, chronic disease has become a major driver of mortality and morbidity. In the United States in 2017, the top ten causes of mortality accounted for 74% of all deaths [2]; of these causes, half are closely linked to diet (heart disease, cancer, stroke, Alzheimer’s and diabetes). [3] In 2013, Ioannidis estimated that 26% of deaths and 14% of disability adjusted life years (DALYs) in the United States may be attributable to dietary risk factors, controlling for obesity. [4] At the same time, diet also has an important impact on the environment. Direct emissions …

Shared Decision Making In The Care Of Post-Acute Psychiatric Individuals With Serious Mental Illness, Natalie J. Maples

Dissertations and Theses (Open Access)

Severe mental illness in adults refers to a group of mental health conditions including schizophrenia and schizoaffective, bipolar and major depressive disorders. These conditions are often characterized by recurring symptoms, multiple hospitalizations, and significant disability. The public health concern with these conditions is amplified because many individuals with severe mental illness fail to engage in outpatient treatment. Methods to support greater rates of participation in outpatient treatment are needed. Encouraging participation in medical decision making is viewed as one method to optimize patient empowerment, increase engagement in care and decrease the negative outcomes that often characterize this population. Shared Decision …

Exploring Community-Based Weight Loss Initiatives, Retention, And Motivation, Miriam Martinez

Dissertations and Theses (Open Access)

Obesity puts individuals at risk of developing diabetes, cardiovascular disease, and cancer. Traditionally obesity was primarily perceived as a personal disorder requiring treatment at the individual level. Strategies to prevent obesity have shifted to an ecological approach. Organizations such as the World Health Organization recommend population based community approaches that connect people, families, schools, and municipalities. Community programs to facilitate weight loss are an effective strategy to reach large populations. The overall goal of this study is to assess community programs, factors associated with retention, and motivation for completing a community weight-loss initiative. A systematic review was conducted to characterize …

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 …

Ubiquitination Of The Dna-Damage Checkpoint Kinase Chk1 By Traf4 Is Required For Chk1 Activation, Xinfang Yu, Wei Li, Haidan Liu, Qipan Deng, Xu Wang, Hui Hu, Zijun Y Xu-Monette, Wei Xiong, Zhongxin Lu, Ken H Young, Wei Wang, Yong Li

Faculty, Staff and Students Publications

BACKGROUND: Aberrant activation of DNA damage response (DDR) is a major cause of chemoresistance in colorectal cancer (CRC). CHK1 is upregulated in CRC and contributes to therapeutic resistance. We investigated the upstream signaling pathways governing CHK1 activation in CRC.

METHODS: We identified CHK1-binding proteins by mass spectrometry analysis. We analyzed the biologic consequences of knockout or overexpression of TRAF4 using immunoblotting, immunoprecipitation, and immunofluorescence. CHK1 and TRAF4 ubiquitination was studied in vitro and in vivo. We tested the functions of TRAF4 in CHK1 phosphorylation and CRC chemoresistance by measuring cell viability and proliferation, anchorage-dependent and -independent cell growth, and mouse …

Patient, Hospital And State-Level Policy Characteristics Associated With Prevalence Of Treating Opioid Use Disorder In United States Emergency Departments, Rafeek Adeyemi Yusuf

Dissertations and Theses (Open Access)

The opioid crisis in the United States was declared a public health emergency due to escalating and untoward human, financial, and systemic consequences and effects on the nation. Opioid use disorder (OUD) comprising opioid abuse and dependence is devastating because of its associated chronic relapsing nature, overutilization of healthcare services, rising morbidity and mortality rates, and high cost of care. Efforts to address this have not made significant positive impacts. It is thus imperative to reassess the influence of factors associated with OUD. This study answered the question, what patient-, hospital-, and state-level policy factors were associated with prevalence of …

Identifying Risk Factors For Chronic Kidney Disease Of Unknown Origin In Six Central American Countries And Houston, Texas, Erika Figueroa-Solis

Dissertations and Theses (Open Access)

Chronic kidney disease (CKD) is a public health problem that is recognized worldwide. The type of CKD in Central America does not fit the “usual” CKD encountered in countries with upper middle-income economies, and is also often referred to as CKD of undetermined cause (CKDu). Evidence suggests that CKDu is a disease of occupational origin that can be brought on by a combination of exposures: hot environments, high physical job demands, inadequate hydration protocols, and effects of other nephrotoxic agents. Many gaps remain in knowledge related to CKDu and its putative risk factors, geographic distribution, distributions of renal function in …