Public Health Commons^™

Spatial Analysis And Correlates Of Waterpipe Tobacco Smoking Among College Students In The United States, Frederick Richard Kates

Theses and Dissertations

Introduction: In the United States, young adults have the highest prevalence of waterpipe tobacco smoking (WTS) according to National Adult Tobacco Surveys (NATS) published by the Center for Disease Control (CDC). Experimentation of different tobacco products is highest among 18-24 year olds. Most recently, WTS has surged in popularity among this demographic group. The rapid diffusion of WTS among this population has been accelerated by marketing efforts on the Internet. There are misperceptions that WTS is less harmful than smoking cigarettes and there is a proliferation of WTS establishments due to tobacco retail exemptions. Presently, WTS establishments are almost completely …

Diagnostics And Model Selection For Generalized Linear Models And Generalized Estimating Equations, Chelsea Boquet Deroche

Theses and Dissertations

The use of generalized linear models and generalized estimating equations in the public health and medical fields are important tools for research, specifically for modeling clinical trials, evaluating preventive measures, and secondary data analysis. It is important for these researchers to have the necessary tools to analyze and model their data correctly. This dissertation focuses on a penalized maximum likelihood estimation method for generalized linear models, measures of association such as the coefficient of determination and R² for generalized estimating equations, and a modified quasi-likelihood information criterion for generalized estimation equations.

Common problems that arise during estimation of generalized …

Smoking Cessation In Pregnancy And Gestational Weight Gain In South Carolinian Mothers, 2009-2011, Laquenta Latreese Weldon

Theses and Dissertations

Purpose: To determine if smoking cessation during pregnancy is associated with excessive gestational weight gain (GWG).

Methods: Data came from the 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing population-based survey of live births in South Carolina (n=2,603). Participant smoking status was classified as nonsmoker (did not smoke before or during pregnancy), persistent smoker (smoked before and throughout pregnancy), or quitter (smoked before but quit during pregnancy). Multinomial logistic regression model was estimated to examine the association between smoking status and meeting the 2009 Institute of Medicine guidelines, while linear regression model was used for the continuous outcomes such …

Longitudinal Study Of The Effectiveness Of The South Carolina Medicaid Policy For The Application Of Fluoride Varnish For Children Age Three And Under, Christine N. Veschusio

Theses and Dissertations

In South Carolina, the burden of dental decay disproportionately affects disadvantaged children enrolled in Medicaid (Dye et al., 2012; Martin et al., 2012; Ayers et al., 2013). To address this oral health disparity, South Carolina’s Medicaid Program initiated payment to physicians for the delivery of fluoride varnish (FV), an evidence-based preventive dental service at the well-child visit, to children up to thirty-six months of age. Fluoride varnish has been found to reduce dental decay by thirty-seven percent when applied two to four times a year (Weyant et al., 2013; Marinho et al., 2013).

Two retrospective cohort studies were undertaken to …

The Role Of Social Relationship In Hiv Healing And Its Implications In Hiv Cure In China, Shan Qiao Ph.D., Jing-Bao Nie, Joseph Tucker, Stuart Rennie, Xiao-Ming Li

Faculty Publications

HIV is both a biomedical disease and a social phenomenon that is constructed in particular cultural contexts. A successful and humane HIV cure requires not only the science of eradicating pathogens, but also the art of healing to restore harmony between mind and body. Healing in the context of HIV cure will be both personal and interpersonal, biological and social, and will involve rebuilding connections between HIV patients and their social environment. Social conceptions of healing have been highlighted in many regions with rich non-biomedical healing traditions, including China. Based on an adapted theoretical model on social relationships and health, …

Association Between Nutritional Awareness And Diet Quality: Evidence From The Observation Of Cardiovascular Risk Factors In Luxembourg (Oriscav-Lux) Study, Ala'a Alkerwi, Nicolas Sauvageot, Leoné Malan, Nitin Shivappa, James R. Hébert

Faculty Publications

This study examined the association between nutritional awareness and diet quality, as indicated by energy density, dietary diversity and adequacy to achieve dietary recommendations, while considering the potentially important role of socioeconomic status (SES). Data were derived from 1351 subjects, aged 18–69 years and enrolled in the ORISCAV-LUX study. Energy density score (EDS), dietary diversity score (DDS) and Recommendation Compliance Index (RCI) were calculated based on data derived from a food frequency questionnaire. Nutritional awareness was defined as self-perception of the importance assigned to eating balanced meals, and classified as high, moderate, or of little importance. Initially, a General Linear …

The Relationship Of The Mediterranean Diet And The Dietary Approaches To Stop Hypertension (Dash) Style Diet With Cardiometabolic Health, Yong-Moon Park

Theses and Dissertations

Introduction: Much evidence shows that the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) style diet are associated with risk reduction of cardiometabolic disease as well as lower risk of all-cause, cardiovascular disease (CVD), and cancer mortality. A subgroup of obese individuals (metabolically healthy obese (MHO) phenotype) and normal weight individuals (metabolically obese normal weight (MONW) phenotype) have been identified to have different cardiometabolic risks compared with their counterparts in the same category of body mass index (BMI). Scarce evidence exists demonstrating a relationship between adherence to Mediterranean diet or DASH style diets with MHO and MONW …

Maternal Obesity, Gestational Weight Gain And Offspring’S Asthma, Kristen Polinski

Theses and Dissertations

Introduction: Obesity is common among women of childbearing age and intrauterine exposures may influence the development of early childhood asthma. A handful of studies have investigated pre-pregnancy obesity, but even fewer have thoroughly explored gestational weight gain as possible childhood asthma risk factors. Gaps remain in the literature and to our knowledge, none have longitudinally explored these relationships in a nationally representative sample of U.S. children.

Methods: We used data from the Early Childhood Longitudinal Study – Birth Cohort, in which children were followed through age four (n≈5,200). Asthma was based on parent report of a physician’s diagnosis. …

Patterns Of Sedentary Behavior And Association With Health Risks Among African American Adults, Tatiana Y. Warren-Jones

Theses and Dissertations

Introduction: There is growing and compelling evidence suggesting time spent in sedentary behaviors (SB) is a unique contributor to health risk that appears to be independent of time spent in moderate- and/or vigorous-intensity physical activity (PA). However, few studies have examined these associations in women and even fewer studies have included ethnic minority populations.

Purpose: The major objectives of this study were to: (1) describe patterns of objectively measured sedentary and PA behaviors and variation in these behaviors in African American (AA) adults; (2) assess the association between bouts of and breaks in SB and waist circumference risk, body mass …

Geographic Accessibility To Health Services And Neonatal Mortality Among Very Low Birthweight Infants In South Carolina, Portavia Featherstone

Theses and Dissertations

Introduction: Infant mortality is commonly denoted as a marker of population health with more than half of all infant deaths occurring during the neonatal period (0-27 days) of infancy. Mortality for infants born very low birthweight (<1500 grams) is markedly higher than the babies born with normal birthweight (2500-4000 grams). The purpose of this research project was to assess geographic access to perinatal health services and the risk of neonatal death among infants born with very low birth weight. Data and methods: The linked birth and death records of a retrospective cohort of very low birthweight (<1500 grams) infants born in South Carolina between the years 2010 and 2012 were used (n=3191). We assessed the impact of travel time from maternal residence to delivery hospital and travel time from maternal residence to the nearest prenatal care provider (obstetricians/gynecologists, community health center, or rural health clinic). Logistic regression modeling was performed with adjustments for maternal characteristics (race, age, chronic/gestational hypertension, chronic/gestational diabetes mellitus, smoking, prenatal care), newborn characteristics (gestational age, birthweight, gender, NICU admission at birth), and the birth in a level III hospital. Results: There were a total of 563 neonatal deaths in this population and the neonatal mortality rate was 17.64 neonatal deaths per 100 live births. We did not find significant associations of travel time from maternal residence to delivery hospital and to a closest prenatal care provider with neonatal death after adjusting for confounders. However, we found that a one-week increase in gestational age (OR: 0.61 [95% CI: 0.57-0.65]) and non-Hispanic Black mothers (versus non-Hispanic White mothers) (OR: 0.65 [95% CI: 0.45-0.94]), were associated with the lower odds of neonatal death, while non-NICU admission at birth (OR: 5.99 [95% CI: 4.05-8.84]) was associated with an increased odds of neonatal death. Conclusion: Although we did not find that travel time was associated with neonatal mortality among very low birthweight infants, our study identified a few significant correlates for neonatal deaths in this birthweight group. Future studies should investigate the role of geographic access to care on mortality during other periods of infancy and among other birthweight groups.

Ethnic Discrimination: Measurement And Associations With Smoking-Related Outcomes Among Arab Male Current And Former Smokers In Israel, Amira Osman

Theses and Dissertations

We evaluated the psychometric properties of two instruments used to assess ethnic discrimination among Arabs in Israel. The “Experiences of Discrimination” (EOD) scale was adapted to assess interpersonal ethnic discrimination (EOD-A) and a new measure was developed to assess perceptions of institutional group discrimination (IGD) against Arabs as an ethnic group. Then, we examined the association between each form of ethnic discrimination (interpersonal and institutional) and smoking outcomes among Arab men from Israel, and whether social support and coping efficacy moderate these associations. Data were analyzed from a cross-sectional study of Arab male current and former smokers, aged 18-64. A …

Patient And Provider Characteristics And Practice Patterns Of Primary Care Physicians Of Weight-Related Counseling, Kolby T. Redd

Theses and Dissertations

Background: The United States Preventive Services Task Force (USPSTF) recommends three types of health education counseling for use in primary care practices for adult, obese patients. While these recommendations are well known, a low percentage of physicians provide this counseling to their patients on a consistent basis. There are inconsistencies in past studies in regards to what aspects of the health encounter influence the likelihood of receiving health education counseling during a primary care visit. The objective of this study was to (1) investigate the patterns of these three types of counseling occurring within primary care practices and to …

Food Security Status And Life Events Among Households With Children In The Midlands Of South Carolina, Erin Rebekah Drucker

Theses and Dissertations

Purpose: Food insecurity is a major public health problem in the United States (US) with 14.5% of US households having experienced some level of food insecurity in 2012. Among households with children, 20% experienced low food security in 2012, and in half of these households, both the children and adults were affected. Food insecurity among children can have lifelong negative health and mental effects. Life events are defined as self-­‐reported life changes, which create a strain on resources and an opportunity for food insecurity, Methods: The Midlands Family Study (MFS) was a cross-­‐ sectional study that surveyed households …

Exploring The Association Between Network, Cognitive, Structural Social Capital And The Risk Of Clinical Depression In Taiwan, Yun-Hsuan Wu

Theses and Dissertations

Depression is the one of most common mental health conditions in Taiwan. Although evidence suggests that social capital is associated with depression, few studies have comprehensively explored the influence of social capital on depression. Also evidence in Taiwan is limited in comparison to other Western countries. Data from the 1997 Taiwan Social Change Survey (n=2,598), which is the only dataset that contains the best available information to measure and compare all three dimensions of social capital (network, cognitive, and structural social capital), were used to examine the association between three dimensions of neighborhood- and individual-level social capital and depression among …

Environmental Exposures And Childhood Pulmonary Function, Pallavi Prakash Balte

Theses and Dissertations

Fetal origins of adult disease hypothesis states that adverse influences early in developmental period and particularly during intrauterine life can result in permanent changes in physiology which may lead to increased disease risk of chronic diseases in adulthood. Both fetal and adolescent period are critical time periods for development of lungs. Any adverse environmental exposures during these critical periods of lung growth is a form of programming which can have long term effects on pulmonary function. The purpose of this dissertation was to examine the association between different environmental exposures and pulmonary function in children and late adolescents. The first …

Statewide Scale-Up Of Group Prenatal Care In South Carolina, Kristin M. Van De Griend

Theses and Dissertations

Background: Poor birth outcomes and racial disparities in birth outcomes in South Carolina are widely recognized problems. To improve maternal and child health outcomes, especially among vulnerable groups, universal access to timely, appropriate, and effective care should remain a priority through increased availability and accessibility. An interagency collaborative in South Carolina expanded CenteringPregnancy (CP) from two to five medical practices throughout the state. CenteringPregnancy is associated with improved birth outcomes and reduced rates of racial disparities in preterm birth throughout the United States. Important questions in the literature remain about strategies and determinants of scaling up sexual and reproductive …

Cluster Analysis With Batch Effect, Yifan Tang

Theses and Dissertations

Clustering, as a fundamental process in data science, is frequently used in preliminary data analysis. Batch effects are a powerful source of variation that can come from many sources in data collection, and influence data. We propose a method to simultaneously remove batch effects and perform cluster analysis. We see a batch effect as a fixed value added on to each batch, and do not make assumptions about the distribution of batch effects. We represent the data using a Gaussian mixture model, and use the EM algorithm to estimate the cluster means, the cluster covariance matrices, and the batch effects, …

Soil Arsenic And Lead Concentrations And Preterm Birth: Investigating Racial Disparities, Sources, Neighborhood Effects, And Spatial Patterns, Pamela Harley Thornton Davis

Theses and Dissertations

Preterm birth, generally defined as birth at <37 weeks of gestation, is an important public health issue that has multiple risk factors related to characteristics of both the mother and her environment. The purpose of this dissertation was to examine potential sources of spatially interpolated (kriged) environmental concentrations of arsenic (As) and lead (Pb) in residential soils and preterm birth in a Medicaid population of mothers giving birth in South Carolina (SC) from 1996-2001. The first objective was to investigate if a racial disparity existed for estimated soil As and Pb concentrations, after adjusting for proximal and distal sources of these metals (including distance and direction to industrial facilities) in a subset of SC Medicaid mothers living in areas of SC where soil samples were collected and analyzed for these metals. The second objective was to test the hypothesis that estimated soil As and Pb concentrations were associated with increased odds of early (<34 weeks) and late (34-36 weeks) preterm births in the same subset of SC Medicaid mothers, after adjusting for individual and neighborhood level risk factors, and examine if measure of neighborhood deprivation and racial residential segregation modified these associations. The third objective was to examine if early and all preterm births, aggregated at the county level, varied spatially and/or temporally in SC for all Medicaid mothers giving birth from 1996-2001 in Bayesian models.

For the first objective, black mothers had significantly higher estimated As and Pb soil concentrations than white mothers in the study population (adjusted betas were 0.12 and 0.22 for As and Pb, respectively; all p<0.006), and proximal sources of metals (e.g., percent of Census block group are covered by roads) were more strongly associated with estimated soil As and Pb concentrations than composite As and Pb releases from industrial facilities categorized by distance from and direction to Census block groups in which maternal residences were located.

For the second objective, estimated soil concentration of neither As nor Pb were associated with increased odds of early or late preterm birth after adjusting for maternal and neighborhood level risk factors. Only individual level covariates were associated with these birth outcomes, and associations were stronger for early as compared to late preterm births. Neighborhood deprivation and racial …

Longitudinal Association Between Television Watching, Computer Use And Meal Frequency And Risk Markers In Diabetes Among Youth With Diabetes, Chao Li

Theses and Dissertations

BACKGROUND AND OBJECTIVES: Television watching and computer use are considered to be the main sedentary behaviors in children and youth. However, their longitudinal impact on HbA1c and serum lipids among youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) are under-studied. Sedentary behavior is normally assessed by questionnaire in large epidemiological studies, however, its measurement by questionnaire has not been evaluated among youth with diabetes. Also, no recent studies have evaluated the optimal meal frequency for glycemic control in youth with T1D and T2D; for this reason nutritional guidelines on meal frequency for youth with diabetes are vague. …

The Influence Of Self-Reported Degree Of Masculinity/Femininity On Condom Use Among Black Men Who Have Sex With Men In The Deep South, Elizabeth D. Peeler

Theses and Dissertations

In the United States, 50,000 Americans are diagnosed with HIV each year (CDCa, 2014). The HIV/AIDS epidemic has had a particularly devastating impact on the southern U.S., especially the Deep South – Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina (Reif, Whetten, Wilson, McAllaster, Pence, Legrand, & Gong, 2014). The Deep South, while only composing of 36% of the national population, accounts for 50% of all people living with HIV/AIDS in the nation (Human Rights Watch, 2010). No other population has been hit harder than men who have sex with men (MSM; Prejean, Tang, & hall, 2013). Black MSM …

Examination Of The Association Of Receipt Of Opioid Therapy And Lung Cancer Patient Survival Rates Among South Carolina Medicaid Recipients, Jametta Sade Magwood

Theses and Dissertations

Introduction: Lung cancer is a high pain cancer that can require the attention of clinical specialists. Already vulnerable populations, like those that inhabit rural areas, when dealing with chronic diseases, like lung cancer, need and deserve adequate medical attention. However, rural communities often lack clinical specialists and are left without the needed care. It is necessary to investigate the current availability of treatment options (medications) available to cancer patients in rural communities. Gaining this knowledge can result in economic savings and improvement of the quality of life for rural populations.

Methods: Medicaid data from 1996-2010 was used to …

Interpregnancy Weight Change And Adverse Maternal Outcomes, Chelsea Lynes

Theses and Dissertations

Obesity during pregnancy is associated with a high risk of adverse maternal outcomes. Little is known about how weight change between consecutive pregnancies impacts subsequent pregnancy complications and newborn outcomes. This study aimed to explore the association between interpregnancy BMI change and adverse maternal outcomes, specifically, gestational diabetes mellitus (GDM), gestational hypertension, pre-eclampsia, non-repeat cesarean delivery (C-section), and vaginal birth after cesarean delivery (VBAC). The study sample was derived from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Consecutive Pregnancy Study, which collected data from 20 hospitals in Utah utilizing electronic medical records and International Classification …

Neural Biomarkers For Assessing Different Types Of Imagery In Pictorial Health Warning Labels For Cigarette Packaging: A Cross-Sectional Study, Roger D. Newman-Norlund, Jim Thrasher, Johann Fridriksson, William Brixius, Brett Froeliger, David Hammond, Michael K. Cummings

Faculty Publications

Objective Countries around the world have increasingly adopted pictorial health warning labels (HWLs) for tobacco packages to warn consumers about smoking-related risks. Research on how pictorial HWLs work has primarily analysed self-reported responses to HWLs; studies at the neural level comparing the brain's response to different types of HWLs may provide an important complement to prior studies, especially if self-reported responses are systematically biased. In this study we characterise the brain's response to three types of pictorial HWLs for which prior self-report studies indicated different levels of efficacy.

Methods Current smokers rated pictorial HWLs and then observed the same HWLs …

Mental Disorders, Mental Health Problems, And Treatment Among Army Recruiters And Recruiting Candidates, 2011-2013: An Examination Of Current Rates In The Recruiting Population, Chadwick Karl Knight

Theses and Dissertations

Purpose: This study sought to determine the prevalence and severity of mental health disorders (MHDs) and/or mental health problems (MHPs) and types of treatments received among soldiers who have or will serve as recruiters. Research Design and Methods: Data were collected between October 2011 to July 2013 from active duty soldiers (N=2,783) attending courses on Fort Jackson at the U.S. Army’s Recruiting and Retention School (RRS). Students consisted of regular active duty soldiers and activated Guard/Reservist that were either recruiters or recruiting candidates. The medical records of participating recruiters and recruiting candidates were reviewed for the prevalence of MHDs and …

Mixture Cure Models: Simulation Comparisons Of Methods In R And Sas, Myra Robinson

Theses and Dissertations

Typical survival methods have the assumption that every subject will eventually experience the event of interest, given enough follow-up time. However, there are some occasions in which a proportion of the population of interest will never experience the event of interest. Therefore, the incorporation of a “cure” fraction in a statistical model is necessary. In this thesis, I comprehensively evaluate mixture cure models in two different statistical software programs: the smcure package in R and the PSPMCM macro in SAS. Extensive simulation studies in R and SAS allow evaluation of the performance of these two models. An additional aspect of …

Gestational Weight Gain, Pregnancy Outcomes, And Use Of Perinatal Health Services, Lujing Zhan

Theses and Dissertations

This dissertation consists of three studies that were undertaken to better understand 1) the role of gestational weight gain (GWG) during early pregnancy on subsequent blood pressure changes and the risk of pregnancy-induced hypertension (PIH), 2) the causal effect of GWG in both early and mid-late pregnancy on the subtypes of preterm births, and 3) the impact of personal capital on the use of perinatal health services (i.e., prenatal care use and preconception care counseling). The first two studies were based on the data from the 1988 National Maternal and Infant Health Survey and the third study employed the data …

Simulation Based Evaluation Of Multiscale Small Area Health Models, Purbasha Dasgupta

Theses and Dissertations

The effects of scale on the analysis of spatial data, often referred to as the modifiable areal unit problem in spatial studies, is one of the issues often encountered in small area health models. These spatial effects of scale are also seen in the areas of disease mapping where data are usually available in counts. Often there is a need to consider the different scales of aggregation that exist within count data, since inferences based on analyses can vary if we change the definition of the unit of analysis. This thesis provides a framework that describes the distribution of relative …

Effect Of Primary Care Physician Density On Late Stage Cervical Cancer Diagnosis, Emily Haanschoten

Theses and Dissertations

INTRODUCTION: Late-stage cervical cancer diagnosis is an important contributing factor to the cervical cancer mortality rate. Screening for cervical cancer is a vital tool in reducing the number of late-stage cases, preventing incident cases and reducing mortality. Access to care is often a significant barrier to receiving these services. Women who have no usual source of care report significantly lower percentages of Pap tests than women who have a usual source. South Carolina ranks 13th in the US in cervical cancer incidence and 7th in cervical cancer mortality. South Carolina also struggles with a primary care physician shortage, ranking 39th …

Examining The Influence Of Healthy Eating Identity On Shopping Behaviors, Jordan Brittingham

Theses and Dissertations

Eating identity is shown to be a promising measure capable of enhancing our understanding of nutrition behavior. Persons with healthy eating identities are less likely to consume the typical American diet and report healthier diets in general. While there are several studies linking healthy eating identity and diet, there is currently no research examining healthy eating identity in relation to food shopping behavior, an important aspect of nutritional intake. The purpose of this study was to examine the influence of healthy eating identity on shopping behaviors including supermarket utilization, supercenter utilization, likelihood of shopping at the nearest store, distance to …

Periodontal Microorganisms, Obesity, Chronic Inflammation, And Type 1 Diabetes, Georges Joseph Nahhas

Theses and Dissertations

Periodontal disease is a low-grade chronic inflammation in the tissues surrounding the teeth caused by multiple, mostly gram-negative pathogens. It is associated with diabetes, obesity, and chronic inflammation. The specific roles that periodontal microorganism play in these conditions are not well-studied. Hereby, we explored how periodontal bacteria from sub gingival plaque clustered in youth with and without type 1 diabetes, and how such patterns related to body-mass-index percentile (BMI percentile), C-reactive protein (CRP) and adiponectin. Cross-sectional data were collected from 105 youth with type 1 diabetes and 71 without diabetes. Participants were between 12 and 19 years of age receiving …