Public Health Commons^™

Information Exchange Through Social Networks Links To Adoption Of Child Feeding Practices In Nepal, Mohammad Masudur Rahman

Theses and Dissertations

While there have been notable decreases in child undernutrition (i.e., stunting) over the past few decades, it remains a major concern in Nepal, with 25% of children under the age of five experiencing chronic undernourishment. There is considerable scope for improving nutrition-related behaviors to address this ongoing issue. In Nepal, knowledge regarding appropriate child feeding practices is often inadequate, and thus additional sources of accurate information are required. Information through multiple sources (i.e., interpersonal communication, mass media, and mobile SMS) provides opportunity to reach households who inadequately practice childcare. Information improves knowledge and information exchange (i.e., receiving or sharing) usually …

Multi-Level Factors Associated With Hiv Late Presentation With Advanced Disease And Delay Time Of Diagnosis In South Carolina, 2005–2019, Fanghui Shi, Jiajia Zhang Ph.D., Shujie Chen, Xueying Yang Ph.D., Zhenlong Li, Sharon Weissman, Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

This study explored individual- and county-level risk factors of late presentation with advanced disease (LPAD) among people with HIV (PWH) and their longer delay time from infection to diagnosis in South Carolina (SC), using SC statewide Enhanced HIV/AIDS Reporting System (eHARS). LPAD was defined as having an AIDS diagnosis within three months of initial HIV diagnosis, and delay time from HIV infection to diagnosis was estimated using CD4 depletion model. 3,733 (41.88%) out of 8,913 adult PWH diagnosed from 2005 to 2019 in SC were LPAD, and the median delay time was 13.04 years. Based on the generalized estimating equations …

Reframing And Advancing Academic Mentorship To Support New And Early Career Faculty Members, Juanita-Dawne R. Bacsu, Patricia C. Heyn, Steffi Kim, Zahra Rahemi, Monique J. Brown, Darina V. Petrovsky, Justine S. Sefcik, Jodi L. Southerland, Jeremy Holloway, Elyse Couch, Ayse Malatyali, Matthew L. Smith

Faculty Publications

Mentorship is critical to fostering professional growth and career development in academia. However, academic mentorship is often an informal activity that is overlooked and under researched. There is much ambiguity and uncertainty surrounding mentorship roles and strategies in academia. This paper provides recommendations and strategies to reframe and advance academic mentorship to support new and early career faculty.

Allura Red Ac Is A Xenobiotic. Is It Also A Carcinogen?, Lorne J. Hofseth Ph.D., James Hébert Scd, Elizabeth Angela Murphy, Erica Trauner, Athul Vikas, Quinn Harris, Alexander A. Chumanevich

Faculty Publications

Merriam-Webster and Oxford define a xenobiotic as any substance foreign to living systems. Allura Red AC (a.k.a., E129; FD&C Red No. 40), a synthetic food dye extensively used in manufacturing ultra-processed foods and therefore highly prevalent in our food supply, falls under this category. The surge in synthetic food dye consumption during the 70s and 80s was followed by an epidemic of metabolic diseases and the emergence of early-onset colorectal cancer in the 1990s. This temporal association raises significant concerns, particularly given the widespread inclusion of synthetic food dyes in ultra-processed products, notably those marketed toward children. Given its interactions …

Allura Red Ac Is A Xenobiotic. Is It Also A Carcinogen?, Lorne J. Hofseth, James R. Hébert Scd, Elizabeth Angela Murphy, Erica Trauner, Athul Vikas, Quinn Harris, Alexander A. Chumanevich

Faculty Publications

Merriam-Webster and Oxford define a xenobiotic as any substance foreign to living systems. Allura Red AC (a.k.a., E129; FD&C Red No. 40), a synthetic food dye extensively used in manufacturing ultra-processed foods and therefore highly prevalent in our food supply, falls under this category. The surge in synthetic food dye consumption during the 70s and 80s was followed by an epidemic of metabolic diseases and the emergence of early-onset colorectal cancer in the 1990s. This temporal association raises significant concerns, particularly given the widespread inclusion of synthetic food dyes in ultra-processed products, notably those marketed toward children. Given its interactions …

The Role Of Nutrition In Modulating Neurodevelopmental And Mental Health Outcomes In Pediatric Populations: A Review, Athul M. Vikas

Senior Theses

Introduction: Neurodevelopmental and mental health disorders, including Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety, and depression, have risen sharply in prevalence among children and adolescents, creating substantial public health concerns. Traditional interventions, primarily pharmacological and behavioral, offer critical but limited support, underscoring the need for integrated approaches. Recent findings suggest that nutrition may play a significant role in supporting brain development and mitigating mental health risks, offering preventive benefits that complement conventional therapies. This review aims to evaluate the influence of specific nutrients—such as folate, iron, DHA, zinc, and vitamin B12—on neurodevelopmental outcomes, emphasizing the importance of these nutrients during critical growth …

A Historical Analysis Of Infant Mortality In South Carolina From 1920-1970, Allison Ritchie

Senior Theses

This study uses Geographic Information Systems (GIS) to investigate racial and spatial inequalities in South Carolina infant mortality rates (IMR’s) between 1920-1970. In the 20th century, IMR’s declined throughout the United States, primarily due to economic growth, increased sanitation, and improved medical knowledge. Factors such as systemic racism and lack of healthcare access resulted in higher IMR’s for Black infants and infants living in rural areas. In 1920, South Carolina’s Black IMR was 1.5 times higher than the white IMR; by 1970 the difference expanded to 1.9, reflecting a 27% rise. The disparity between Black and white IMR’s increased in …

Pelvic Floor Physical Therapy In Pregnant And Postpartum Women, Madison G. Kaup

Senior Theses

This project had three main goals: 1) Explore how pregnancy and childbirth affect the female pelvic floor anatomy and physiology, 2) Examine current practices through a literature review and interviews conducted with pelvic floor physical therapists currently practicing in various clinical settings across the United States, and 3) Develop suggestions to mitigate the challenges currently faced in the field by patients and therapists.

The female pelvic floor undergoes extensive changes throughout pregnancy as its structures are targeted by laxity-inducing hormones and mechanical stress from the growing fetus. During childbirth, the system is stretched beyond its physiological limit, causing damage to …

Predicting Poor Mental Health Among Older Syrian Refugees In Lebanon During The Covid-19 Pandemic: A Nested Cross-Sectional Study, Berthe Abi Zeid, Leen Farouki, Tanya El Khoury, Abla M. Sibai, Carlos Mendes F. De Leon, Marwan F. Alawieh, Zeinab Ramadan, Sawsan Abdulrahim, Hala Ghattas Ph.D., Stephen J. Mccall

Faculty Publications

Background: Post-term pregnancy, defined as reaching or exceeding 42 + 0 weeks of gestation, is known to be associated with unfavourable birth outcomes. High-income countries have responded to this risk by widely adopting labour induction protocols in late-term, but many low- and middle-income countries have not. However, understanding underlying mechanisms linking post-term births to adverse newborn and infant outcomes remains limited.

Objective:To investigate the (a) prevalence of post-term, (b) the risk factors associated with post-term (c) the association between post-term births and the risk of smallfor-gestational-age (SGA) neonates and of infant mortality in middle-income settings.

Methods:We used existing …

Multilevel Factors Affecting Covid-19 Vaccination Among African American Communities In South Carolina, Ran Zhang

Theses and Dissertations

Background: Persistent health disparities has led to significant public health challenges, especially for African American (AAs) communities, and have been exacerbated by the COVID-19 pandemic. Achieving high population vaccination rates are crucial to controlling the virus’ spread. However, AAs have higher rates of COVID-19 infection and mortality than Whites, yet their vaccination rates remain relatively low. The dissertation aimed to investigate the multilevel factors and mechanisms that affect AAs’ vaccination behavior. The first objective is to assess the impact of the intrapersonal level factor (i.e., perceived barriers to vaccination) on vaccination behavior. The second objective is to investigate the impact …

The Role Of Telehealth And Obstetrics Capacity On Maternal Health Care: A Mixed Methods Approach, Shanikque L. Barksdale

Theses and Dissertations

Background: The United States (US) is experiencing a maternal health crisis, with rising severe maternal morbidity and mortality rates and persistent racial, ethnic, and geographic disparities. While telehealth can address access challenges, there is limited evidence of its impact on access to maternity care and outcomes among rural and minoritized communities. The overall objective of this study was to analyze the disparities in maternal outcomes and user satisfaction by hospital-based telehealth and obstetric care availability.

Methods: A convergent parallel mixed methods approach was used. A multinomial logistic regression was used to analyze whether the changes in the proportions of hospitals …

Nutrition And Mental Health Related Factors Across Historically Black College And University Students, Nancy Anai Uriegas

Theses and Dissertations

The prevalence of food insecurity across college campus in the United States has been widely explored, with the primary focus placed on large, 4-year, primarily White institutions. Less is known about the prevalence of food insecurity and the impact it may have on health behaviors among minority serving institutions, including Historically Black Colleges and Universities (HBCU). Young adults attending college, and more specifically student-athletes (SAs), are typically in a new place, facing new stressors and high rates of food insecurity, which in turn may play a critical role in their current health status as it pertains to meeting their energy …

The Effect Of Covid-19 Restrictions On The Social Support Experiences Of Black Women Giving Birth In South Carolina Hospitals During The First Year Of The Covid-19 Pandemic (2020) As Compared To A Previous Birth, Tiffany Eva Byrd

Theses and Dissertations

The United States is experiencing a maternal health crisis, which disproportionately affects Black women. Black women die from pregnancy-related causes two to three times as often as their White counter parts, and the majority of maternal death are preventable. In recent years, public health and national governing authorities have devoted resources to monitoring the health crisis and raising the public’s knowledge of warning signs; however, maternal mortality rates continue to rise. Noted contributors to Black maternal mortality include, but are not limited to, racism, delayed treatment and response to health emergencies, and lack of social and emotional support during childbirth, …

Internalizing Mental Health Symptoms And Nicotine Use Among Adolescents In Canada, England, And The Us From 2020-2022, Emily E. Hackworth

Theses and Dissertations

Background: There is a well-established bi-directional relationship between cigarette smoking and internalizing mental health (IMH) symptoms (e.g., symptoms of depression, symptoms of anxiety). However, it is unclear whether IMH symptoms are associated with using different types of nicotine products among adolescents, as adolescents are using a variety of nicotine products, including combustible products (cigarettes), non-combustible products (e-cigarettes), or combinations of both types of products. This dissertation examines associations between IMH symptoms and current use of various types of nicotine products across three countries from 2020-2022.

Methods: Data come from the 2020-2022 waves of the International Tobacco Control (ITC) Adolescents Tobacco …

Associations Between The Use Of Ssri Medication In Older Adults And Cognitive Decline And Impairment, Paige Jones

Theses and Dissertations

Previous research has indicated that depression is a risk factor for dementia. Since SSRI medication is the most common treatment for depression, it is important to determine if SSRIs are associated with reduced dementia and better cognitive outcomes. Using longitudinal data from the 2004-2014 waves of the Health and Retirement Study merged with the 2005 Prescription Drug Study, we examined potential associations between SSRI and TCA medication and cognitive impairment and cognitive decline. The study population consisted of 1,775 older adults who participated in the PDS in 2005. We found that SSRIs were associated with significantly higher odds of cognitive …

Impacts Of Covid-19 And Taliban Takeover On U.S. Afghan Refugee Women’S Mental Health: A Socio-Ecological Approach To Resilience Resources, Atefeh Aghaei

Theses and Dissertations

In response to the escalating global refugee crisis, intensified by ongoing conflicts and environmental changes, this dissertation research focuses on the mental health of Afghan refugee women in the United States (U.S.), particularly in the context of the COVID-19 pandemic and the 2021 Taliban takeover. With over 114 million people displaced globally, Afghan refugees, notably women, encounter heightened mental health risks due to violence, deprivation, systemic persecution, and the challenges of migration. This vulnerability is exacerbated by recent mass traumatic events, including the pandemic and political upheaval in Afghanistan. Our study, conducted through semi-structured interviews with Afghan refugee women and …

Barriers And Facilitators To 24-Month Maintenance Of The Faith, Activity, And Nutrition Program In The U.S., Kelsey R. Day, John A. Bernhart Ph.D., Rd, Sara Wilcox Phd

Faculty Publications

Little is known about the barriers and facilitators to organizational maintenance of faith-based health promotion programs. This study used qualitative data (collected from 2016–2019) from pastors (n = 81) and program coordinators (n = 103) to identify barriers and facilitators to 24-month maintenance of a faith-based physical activity (PA) and healthy eating (HE) intervention in South Carolina. Barriers differed for PA versus HE: resistance to change impeded HE while church characteristics tended to impede PA. Similar themes emerged for PA and HE facilitators: healthy opportunities, church communication, and consistency. Future research should build upon this study to tailor faith-based health …

Interpregnancy Interval And Adverse Perinatal Outcomes: A Within-Individual Comparative Method, Maria Sevoyan, Marco Geraci, Edward A. Frongillo, Jihong Liu, Nansi S. Boghossian

Faculty Publications

Background and Aim: Previously observed associations between interpregnancy interval (IPI) and perinatal outcomes using a between-individual method may be confounded by unmeasured maternal factors. This study aims to examine the association between IPI and adverse perinatal outcomes using within-individual comparative analyses. Methods: We studied 10,647 individuals from the National Institute of Child Health and Human Development Consecutive Pregnancies Study in Utah with ≥3 liveborn singleton pregnancies. We matched two IPIs per individual and used conditional logistic regression to examine the association between IPI and adverse perinatal outcomes, including preterm birth (PTB, < 37 weeks’ gestation), small-for-gestational-age (SGA, < 10th percentile of sex-specific birthweight for gestational age), low birthweight (LBW, < 2,500 g), and neonatal intensive care unit (NICU) admission. Point and 95% confidence interval (CI) estimates were adjusted for factors that vary across pregnancies within individuals. Results: CIs did not unequivocally support either an increase or a decrease in the odds of PTB (adjusted odds ratio [aOR]: 1.31, 95% CI: 0.87, 1.96), SGA (aOR: 0.81, 95% CI: 0.51, 1.28), LBW (aOR: 1.59, 95% CI: 0.90, 2.80), or NICU admission (aOR: 0.96, 95% CI: 0.66, 1.40) for an IPI < 6 months compared to 18–23-months IPI (reference), and neither did the CIs for the aOR of IPIs of 6–11 and 12–18 months compared to the reference. In contrast, an IPI ≥24 months was associated with increased odds of LBW (aOR: 1.66, 95% CI: 1.03, 2.66 for 24–29 months; aOR: 2.27, 95% CI: 1.21, 4.29 for 30–35 months; and aOR: 2.09, 95% CI: 1.17, 3.72 for ≥36 months). Conclusions: Using a within-individual comparative method, we did not find evidence that a short IPI compared to the recommended IPI of 18–23 months was associated with increased odds of PTB, SGA, LBW, and NICU admission. IPI ≥ 24 months was associated with increased odds of delivering an LBW infant.

Development And Validity Of The 'Modified Mediterranean Prime Screen' To Assess Dietary Intake Among Women Of Reproductive Age In Lebanon, Mariam Assaad, Sara Ajjour, Maya Rahme, Laila Al-Shaar, May Sakr, Hala Ghattas Ph.D., Ghada El-Hajj Fuleihan, Jana Jabbour

Faculty Publications

The Mediterranean Region registers an increasing prevalence of obesity. The region lacks a diet screener to assess obesogenic nutrients. This study aimed to evaluate the reproducibility and validity of the Modified Mediterranean Prime Screen (MMPS) in estimating obesogenic nutrients' intake among women of reproductive age, as compared with a culturally validated Food Frequency Questionnaire (FFQ), in Lebanon. We developed the MMPS consisting of thirty-two food/beverage items specific to the Lebanese Mediterranean culture. The MMPS and FFQ were administered in two visits (2 weeks-6 months apart), face to face and via telephone during the coronavirus disease 2019 pandemic. The reproducibility and …

Childhood Sexual Abuse And Compulsive Sexual Behavior Among Men Who Have Sex With Men Newly Diagnosed With Hiv, Monique J. Brown, Medinat Omobola Osinubi, Daniel Amoatika, Mohammad Rifat Haider, Sally Kirklewski, Patrick Wilson, Nathan B. Hansen

Faculty Publications

Childhood sexual abuse (CSA) continues to be a public health challenge. The prevalence of experiencing CSA is higher among men who have sex with men (MSM) than the general population. CSA has been linked to compulsive sexual behavior (CSB) among varying populations but has not been examined among MSM who were newly diagnosed with HIV. Therefore, the aims of this study were to assess the direct association between CSA and CSB among newly diagnosed MSM living with HIV, and to identify the potential mediating roles of depressive symptoms and emotion regulation in the association between CSA and CSB. The study …

Knowledge, Attitudes And Practices Regarding Sexually Transmitted Infections In South Carolina: A Cross-Sectional Survey And Comparison To Geographically-Associated Social Determinants Of Health, Sean Patrick Sweeney

Theses and Dissertations

Sexually transmitted disease (STD) rates are on the rise in the United States. South Carolina ranks consistently among the states with the highest STD burdens, especially for the bacterial diseases gonorrhea and chlamydia. This study sought to determine the opinions, beliefs, and knowledgebase of South Carolina citizens regarding STDs and sexual health/education. In doing so, the study seeks to identify areas of improvement for educators, healthcare workers, and public health employees. Using a web-based cross-sectional survey, this study contacted approximately 900,000 South Carolina residents for participation. Participants were asked a variety of questions focused on STD knowledge, opinions, and practices. …

Association Of Hiv Status And Other Minoritized Identities With Psychiatric Diagnoses Among Transgender And Gender Diverse Individuals In The All Of Us Research Program, Fanghui Shi

Theses and Dissertations

Background: Transgender and gender diverse (TGD) people, whose gender identities or expressions differ from the sex assigned at birth, are disproportionately affected by adverse health outcomes, including various psychiatric diagnoses such as depression, anxiety, stress, and substance use disorders. The Gender Minority Stress Model emphasizes that TGD people face both proximal stressors at a personal/individual level (e.g., internalized stigma) and distal stressors at a societal level (e.g., discrimination) due to their minority status, which largely contributes to their increased risk of psychiatric diagnoses. Despite these health disparities, there is a paucity of gender identity data collected in large population-based health …

Communicating About A Nicotine Reduction Policy Among People Who Use Little Cigars And Cigarillos, Charity Afi Ntansah

Theses and Dissertations

The U.S. Food and Drug Administration (FDA) has proposed rulemaking to reduce the nicotine content in cigarettes and other combusted tobacco products to non-addictive levels. A very low nicotine content (VLNC) policy aimed primarily at cigarettes could drive people to other combusted products like little cigars and cigarillos (LCCs), potentially undermining its effectiveness. Expanding the policy to include LCCs requires effective messages for people who use LCCs. This dissertation explores how to communicate the reduced nicotine policy to people who use LCCs. The research recruited four populations with the highest prevalence of cigar use: African American and White males and …

Understanding Differential Reductions In Undernutrition Among Districts In Rwanda Through The Perspectives Of Mid-Level And Community Actors On Policy Commitment And Policy Coherence, Elyse Iruhiriye, Edward A. Frongillo Ph.D., Deanna K. Olney, Emmanuel Niyongira, Simeon Nanama, Christine E. Blake Ph.D., Rd, Eugene Rwibasira, Paul Mbonyi

Faculty Publications

Understanding the drivers of improvements in child undernutrition at only the national level can mask subnational differences. This paper aimed to understand the contributions of factors in the enabling environment to observed differences in stunting reduction between districts in Rwanda. In 2017, we conducted 58 semi-structured interviews with mid-level actors (n = 38) and frontline workers (n = 20) implementing Rwanda's multi-sectoral nutrition policy in five districts in which stunting decreased (reduced districts) and five where it increased or stagnated (non-reduced districts) based on Rwanda's 2010 and 2014/15 Demographic and Health Surveys. Mid-level actors are government officials and service providers …

An Examination Of Self-Identity In Relation To Smoking And Vaping In South Carolina, Jaron Hoani King

Theses and Dissertations

BACKGROUND

This dissertation examines self-identity in the context of smoking and vaping among adults in South Carolina (SC) using data from the 2023 SC Adult Tobacco Survey (n=1370). The conceptual model created to guide this dissertation is called the “Smoker and Vaper Behavior-Identity Model” and draws constructs from theoretical frameworks in health behavior and social identity theories. Behavior was defined as lifetime and past 30 day cigarette or e-cigarette use. Self-identity was defined by asking respondents with a history of cigarette or e-cigarette use “Do you consider yourself a smoker/vaper”, respectively.

METHODS

First, this study assesses the prevalence of mismatching …

Functional Multivariable Logistic Regression With An Application To Hiv Viral Suppression Prediction, Siyuan Guo, Jiajia Zhang Ph.D., Yichao Wu, Alexander C. Mclain Ph.D., James W. Hardin, Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Motivated by improving the prediction of the human immunodeficiency virus (HIV) suppression status using electronic health records (EHR) data, we propose a functional multivariable logistic regression model, which accounts for the longitudinal binary process and continuous process simultaneously. Specifically, the longitudinal measurements for either binary or continuous variables are modeled by functional principal components analysis, and their corresponding functional principal component scores are used to build a logistic regression model for prediction. The longitudinal binary data are linked to underlying Gaussian processes. The estimation is done using penalized spline for the longitudinal continuous and binary data. Group-lasso is used to …

Social-Ecological Determinants Of Affective States Among College Students: A Cross-Cultural Ecological Momentary Assessment Study, Abhishek Aggarwal

Theses and Dissertations

Background: College students experience a complex and diverse array of stressors during their college life, making them vulnerable to severe mental health issues. Momentary affective states are linked to major mental health disorders and overall well-being; however, the current social-ecological model of affect lacks a temporal dimension, failing to account for within-person dynamics of affective states over time. This study disentangles the complex temporal dynamics among the momentary, multilevel social-ecological factors and affective states in the real-world setting of college students across the United States (US) and India. However, establishing invariance of the affect model across time, people, and cultures …

Understanding Cancer Grade And Survival Disparities Among Young Adults Diagnosed With Non-Hodgkin’S Lymphoma (Nhl) Residing In South Carolina, Prema S. Bhattacharjee

Theses and Dissertations

Introduction. Previous research has shown that age and cancer grade differences must be carefully considered when developing initiatives to improve outcomes for NHL among the young adult population. The aims of this study are 1) to examine differences between low vs. high grade in NHL by race/ethnicity, healthcare insurance, and geographic factors among YAs aged 18-39 years of age in South Carolina, 2) to examine delays in the first course of cancer treatment for NHL by race/ethnicity, healthcare insurance, and county of residence (urban vs. rural) among YAs aged 18-39 years of age in South Carolina, and 3) examine differences …

Short- And Medium-Term Impacts Of Small-Scale Vegetable Support On Food Security: Evidence From Syria, Ghassan Baliki, Melodie Al Daccache, Hala Ghattas Ph.D., Tilman Brück

Faculty Publications

Small-scale agricultural and horticultural interventions play a critical role in improving nutrition and food security of vulnerable households in peaceful settings. However, scant rigorous evidence exists on the impacts and sustainability of such interventions in conflict settings. In this paper, we address this knowledge gap by analyzing the short- and medium-term impacts of a small-scale vegetable input support program involving asset transfers on food security and diets in war-time Syria. We use longitudinal panel household survey data from a quasi-experimental study collected at three rounds: before, one year, and two years after the horticultural intervention ended. We use propensity score …

Development And Validity Of The ‘Modified Mediterranean Prime Screen’ To Assess Dietary Intake Among Women Of Reproductive Age In Lebanon, Mariam Assaad, Sara Ajjour, Maya Rahme, Laila Al-Shaar, Hala Ghattas Ph.D., Ghada El-Hajj Fuleihan, Jana Jabbour

Faculty Publications

The Mediterranean Region registers an increasing prevalence of obesity. The region lacks a diet screener to assess obesogenic nutrients. This study aimed to evaluate the reproducibility and validity of the Modified Mediterranean Prime Screen (MMPS) in estimating obesogenic nutrients’ intake among women of reproductive age, as compared with a culturally validated Food Frequency Questionnaire (FFQ), in Lebanon. We developed the MMPS consisting of thirty-two food/beverage items specific to the Lebanese Mediterranean culture. The MMPS and FFQ were administered in two visits (2 weeks–6 months apart), face to face and via telephone during the coronavirus disease 2019 pandemic. The reproducibility and …