Public Health Commons^™

Basic Human Values Drive Food Choice Decision-Making In Different Food Environments Of Kenya And Tanzania, Christine E. Blake Ph.D., Rd, Eva C. Monterrosa, Krystal K. Rampalli, Abdullah Nurus Salam Khan, Ligia I. Reyes, Shiny Deepika Drew, Paula Dominguez-Salas, Salome A. Bukachi, Mariah Ngutu, Edward A. Frongillo Ph.D., Elyse Iruhiriye, Amy Webb Girard

Faculty Publications

Increased access to a variety of foods in low-and-middle-income countries (LMICs) has led to greater autonomy in food choice decision-making. Autonomy allows individuals to make decisions through negotiation of considerations in ways that are consistent with basic values. The aim of this study was to identify and describe how basic human values drive food choice in two diverse populations with transitioning food environments living in the neighboring East African countries of Kenya and Tanzania. Secondary data analysis was carried out on focus group discussions conducted with men and women in Kenya (n = 28) and Tanzania (n = 28) as …

Developing An Ethical Framework-Guided Instrument For Assessing Bias In Ehr-Based Big Data Studies: A Research Protocol, Shan Qiao Ph.D., George Khushf, Xiaoming Li, Jiajia Zhang Ph.D., Bankole Olatosi Ph.D.

Faculty Publications

Introduction The emergence of Big Data health research has exponentially advanced the fields of medicine and public health but has also faced many ethical challenges. One of most worrying but still under-researched aspects of the ethical issues is the risk of potential biases in data sets (eg, electronic health records (EHR) data) as well as in the data curation and acquisition cycles. This study aims to develop, refine and pilot test an ethical framework-guided instrument for assessing bias in Big Data research using EHR data sets.

Methods and analysis Ethical analysis and instrument development (ie, the EHR bias assessment guideline) …

Changes In Medicaid Fee-For-Service Benefit Design For Substance Use Disorder Treatment During The Opioid Crisis, 2014 To 2021, Angela Shoulders, Christina Andrews, Melissa A. Westlake, Amanda J. Abraham, Colleen M. Grogan

Faculty Publications

Importance: Medicaid is the largest payer of substance use disorder treatment in the US and plays a key role in responding to the opioid epidemic. However, as recently as 2017, many state Medicaid programs still did not cover the full continuum of clinically recommended care. Objective: To determine whether state Medicaid fee-for-service (FFS) programs have expanded coverage and loosened restrictions on access to substance use disorder treatment in recent years. Design, Setting, and Participants: In 2014, 2017, and 2021, a survey on coverage for substance use disorder treatment was conducted among state Medicaid programs and the District of Columbia with …

Prenatal Depression And Breastfeeding Practices Healthy Start Participants, 2019-2022, Peyton Ashleigh Mosher

Theses and Dissertations

Background: Breastfeeding has health benefits for both mother and child, but breastfeeding practices among Black and lower-income women are the poorest in the United States. Few studies have examined the associations between maternal prenatal depression and breastfeeding duration, even fewer among a predominantly low-income Black population. Objective: To explore the association between prenatal depression and breastfeeding practices among low-income Black women during the COVID-19 pandemic.

Methods: Prospective cohort data from Midlands Healthy Start (MHS) was analyzed to examine women’s depression symptoms during pregnancy and their breastfeeding initiation and duration through two and six months. Perinatal depressive symptoms were identified using …

Exploration Of The Association Between Obesogenic Environments And Childhood Overweight/Obesity Rates In Rural Counties In The United States, Kara Lea Ferguson Davis

Theses and Dissertations

Rising obesity rates, particularly among children, pose a significant public health concern. Of particular concern is the prevalence of childhood obesity in rural communities, with up to 38% of rural children classified as overweight or obese, compared to 30% of urban children. Rural communities often lack the typical built environment characteristics associated with increased physical activity rates and healthy eating behaviors. Further, research on obesogenic environments within rural areas is limited. This study aimed to address this research gap by examining the association between obesogenic environment features and childhood overweight/obesity rates across the urban-rural continuum.

Simple and multiple linear regression …

Insurance Status And Cancer Staging, Time To Treatment, And Mortality: Examining Cancers Of The Breast, Colon, And Lung, Gabriel A. Benavidez

Theses and Dissertations

Introduction: When examining cancer outcomes, timely detection and treatment are critical factors for favorable prognoses. Previous studies have shown that individuals with public health insurance, specifically Medicaid, have worse cancer outcomes than those with private insurance. While differences in socioeconomic status may account for this disparity, one potential area for further investigation is the effect of Medicaid enrollment timing on cancer outcomes. In some states, individuals may not be eligible for Medicaid until after their cancer diagnosis, potentially nullifying health insurance benefits. This analysis examines the impact of Medicaid enrollment timing on cancer outcomes by comparing patients not enrolled in …

Babe (Body Appreciation And Better Eating), Just Add A Dash Of Self-Compassion: A Randomized Controlled Pilot Study For Black/African American Teenage Girls, Nkechi Bianca Okpara

Theses and Dissertations

Introduction

Body dissatisfaction contributes to disproportionately high rates of disordered eating behaviors observed in Black teenagers. Given that self-compassion is found to buffer against eating pathology and body dissatisfaction and is linked to reduced incidences of binge eating and disordered eating behavior. Incorporating the self-compassion construct, specifically centering on nutrition, with a program that combats negative body image, like the Body Project, may further help decrease body dissatisfaction and improve overall nutrition.

Purpose

The aim of this dissertation was to test (1) the acceptability and feasibility of a novel program, Body Appreciation and Better Eating, add self-compassion (BABE+SC), and to …

Beyond Vaccination Coverage: A Critical Look At Zero-Dose Children In Sub-Saharan Africa, Chamberline Ekene Ozigbu

Theses and Dissertations

Background: Despite continuous efforts to enhance childhood vaccination coverage, a considerable number of children in sub-Saharan Africa (SSA) remain unvaccinated (zero-dose). Recent estimates indicate that approximately 17 million zero-dose children reside mainly in 10 Low- and Middle-Income Countries (LMICs) in SSA. The Immunization Agenda 2030 (IA2030) aims to reduce the number of zero-dose children by half, necessitating research to identify populations and groups at higher risk of being unvaccinated.

Objectives: This research sought to (1) examine individual and contextual factors associated with zero-dose status in SSA, (2) assess the geographical clustering of zero-dose children aged 12-59 months in SSA and …

Phoneme Stability In Speech Production Of Cognate And Non-Cognate Nouns In A Bilingual With Aphasia, Katherine Vlach

Theses and Dissertations

With the growing bilingual population in the world comes a greater incidence of bilingual aphasia, a communication disorder characterized by expressive or receptive language impairment in one or both of a bilingual speaker’s languages. The cognate facilitation effect, which has greatly been explored in healthy bilingual studies, has shown that cognates are named faster and more accurately than non-cognates; as the cognate facilitation effect is also retained in bilingual speakers with aphasia, it is thought that cognates could potentially be used as a treatment tool to facilitate lexical access, particularly when a bilingual speaker with aphasia presents with one of …

Bayesian Spatial And Spatio-Temporal Models For Complex Data Sets, Rongjie Huang

Theses and Dissertations

The cost of testing for infectious diseases can be high, and analyzing large amounts of historical data to forecast disease prevalence can be a time-consuming process. Group testing techniques offer a way to decrease the expenses associated with testing, but this comes at the cost of increased complexity of the data structure due to grouping and imperfect testing when compared to individual-level testing. In this dissertation research, we propose two Bayesian mixed effects spatial group testing regression models: one for areal data and the other for point process data. The former model utilizes a conditional autoregressive (CAR) prior for areal …

Parenting During A Pandemic: Understanding The Impact Of Covid-19 On Early Childhood Development, Jessica A. Manes

Senior Theses

The early years of a child's life are crucial for their development, shaping their ability to process information, communicate, and form their identity. However, the COVID-19 pandemic disrupted essential elements necessary for optimal early childhood development, including quality education, nurturing environments, and social stimulation. This study explored how parents in South Carolina perceived the pandemic's impact on their children's development. Five themes emerged from the study. Firstly, remote work due to pandemic protocols significantly affected the parent-child relationship. Secondly, the family's socioeconomic status influenced their ability to cope with and protect their children from the pandemic's impact. Thirdly, isolation resulting …

Examining The Associations Of The Kidney Allocation System With Patient Sensitivity, Wait Time To Transplant, And Donor Distance, Shamika Danielle Jones

Theses and Dissertations

Background

The Kidney Allocation System (KAS) was created in 2014 to address long wait times for a kidney transplant, inappropriately matched kidneys, and high re-transplantation rates. This research examines the associations of the KAS with the percentage of sensitized patients receiving a kidney transplant, wait time to transplant and the distance between donor and recipient hospitals.

Methods

Data from the Scientific Registry of Transplant Recipients (SRTR) was used for this research. The study population included adults over 18 in the United States who received a kidney transplant between December 4, 2009, and December 4, 2018. Patients simultaneously waitlisted for other …

Complementary And Integrative Health (Cih) And Opioid Use Among Adults With Chronic Noncancer Pain In The Us, Yi-Wen Shih

Theses and Dissertations

Chronic noncancer pain (CNCP) is defined as persistent pain lasting for more than three months due to conditions other than malignancy. This condition affects one in five American adults annually. The prescribing of opioids to individuals experiencing CNCP has been recognized as a critical contributor to the ongoing opioid crisis. In 2016, the Centers for Disease Control and Prevention (CDC) recommended Complementary and Integrative Health (CIH) as a nonpharmacologic treatment to be used among adults with CNCP. Despite the potential benefits of CIH for pain relief, there may be a discrepancy between individuals with CNCP and their insurance coverage for …

Patient Experiences And Disparities In Telehealth Hiv Care During The Covid-19 Pandemic: Study Results From The Southern United States, Valerie Yelverton

Theses and Dissertations

Background: To maintain HIV care continuity during the COVID-19 pandemic, most HIV care facilities in the United States adopted telehealth. However, not everyone was participating in telehealth equally. This dissertation seeks to understand experiences with and the use of telehealth in HIV care, and decision processes guiding the selection of visit type during the COVID-19 pandemic.

Methods: Qualitative interviews explored people living with HIV’s (PWH) and HIV care provider’s experiences with telehealth HIV care and visit type decision processes. Quantitative analyses of electronic health record (EHR) data characterized patterns of and disparities in telehealth HIV care during the COVID-19 pandemic. …

The Determinants Of Sustained Adherence To Covid-19 Preventive Measures Among Older Syrian Refugees In Lebanon, Nisreen Salti, Stephen J. Mccall, Berthe Abi Zeid, Noura El Salibi, Marwan Alawieh, Zeinab Ramadan, Hala Ghattas Ph.D, Sawsan Abdulrahim

Faculty Publications

Introduction Lebanon has battled the COVID-19 pandemic in the midst of an economic crisis. The evolution of the pandemic and a fragile health system have meant that public health policy has had to rely heavily on non-pharmaceutical interventions for disease control. However, changes in disease dynamics, an unraveling economy, and pandemic fatigue have meant that disease control policies need to be updated. Methods Using recent and timely data on older (50 years and above) Syrian refugees in Lebanon, this paper uses multivariate linear probability models to explore the determinants of adherence to two non-pharmaceutical COVID-19 prevention measures (wearing a mask …

Effects Of Size At Birth On Health, Growth And Developmental Outcomes In Children Up To Age 18: An Umbrella Review, Zeina Jamaluddine, Eman Sharara, Vanessa Helou, Nadine El Rashidi, Gloria Safadi, Nehmat El-Helou, Hala Ghattas Ph.D, Miho Sato, Hannah Blencowe, Oona M.R. Campbell

Faculty Publications

Background Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps.

Methods We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association.

Findings We screened 16 641 articles and identified 302 …

Inequalities In Wellbeing In Lebanese Children And Different Refugee Subpopulations: A Multidimensional Child Deprivation Analysis, Zeina Jamaluddine, Gloria Safadi, Alexandra Irani, Nisreen Salti, Jad Chaaban, Sawsan Abdulrahim, Alban Thomas, Hala Ghattas Ph.D.

Faculty Publications

Background and Objectives:

This study constitutes the first attempt to describe the overlapping deprivations faced by Lebanese children (Lebanese) and that of the three sub-populations of refugees living in Lebanon: Palestinian refugees living in Lebanon, Palestinian refugees from Syria and Syrian refugees.

Methods:

Using data from the United Nations International Children's Emergency Fund (UNICEF) Household Survey 2016 (n = 10,555 Lebanese; 7,106 Palestinian refugees living in Lebanon; 2,768 Palestinian refugees from Syria and 5,891 Syrian refugee children aged 2 to 17 years old), we report on single and overlapping deprivations (at least two concurrent deprivations) using indicators related to survival …

Incidence Of Chronic Kidney Disease Following Acute Coronavirus Disease 2019 Based On South Carolina Statewide Data, Roy O. Mathew, Jiajia Zhang Ph.D., Xueying Yang, Shujie Chen, Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Background: Coronavirus disease 2019 (COVID-19) was associated with severe acute illness including multiple organ failure. Acute kidney injury (AKI) was a common finding, often requiring dialysis support.

Objective: Define the incidence of new clinically identified chronic kidney disease (CKD) among patients with COVID-19 and no pre-existing kidney disease.

Design Participants: The South Carolina (SC) Department of Health and Environmental Control (DHEC) COVID-19 mandatory reporting registry of SC residents testing for COVID-19 between March 2020 and October 2021 was included.

Design Main Measures: The primary outcome was a new incidence of a CKD diagnosis (N18.x) in those without a pre-existing diagnosis …

Ten‐Year Cardiovascular Disease Risk Score And Cognitive Function Among Older Adults: The National Health And Nutrition Examination Survey 2011 To 2014, Jingkai Wei, Hanzhang Xu, Angela D. Liese, Anwar T. Nerchant Sc.D, Mph, Dmd, Liang Wang, Chih-Hsiang Yang, Matthew C. Lohman, Monique J. Brown Ph.D., Mph, Tiansheng Wang, Daniela B. Friedman Ph.D.

Faculty Publications

BACKGROUND: The Framingham 10-year cardiovascular disease risk score, which is based on age, sex, smoking, total cholesterol, high-density lipoprotein-cholesterol, blood pressure, and diabetes, has been found to be associated with cognitive health, but these findings have not been validated in a representative sample in the United States. We aimed to examine the associations of Framingham risk score with cognitive function among older adults in a nationally representative sample, as well as by race or ethnicity, education, and family income.

METHODS AND RESULTS: A total of 2254 older adults ≥60years (57% female, 79% non-Hispanic White) in the National Health and Nutrition …

Patterns Of Hiv Disclosure And Its Impact On The Hiv Care Continuum Among Black Men Who Have Sex With Men In South Carolina, Xueying Yang Ph.D., Titilayo A. James, Monique J. Brown Ph.D., Mph, Tony Brown, Sydney Zarsadias, Ran Zhang, Fanghui Shi, Xiaoming Li Ph.D.

Faculty Publications

Addressing the psychosocial concerns of Black men who have sex with men (MSM), such as HIV disclosure, is critical for effective HIV treatment efforts. Black MSM living with HIV experience multiple psychosocial challenges, such as “triple stigma” due to their sexual orientation, racial minority status, and HIV status, which hinder their HIV disclosure and subsequent HIV care-seeking behavior. Our study sought to examine the HIV disclosure patterns and their impact on the HIV care continuum among Black MSM using a qualitative approach. Semi-structured interviews were carried out among 28 Black MSM aged ≥18 years old living in South Carolina. A …

Association Of Selected State Policies And Requirements For Buprenorphine Treatment With Per Capita Months Of Treatment, Bradley D. Stein, Brendan K. Saloner, Olivia K. Golan, Barbara Andraka-Christou, Christina M. Andrews Ph.D., Andrew W. Dick, Corey S. Davis, Flora Sheng, Adam J. Gordon

Faculty Publications

IMPORTANCE Expanding the use of buprenorphine for treating opioid use disorder is a critical component of the US response to the opioid crisis, but few studies have examined how state policies are associated with buprenorphine dispensing. OBJECTIVE To examine the association of 6 selected state policies with the rate of individuals receiving buprenorphine per 1000 county residents. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used 2006 to 2018 US retail pharmacy claims data for individuals dispensed buprenorphine formulations indicated for treating opioid use disorder. EXPOSURES State implementation of policies requiring additional education for buprenorphine prescribers beyond waiver training, continuing medical …

Protocol For Developing A Personalised Prediction Model For Viral Suppression Among Under-Represented Populations In The Context Of The Covid-19 Pandemic, Jiajia Zhang Ph.D., Xueying Yang Ph.D., Sharon Weissman, Xiaoming Li Ph.D., Bankole Olatosi Ph.D.

Faculty Publications

Introduction Sustained viral suppression, an indicator of long-term treatment success and mortality reduction, is one of four strategic areas of the 'Ending the HIV Epidemic' federal campaign launched in 2019. Under-represented populations, like racial or ethnic minority populations, sexual and gender minority groups, and socioeconomically disadvantaged populations, are disproportionately affected by HIV and experience a more striking virological failure. The COVID-19 pandemic might magnify the risk of incomplete viral suppression among under-represented people living with HIV (PLWH) due to interruptions in healthcare access and other worsened socioeconomic and environmental conditions. However, biomedical research rarely includes under-represented populations, resulting in biased …

Development And Validation Protocol For An Instrument To Measure Household Water Insecurity Across Cultures And Ecologies: The Household Water Insecurity Experiences (Hwise) Scale, Sera L. Young, Shalean M. Collins, Godfred O. Boateng, Torsten B. Neilands, Zeina Jamaluddine, Joshua D. Miller, Alexander A. Brewis, Edward A. Frongillo Jr., Wendy E. Jepson, Hugo Melgar-Quiñonez, Roseanna C. Schuster, Justin B. Stoler, Amber Wuitch, Hwise Research Coordination Network

Faculty Publications

Introduction A wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts.

Methods and analysis After domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which water-related problems have been reported (eg, shortages, excess …

Trends In Resources For Neonatal Intensive Care At Delivery Hospitals For Infants Born Younger Than 30 Weeks' Gestation, 2009-2020, Nansi S. Boghossian, Marco Geraci, Ciaran S. Phibbs, Scott A. Lorch, Erika M. Edwards, Jeffrey D. Horbar

Faculty Publications

Importance: In an ideal regionalized system, all infants born very preterm would be delivered at a large tertiary hospital capable of providing all necessary care. Objective: To examine whether the distribution of extremely preterm births changed between 2009 and 2020 based on neonatal intensive care resources at the delivery hospital. Design, Setting, and Participants: This retrospective cohort study was conducted at 822 Vermont Oxford Network (VON) centers in the US between 2009 and 2020. Participants included infants born at 22 to 29 weeks' gestation, delivered at or transferred to centers participating in the VON. Data were analyzed from February to …

Why Understanding Food Choice Is Crucial To Transform Food Systems For Human And Planetary Health, Krystal K. Rampalli, Christine E. Blake Ph.D., Rd, Edward A. Frongillo Ph.D., Joseph Montoya

Faculty Publications

What, how and why people eat has long been understood to be important for human health, but until recently, has not been recognised as an essential facet of climate change and its effects on planetary health. The global climate change and diet-related health crises occurring are connected to food systems, food environments and consumer food choices. Calls to transform food systems for human and planetary health highlight the importance of understanding individual food choice. Understanding what, how and why people eat the way they do is crucial to successful food systems transformations that achieve both human and planetary health goals. …

Predictors And Barriers To Vaccination Among Older Syrian Refugees In Lebanon: A Cross-Sectional Analysis Of A Multi-Wave Longitudinal Study, Berthe Abi Zeid, Tanya El Khoury, Hala Ghattas Ph.D., Marwan F. Alawieh, Zeinab Ramadan, Sirine Anouti, Sawsan Abdulrahim, Stephen J. Mccall

Faculty Publications

Background:

Vaccination is important to prevent morbidity and mortality due to COVID-19 among older Syrian refugees. We aimed to elucidate the predictors of COVID-19 vaccine uptake among Syrian refugees aged 50 years or older in Lebanon and to understand their main reasons for not receiving the vaccine.

Methods:

This was a cross-sectional analysis of a five-wave longitudinal study, conducted through telephone interviews between Sept 22, 2020, and March 14, 2022, in Lebanon. For this analysis, data were extracted from wave 3 (Jan 21–April 23, 2021), which included a question on vaccine safety and on whether participants intended to receive the …

Predicting Adolescent Intervention Non-Responsiveness For Precision Hiv Prevention Using Machine Learning, Bo Wang, Feifan Liu, Lynette Deveaux, Arlene Ash, Ben Gerber, Jeroan Allison, Carly Herbert, Maxwell Poitier, Karen Macdonell, Xiaoming Li Ph.D., Bonita Stanton

Faculty Publications

Interventions to teach protective behaviors may be differentially effective within an adolescent population. Identifying the characteristics of youth who are less likely to respond to an intervention can guide program modifications to improve its effectiveness. Using comprehensive longitudinal data on adolescent risk behaviors, perceptions, sensation-seeking, peer and family influence, and neighborhood risk factors from 2564 grade 10–12 students in The Bahamas, this study employs machine learning approaches (support vector machines, logistic regression, decision tree, and random forest) to identify important predictors of non-responsiveness for precision prevention. We used 80% of the data to train the models and the rest for …

Covid-19 Challenges, Responses, And Resilience Among Rural Black Women: A Study Protocol, Fanghui Shi, Jiajia Zhang Ph.D., Chengbo Zeng, Xiaowen Sun, Zhenlong Li, Xueying Yang, Sharon Weissman, Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Background

Timely linkage to care (LTC) is key in the HIV care continuum, as it enables people newly diagnosed with HIV (PNWH) to benefit from HIV treatment at the earliest stage. Previous studies have found LTC disparities by individual factors, but data are limited beyond the individual level, especially at the county level. This study examined the temporal and geographic variations of county-level LTC status across 46 counties in South Carolina (SC) from 2010 to 2018 and the association of county-level characteristics with LTC status.

Methods

All adults newly diagnosed with HIV from 2010 to 2018 in SC were included …

A Process For Converting An In-Person Training To Increase Church Capacity To Implement Physical Activity And Healthy Eating Practices And Policies To An Online Format, Sara Wilcox Phd, Ruth P. Saunders Ph.D., Jessica Stucker, Andrew T. Kaczynski Ph.D., Kelsey R. Day, Deborah Kinnard, Lindsay Decker, John A. Bernhart Ph.D., Mph, Ches

Faculty Publications

The implementation of evidence-based public health programs into practice is critical for improving health, but trainings for organizational change agents are often not scalable. To describe the process of converting a training that targets faith-based organizational capacity development from an in-person to an online format. We engaged in an iterative process to convert the training delivery mode from in-person to online that included assessing stakeholder support, consulting the literature on best practices, seeking a design team, consolidating content, designing engaging lessons, and building an online site. Feedback from end-users and other audiences was incorporated throughout. Pilot participants with characteristics like …

A Cross-Sectional Analysis Of Infectious Causes Of Congenital Morbidity And Mortality In Central America: Torch, El Salvador, Mary Katherine Lynn

Theses and Dissertations

The primary goal of this dissertation was to understand the prevalence of the most regionally salient TORCH pathogens among a group of perinatal women from a highly vulnerable region of El Salvador at the time of parturition. TORCH pathogens, that cause TORCH congenital syndromes, are classically defined as Toxoplasma gondii, other infectious causes of concern (Zika virus, malaria, human immunodeficiency virus, etc), Rubella virus, Cytomegalovirus(CMV), and Herpes Simplex Viruses. These infections can be passed from mother to fetus through the placenta or other perinatal routes and cause severe maternal and neonatal morbidity and mortality. This dissertation sought to understand perinatal …