Public Health Commons^™

Food Insecurity In Youth And Young Adults With Diabetes: Prevalence And Association With Health Behaviors, Lauren Helene Martini

Theses and Dissertations

Given the life-long impact of diabetes(1-5), it is important to engage in behaviors that promote health and wellness to delay or prevent negative health outcomes(3, 6-10). Despite this, youth and young adults with diabetes generally do not adhere to nutritional(11-17) or physical activity(18, 19) recommendations. In households experiencing financial difficulties, especially those who are having difficulty providing sufficient food to all of its members, adhering to recommendations may be even more difficult.

The purpose of this dissertation is to better understand and contextualize food insecurity among youth and young adults (YYA) with youth-onset T1DM and T2DM. The first aim addresses …

Revealing Geographic Transmission Pattern Of Covid-19 Using Neighborhood-Level Simulation With Human Mobility Data And Seir Model: A Case Study Of South Carolina, Huan Ning, Zhenlong Li, Shan Qiao, Chengbo Zeng, Jiajia Zhang Ph.D., Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Direct human physical contact accelerates COVID-19 transmission. Smartphone mobility data has emerged as a valuable data source for revealing fine-grained human mobility, which can be used to estimate the intensity of physical contact surrounding different locations. Our study applied smartphone mobility data to simulate the second wave spreading of COVID-19 in January 2021 in three major metropolitan statistical areas (Columbia, Greenville, and Charleston) in South Carolina, United States. Based on the simulation, the number of historical county-level COVID-19 cases was allocated to neighborhoods (Census block groups) and points of interest (POIs), and the transmission rate of each allocated place was …

Covid-19 Vaccine Hesitancy And Vaccination Rate Among The Latino Population In South Carolina, Brynn E. Lynagh

Senior Theses

It is common knowledge that COVID-19 disproportionately impacts racial and ethnic minorities in the United States. Furthermore, these sects of the population exhibit increased vaccine hesitancy and lower vaccination rates as compared to the aggregated population of the United States, furthering the risk posed by COVID-19 to these communities. In particular, this study focuses on the Latino population in South Carolina, the vaccination rate among this community, and the perspectives which contributed to their vaccination decision. Two hundred Spanish and Portuguese speaking residents of South Carolina were interviewed using a paper survey conducted by pre-trained interviewers. The survey gathered data …

The Associations Of Built Environments On College Students' Physical Activity Levels, Catherine M. Neel

Senior Theses

The issues with American physical activity infrastructure have been causing The United States to have lower levels of physical activity compared to other developed countries. The social and physical built environments of college students typically provide more access for students to be able to be active; however most students still do not meet the recommended amount of physical activity. The purpose of this study was to determine what in their physical and social environment that students utilize in order to participate in physical activity and what aspects of their environment discourage physical activity or limit access to being active. This …

Atomic Utopia: Nuclear Power At The Oconee Power Station In Seneca, South Carolina, Dalton Bridges

Senior Theses

In this thesis, I propose that South Carolina residents have developed a perception of their communities as “nuclear utopias.” I focus specifically on the Oconee Nuclear Power station in Seneca in the northwestern part of the state. I argue that the state’s extensive connections to the nuclear industry, coupled with the fact that many individuals have profited from the job opportunities and economic benefits that this sector provides, have led to a general acceptance of and even appreciation for nuclear power. Nuclear utopia suggests that individuals in South Carolina may view the nuclear industry as a source of hope and …

Comparative Medicaid Policy Analysis Related To Maternal And Infant Birth Outcomes In South Carolina, Cassidy L. Lena

Senior Theses

The United States despite being one of the most industrialized and wealthiest nations in the world, has the worst maternal and child health outcomes of any industrialized nation. The rates of maternal morbidity, mortality, and infant mortality have been increasing within the past decade, when many causes of death for this population are preventable. This study conducted a literature review on Medicaid policies and associated programs between three states (South Carolina, North Carolina, and California) in order to gain background information. Secondly, a comparative Medicaid policy analysis was completed using the Centers for Disease Control and Prevention [CDC] framework, which …

Language Services For Populations With Limited English Proficiency (Lep) And The Necessity For Proper Medical Interpretation With A Focus In South Carolina, Elizabeth Pung

Senior Theses

Linguistically appropriate healthcare is a cornerstone of providing quality patient care. Provider-patient communication is imperative to achieving linguistically appropriate healthcare; unfortunately, language barriers introduced by different spoken languages of patients to their providers hinders this communication. Patients with limited English proficiency (LEP) are ensured accessible healthcare under federal regulations such as the National Standards for Culturally and Linguistically Appropriate Services (CLAS standards); however, a gap between patients with LEP and the healthcare system remains. Not only is there a gap in communication for patients with LEP to their providing physician, but there is a nationwide epidemic resulting in poor health …

Examining Associations Between Social Needs And Mental Health Among Youth And Young Adults With Diabetes, Andrea Danielle Brown

Theses and Dissertations

Household food insecurity (HFI) disproportionally affects people with diabetes living in the United States and is more likely to occur in households with children and in minority race/ethnicity households. Food insecure people with youth-onset diabetes likely have increased risk for poor mental health due to dealing with stress and cost related to diabetes management, especially if facing additional health-related social needs that intersect with HFI. If left untreated, poor mental health among youth and young adults (YYA) with diabetes can lead to diabetes-related complications, increased health care costs, and mortality. Yet few studies have examined associations between HFI and mental …

Ultra-Processed Food Consumption And Risk Of Liver Cancer, Longgang Zhao

Theses and Dissertations

Background: Studies have shown positive associations between ultra-processed food (UPF) intake and obesity and type 2 diabetes, two risk factors for liver cancer. However, the relationship between UPF intake and liver cancer has scarcely been studied. We aimed to evaluate the association between UPF intake and the risk of liver cancer in three prospective cohorts and further explore the role of genetic predisposition to fatty liver diseases and biomarkers of liver health on modifying the association.

Methods: We used data from the Nurses’ Health Study (1986-2012), the Health Professionals Follow-up Study (1986-2012), and UK Biobank (2006-2020). Diet was assessed with …

Multilevel Description Of Spotted Fever Group Rickettsia Among Humans, Animals, And The Environment In Miraflores, Colombia, And South Carolina, Usa, Lidia Gual Gonzalez

Theses and Dissertations

Tick-borne diseases are emerging worldwide due to environmental shifts caused by land fragmentation and climate change. Among the most important ones spotted fever group rickettsioses (SFGRs) are of particular interest due to their wide species variety and high pathogenicity. Given the global spotted fever group rickettsia (SFGR) distribution, evaluation and comparison of different populations is critical to better understand these pathogens' epidemiology and unravel the risk factors affecting disease occurrence. Consequently, this dissertation investigates SFGR highlighting the One Health framework, assessing animals, humans, and the environment. The first part includes an evaluation at the household level using human and canine …

The Intersectionality Of Race And Rurality In Polysubstance Use During Pregnancy In The United States: A Study Of National Survey On Drug Use And Health, Sophia Tavakol

Senior Theses

Importance: Though detrimental consequences, many pregnant individuals are still binging alcohol, smoking, and/or using illicit drug. Yet, little is known regarding variations in such behaviors across pregnant people in the United States.

Objective: To examine alcohol, tobacco, and drug use during pregnancy in 2015-2020 and assess their racial, ethnic, and rural disparities.

Design: This cross-sectional descriptive study derived maternal characteristics and self-reported prenatal substance use data from 2015 and 2020 National Survey on Drug Use and Health, considering the complex sampling weight per participant per year produced by NSDUH.

Setting: United States.

Participants: A scientific random sample of non-institutionalized residents …

Accuracy Of Therapeutic Drug Monitoring In Vancomycin And The Pharmacist Role: A Retrospective Case-Series, Kateryna Parkhomenko

Senior Theses

Vancomycin is a mainstay of therapy for treating virulent and resistant infections, especially methicillin-resistant Staphylococcus aureus (MRSA). However, vancomycin requires therapeutic drug monitoring (TDM) for optimal dosing and treatment. This requires pharmacists to calculate a dosing regimen that correlates to appropriate goal vancomycin concentrations in the blood. Dosing vancomycin can be difficult, as it varies on a patient’s weight, renal function, age, etc. Doses may have to be adjusted in response to out-of-range concentrations, which requires further pharmacy calculations. Inaccurate dosing poses a risk to patient safety and places a resource and time burden on pharmacists. If vancomycin dosing methods …

Fixing The System: A Comparative Review Of The United Kingdom, Germany, And United States’ Healthcare Systems And Lessons Learned For Potential Improvements In The United States, Jessica Goddard

Senior Theses

In an effort to provide recommendations to the United States’ considerations of a universal healthcare system, this thesis analyzes the United States healthcare system alongside the sophisticated systems of the United Kingdom and Germany. Literature review and an analysis of 10 health outcomes and indicators guided the framework for a set of interview questions to be asked of healthcare professionals in all three countries. The interview response data was then organized and used to guide the suggested recommendations to the United States in its path towards universal healthcare. While a limited number of solutions could be provided given the time …

Girls Just Want To Be Safe: An Analysis Of Drugged Drinking And Prevention Amongst Students At The University Of South Carolina, C. Gray Forsberg

Senior Theses

Drink-spiking has become a well-known phenomenon since the turn of the century, especially on college campuses in the United States. Drink-spiking or drugging can be defined as “adding alcohol or drugs into someone’s drink without their knowledge or permission” (Alcohol and Drug Foundation, 2006). Drink-spiking is not just relevant to the concern of an illicit substance being placed into an alcoholic drink, but adding additional alcohol to drinks or adding alcohol or drugs to non-alcoholic drinks is considered drugging as well. This study collected data through a survey sent to 250 current students at the University of South Carolina regarding …

Wernicke's Encephalopathy: Mapping The Risk Factors Throughout The State Of South Carolina, Shannon M. Rychener

Senior Theses

Wernicke’s Encephalopathy is a consistently underrecognized neurodegenerative brain disorder resulting from prolonged thiamine deficiency. Clinical presentation of the disease results from brain lesions attributable to thiamine deficiency. Because these lesions occur in various locations in the cerebral cortex, symptoms can vary significantly. Varied presentation of symptoms, in addition to the lack of a widely accepted biomarker for the disorder cause challenges to clinicians when identifying and diagnosing the disorder. Due to these challenges, healthcare providers must heavily rely on patient history and risk factor prevalence when multiple symptoms of the disorder are present. By mapping the prevalence of the four …

Undergraduate Major And Covid-19 Vaccination Rates Among University Of South Carolina Students, Rebecca Stoltz

Senior Theses

The COVID-19 pandemic brought new vaccines to the forefront of public attention, and with it came a wide array of different opinions. The University of South Carolina did not require students to receive a COVID vaccine, so the decision was left entirely to the individual. Many of my peers have shown support or voiced opposition to the vaccine, and I noticed that those who opposed tended to fall within certain major categories. This study seeks to determine whether a correlation exists between undergraduate major groups and vaccination status, and to gather student attitudes and concerns surrounding vaccines. Among 172 survey …

Female Infertility And Maternal And Infant Outcomes In South Carolina – The Role Of Insurance Type, Chelsea Mencio Norregaard

Theses and Dissertations

The overall objective of this research study was to examine the association between fertility treatments and maternal and infant birth outcomes, and to understand what role insurance type plays in these associations.

This retrospective statewide cohort study utilized population-based birth certificate data from January 2018 – December 2021in South Carolina, linked to all-payer claims data for outpatient services, inpatient admissions/discharges, and emergency department visits. Key exposure variables included insurance type and fertility treatment, depending on Aim. Key outcomes of interest included fertility treatment (Aim 1); maternal outcomes (Aim 2) including severe maternal morbidity, cesarean delivery without medical indication, elective labor …

Up-03 Identifying The Determinants Of Pediatric Vaccine Uptake During The Covid-19 Pandemic, Colleen Phan, Brandon Mercardo, Justin Travis Ph.D., Ginny Webb Ph.D.

SC Upstate Research Symposium

COVID-19 has caused over a million deaths in the United States. Preventative measures such as masks, social distancing, and vaccination have been implemented to fight against the disease. Unfortunately, a large subset of Americans opposed these efforts.

SC DHEC reports that as of January 2023, only 53.9 % of eligible South Carolinians have been fully vaccinated against COVID-19. Previous studies have shown vaccine hesitancy is influenced largely by personal concerns about vaccine development, peer vaccination status, and general skepticism of immunization.

Hesitancy towards pediatric vaccination is particularly concerning because unvaccinated children can act as vessels to exponentially accelerate COVID-19 transmission. …

Capturing Children Food Exposure Using Wearable Cameras And Deep Learning, Shady Elbassuoni, Hala Ghattas Ph.D., Jalila El Ati, Yorgo Zoughby, Aline Semaan, Christelle Akl, Tarek Trabelsi, Reem Talhouk, Houda Ben Gharbia, Zoulfikar Shmayssani, Aya Mourad

Faculty Publications

Children’s dietary habits are influenced by complex factors within their home, school and neighborhood environments. Identifying such influencers and assessing their effects is traditionally based on self-reported data which can be prone to recall bias. We developed a culturally acceptable machine-learning-based data-collection system to objectively capture school-children’s exposure to food (including food items, food advertisements, and food outlets) in two urban Arab centers: Greater Beirut, in Lebanon, and Greater Tunis, in Tunisia. Our machine-learning-based system consists of 1) a wearable camera that captures continuous footage of children’s environment during a typical school day, 2) a machine learning model that automatically …

Maternal And Infant Outcomes Of Syrian And Palestinian Refugees, Lebanese And Migrant Women Giving Birth In A Tertiary Public Hospital In Lebanon: A Secondary Analysis Of An Obstetric Database, Stephen J. Mccall, Tanya C. El Khoury, Hala Ghattas Ph.D., Shady Elbassuoni, Mhd Hussein Murtada, Zeina Jamaluddine, Christine Haddad, Aya Hussein, Amina Krounbi, Jocelyn Dejong, Janoub Khazaal, Rabih Chahine

Faculty Publications

Objectives This study aims to assess whether the characteristics, management and outcomes of women varied between Syrian and Palestinian refugees, migrant women of other nationalities and Lebanese women giving birth at a public tertiary centre in Beirut, Lebanon.

Methods This was a secondary data analysis of routinely collected data from the public Rafik Hariri University Hospital (RHUH) between January 2011 and July 2018. Data were extracted from medical notes using text mining machine learning methods. Nationality was categorised into Lebanese, Syrian, Palestinian and migrant women of other nationalities. The main outcomes were diabetes, pre-eclampsia, placenta accreta spectrum, hysterectomy, uterine rupture, …

Effect Of A Plant-Based Vs Omnivorous Soul Food Diet On Weight And Lipid Levels Among African American Adults: A Randomized Clinical Trial, Gabrielle M. Turner-Mcgrievy Ph.D., Rd, Sara Wilcox Phd, Edward A. Frongillo Jr. Ph.D., E. Angela Murphy, Brent Hutto Msph, Mary Wilson Phd, Mph, Marty Davey, John A. Bernhart Ph.D., Mph, Ches, Nkechi Okpara, Shiba Bailey, Emily Hu

Faculty Publications

Importance: More African American individuals die from cardiovascular disease (CVD) than any other chronic disease condition. Despite this disparity, African American individuals are underrepresented in nutrition and CVD interventions. Objective: To compare the effects of an entirely plant-based (vegan) or low-fat omnivorous (omni) diet on change in body weight and lipids during a 2-year intervention. Design, Setting, and Participants: The Nutritious Eating With Soul (NEW Soul) study was a 2-year, randomized clinical trial conducted in 2 cohorts (2018-2020 and 2019-2021) that took place in a university teaching kitchen in Columbia, South Carolina (before March 2020), and via online videoconference sessions …

Perspective: Food Environment Research Priorities For Africa-Lessons From The Africa Food Environment Research Network, Amos K. Laar, Phyllis Addo, Richmond Aryeetey, Charles Agyemang, Francis Zotor, Gershim Asiki, Krystal K. Ramapalli, Gideon S. Anevinya, Akua Tandoh, Silver Nanema, Akosua Pokua Adjei, Matlida E. Laar, Kobby Mensah, Dennis Laryea, Daniel Sellen, Stefanie Vandevijvere, Christopher Turner, Hibbah Osei-Kwasi, Mark Spires, Christine E. Blake, Dominic Rowland, Suneetha Kadiyala, Isabel Madzorera, Adama Diouf, Namukolo Covic, Isaac M. Dzudzor, Reginald Annan, Peiman Milani, John Nortey, Nicholas Bricas, Sukati Mphumuzi, Kenneth Yongabi Anchang, Ali Jafri, Meenal Dhall, Amanda Kee, Sally Mckay, Samuel O. Oti, Karen Hofman, Edward A. Frongillo Jr. Ph.D., Michelle Holdsworth

Faculty Publications

Over the last 2 decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization, and development. These changes have altered African food environments and, subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transition have contributed to Africa's complex burden of malnutrition—obesity and other diet-related noncommunicable diseases (DR-NCDs)—along with persistent food insecurity and undernutrition. Available evidence links unhealthy or obesogenic food environments (including those that market and offer energy-dense, nutrient-poor foods and beverages) with suboptimal diets and associated adverse health outcomes. Elsewhere, governments have responded with policies to improve food …

Moderation Effect Of Community Health On The Relationship Between Racial/Ethnic Residential Segregation And Hiv Viral Suppression In South Carolina: A County-Level Longitudinal Study From 2013 To 2018, Fanghui Shi, Jiajia Zhang Ph.D., Xueying Yang Ph.D., Xiaowen Sun, Zhenlong Li, Chengbo Zeng, Huan Ning, Sharon Weissman, Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Background: Viral suppression is the ultimate goal of the HIV treatment cascade and a primary endpoint of antiretroviral therapy. Empirical evidence found racial/ethnic disparities in viral suppression among people living with HIV (PWH), but the evidence of the relationship between racial/ethnic residential segregation and place-based viral suppression is scarce. Further exploring potential structural moderators in this relationship has substantial implications for healthcare policymaking and resource allocation. The current study aimed to investigate the spatial-temporal disparities in the HIV viral suppression rate across 46 counties in South Carolina from 2013 to 2018. We also examined the impact of racial/ethnic residential segregation …

Qualitative Analysis Of Anti-Abortion Discourse Used In Arguments For A 6-Week Abortion Ban In South Carolina, Victoria C. Lambert, Emily E. Hackworth, Deborah Lynn Billings Phd

Publications

Background: On June 24, 2022, The U.S. Supreme Court overturned Roe v. Wade, leaving abortion legislation entirely up to states. However, anti-abortion activists and legislators have organized for decades to prevent abortion access through restrictive state-level legislation. In 2019, South Carolina legislators proposed a bill criminalizing abortion after 6 weeks gestation, before most people know they are pregnant. The current study examines the anti-abortion rhetoric used in legislative hearings for this extreme abortion restriction in South Carolina. By examining the arguments used by anti-abortion proponents, we aim to expose their misalignment with public opinion on abortion and demonstrate that their …

Lived Experiences Of College-Educated Black Women: Contextualizing Gendered Racial Health Disparities, Christiana L. Johnson

Theses and Dissertations

Black women are disproportionately affected by gendered racial health disparities. Public health research that seeks to unearth the root cause of these gendered racial health disparities is insufficient. More recently, researchers have turned their attention to structural inequities and their influence on the lived experiences of Black women. This study contributes to this body of work by using a theoretical concept derived from intersectionality⎯structural gendered racism⎯to identify key upstream social factors that shape nulliparous, college-educated Black women's lived experience and childbearing desires. Semi-structured, individual interviews were conducted with nulliparous, college-educated Black women (n=30), ages 25 to 35, living in the …

Association Of Hospital Incentive Care Management Partnerships For Uninsured Patients With Emergency Department Utilization, Sarah Gareau, Ana Lopez-De Fede, Zhimin Chen, Nathaniel Bell

Publications

IMPORTANCE The South Carolina (SC) Healthy Outcomes Plan (HOP) program aimed to expand access to health care to individuals without insurance; it remains unknown whether there is an association between the SC HOP program and emergency department (ED) use among patients with high health care costs and needs. OBJECTIVES To determine whether participation in the SC HOP was associated with reduced ED utilization among uninsured participants. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 11 684 HOP participants (ages 18-64 years) with at least 18 months of continuous enrollment. Generalized estimating equations and segmented regression of interrupted time-series analyses …

Issue Of Data Imbalance On Low Birthweight Baby Outcomes Prediction And Associated Risk Factors Identification: Establishment Of Benchmarking Key Machine Learning Models With Data Rebalancing Strategies, Yang Ren, Dezhi Wu, Yan Tong, Ana Lopez-De Fede

Publications

Background: Low birthweight (LBW) is a leading cause of neonatal mortality in the United States and a major causative factor of adverse health effects in newborns. Identifying high-risk patients early in prenatal care is crucial to preventing adverse outcomes. Previous studies have proposed various machine learning (ML) models for LBW prediction task, but they were limited by small and imbalanced data sets. Some authors attempted to address this through different data rebalancing methods. However, most of their reported performances did not reflect the models’ actual performance in real-life scenarios. To date, few studies have successfully benchmarked the performance of ML …

Residential Segregation And County-Level Covid-19 Booster Coverage In The Deep South: Surveillance Report And Ecological Study, Chengbo Zeng, Jiajia Zhang Ph.D., Zhenlong Li, Xiaowen Sun, Huan Ning, Xueying Yang, Sharon Weissman, Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Background: COVID-19 had a greater impact in the Deep South compared with other regions in the United States. While vaccination remains a top priority for all eligible individuals, data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age are sparse. Despite existing evidence of racial and ethnic disparities in COVID-19 vaccinations at the individual level, there is an urgent need for evidence at the population level. Such information could highlight vulnerable communities and guide future health care policy-making and resource allocation.

Objective: We aimed to evaluate county-level COVID-19 booster coverage …

Using Geospatial Social Media Data For Infectious Disease Studies: A Systematic Review, Fengrui Jing, Zhenlong Li, Shan Qiao Ph.D., Jiajia Zhang Ph.D., Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Geospatial social media (GSM) data has been increasingly used in public health due to its rich, timely, and accessible spatial information, particularly in infectious disease research. This review synthesized 86 research articles that use GSM data in infectious diseases published between December 2013 and March 2022. These articles cover 12 infectious disease types ranging from respiratory infectious diseases to sexually transmitted diseases with spatial levels varying from the neighborhood, county, state, and country. We categorized these studies into three major infectious disease research domains: surveillance, explanation, and prediction. With the assistance of advanced computing, statistical and spatial methods, GSM data …

Ecologic Analysis Of Antimicrobial Use In South Carolina Hospitals During 2020–2022, Pamela Bailey, Shujie Chen, Majdi N. Al-Hasan, Bankole Olatosi Ph.D., Xiaoming Li Ph.D., Jiajia Zhang Ph.D.

Faculty Publications

Background:

Factors influencing excessive antimicrobial utilization in hospitalized patients remain poorly understood, particularly with the COVID-19 pandemic.

Methods:

In this retrospective cohort, we compared administrative data regarding antimicrobial prescriptions in hospitalized patients in South Carolina from March 2020 through September 2022. The study examined variables associated with antimicrobial use across demographics, COVID status, and length of stay, among other variables.

Results:

Significant relationships were seen with antimicrobial use in COVID-19 positive patients (OR 2.00, 95% Confidence Interval (CI): 1.9–2.1), young adults (OR 1.08, 95% CI: 0.99–1.12, COVID-19 positive Blacks and Hispanics (OR 1.06, 95% CI: 1.01–1.11, OR 1.05, 95% CI: …