Public Health Commons^™

The Skin Cancer Health Crisis And Recommended Intervention Methods, Blaire Brooks

Senior Theses

Despite the increasing research connecting UVR exposures to skin cancer, rates of skin cancer are rising. Skin cancer is now the most common form of cancer and there are significant health care costs associated with treating the cases (Balk et al., 2013). As a result, the United States needs greater initiatives to increase educational programs, physician counseling, and political action regarding ultraviolet exposure and incidence of skin cancer. Evaluation of the types of skin cancer, perceptions of tanning, and current regulations and recommendations are required in order to form the initiatives to combat the growth of skin cancer.

Common Histories And Common Failures: How The Historical Events Of Ireland And The United States Have Led To Their Vastly Different, Equally Failing, Health Care Systems, Kimberly Narro

Senior Theses

The United States healthcare system is a constant source of debate and public interest, with the only common ground between political parties being that the current system is deeply flawed and needing improvement. Individuals often point to European single-payer systems as the answer, neglecting to mention the flaws also inherent in these systems. This thesis aims to suss out the successes and failings of the Irish and American healthcare systems through a thorough scholarly literature review, with an emphasis on the two countries’ origins and development, to lead to a discussion about why two countries with similar historical beginnings have …

College Student Health: How Cooking Can Promote Nutrition And A Healthy Diet, Sara Garzia

Senior Theses

This paper focuses on college student health and the manner in which nutrition and overall health can be improved by cooking. College students are at a high risk of poor health because of the college lifestyle. They are faced with a great deal of demands on their time from classes, extracurricular activities, work, and friends. Many students cite this lack of time as one of the main reasons they do not prepare their meals at home. Students also struggle with the perceived inadequacy of their cooking skills, and therefore find it much easier to purchase prepared food instead of making …

Gender Disparities In Midlife Hypertension: A Review Of The Evidence On The Arab Region, Christelle Akl, Chaza Akik, Hala Ghattas Ph.D., Carla Makhlouf Obermeyer

Faculty Publications

Objective

While gender differences in hypertension and increased prevalence rates among women at midlife have been documented in multiple settings, the evidence on the Arab world has not been systematically examined. This review summarizes the evidence related to gender disparities in midlife hypertension in this region.

Methods

We searched MEDLINE and Social Sciences Citation Index (SSCI) databases for studies, published between January 2000 and August 2015, on hypertension in the 22 countries of the Arab region. We abstracted information on the prevalence of hypertension among women and men, in general populations during midlife.

Results

Nineteen studies provided data on the …

Disc Golf As A Public Health Option: Utilizing America's Natural Resources To Offer Low Cost Outdoor Exercise, Victor Martins

Senior Theses

This paper explores the appeal and growth potential of disc golf as a way to offer a fun and immersive exercise experience. In a time when the United States is a world leader in obesity, understanding issues like appeal, exercise motivation and accessibility are important as the country looks to redirect itself towards a healthier future. In order to understand what brings disc golfers in, a survey of player motivations across demographic groups was completed using a rated average system. In doing so, researchers gained insight and verification of the game’s appeal under the framework of previous public health and …

Trading Pounds For Points: Engagement And Weight Loss In A Mobile Health Intervention, Sarah Hales, Gabrielle Turner-Mcgrievy, Sarah Wilcox, Rachel Davis, Arjang Fahim, Michael N. Huhns, Homayoun Valafar

Faculty Publications

Abstract Objective The objective of this study was to describe participant engagement and examine predictors of weight loss and points earned through the point-based incentive system of the Social Pounds Off Digitally (POD) app.

Materials and methods Overweight and obese adults with Android smartphones/tablets (body mass index 25–49.9 kg/m2; N = 24) were recruited for a 3-month weight loss intervention. Participants completed a survey assessing demographics and personality and had their weight measured. Participants received the content of the intervention via podcasts and used the Social POD app to self-monitor diet, physical activity, and weight. The Social POD app contained: …

Social Franchising And A Nationwide Mass Media Campaign Increased The Prevalence Of Adequate Complementary Feeding In Vietnam: A Cluster-Randomized Program Evaluation, Rahul Rawat, Phuong Hong Nguyen, Lan Mai Tran, Nemat Hajeebhoy, Huan Van Nguyen, Jean Baker, Edward A. Frongillo Jr., Marie T. Ruel, Purnima Menon

Faculty Publications

Rigorous evaluations of health system-based interventions in large-scale programs to improve complementary feeding (CF) practices are limited. Alive & Thrive applied principles of social franchising within the government health system in Vietnam to improve the quality of interpersonal counseling (IPC) for infant and young child feeding combined with a national mass media (MM) campaign and community mobilization (CM). We evaluated the impact of enhanced IPC + MM + CM (intensive) compared with standard IPC + less-intensive MM and CM (nonintensive) on CF practices and anthropometric indicators. A cluster-randomized, nonblinded evaluation design with cross-sectional surveys ( = ∼500 children aged 6-23.9 …

Pre-Pregnancy Body Mass Index Is Associated With Dietary Inflammatory Index And C-Reactive Protein Concentrations During Pregnancy, Dayeon Shin, Junguk Hur, Eun-Hee Cho, Hae-Kyung Chung, Nitin Shivappa, Michael D. Wirth, James R. Hébert, Kyung Won Lee

Faculty Publications

There have been a limited number of studies examining the association between pre-pregnancy body mass index (BMI) and dietary inflammation during pregnancy. Our aim is to examine the association between pre-pregnancy BMI and the Dietary Inflammatory Index (DII)™ and C-reactive protein (CRP) concentrations during pregnancy. The study included 631 pregnant American women from the National Health and Nutrition Examination Survey (NHANES) cross-sectional examinations from 2003 to 2012. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. The cut-offs of <18.5 (underweight), 18.5–24.9 (normal), 25.0–29.9 (overweight), and ≥30 kg/m2 (obese) were used to categorize the weight status of pregnant women prior to pregnancy. The DII, a literature-based dietary index to assess the inflammatory properties of diet, was estimated based on a one-day 24-h recall. Multivariable linear and logistic regressions were performed to estimate beta coefficients and the adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) on the association of pre-pregnancy BMI categories with the DII and CRP concentrations during pregnancy. After controlling for variables including: race/ethnicity, family poverty income ratio, education, marital status, month in pregnancy, and smoking status during pregnancy; women who were obese before pregnancy (n = 136) had increased odds for being in the highest tertile of the DII and CRP concentrations compared to women with normal weight (AORs 2.40, 95% CIs 1.01–5.71; AORs 24.84, 95% CIs 6.19–99.67, respectively). These findings suggest that women with pre-pregnancy obesity had greater odds of reporting higher DII and having elevated CRP. In conclusion, high pre-pregnancy BMI was associated with increased odds of pro-inflammatory diet and elevated CRP levels during pregnancy in the USA.

Multimorbidity And Mortality Risk: The Effect Of Depressive Symptom Trajectories Among Middle-Aged And Older Adults, Katherine Reynolds O’Shields

Theses and Dissertations

Introduction

Multimorbidity, commonly defined as having two or more chronic conditions, is a major burden in middle-aged and older adults, causing increased risks for hospitalizations, medical care costs, and even death. One condition with severe adverse effects in the older population is depression. Depression has been shown to increase ones social isolation while compounding self-management, eventually increasing ones chance for mortality. Multimorbidity coupled with depression has been shown to increase the risk for mortality; however, these results are typically based on a one-time depression evaluation. The main objective of this study is to examine if depressive symptom trajectories modifies the …

First Year Physical Activity Findings From Turn Up The Heat (Healthy Eating And Activity Time) In Summer Day Camps, Robert Weaver, Keith Brazendale, Jessica L. Chandler, Gabrielle Turner-Mcgrievy, Justin B. Moore, Jennifer L. Huberty, Dianne S. Ward, Michael W. Beets

Faculty Publications

Background Summer day camps (SDCs) serve 14 million children yearly in the U.S. and aim to provide participating children with 60 minutes of moderate-to-vigorous physical activity (MVPA). This study evaluated an intervention designed to increase the percent of children meeting this MVPA guideline.

Design Two-group, pre-post quasi-experimental.

Setting/Participants Twenty SDCs serving 1,830 children aged 5–12 years were assigned to MVPA intervention (n = 10) or healthy eating attention control (n = 10).

Intervention

The STEPs (Strategies to Enhance Practice) intervention is a capacity-building approach grounded in the Theory of Expanded, Extended and Enhanced Opportunities. Camp leaders and staff receive training …

Inflammatory Potential Of Diet, Weight Gain, And Incidence Of Overweight/Obesity: The Sun Cohort, Alyson Haslam, Sara Wagner Robb, James R. Hébert, Hanwen Huang, Michael David Wirth, Nitin Shivappa, Mark H. Ebell

Faculty Publications

Objective

The Dietary Inflammatory Index (DII)TM, which was developed to characterize the inflammatory potential of a person’s diet, has been shown to be associated with inflammatory conditions such as cancer. The present study aimed to investigate the association between DII scores and colorectal adenoma (CRA), a pre-cancerous condition.

Design

Responses to baseline dietary questionnaires were used calculate DII scores. In a cross-sectional study design, the association between DII scores and CRA prevalence was determined in men and women separately using logistic regression models.

Setting

Ten cancer screening centres across the USA.

Subjects

Participants were those included in the screening arm …

Changes In Underlying Determinants Explain Rapid Increases In Child Linear Growth In Alive & Thrive Study Areas Between 2010 And 2014 In Bangladesh And Vietnam, Phuong Hong Nguyen, Derek Headey, Edward A. Frongillo Jr., Lan Mai Tran, Rahul Rawat, Marie T. Ruel, Purnima Menon

Faculty Publications

Background: Child linear growth sometimes improves in both intervention and comparison groups in evaluations of nutrition interventions, possibly because of spillover intervention effects to nonintervention areas or improvements in underlying determinants of nutritional change in both areas.

Objective: We aimed to understand what changes in underlying socioeconomic characteristics and behavioral factors are important in explaining improvements in child linear growth.

Methods: Baseline (2010) and endline (2014) surveys from the Alive & Thrive impact evaluation were used to identify the underlying determinants of height-for-age z scores (HAZs) among children aged 24–48 mo in Bangladesh (n = 4311) and 24–59 mo …

Fewer Acute Respiratory Infection Episodes Among Patients Receiving Treatment For Gastroesophageal Reflux Disease, Herng-Ching Lin, Sudha Xirasagar, Shiu-Dong Chung, Chung-Chien Huang, Ming- Chieh Tsai, Chao-Hung Chen

Faculty Publications

Patients with gastroesophageal reflux disease (GERD) present with comorbid complications with implications for healthcare utilization. To date, little is known about the effects of GERD treatment with a proton-pump inhibitor (PPI) on patients’ subsequent healthcare utilization for acute respiratory infections (ARIs). This population-based study compared ARI episodes captured through outpatient visits, one year before and one year after GERD patients received PPI treatment. We used retrospective data from the Longitudinal Health Insurance Database 2005 in Taiwan, comparing 21,486 patients diagnosed with GERD from 2010 to 2012 with 21,486 age-sex matched comparison patients without GERD. Annual ARI episodes represented by ambulatory …

Neighborhood Environment And Falls Among Community-Dwelling Older Adults, Emily Joy Nicklett, Matthew C. Lohman Ph.D., Matthew Lee Smith

Faculty Publications

Background: Falls present a major challenge to active aging, but the relationship between neighborhood factors and falls is poorly understood. This study examined the relationship between fall events and neighborhood factors, including neighborhood social cohesion (sense of belonging, trust, friendliness, and helpfulness) and physical environment (vandalism/graffiti, rubbish, vacant/deserted houses, and perceived safety walking home at night). Methods: Data were analyzed from 9259 participants over four biennial waves (2006–2012) of the Health and Retirement Study (HRS), a nationally representative sample of adults aged 65 and older in the United States. Results: In models adjusting for demographic and health-related covariates, a one-unit …

Large-Scale Behavior-Change Initiative For Infant And Young Child Feeding Advanced Language And Motor Development In A Cluster-Randomized Program Evaluation In Bangladesh, Edward A. Frongillo Jr., Phuong H. Nguyen, Kuntal K. Saha, Tina Sanghvi, Kaosar Afsana, Raisul Haque, Jean Baker, Marie T. Ruel, Rahul Rawat, Purnima Menon

Faculty Publications

Background: Promoting adequate nutrition through interventions to improve infant and young child feeding (IYCF) has the potential to contribute to child development.

Objective: We examined whether an intensive intervention package that was aimed at improving IYCF at scale through the Alive & Thrive initiative in Bangladesh also advanced language and gross motor development, and whether advancements in language and gross motor development were explained through improved complementary feeding.

Methods: A cluster-randomized design compared 2 intervention packages: intensive interpersonal counseling on IYCF, mass media campaign, and community mobilization (intensive) compared with usual nutrition counseling and mass media campaign (nonintensive). Twenty subdistricts …

The Slow Food Movement: A 'Big Tent' Ideology, Mark N. Wexler, Judy Oberlander, Arjun Shankar

Journal of Ideology

The Slow Food Movement (SFM) has been characterized as a reminder of the centrality of the kitchen in the “good old days”. It has also been referred to as a poor use of science posing as a rallying point for the beleaguered middle class trying to reclaim psychological territory lost to the fast-paced commercialization of what was once private or leisure time. This paper argues that both these criticisms contain more than a kernel of truth. However, each misses the mark when it comes to explaining the relative successes of SFM. In this paper, we explore SFM’s basic ideological premises. …

Hair Measurements Of Cortisol, Dhea, And Dhea To Cortisol Ratio As Biomarkers Of Chronic Stress Among People Living With Hiv In China: Known-Group Validation, Shan Qiao Ph.D., Xiaoming Li, Samuele Zilioli, Zheng Chen, Huihua Deng, Juxian Pan, Weigui Guo

Faculty Publications

Background

Existing literature suggests that endocrine measures, including the steroid hormones of cortisol and Dehydroepiandrosterone (DHEA), as well as the DHEA to cortisol ratio in the human hair can be used as promising biomarkers of chronic stress among humans. However, data are limited regarding the validity of these measures as biomarkers of chronic stress among people living with HIV (PLWH), whose endocrine system or hypothalamic pituitary adrenal (HPA) axis may be affected by HIV infection and/or antiretroviral therapy (ART) medications.

Method

Using hair sample data and self-reported survey from 60 PLWH in China, we examined the validity of three endocrine …

Ethnicity, Stigma And Adherence To Antiretroviral Therapy (Art) Among People Living With Hiv/Aids In Guangxi, China, Yuchen Mao, Xiaoming Li Ph.D., Shan Qiao Ph.D., Yuejiao Zhou, Qun Zhao

Faculty Publications

This study examines the impact of ethnicity and multiple types of HIV-related stigma on adherence to antiretroviral therapy (ART) among 2,146 people living with HIV/AIDS (PLWHA) in Guangxi, China who had initiated ART. The results of multiple binary logistic regressions indicate that those who had experienced enacted stigma tended to report lower adherence, while better adherence was associated with older age, being women and having a job. Ethnicity had a moderator effect on the association between internalized stigma and adherence since better adherence was associated with lower internalized stigma among participants in ethnic minority groups other than Zhuang. Our findings …

The Association Between Clinical Recognition Of Depression And Unplanned Hospital Readmission Among Older Adults, Karen M. Jones

Theses and Dissertations

Purpose

The likelihood of a depression diagnosis may differ based on whether the patient was seen in an inpatient or outpatient setting. Depression has been associated with an increased risk of a 30-day readmission. The purpose of this study was to determine the level of agreement (concordance) between depression diagnosis as identified by inpatient and outpatient records and examine the relationship between depression diagnostic concordance and 30-day readmission.

Methods

Using universal administrative claims data from South Carolina, we examined inpatient and outpatient records. The analysis was restricted to Medicaid recipients aged 55 years and older with a primary admitting diagnosis …

Exploring Spatial Patterning And The Impact Of Obesogenic Built Environments For Youth Obesity, S. Morgan Hughey

Theses and Dissertations

Youth obesity is a major public health concern due to an array of physical, social, and psychological health consequences. Residential location, often referred to as ‘place’, has continued to emerge as a key health determinant with studies showing that where a child lives impacts their health. Environments where it is easy for individuals to have low levels of physical activity – either by discouraging active behavior or promoting sedentary behavior – and easy for individuals to consume unhealthful foods – either by the limited availability of healthful foods or increased availability of unhealthy foods – have been coined ‘obesogenic’. Additional …

Prenatal Methylmercury Exposure In A South Carolina Coastal Cohort, Alexis Donohue

Theses and Dissertations

Objectives: Methylmercury is a neurotoxin that has the ability to cross the placenta and adversely affect the developing fetus. Our primary objective was to investigate whether prenatal methylmercury exposure varied longitudinally, and whether differences were associated with maternal characteristics.

Methods: Pregnant mothers were recruited in Charleston, South Carolina (8-17 weeks gestation) (n=78). Blood samples were collected during both early (11.8 ± 1.7 weeks) and late (35.3 ± 2.0 weeks) gestation. Blood total mercury and methylmercury concentrations were analyzed. Upon enrollment in the study, mothers filled out a sociodemographic questionnaire that included questions regarding maternal age, race/ethnicity, and education level. Additionally, …

Inflammatory Potential Of Diet And Pancreatic Cancer Risk: Interaction And Mediation Analysis In Two Prospective Cohorts, Jiali Zheng

Theses and Dissertations

Background: Inflammation plays a pivotal role in pancreatic cancer etiology and can be modulated by diet. We aimed to examine the association between inflammatory potential of diet, assessed with the Dietary Inflammatory Index (DIITM), and pancreatic cancer risk in two prospective cohorts, the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and the National Institutes of Health American Association of Retired Persons (NIH-AARP) Diet and Health Study. We explored effect modification by important inflammation-related lifestyle factors, and investigated whether type-2 diabetes mediated the association in a pooled analysis of both studies.

Methods: A total of 101,449 and …

Evaluating Loss To Follow-Up In Newborn Hearing Screening In A Southern State, Elizabeth L. Crouch, Janice Probst, Kevin J. Bennett, Tara Carroll

Faculty Publications

Objective: The aim of this study was to examine loss to follow-up (LTFU) for diagnostic or early intervention (EI) services for South Carolina infants screened or diagnosed with hearing loss, and the risk factors associated with LTFU.

Design: A cross sectional analysis of data from South Carolina was used to examine LTFU for the use of audiologic evaluation services after initial newborn hearing screening and receipt of EI services after confirmation of hearing loss.

Results: Three percent (3.1%) of newborns screened in the state of South Carolina did not pass their hearing screening in 2013. Nearly half (49.1%) of those …

Knowledge And Use Of E-Cigarettes And Risk Perception In Brazil: Results From A Country With Strict Regulatory Requirements, Tânia Maria Vavalcante, André Salem Szklo, Cristina De Abreu Perez, James Thrasher Phd, Moyses Szklo, Janine Ouimet, Shannon Gravely, Geoffrey T. Fong, Liz Maria De Almeida

Faculty Publications

Due to uncertainties about the impact of electronic cigarettes on health, Brazil adopted, in 2009, a regulation that prohibited the sale, importation and advertising of these products until manufacturers can demonstrate that they are safe and/or effective in smoking cessation. The objective of the study was to analyze among Brazilian smokers: (1) knowledge about the existence of electronic cigarettes, lifetime use, and recent use; (2) risk perception of e-cigarettes compared to conventional cigarettes; and (3) factors correlated with knowledge and perception of risk. This is a cross-sectional study among Brazilian smokers (≥ 18 years old) using a replacement sample from …

Socially Assigned Race, Reactions To Perceived Racial Discrimination And Type Ii Diabetes Mellitus, Jourdyn A. Lawrence

Theses and Dissertations

Background: Numerous studies have utilized race to document health inequities. As race is considered a social classification of persons based upon physical traits, studies have begun to consider socially assigned race defined as the race/ethnicity perceived by others. Socially assigned race may serve as the basis for differential or unfair treatment of persons ascribed to historically oppressed groups. Socially assigned race may also provide additional insight into racial health disparities, particularly among Latino populations who are commonly defined by their ethnicity. This study assesses the relationship between self-identified and socially assigned race/ethnicity and tests the moderating effects of emotional and …

Association Between Diabetes And Cancer In Indian And Us Populations Using Longitudinal Study Design, Shraddha S. Vyas

Theses and Dissertations

Background: There is growing evidence of association between diabetes and cancer. No studies have been conducted in India evaluating this association. With the current epidemiologic, nutritional and economic transition in India, it becomes extremely important to examine this association in an Indian population. Additionally, difference in association exists based on different cancer subtypes. Research has shown that diabetes is associated with an increased risk of colorectal cancer. However most of these studies suggest detection bias to be one of the probable reasons for this association. Additionally, the common risk factors shared by both these conditions are considered to one of …

Association Of Gestational Weight Gain During Twin Gestations And Adverse Maternal Outcomes, Kerry Spillane

Theses and Dissertations

Objective: To examine the association between gestational weight gain (GWG) in twin gestations and the odds of adverse maternal outcomes.

Setting and Participants: Study population included 3,081 women with a twin gestation delivered between 23-42 gestational weeks from 19 hospitals across the United States (2002-2008) participating in the Consortium on Safe Labor (CSL) study.

Main Outcomes: Main outcomes of interest included: gestational hypertension, preeclampsia, gestational diabetes mellitus, and cesarean delivery.

Methods: Quantile regression estimated the 25th and 75th percentiles of total GWG, respective of pre-pregnancy BMI and gestational age at delivery, and was used to create our new total GWG …

Effectiveness Of Community-Based Eibi Treatment: A Longitudinal Analysis Of Adaptive Behavior And Language Outcomes, John Kuntz

Theses and Dissertations

Autism spectrum disorders (ASDs) are a group of lifelong, neurodevelopmental disorders characterized by deficits in social interaction, communication, relationship development and by the presence of repetitive or stereotypical behaviors including restricted interests. Continued advances in understanding treatment outcomes and broadening access to effective treatment is critical to improving the quality of life of children with autism and their families and minimizing the cost associated with care. The overall aim of this study is to assess the effectiveness of a community-based implementation of an Early Intensive Behavioral Intervention (EIBI) treatment program through a large-sample, longitudinal secondary analysis of administrative data. Additionally, …

Effects Of A Mindfulness Based Intervention On Diurnal Cortisol In Cancer Survivors, Susannah Small

Theses and Dissertations

Background. There are approximately 15.5 million individuals alive today in the U.S. with a personal history of cancer. For this large and growing population, ill effects associated with cancer diagnosis and treatment include both physical and psychosocial symptoms adversely affecting quality of life. One low-risk alternative to conventional pharmaceutical use in treating these symptoms is mindfulness practice. Research on self-reported measures provides strong evidence that this type of intervention improves quality of life for cancer survivors, but evidence of impact on objective measures is limited. Cortisol, the body’s primary stress hormone, is one relatively easy to measure indicator that …

Assessing The Relationship Between Periodontal Disease And Subsequent Inflammatory Responses And Headache Disorders, Bryn E. Davis

Theses and Dissertations

Headaches are the sixth leading cause of disability worldwide, and the third leading cause of disability amongst those aged 50 and older. Several headache disorders, including migraines, have been associated with nitric oxide production. It is widely accepted that the pain associated with headache disorders is due to the ability of nitric oxide to function as a vasodilator. While nitric oxide is a known vasodilator and has been linked to headache disorder, it is also produced in response to bacterial infections. Periodontal disease is the result of long term bacterial infections occurring in the gum line and nitric oxide is …