Public Health Commons^™

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

Theses and Dissertations

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

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

Theses and Dissertations

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

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

Theses and Dissertations

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

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

Theses and Dissertations

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

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

Theses and Dissertations

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

Single Nucleotide Polymorphisms In Dna Repair And Oxidative Stress Genes, And Their Interaction With Antioxidants On Prostate Cancer Aggressiveness, Samuel Antwi

Theses and Dissertations

Prostate cancer is the leading invasive malignancy and the second most common cause of cancer death among American men. Despite compelling evidence that oxidative stress, ineffective DNA damage repair, and habitually low antioxidants intake may act in tandem to influence prostate carcinogenesis, few studies have examined gene-diet interactions involving these risk factors. Even fewer studies have examined such interactions in relation to prostate cancer aggressiveness. This study investigated whether single nucleotide polymorphisms (SNPs) in DNA repair- and oxidative stress-related genes modulated associations between antioxidant intake and prostate cancer aggressiveness. We utilized data from the North Carolina-Louisiana Prostate Cancer Project (PCaP) …

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

Theses and Dissertations

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

Exploring The Association Between Depression And Obesity Among Alzheimer's Patients, Stephanie Clugstone

Theses and Dissertations

Alzheimer’s disease (AD) is a neurological disorder that affects elderly individuals, and is becoming an increasing concern among the aging population of the world. Due to the projected increase in incidence of AD, modifiable risk factors such as depression and obesity should be evaluated, as prevention is the only current option. This study aimed to determine the prevalence of obesity and depression among AD patients, and to evaluate the association between depression and obesity. Patients were chosen from a subset of the South Carolina Alzheimer’s disease registry, which included information about weight status and depression, as well as several other …

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

Theses and Dissertations

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

College Student Lay Health Information Mediary Behavior: An Examination Of Ehealth Literacy And Unrequested Health Advice, Andrew William Cole

Theses and Dissertations

Lay health information mediary behavior (LHIMB) describes individuals seeking health information to relay to others. The current study examines LHIMB as a relationship between eHealth literacy and unrequested health advice (UHA). 254 undergraduate students completed a survey addressing eHealth literacy levels, general UHA behaviors and specific UHA episodes. Results on general UHA behaviors indicate no significant relationship exists between eHealth literacy and utilizing UHA in health decision-making or frequency of offering UHA. However, self-perceived health status and degree of health worry significantly predict using UHA in health decision-making. Further, as health worry increases, participants appear significantly more likely to receive …

The Role Of Interactive And Critical Health Literacy In Appointment Cancellations: A Quality Assurance Survey, Amanda Nielsen

Theses and Dissertations

Objective: An agency located in the Midwest identified a 30 percent cancellation rate in their federally funded Part C early intervention (EI) program. Parents and caregivers of children with developmental delays tend to access and utilize the health care system and programs aimed at improving developmental outcomes more frequently. These children will likely benefit from caregivers who have ample health literacy to navigate the complicated systems of care. Although the role of functional health literacy (i.e., reading and numeracy skills) on health and developmental outcomes is well documented in the literature, limited research exists on the importance of interactive and …

Longitudinal Changes In The Inflammatory Potential Of Diet And Risk Of Cancer In Women, Fred Kinyuytabung

Theses and Dissertations

Introduction: The dietary inflammatory index (DII) assesses an individual’s overall diet quality with regards to its inflammatory potential on a continuum from maximally anti-inflammatory (lower or healthier DII scores) to maximally pro-inflammatory (higher or unhealthy DII scores). The DII measured at one point in time has been associated with cancer risk in previous studies; however, data are lacking regarding the change in DII over time and how these changes impact cancer risk. We assessed changes in the DII, and evaluated associations between cumulative history, and changes over time in dietary inflammatory potential, and risk of colorectal cancer (CRC) and breast …

Two Studies Of Family-Centered Care Family-Centered Care And Shared Decision Making: Are They The Same Construct? And The Association Of Family-Centered Care And Shared Decision Making With Receipt Of All Needed Prescription Drugs And Emergency Department Visits In Children With Asthma, Barbara Lee Brumbaugh

Theses and Dissertations

Family-Centered Care (FCC) is considered the standard of care in pediatrics, being affirmed in 2003 by the American Academy of Pediatrics (AAP). Family centered practices center around five specific provider actions: (1) did the provider spend enough time; (2) did the provider listen carefully; (3) was the provider sensitive to the needs of the family, including their values and customs; (4) did the provider provide information as needed; (5) did the provider make the caregiver feel like a partner in the care of the child. In addition to FCC practices, shared decision making (SDM) has been indicated as important in …

Role Of Chronic Inflammation On Liver Function During Cachexia Progression In The ApcMin/+ Mouse Model, Aditi Narsale

Theses and Dissertations

Cachexia is a multifactorial syndrome that manifests during the advanced stage of chronic diseases and is characterized by a progressive loss of body mass sustained by underlying inflammation. The ApcMin/+ mouse is an established model of cachexia that exhibits a gradual loss of body mass correlating with increasing tumor burden and plasma IL – 6 levels. Moreover it also mimics other secondary characteristics observed in cachectic patients like splenomegaly, elevated plasma endotoxin levels, gut barrier dysfunction, hypogonadism and an overall hypermetabolic state. Liver controls the energy metabolism in the body by regulating glucose and lipid metabolism, glycogen storage, filtration of …

Association Of Serum Immunoglobulin G (Igg) Antibodies Against Periodontal Bacteria In Type 2 Diabetes And Pre-Diabetes And Cardiovascular Risk Factors, Deepika Shrestha

Theses and Dissertations

Periodontal disease is an inflammatory disease caused by polybacterial infection and inflammation plays key role that associates periodontal disease with different systemic diseases including diabetes and cardiovascular diseases. The main objective of this study is to evaluate and explore the association of serum IgG antibodies in four distinct clusters that were formed empirically from species specific 19 periodontal antibody titers with T2DM and pre-diabetes adjusting for known confounders such as age, sex, race-ethnicity, income to poverty ratio, education, smoking and drinking alcohol, BMI, WC, physical activity, missing teeth, dentist visits and other nutritional factors.

From the first aim, we formed …

Role Of Allergic Sensitization, Filaggrin Variants, And Dna, Ali H. Ziyab

Theses and Dissertations

Background: Allergic disorders, including eczema, asthma, and rhinitis, have emerged as a global public health concern due to their elevated prevalence and the associated clinical morbidity. Environmental, immunologic, and genetic factors have been implicated in the pathogenesis of allergic disorders. Allergic sensitization (representing deviated immune responses) and filaggrin gene (FLG) variants (leading to dysfunctional epidermal barrier) have shown to be common predisposing factors in the development of allergic disorders. However, there is a lack of knowledge on their joint effects on the development of single and multiple (coexistence) allergic disorders. More recently, epigenetic mechanisms, such as DNA methylation, have emerged …

Understanding The Relationship Between Health Locus Of Control And God Locus Of Health Control And Health Behaviors In College Students Through Mediation Analysis, Joni Deann Marr

Theses and Dissertations

Background: Similar to the general population, college students have high rates of overweight/obesity and low rates of physical activity (PA) and healthy nutrition habits. Internal health locus of control (LOC) and religiosity/spirituality have been associated with positive health behaviors in various populations, but the mechanisms explaining these associations are still unclear. Purpose: The goals of this study were to understand the relationship between both health LOC and God locus of health control (independent variables) and PA, fruit and vegetable intake (FVI) and dietary fat intake (dependent variables) of college students through mediation analysis. Self-efficacy, social support, congregational social support and …

A Study Of An Uncharacterized Penicillium Species Isolated From A Hypersaline Pond In San Salvador, Bahamas, Virginia Elizabeth Hopkins

Theses and Dissertations

A large number of facultative marine fungi are unexplored (Lai et al., 2007). They exist in the hypersaline environment with reduced growth and metabolism for an indeterminable period of time and are believed to have no ecological role. Here we report the discovery of one novel facultative Penicillium species that we named Penicillium virginium. We show that when transferred from its native ecosystem, a salt pond in San Salvador, Bahamas, to a laboratory fungal growth medium, Penicillium virginium demonstrates a higher growth rate in absence of salt than in presence of salt confirming that it is a facultative marine fungus. …

Women’S Hiv Prevention Study (Whips): A Proposal To Pilot Test An Hiv Intervention For Older African American Women Living With Hiv, Charsey Cherry

Theses and Dissertations

Despite improvements in treatments over the past 30 years, HIV /AIDS continues to be a major public health threat, particularly among sub-populations such as African American women. Midlife and older adults (those aged 40 years and over) are fast becoming a growing concern for HIV/AIDS infections, particularly older African American women. There has been limited research targeting midlife and older African American women living with HIV that aimed to reduce their transmission of HIV and promote them becoming prevention advocates. In response to this gap in the literature, a culturally tailored intervention guided by the IMB Model of behavior change …

Prediction Of Coronary Heart Disease Within The Aerobics Center Longitudinal Study Population, Jennifer Carol Gander

Theses and Dissertations

This dissertation is a compilation of three studies that were conducted to better 1) Further validate a thoroughly tested Framingham Risk Score (FRS) on a unique cohort with comprehensive measures available, 2) Update and improve the predictability of the FRS through the addition of cardiorespiratory fitness (CRF) while resolving limitations in previous studies, and 3) Assess the predictability of non-exercise estimated CRF (e-CRF) and FRS on CHD. A manuscript was generated for each study utilizing data from the Aerobics Center Longitudinal Study.

To validate the FRS, a multivariable Cox Proportional Hazard Model was used to determine the association between FRS …

The Development, Implementation, And Testing Of An Interactive Sexual Health Web-Based Application Intervention To Reduce Sexual Risk Behaviors Among College Students, Dawnyéa Dominique Jackson

Theses and Dissertations

College life is often regarded as a time for exploration and growth. One major area of exploration and growth for college students is sex and sexuality. Growth and exploration involves not only learning how to master these life situations, but also experiencing some negative consequences. Negative consequences for college students engaging in sexual risk-taking behaviors often lead to a high prevalence of sexually transmitted infections (STIs), unintended pregnancies, emotional distress, and large healthcare costs. Given the high prevalence of risky sexual behavior among young adults and the highly negative consequences of risky sexual behavior for this population, it is critical …

A Multiple Imputation Approach For Semiparametric Cure Model With Interval Censored Data, Jie Zhou

Theses and Dissertations

Interval censored survival data, where the exact event time is only known to lie in an observed time interval, is commonly encountered in practice. Such data analysis may be conducted under the setting where a fraction of patients can be considered as fully recovered and will not experience the event of interest in the future; while the other patients who did not recover totally will have the outcome of interest. We proposed a semiparametric estimation method for the proportional hazard mixture cure model, which is easy to implement and computationally efficient. A multiple imputation approach based on the asymptotic normal …

Longitudinal Evaluations Of Objectively Measured Physical Activity: Capturing The Full Spectrum Of Duration And Intensity, Amanda E. Paluch

Theses and Dissertations

Most physical activity research to date narrows its focus toward intensities and durations only encompassed in the Physical Activity Guidelines of moderate to vigorous intensity in at least 10 minute bouts (MVPA-10). Examining activity in this manner excludes light activity and shorter bouts, sometimes referred to as baseline physical activity (BPA) as it consists of the activity accumulated during daily life at durations and/or intensities below what is recommended. This dissertation provides an evaluation of the entire spectrum of physical activity (PA). Physical activity was studied in a unique way by looking at MVPA-10, then adding shorter bouts and light …

Dietary Inflammatory Index And Its Relationship With Inflammation, Metabolic Biomarkers And Mortality, Nitin Shivappa

Theses and Dissertations

Background: Diet and its components are known to play an important factor in the process of inflammation and in turn on the health effects that are related to inflammation like cancer, and cardiovascular diseases. Previous research so far has mainly looked at the effect of specific food or nutrients on inflammation and health outcomes. In this regard a new literature derived and population based dietary index called Dietary Inflammatory Index (DII) was developed after carefully screening around 6000 articles that looked at the association between 45 food parameters and 6 commonly studied inflammatory markers. The list of food parameters includes …

Assessing The Impact Of An Incentivized Employee Wellness Program On Participation And Weight, Jennifer T. Fink

Theses and Dissertations

ABSTRACT

ASSESSING THE IMPACT OF AN INCENTIVIZED EMPLOYEE WELLNESS PROGRAM ON PARTICIPATION AND WEIGHT

by

Jennifer Fink

The University of Wisconsin-Milwaukee, 2014

Under the Supervision of Dr. Doug Ihrke

Introduction: Employers are increasingly adopting workplace wellness programs designed to improve employee health and decrease employer costs associated with health insurance and job absenteeism. This dissertation examines the outcomes of 6,375 obese health care workers who were offered financial incentives for participating in an employee wellness program (EWP) as they relate to participation and potential change in body mass index (BMI). This study aims to contribute to three distinct literatures, including …

Does Stigma Against Smokers Really Motivate Cessation? A Moderated Mediation Model On The Effect Of Anti-Smoking Campaigns Promoting Smoker-Related Stigma On Cessation Intentions, Jinyoung Kim

Theses and Dissertations

Over the past decade, an increasing number of strong tobacco control legislations (e.g., high cigarette taxes and strict ban on smoking in public places) have passed through Congress to reduce the size of smoking population in the United States. As a part of such national efforts, anti-smoking campaigns have been introduced to curb health problems associated with smoking. Recent anti-smoking campaigns often employ de-normalization strategies that portray smoker(s) as deviant and stigmatized minorit(ies) and smoking as an abnormal and non-mainstream activity in order to better stimulate cessation. As a result of implementing such stigmatization tactics, prevalence of smoking at a …

The Subjective Well-Being Of Youth Heads Of Households In Rural Southern Malawi, Pamela Fruechting

Theses and Dissertations

Youth-headed households in HIV-endemic sub-Saharan Africa face harsh realities of poverty and loss of parental care. Scientific knowledge of these youth is generally limited to socio-economic and psychological indicators of vulnerability while much less is known about youth-centric meanings of well-being. This is the first known study on the subjective well-being of youth heads of households.

The purpose of this exploratory, youth-centric, qualitative study was to identify experiences of subjective well-being, factors for regulating well-being, and meanings of well-being among youth heads of household in the Thyolo and Chiradzulu districts of rural southern Malawi. The theoretical foundation for this study …

Strategic Flexibility In Not-For-Profit Acute Care Hospitals, Donna Fe Jamieson

Theses and Dissertations

ABSTRACT

STRATEGIC FLEXIBILITY IN NOT-FOR-PROFIT ACUTE CARE HOSPITALS

by

Donna F. M. Jamieson

Despite multiple industry cycles of rapid and complex changes in the last three decades, the body of research in health care services strategy has not addressed the idea of strategic flexibility, that is, when and how should strategy evolve under conditions of environmental turbulence. Strategic flexibility has been defined in the literature as the ability to adapt to rapidly changing conditions by leveraging internal resources and competencies to effectively compete. With increasing scope of responsibility in both nursing and non-nursing functional areas, nurse executives have not only …

Effects Of Traffic And Air Pollution On Risk Of Preterm Birth And Low Birth Weight Outcomes In Milwaukee County, 2005-2010, Deborah Lynn Pasha James

Theses and Dissertations

Between 2005 and 2010, infants born to non-Hispanic black mothers experienced a 3-fold elevated risk of infant mortality compared to those born to white and Hispanic mothers. Preterm birth (PTB) and low birth weight (LBW) are strong predictors of infant mortality. To our knowledge, this is the first study of Wisconsin births to evaluate the effect of social and environmental factors on risk of PTB and LBW. We hypothesize that the observed racial inequalities in PTB and LBW are related to traffic density and air pollution. The Milwaukee INFANTS Study used 2005-2010 electronic birth record data (N = 85,045) geocoded …

Citefinder: A System To Find And Rank Medical Citations, Seyed Soheil Moosavinasab

Theses and Dissertations

This thesis presents CiteFinder, a system to find relevant citations for clinicians' written content. Inclusion of citations for clinical information content makes the content more reliable through the provision of scientific articles as references, and enables clinicians to easily update their written content using new information. The proposed approach splits the content into sentences, identifies the sentences that need to be supported with citations by applying classification algorithms, and uses information retrieval and ranking techniques to extract and rank relevant citations from MEDLINE for any given sentence. Additionally, this system extracts snippets from the retrieved articles. We assessed our approach …