Public Health Commons^™

Estimating Covid-19 Survival Rate And Inferring Case Severity With Respect To Milwaukee County Policy Change Using Logistic Regression, Geoff M. Chappelle

Theses and Dissertations

Coronavirus disease 2019 (COVID-19) is a global issue, and it is affecting 170 countries in very different ways. In the United States, a lot of efforts have been made nationally and by individual states to curb the spread and severity of COVID-19. Policy changes and recommendations have been met with variable success across the country. There is a wealth of information on where COVID-19 infection and death are prevalent, and there are several articles discussing disparities in those outcomes among different populations. However, those findings are not necessarily tied to a policy change or, in the weeks that follow a …

Parent-Child Sexual Communication And Sexual Risk: A Meta-Analytic Review, Brittnie Star Peck

Theses and Dissertations

This meta-analysis examines the effect of parent-child sexual communication (PCSC) on sexual risk behaviors and outcomes during adolescence. Results confirm that PCSC increases risk prevention strategies and reduces sexually risky behaviors with corresponding reductions in unplanned pregnancy and sexually transmitted infections (STI). Moderating variables include extent of communication, the content of PCSC interactions, operationalization of risk, timing of the interaction, biological sex of the adolescent, the dyadic composition of the parent-child interaction (e.g., mother-daughter, father-son), and the racial or ethnic makeup of the sample. The frequency, depth, and breadth of PCSC interactions, and inclusion of descriptive/instructional and contraception/risk information are …

Maternal Preventive Dental Services Utilization: The Role Of Preconception Oral Health Counseling In And The Association With Birth Outcomes: Evidence From South Carolina Prams, Monique Johnette Williams

Theses and Dissertations

ABSTRACTThe purpose of this study is to examine maternal preventive dental services utilization by analyzing the role of preconception oral health counseling in utilization of dental cleaning services before or during pregnancy and the association of utilization with preterm birth (<37 weeks) and small for gestational age (SGA) (same sex newborns having birth weight for gestational age below the 10th percentile of the reference population as defined by the World Health Organization (WHO)). Studies suggest that unfavorable maternal oral conditions have significance in birth outcomes, specifically periodontal disease (periodontitis), an oral inflammatory condition which is shown to be a risk factor for preterm birth and low birth weight (Dortbudak et al., 2005; Guimarães et al., 2012; Tejada et al., 2012). Dental cleaning before and during pregnancy is effective in the prevention of oral disease including gingivitis and periodontitis (Johnson et al., 2006; Kurien et al., 2013; Steinberg et al., 2013).

Cross-sectional 2012-2015 data from the South Carolina Pregnancy Risk Assessment Monitoring System (SC PRAMS) survey, a population-based surveillance system on prenatal, perinatal and postpartum experiences of resident mothers who recently delivered a live-born infant, were analyzed using weighted analyses in SAS. Analyses included demographic univariate analyses, Rao-Scott Chi-squared tests of significance to study differences between groups, and multivariate logistic …

Examining Parental Perceptions And Decisions To Uptake Child Influenza Immunizations: Assessing Pandemic And Policy Impacts On Vaccination Rates Following The H1n1 Pandemic, And The Acip Laiv Preferential Recommendation Revocation, Amir H. Mehrabi

Theses and Dissertations

Introduction

2009 H1N1 Pandemic: The historical 2009 H1N1 Influenza pandemic, which had a CDC estimated accrued disease burden of 100.5 million illnesses, 936,000 hospitalizations, and 75,000 deaths from 2009 to 2018, resulted in a declared state of emergency nationally, with ensuing diminished vaccine confidence and amplified fears of infection, prompting some to pursue flu vaccination, and others to forego. Although the Centers for Disease Control and Prevention (CDC), and its Advisory Committee on Immunization Practices (ACIP) recommend an annual flu vaccine for individuals 6 months of age and older as the “first and best” defense against influenza, a low percentage …

Effect Of Lifestyle, Medical School Culture And Income On Medical Students' Decision To Pursue A Primary Care Career In Saudi Arabia, Ahmed Abdullah Alhussain

Theses and Dissertations

This study aims to examine the relationship of medical school students who select primary care as their career specialty. Based on extensive literature review, we focused on the three main factors that influence students to consider career specialty: lifestyle, income, and medical school culture. With a paper questionnaire of a cross-sectional study survey at ten medical schools, we were able to collect 1,006 participants from fourth and fifth year students. The clear majority of students considered lifestyle characteristics to be a significant influence in their career decision (PP<.05). Also, we found there was a significant relationship between students’ specialty choices and income variables. The result showed us that medical school culture played a notable role in terms of forming the students’ decisions in different ways. First, specialty characteristics were strongly correlated with career consideration. Second, having advising and mentoring within the medical school enhanced the probability of choosing primary care specialty. Finally, the effect of the primary care course was significant and closely related to the choice of the primary care specialty. In conclusion, the study demonstrated the impact of lifestyle, income, and medical school culture on student career selection. These results are in parallel with previous studies conducted in many countries around the world.

Package Warning Labels For Communicating Relative Risks Of Cigarettes, Heated Tobacco Products, And E-Cigarettes, Yoo Jin Cho

Theses and Dissertations

Package warning labeling policy is a fundamental public health strategy for communicating about tobacco product risks. The rapidly growing markets for novel tobacco products, such as heated tobacco products (HTPs) and e-cigarettes (ECs), make it critical to determine the characteristics of effective warning label policies for these products, which have lower levels of risk compared to cigarettes according to available evidence. Whether warning labels can communicate information about a continuum of risk across tobacco products is unexplored.

This dissertation investigated two warning label systems for communicating the relative risks of cigarettes, HTPs, and ECs: (1) varying warning sizes as a …

Survey Of Airflow Around A Heated Manikin As A Simulated Aeromedical Evacuation Patient On A Litter With Computational Fluid Dynamics Models, George P. Lemmer

Theses and Dissertations

Aeromedical Evacuations remain the predominant method used to transport patients from forward deployed areas of operations to secure locations with more robust medical infrastructure. Transportation of chemical warfare casualties and infectious patients require additional attention to prevent cross contamination. Specific airflow characteristics paired with environmental control system settings are a gap in scholarly literature. Based on the available literature computational fluid dynamics models were created to simulate the airflow around a patient represented by human geometry using commercially available software. In order to compare simulated and experimental results a heated manikin was placed in the MURPHEE aerosol exposure chamber and …

Development Of A Semi-Quantitative Methodology For Evaluation Of Whole-Body Chemical, Biological, Radiological, And Nuclear Decontamination Using An Ultraviolet Fluorescent Aerosol, Emily M. Titus

Theses and Dissertations

This work describes a literature review which was conducted on publicly available literature on chemical, biological, radiological, and nuclear (CBRN) decontamination to understand the body of knowledge and gaps in this body of knowledge, including the assumption that disrobing after a CBRN incident will remove 90% of contamination. Also included is a description of the design and characterization of an aerosol test chamber which was constructed for use in this research. Finally, the bulk of this work describes the development of a semi-quantitative methodology for visualizing contamination. This method uses an ultraviolet fluorescent aerosol (to simulate contamination by a chemical …

Machine-Learning-Based Prediction Of Sepsis Events From Vertical Clinical Trial Data: A Naïve Approach, Tyler Michael Gaddis

Theses and Dissertations

Sepsis is a potentially life-threatening condition characterized by a dysregulated, disproportionate immune response to infection by which the afflicted body attacks its own tissues, sometimes to the point of organ failure, and in the worst cases, death. According to the Centers for Disease Control and Prevention (CDC) Sepsis is reported to kill upwards of 270,000 Americans annually, though this figure may be greater given certain ambiguities in the current accepted diagnostic framework of the disease.

This study attempted to first establish an understanding of past definitions of sepsis, and to then recommend use of machine learning as integral in an …

A Mixed Methods Evaluation Of An Intersectional Bystander Program Against Sexual Violence Using The Integrated Model Of Behavioral Prediction Within A Cluster Randomized Control Trial, Rose Hennessy

Theses and Dissertations

Background: Sexual violence is a critical public health problem that is particularly salient on college campuses. Bystander intervention is a prevention approach that teaches students who are not directly affected by a situation to take action to help others. Research is needed to understand the relationship between bystander training and changes in behavior to intervene against sexual violence, racism, and unhealthy alcohol outcomes.

Methods: A cluster randomized waitlist control trial was used to evaluate the bystander program Our School TAKES ACTION. Upper-level undergraduate students were randomized by housing floor from buildings of a private, midwestern university. Data was collected in …

Communicating About Routine Childhood Vaccines: Meta-Analysis Of Parental Attitudes, Behaviors, & Vaccine Hesitancy, Angela Victor

Theses and Dissertations

As scientific and medical communities research the next generation of vaccines, medical providers and parents observe the current routine vaccination schedules published for children today. And despite the fact protection is available from a number of preventable diseases through the use of safe, reliable, and accessible vaccines, Vaccine Hesitancy VH (delaying or refusing vaccination for reasons other than accessibility) is a growing issue. Using meta-analysis to examine existing research on communication about routine childhood vaccines, the study explores parental attitudes, behaviors, and demographics using the Protection Motivation Theory PMT. The study explores categories influencing VH such as: alternative medicine, safety, …

The Long-Term Persistence And Tissue Tropism Of Brazilian Zika Virus In Monodelphis Domestica, Marisol Morales

Theses and Dissertations

Zika virus (ZIKV) rose as a major public health concern due to the congenital abnormalities of infants born to infected mothers during the 2015 Latin American outbreak. While animal models such as transgenic mice and nonhuman primates are used to study ZIKV pathogenesis, they display various limitations. Additionally, the persistence and tissue distribution of long-term ZIKV infection remains unknown. We describe the laboratory opossum, Monodelphis domestica, as a potential new model for ZIKV pathogenesis research to address these issues. We utilized immunohistochemistry, RT-PCR, and ELISA to show that: infant animals inoculated intracerebrally were susceptible to infection, ZIKV infection persisted …

A Study Of Covid-19 Mortality Under Varying Patient Frailty, Alison N. Sifuentes

Theses and Dissertations

Modeled the spread and mortality of COVID-19 throughout the city of Chicago. By incorporating group frailty into a classic SEIR infectious disease model, we were able to differentiate the population of Chicago by their response to COVID-19. Three age groups with different COVID-19-induced death rates were examined, and the model sought to showcase the multiplicative deviation of each age group death rate from the average disease-induced death rate. This adjustment for different death rates among age groups accounted for heterogeneity within the population, and sought to introduce a more accurate manner for modeling the spread of infectious diseases.

Does Marriage, Employment And Having Children Matter? A Secondary Analysis On Physical Activity Levels, Leisure Time Physical Activity, And Social Roles Among Women In The United States, Tramaine Paul Mcmullen

Theses and Dissertations

Background: Social roles, such as being married, employed, or having children, have been shown to have independent negative relationships with moderate to vigorous physical activity (MVPA) levels among women. Increasing the number of women with children that meets physical activity guidelines is critical to reduce chronic disease and early mortality in this population. However, few studies have examined the relationship between holding multiple social roles, MVPA, and leisure-time physical activity (LTPA) among women with children. The study had two aims: 1) to determine the relationship between objectively measured MVPA by social roles and 2) to examine the frequency of specific …

Association Between Urinary Enterolignans As A Marker For Gut Microbiome Diversity And Depression In Nhanes, Marie Knoll

Theses and Dissertations

Depression is a chronic disease which inflicts functional and emotional impairment that has been a growing issue in the United States (US). Depression is the most prevalent mental disorder in the US and is the leading cause of disability in the world. By 2030, It is projected that major depressive disorder will be the second largest contributor to global burden of disease. Causes of depression are still largely unknown and treatments are often expensive, time consuming, and only available to certain populations. Treatment often requires a combination of medicines and therapy to be effective. In recent years, the gut microbiome …

Effectiveness And Experience Of An Integrated Maternal Mental Healthcare Intervention In Private Clinics And Public Health Facilities In Pakistan, Syeda Somyyah Owais

Theses and Dissertations

Maternal depression is often undetected or undertreated at the primary care level. Despite the growing high prevalence of depression among women of childbearing age, the usual primary care practice in Pakistan does not include depression screening. Two facility-based cluster randomized control trials, including a maternal depression intervention component, were conducted within two healthcare settings, private and public primary care facilities in Rawalpindi and Lahore. This study aimed to estimate the effectiveness of each trial in reducing maternal depression among mothers in the intervention arm compared to the control by analyzing the change in PHQ-9 (Patient Health Questionnaire-9) scores from baseline …

Understanding The Role Of Political Commitment And Coherence Across Sectors And Across National And Sub-National Levels In Enabling Improvements In Nutrition In Rwanda, Elyse Iruhiriye

Theses and Dissertations

Reducing undernutrition is on the political agendas of many low- and middle-income countries. There is general consensus that to improve nutritional outcomes involves actions across the different sectors that influence both the immediate and underlying determinants of optimal nutrition and an enabling environment to support the political and policy processes. Despite renewed attention over the last 15 years, addressing nutrition in a multisectoral way was previously promoted in the 1970’s but failed to have sustained political commitment due to its organizational complexities to plan and implement strategies across sectors.

We conducted an in-depth retrospective case study to understand how Rwanda, …

Using Genetic Diversity To Differentiate Mosquito Populations, Rachel Christine Malampy

Theses and Dissertations

Experiment 1: Little is known about Aedes aegypti females sharing oviposition sites. We examined four different oviposition sites in McAllen, TX. A mitochondrial gene was used to analyze the variation within the oviposition site to understand how many egg-laying females are sharing oviposition sites. These results will aid in the understanding of Aedes. aegypti oviposition behavior and contribute to more effective mosquito control techniques.

Experiment 2: Mosquito flight patterns and movement from habitat to habitat can drastically influence the spread of diseases. The anthropophilic Aedes aegypti mosquito has historically been identified as having a very limited flight range. Studies also …

Vertical Transmission And Venereal Transmission Of Zika Virus In A Population Of South Texas Aedes Aegypti, Jeremy Marshall

Theses and Dissertations

Zika virus has become a greater global public health concern from the occurrence of outbreaks in 2007 and its expansion to the Americas in 2015. The presence of Aedes aegypti in the Lower Rio Grande Valley and evidence of local transmission of Zika in Brownsville, Texas provides a need to research transmission dynamics of local populations. In these experiments, a locally acquired, laboratory colony of Aedes aegypti mosquitoes were infected with a blood meal featuring a Mexican isolate of Zika virus to display vector competency, vertical transmission, venereal transmission. Here, we infected 39 females, with 34 of them displaying evidence …

Correlates Of Maternal Health Service Use And Women’S Experiences Using Antenatal Care In Ghana: A Mixed-Methods Study, Anna Cofie

Theses and Dissertations

The pace of improvements in maternal mortality has been slow in Ghana. While Ghana’s maternal mortality ratio (MMR) decreased from 635 per 100,000 live births to 319 per 100,000 live births between 1990 and 2015, the country failed to meet the 75% reduction target set by Millennium Development Goal (MDG) goal 5A, to reduce maternal mortality ratio by 75% between 1990 and 2015. Antenatal care (ANC) is critical to improving maternal morbidity and mortality and child deaths. In 2003, Ghana introduced the National Health Insurance Scheme to ensure that all pregnant women have access to free maternal care, and in …

Aging With Hiv In The United States: Trends And Impact Of Hospital Stays On Inpatient Resource Utilization, And Costs Of Care, 2003-2015, Khairul Alam Siddiqi

Theses and Dissertations

Background:

Due to advances in Antiretroviral Therapy (ART), people living with HIV (PLWH) live longer in the United States. Aging prolongs exposure to HIV and antiretroviral drugs, which could lead to an elevated risk of developing multiple age-related comorbidities [HIV Associated Non-AIDS (HANA) conditions], earlier for PLWH. Higher comorbidity burdens among older PLWH may require greater use of inpatient care, i.e., higher hospitalization, inpatient resource utilization, and costs. This study examined the trends and characteristics of comorbidities, resource utilization, and costs of hospital stays with HIV (HSWH) compared to hospital stays without HIV (HSWOH). We also assessed trends for resource …

Intracranial Atherosclerotic Stenosis And Its Association With Inflammation And Meditarrenean Diet, Tushar Trivedi

Theses and Dissertations

Intracranial Atherosclerotic Stenosis (ICAS) is associated with 8 to 10% of all strokes in the U.S. Although there is some evidence that in the Asian population inflammation plays a role in asymptomatic ICAS, it has not been shown in the U.S. population. Prior studies have shown associations between diet and regulation of inflammation. Mediterranean dietary pattern has been associated with lower levels of inflammation and cardiovascular disease (CVD). In light of the important role of inflammation in intermediate stroke risk factors including atherosclerotic disease, and potential role of diet in modulating inflammation, understanding individuals’ diets according to their inflammatory properties …

Effectiveness Among Community Health Center Governing Boards: An Assessment Of The Different Governing Board Members’ Perspectives, Brandi L. Wright

Theses and Dissertations

Governing boards of Community Health Centers were created with the anticipation that majority of its members be patients (users) of the Community Health Center they served. This study assessed South Carolina Community Health Center governing board members’ perception and understanding of what they believe their roles and responsibilities are, and their perceived overall effectiveness. It provides a framework for understanding the governance structure of Community Health Centers, based on examining three characteristic areas (Board Function, Board Performance and Board Development) of Community Health Centers located in South Carolina.

This study invited 234 governing board members to obtain members perceptions. Key …

Examining The Organizational Capacity Of Public Libraries That Offer Obesity Prevention Programs, Olivia Whitt

Theses and Dissertations

Supplemental Nutrition Assistance Program Education (SNAP-Ed) is a federally funded grant program that helps SNAP-eligible populations make healthy choices, like those outlined by the Dietary Guidelines for Americans and the Physical Activity Guidelines for Americans. Together with implementation agencies (IAs) and local sites, SNAP-Ed provides direct nutrition education and facilitates policy, systems, and environmental strategies (PSEs) such as farmers markets and community gardens. This qualitative research investigated two specific aims: 1.) Understand the elements of organization capacity that influence a public library’s ability to implement obesity prevention programs and 2.) Evaluate the need for library staff public health knowledge …

Determinants Of Nutrition Agenda Setting In The Context Of The Double Burden Of Malnutrition In Tamil Nadu, India, Shilpa Vimalananda Constantinides

Theses and Dissertations

The double burden of malnutrition is increasing in low- and middleincome countries, with economic, social, and health consequences. Policies and programs to address malnutrition at the national and subnational levels reflect the priorities and framing of the problem by the stakeholder community. Previous studies have examined if and how nutrition-related NCDs have been included into national nutrition policy agendas that have historically focused on reduction of undernutrition, but little is known about if or how this process occurs at the subnational level where policies are translated and implemented according to local contexts, priorities, and frames of nutrition-related NCDs.

We aimed …

Contribution Of Individual, Community, And Health System Factors To Health Outcomes In Inner-City African Americans With Type 2 Diabetes, Jennifer Annette Campbell

Theses and Dissertations

Diabetes is a complex disease that represents a major public health challenge due to its high prevalence, its association with increased morbidity, and early mortality. Inner-city African Americans with diabetes suffer a disproportionate burden of disease due to both economic and social disadvantage that reaches across individual, community, and health system levels of influence. Central to the principles of Public Health is the “pursuit of health equity for the elimination of health disparities, specifically in accordance to the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all”. To …

Life Course Health Effects Of Early Life Trauma, Jennifer Mei Ping Woo

Theses and Dissertations

The experience of trauma and psychosocial stress over the life course can have lasting impacts on health. Childhood and adolescence may serve as a particularly sensitive period during which trauma may become biologically embedded and affect adult health. Evaluating the pathways through which early life trauma can affect biological mechanisms of disease development provides insight into the early origins and etiology of adverse health outcomes in adulthood and provides potential targets to help mitigate their effects.

Using data from the Sister Study, a large prospective cohort study of women residing in the U.S. or Puerto Rico aged 35 to 74 …

Infant Mortality In The United States: Socioeconomic Factors Predicting Infant Survival In Late Neo-Natal And Post Neo-Natal Infants From Birth Certificate Data, Mark Brunk-Grady

Theses and Dissertations

According to the Centers for Disease Control and Prevention, the infant mortality rate in the United States in 2018 was 5.6 deaths per 1000 live births. Infant mortality is defined as a child being born alive but dying before their first birthday. This study aimed to determine if adding socioeconomic factors to traditional predictive survival models improved the predictive power in terms of survival for late and post neonatal infants. Secondly, this study looked to develop a risk score to and predict which mothers would be classified as “High” or “Low” risk for infant death.

Data were analyzed from a …

Practical Problems And Moral Discourses: An Ethnography Of Breastfeeding, Tara Ann Gallagher

Theses and Dissertations

Universal and bioactive, breastfeeding is a burgeoning biocultural topic because it incorporates biological and social determinants of human behavior. The topic has amassed media attention framed as part of a bigger imagining of motherhood as an idealized state directed at the female body’s performance. This paper questions media and public policy’s role in the dissemination of culture and the symbolic value of breastmilk. This study examines breastfeeding discourses through the lens of an American, mostly white, Midwestern middle-class social structure. Using participant observation data of two postpartum support groups and semi-structured interviews with six primiparous mothers, my data suggests that …

Toxicological Effects Of Antimicrobials (Triclosan And Triclocarban) And Cyanopeptides (Anabaenopeptins And Cyanopeptolins) In The Nematode C. Elegans, Kade A. Lenz

Theses and Dissertations

Environmental contaminants are increasingly detected in surface water, soil, and sediment. There is a concern that environmental contaminants, such as cyanpeptides and antimicrobials pose potential harm to environmental and public health. It is important that scientists evaluate the potential impacts that cyanopeptides and antimicrobials may have on the environment and public health in order to guide stakeholders in determining appropriate policies and regulations. Here we investigated the toxicological effects of two types of commonly detected environmental contaminants, antimicrobials (triclosan and triclocarban) and cyanopeptides (anabaenopeptins and cyanopeptolins), using the model organism Caenorhabditis elegans (C. elegans). Chapter 1 introduces the model organism …