Public Health Commons^™

Nutrition Facts Label Use Among U.S. Adolescents, Jennifer Beth Mandelbaum

Theses and Dissertations

Despite the promise of Nutrition Facts label (NFL) use as a population-level intervention with broad reach, few studies have examined determinants of adolescents’ NFL use, and how this label use may be associated with nutrition behaviors. This study used data from the International Food Policy Study, an online cross-sectional survey of trends in dietary patterns and policy-relevant behaviors in the U.S. and five other countries. First, this study examined 1) whether NFL use was associated with healthy eating efforts and 2) whether there were sociodemographic differences in NFL use among U.S. adolescents. Results demonstrated that NFL use was positively associated …

Assessment Of The Quality Of Emergency Obstetric Care In Public Hospitals In Bangladesh: Evidence From The National Health Facility Assessment Survey, Kaji Korotki

Theses and Dissertations

INTRODUCTION: The quality of obstetric care is low in Bangladesh, especially at the sub-district level, and below sub-district level facilities such as union health centers and community clinics. Using nationally representative health facility assessment survey data, this study assessed the change in the quality of basic and comprehensive obstetric care in terms of human resources, equipment, and service availability at sub-district public health facilities in 2014 and 2017.

METHODS: Based on Donabedian’s model of quality of care (QoC), the quality of comprehensive delivery care was measured using an index of 9 indicators known as Signal Functions (SF), while basic obstetric …

Association Of Prior Periodontal Disease With Cancer – Exploring Epidemiologic Evidence Of Periodontal Exudate-Exposed Site Cancer Risk Versus Remote Gastrointestinal Sites, Asma Alzahrani

Theses and Dissertations

Background: Periodontal disease, a chronic bacterial infection of the gums, if untreated, causes chronic inflammation over years and eventual tooth loss. The associations between periodontal disease (measured by missing teeth) and certain sites of cancer have been established, in epidemiological studies, and attributed to systemic inflammatory impacts causing carcinogenic change over decades. Because periodontal exudates are toxic, containing locally bioactive bacteria and toxins, this study hypothesized and studied the potential higher cancer risk of anatomic sites exposed to oral exudates (exudate-exposed site cancers (EEC); head and neck, oral, pharynx, larynx, esophagus, stomach). The study studied the risk of exudate exposed …

Novel Dietary Index For Gut Microbiota And Associations With Colorectal Cancer And Breast Cancer Risk, Bezawit Eyob Kase

Theses and Dissertations

Introduction: Diet serves as a driving force for shaping the gut microbiome. Understanding how diet may modify gut microbiota and subsequently may be associated with chronic disease is critical to public health prevention efforts. Aims: We aimed to develop a novel dietary index that captures the quality of diet with respect to attaining beneficial composition and function of gut microbiota. We then examined the relationship between the dietary index and two gut microbiota-related cancers, i.e., colorectal and breast cancers.

Methods: We conducted a systematic review of studies that examined the effect of foods on gut microbiota in adult populations. Dietary …

Identifying Racial Differences In Colorectal Polyp Profile At Screening Colonoscopy Using Traditional Regression And Machine Learning Approaches, Yuqi Wu

Theses and Dissertations

Background

Colorectal cancer (CRC), the second leading cause of cancer and cancer deaths in the United States, can largely be prevented by screening the age-appropriate adult population with colonoscopy to remove precancerous lesions. However, despite the encouraging annual, population-wide decline in CRC incidence and mortality in recent decades, and widespread adoption of screening colonoscopy since 2000 (~60% population coverage rate), the Black population has consistently suffered higher CRC incidence and mortality than Whites, currently 20% and 40% respectively, little changed from the 2000 rats of 26% and 52%.

The reason for this is thought to be that the Black population …

Greenspace Across The United States: Exploring Equity And Associations With Physical Activity, Obesity, And Health-Related Quality Of Life, Ellen W. Stowe

Theses and Dissertations

Neighborhood greenspace is important for health and well-being but may not be equitably present in neighborhoods across the United States. Also, many adults are physically inactive, have obesity, and report poor health-related quality of life. Greenspace has been tied to these health conditions, but with mixed findings. The purpose of this study was to 1) use an environmental justice perspective to examine variations in 11 measures of greenspace by neighborhood race/ethnicity, income, and rurality in block groups across the contiguous United States and 2) examine 11 greenspace measures in connection to physical activity, obesity, and health-related quality of life in …

Could Cultures Determine The Course Of Epidemics And Explain Waves Of Covid-19?, Md Salman Rahman

Theses and Dissertations

Coronavirus Disease (COVID-19), caused by the SARS-CoV-2 virus, is an infectious disease that quickly became a pandemic spreading with different patterns in each country. Travel bans, lockdowns, social distancing, and non-essential business closures caused significant economic disruptions and stalled growth worldwide in the pandemic’s first year. In almost every country, public health officials forced and/or encouraged Nonpharmaceutical Interventions (NPIs) such as contact tracing, social distancing, masks, and quarantine. Human behavioral decision-making regarding social isolation significantly impedes global success in containing the pandemic. This thesis focuses on human behaviors and cultures related to the decision-making of social isolation during the pandemic. …

Association Between Postpartum Weight Retention And The Dietary Inflammatory Index, Nyrobi Tyson

Theses and Dissertations

Objective: The objective of this thesis is to examine the relationship between the Dietary Inflammatory Index (DII), measured during the postpartum period, and postpartum weight retention.

Setting and Participants: We used the Infant Feeding Practices Study (IFPS) II (n=5000), a longitudinal study of women from late pregnancy through their infant’s first year of life conducted between 2005 and 2007. Survey topics included feeding practices, infant health, food allergies, sleeping arrangements, mother’s employment, childcare, and mother’s dietary intake.

Main Outcomes: Postpartum weight retention (PPWR) was calculated in kilograms by subtracting self-reported body weight at 3, 6, 9, and 12 months postpartum …

Rural-Urban Differences In Survival Among People With Early Onset Colorectal Cancer, Radhika Ranganathan

Theses and Dissertations

Colorectal cancer (CRC) is the third most common cancer and the second most among cancer deaths both in the US and globally. Early Onset Colorectal Cancer (EOCRC), occurring between the ages of 20 and 49, has continued to rise over the past decades. Several studies have reported a persistent increase in EOCRC incidence and mortality, especially in rural areas as compared to urban areas, despite decreases in rates for people over the age of 50 years. Increase in EOCRC may have played a role in lowering the age of screening recommendation to 45-49 age group. The objective of this study …

Hiv-Related Stigma, Sexual And Gender Minority-Related Stigma, And Health Outcomes Among Msm Living With Hiv: Measurement, Impact, And Intersectionality, Tianyue Mi

Theses and Dissertations

Background: Many men who have sex with men (MSM) living with human immunodeficiency virus (HIV) experience suboptimal health outcomes compared to nonMSM males living with HIV, including a faster decline in CD4 count before initiating antiretroviral therapy (ART), slower immune recovery after initiating ART, more mental health problems, suboptimal ART adherence, and lower retention in care. MSM living with HIV are often exposed to multiple layered stigmas, including, but not limited to, stigma related to being infected with HIV and stigma related to sexual and gender minority (SGM) status. Although various scales of HIV-related stigma have been frequently used for …

Unearthing An Emerging Neglected Bacterial Disease: Evidence Of Spotted Fever Group Rickettsioses In El Salvador, Kyndall Christian Braumuller

Theses and Dissertations

The main objectives of this dissertation were to investigate the seroprevalence of Spotted Fever Group Rickettsioses (SFGR) antibodies in a specific vulnerable population at high risk for vector-borne disease in El Salvador, understand the relevant risk factors for SFGR past and acute infection in this same population through logistic regression modeling, and clarify the presence of SFGR bacteria in locally collected ticks.

SFGR are a group of bacterial diseases caused by species in the Rickettsia genus of the phylogenetic spotted fever group. These are tick-borne diseases (TBD) that have been described in almost every region of the world. SFGR are …

Trajectories, Prevention Strategies, And Health Impacts Of Perinatal Depression, Sabrina Karim

Theses and Dissertations

Background

Perinatal depression is one of the most common and underdiagnosed obstetric complications. Extant research on perinatal depression is mostly focused on white women and women who are not at risk for depression. Little is known about the trajectories, prevention strategies and adverse outcomes of perinatal depression among high-risk populations, for example, women with overweight and obesity or women of color or low socioeconomic status.

Purpose

Our study examined the longitudinal trajectories of perinatal depression, effect of a behavioral lifestyle intervention on perinatal depression and association between prenatal physical activity and perinatal depression among women with overweight and obesity. We …

Subject Cognitive Decline In Informal Caregivers, Eunika Simons

Theses and Dissertations

Purpose. The United States is experiencing unprecedented demographic shifts as the population continues to age. More than 53 million Americans are caregivers and that number is continuing to grow. Caregiving has become a significant societal and public health issue to be addressed. This study provided a population-based national perspective regarding informal caregivers to identify differences between caregivers reporting cognitive decline and those caregivers reporting no cognitive decline. The analysis explored the relationships between the type and characteristics of informal caregivers, the nature of the caregiving relationship, caregiver unmet needs, and the general, physical, and mental health-related outcomes of the caregivers. …

Food Insecurity Resilience Of Refugee Families In The United States: A Qualitative Study, Maryam Suliman Alhabas

Theses and Dissertations

Refugee families living in the United States often encounter a number of challenges while trying to build a new home and maintain their household food security. Refugee families at high risk of experiencing food insecurity in the resettlement country. Food insecurity among US refugee families is a major public health concern as it adversely impacts their health and wellbeing, since it affects dietary intake and mental health and associated with illness, poor nutrition, and obesity. Little is known about what happens when refugee families face food insecurity experience, and the role of their social contexts in that experience. The objective …

Living With Ulcerative Colitis: Exploring Dietary Inflammatory Intake, Physical Activity, And Methods To Manage The Burden Of Illness, Kelli E. Dubois

Theses and Dissertations

Ulcerative Colitis (UC) is a chronic illness under the umbrella of Inflammatory Bowel Disease (IBD). IBD is becoming a global health issue as incidence rates are rising throughout the world. UC is characterized by chronic inflammation and ulcerations in the colon’s mucosal lining due to abnormal inflammatory and immune system responses. Patients with UC experience a range of gastrointestinal and extraintestinal symptoms as well as psychosocial challenges throughout the course of illness that generate a significant burden on daily life. Periods of active disease, or flares, present exacerbations of disease symptoms and the greatest burden on daily functioning, yet disease …

Using Geospatial Analysis To Evaluate Relationships Between Cancer Incidence And Social Factors In Brooklyn, Ny, Sheena Philogene

Theses and Dissertations

This study explored the spatial distribution of cancer incidence in Brooklyn, NY. Using publicly available data, the relationships between cancer incidence and factors linked to cancer were investigated. Furthermore, the study explored the value of using large amounts of data with GIS techniques to quickly analyze geographic trends for cancer.

An Application Of Matrices To The Spread Of The Covid 19, Selena Suarez

Theses and Dissertations

We represented a restaurant seating arrangement using matrices by using 0 entry for someone without covid and 1 entry for someone with covid. Using the matrices we found the best seating arrangements to lessen the spread of covid. We also investigated if there was a factor needed to create a formula that could calculate the matrix that shows who would be affected with covid with each seating arrangement. However, there did not seem to be a clear pattern within the factors. Aside from covid applications, we also investigated the symmetries in seating arrangements and the possible combinations with these arrangements …

Parenthood Orientation Among Young Women: Is It Associated With Pregnancy Intention And Unprotected Intercourse?, Nakeisha Blades

Theses and Dissertations

This study explored relationships between parenthood orientation, pregnancy intention, and unprotected intercourse. Nulligravid, sexually active women aged 18-29 (N = 252) were surveyed on these topics in May 2019. There were significant differences in parenthood orientation by past and current pregnancy intention. Higher scores on parenthood orientation were associated with increased odds of past unprotected intercourse and expecting future unprotected intercourse. Only education and contraceptive self-efficacy retained significance in adjusted models. Study results are consistent with prior work on parenthood orientation and pregnancy intention and point to other factors as stronger correlates of contraceptive use.

Exploration Of The Role Of Neighborhood Residential Segregation By Race And Ethnicity In Obesity Risk Among School-Aged, Melissa L. Fair

Theses and Dissertations

Youth obesity prevalence remains high, despite decades of intervention. Grounded in the social ecological model, neighborhoods and schools are important settings in addressing the complex systems that influence obesity. Contributing to disparities, by race/ethnicity, Black and Hispanic youth are more likely to live in segregated neighborhoods and attend segregated schools, which are also more likely to have high rates of poverty and are less likely to have high quality nutrition and built environments. Leveraging data from local school district (district and state department of education) and national datasets (ACS, Childhood Opportunity Index 2.0), this study examined the associations between school …

Homestead Vegetable And Poultry Production And Related Practices: An Assessment In Nepal, Shiva Bhandari

Theses and Dissertations

Consumption of nutrients-rich foods like diverse vegetables, eggs, and meat throughout a year remains a challenge in low- and middle-income countries due to poor availability, accessibility, and affordability. One important way to overcome the challenge is to promote households’ own production of these foods and encourage individuals to consume. Improving household production of the foods necessitates understanding whether active participation and performance of frontline workers in the communities and performing improved production-related practices can translate into improved production of nutrients-rich foods. This study had two specific aims. The first aim was to examine demographic, socio-economic, and programmatic determinants of active …

Perspectives About Food Safety In Diverse Low- And Middle-Income Countries, Sejla Isanovic

Theses and Dissertations

Concerns about unsafe food influence food choice, and consumption of unsafe foods increases morbidity and mortality, particularly in low- and middle-income countries. Actions to ensure safety of food are dominated by mitigation of biological and chemical hazards through supply-side risk management, disregarding individuals’ experiences and perspectives of food safety. We aimed to identify and categorize perspectives about food safety in five countries. Five Drivers of Food Choice projects provided transcripts from 17 focus groups discussions and 303 interviews in Kenya, Ghana, India, Guinea, and Vietnam. We analyzed transcripts using a priori and emergent codes. Individuals constructed meaning about food safety …

Gonorrhea: Core Areas And State Policies, Jessica Purser

Theses and Dissertations

This research looked at gonorrhea rates both from a community perspective and at the state level. Using hot spot analysis, means differences, and quantile regression, we found that education, specifically the percent of people over the age of 25 with less than a high school education, was the dominant factor at the state level while core areas of gonorrhea exist in the PeeDee and western Lowcountry regions of South Carolina in 2017 and 2018. Risky sexual behaviors are well-defined in the literature for individual persons, but this shows that looking at societal and community factors is important.

This is a …

The Impact Of Cannabis And Alcohol Use On The Management Of Type 1 Diabetes Mellitus, Joshua Eric Sellner

Theses and Dissertations

This dissertation sought to contribute to the evidence-base of diabetes management and acute complications associated with alcohol and cannabis use among individuals with Type 1 Diabetes (T1DM). Three interconnected studies were initiated to complete this goal. First, existing literature surrounding the potential consequences of cannabis consumption among individuals with T1DM were summarized within a systematic review. Study results were combined to provide a single measure of association through a meta-analysis. Second, identified associations were further investigated through a cross-sectional study using the SEARCH for Diabetes in Youth data on alcohol and cannabis use on diabetes management and acute complications including …

Associations Of The Fto Gene And Risk Of Acute Myeloid Leukemia, Avery Ulrich

Theses and Dissertations

Background Acute Myeloid Leukemia (AML) is a blood cancer that affects ~70,000 people each year in the US. The Fat Mass and Obesity (FTO) gene on chromosome 16 has been reported to be associated with obesity, solid tumor cancers (lung, renal, breast, prostate, pancreatic, endometrial), and more recently with hematologic malignancies, like AML. In this thesis, we test the hypothesis that inherited variants within the FTO gene are associated with an increased risk of AML. Methods Using the DISCOVeRY-BMT (Determining the Influence of Susceptibility COnveying Variants Related to one-Year mortality after Blood and Marrow Transplantation), a well-powered genome-wide association study …

Longitudinal Relation Of Dietary Quality And Hemoglobin A1c In Youth And Young Adults With Diabetes, Hope Bercaw

Theses and Dissertations

Background Hemoglobin A1c (HbA1c) is a clinical measure of glycemic control among people with diabetes and is associated with health outcomes such as cardiovascular disease. It is possible to decrease HbA1c by improving diet, but it is largely unknown which dietary components are most important in targeting glycemic control.

Objective This study aims to examine whether changes in diet quality across diabetes duration, assessed with the 2015-Healthy Eating Index (HEI), are associated with HbA1c in youth and young adults (YYA) with type 1 (T1D) and type 2 diabetes (T2D). Additionally, we aim to assess whether these relationships differ when dietary …

Evaluating The Military Medical Evacuation Dispatching And Delivery Problem Via Simulation And Self-Exciting Hawkes Process, Virbon B. Frial

Theses and Dissertations

The location, allocation, and utilization of military medical evacuation (MEDEVAC) resources significantly impact the quality and timeliness of medical care to injured troops. In 2009, Secretary of Defense Robert Gates introduced the Golden Hour mandate that entails the evacuation of critically-injured troops to military treatment facilities (MTFs) within an hour to prevent further complications. To develop high-quality policies that improve MEDEVAC system performance, several papers in the current literature assume that MTFs have both the capacity and capability of treating any patient, regardless of the type of injury. However, these assumptions are unrealistic when conducting high-intensity operations. While acknowledging MTF …

Effect Of Covid-19 On The Wellbeing Of Healthcare Professionals In Public Isolation Hospitals In Egypt, Shaimaa Sabbah

Theses and Dissertations

One of the most vulnerable groups severely hit by the COVID-19 pandemic has been the Healthcare Professionals (HCPs), especially the physicians, pharmacists, and nurses who work in public Isolation hospitals. The Egyptian medical syndicate declared the death of more than 600 physicians from February 2020 till January 2022. In the meantime, the Egyptian government has worked on different policies for relieving the negative effects of the pandemic on this vulnerable group; however, easing restrictions, no total lockdown implementation, and monitoring bureaucracy has negatively affected the wellbeing of those HCPs. The study aims to figure out recommended policies to protect HCPs’ …

Exploring Predictors In The Receipt Of Patient/Family-Centered Care, Arami Anwell

Theses and Dissertations

Study 1

OBJECTIVES: The research aim of this study was to identify predictors associated with the receipt of PFCC among U.S. children/families

METHODS: Caregivers of 38,803 non-institutionalized children, aged 0 to 17 years, were surveyed by the National Survey of Children’s Health (NSCH) 2018–20019. Patient/family-centered care (PFCC) was measured using five components of health care delivery that were answered on a 4-point Likert scale. Logistic regression models were analyzed for the overall receipt of PFCC and each component of PFCC, with survey weighting added to adjust for complex sampling design.

RESULTS: Many predictors were associated with the receipt of PFCC. …

Using Difference-In-Difference To Assess The Impact Of Medicaid Policy On The Addiction Treatment Provider Workforce And Prescribing Behavior In Virginia, Erin Britton

Theses and Dissertations

This dissertation is unified by both policy opportunity and estimation method, examining the impact of Medicaid behavioral health policy in Virginia using a difference-in-differences framework. Medicaid-covered substance use disorder (SUD) treatment benefits in Virginia were significantly enhanced through a Section 1115 SUD waiver, which are required to be budget neutral. Therefore, it is critical to understand whether the objectives of the waiver are met using reliable, unbiased estimation methods. This dissertation includes two empirical research projects evaluating the impact of Medicaid policy on removing barriers in access to care and one methodological project comparing the performance of alternate approaches to …

A Technology-Based, Mixed Methods Approach To Examining The Psychosocial Determinants Of Maternal Health Disparities, Hannah M. Ming

Theses and Dissertations

Background: Exposure to racism and discrimination in the U.S. increases Black women’s risk for experiencing maternal health disparities. Additionally, racism and discrimination affect maternal psychosocial well-being, creating evidence for a biopsychosocial relationship between racism and maternal health outcomes. However, current research does not define the psychosocial Black maternal self well. Given the dynamic relationship between racism, psychosocial well-being, and Black maternal health outcomes, research must comprehensively examine the Black maternal self. The operationalization of a comprehensive construct for Black maternal psychosocial well-being can improve understanding of the relationship between racism, psychosocial well-being, and Black maternal health outcomes.

Purpose: …