Public Health Commons^™

Association Between Snps In The Vitamin D Binding Protein, Vitamin D Status, And Aggressive Prostate Cancer By Race, Diana Diaz

Theses and Dissertations

Prostate cancer incidence and mortality have been decreasing in recent years, but it remains the most commonly diagnosed cancer among men. Racial disparities exist in prostate cancer with African Americans (AAs) having notably higher rates of incidence and mortality, lower survival rates, and are more likely to be diagnosed with a highergrade cancer compared to European Americans (EAs). Genome-wide association studies have revealed several single nucleotide polymorphisms (SNPs) within the vitamin Drelated GC gene that may be associated with prostate cancer aggressiveness. In addition to SNPs, previous research has suggested that low levels of 25-hydroxyvitamin D (25(OH)D) may be related …

The Association Of Rural Hospital Closures With In-Hospital And 30-Day Post Hospital Discharge Mortality From Emergency Care Sensitive Conditions, Melinda A. Merrell

Theses and Dissertations

Purpose

Over 100 rural hospitals have closed in the U.S. since 2010. Continuous pressures on the rural health care delivery system suggest that the trajectory of closures will continue in at least the short-term. While the causes of rural hospital closures have been described in the literature, the effects on the health outcomes of populations that experience these closures are still poorly understood. The purpose of this study was to determine associations between rural hospital closures and in-hospital and 30-day post hospital discharge mortality rates for affected residents experiencing time-sensitive emergencies in two U.S. states.

Methods

Rural hospital closures were …

Pre-Exposure Prophylaxis (Prep) For Hiv Prevention: A Mixed-Methods Study Of Sexual Risks And Knowledge, Perceptions, And Willingness Of Prep Use Among African American Women In The South, Jamie Troutman

Theses and Dissertations

There are approximately 1.1 million people living with HIV in United States, with nearly 40,000 new diagnoses annually. Significant regional and racial disparities are associated with HIV diagnoses — with the South experiencing the greatest burden of HIV and African American women accounting for 60% of new diagnoses among women. Pre-exposure prophylaxis (PrEP) has been designated as an effective tool to prevent HIV transmission among individuals who may be at risk of HIV infection. Earlier PrEP research has focused mainly on at-risk groups such as men who have sex with men (MSM). Previous PrEP research involving African American women included …

Disparities In Non-Small Cell Lung Cancer In The United States: An Examination Of Treatment, Survival, And Access To Care, Cassie Lewis Odahowski

Theses and Dissertations

Lung cancer is the leading cause of cancer-related deaths in the United States with a 5-year survival rate of only 18%. Differences in access to care and treatment utilization may play a role in observed survival disparities among rural patient populations. This dissertation aimed to examine rural disparities in all-cause and lung-cancer specific survival, time to treatment initiation, and utilization of surgical treatment among non-small cell lung cancer cases.

We utilized comprehensive cancer registry data from the Surveillance, Epidemiology, and End Results program linked with Medicare billing claims (SEER-Medicare) for non-small cell lung cancer (NSCLC) patients diagnosed between 2003-2011. We …

Effect Of Heart Rate Variability Biofeedback On Sleep, Joshua Mercadel

Theses and Dissertations

Healthy amounts of sleep is vital for normal human functions such as daily learning, memory, emotional state and cardiovascular function. Studies conducted previously have shown sleep deprivation to be associated with increases in sympathetic activity contributing to autonomic nervous system (ANS) dysregulation. HRV biofeedback (HRVB) training induces HRV coherence, a condition that maximizes HRV and facilitates autonomic and cardiorespiratory homeostasis. This randomized, controlled, intervention trial will test the hypothesis that HRVB can improve HRV coherence and increase overall sleep quality. Patients are randomized to previously established HRVB or sham protocols (n=40 each, total planned enrollment N=80). Each participant completes a …

Experience Of Persistent Pain Among Military Service Members Participating In An Interdisciplinary Intensive Outpatient Program, Barbara Katarzyna Bujak

Theses and Dissertations

Persistent pain is one of today’s most complex issues in healthcare. In the U.S. military, persistent pain affects close to half of the service members who have deployed overseas and up to 73.2% of service members and veterans experiencing persistent pain. Interdisciplinary pain management, considered one of the most effective ways to manage persistent pain, utilizes the biopsychosocial model that illustrates the dynamic interaction between the physiological, psychological and social factors involved in the experience of persistent pain. Effective interdisciplinary programs address all components of the model and result in better coping skills to self-manage persistent pain, decreased fear of …

The Association Of Cardiorespiratory Fitness With Advancing Age Among Those With And Without Type Ii Diabetes, Amber Kathlyn Watson

Theses and Dissertations

OBJECTIVE: This study examined the relationship between cardiorespiratory fitness (CRF) and age to determine if the decrease in CRF associated with advancing age is greater among those with type 2 diabetes mellitus (T2DM) as compared to those without T2DM. This study also assessed if differences in CRF between persons with T2DM and those without are consistent across CRF percentiles.

METHODS: Data from the Aerobics Center Longitudinal Study (ACLS, Dallas, Texas, 1970-2006) were utilized in the current study. CRF was measured by maximal treadmill exercise testing using the Balke protocol and T2DM status was determined by self-report of previous diagnosis by …

Disparities In Colorectal Cancer: Measuring Spatial Accessibility, Screening, And Surveillance Outcomes In South Carolina, Michele J. Josey

Theses and Dissertations

The purpose of this dissertation project is to add to the growing literature about the multi-faceted aspects of colorectal cancer (CRC) prevention and related disparities. We focused on the spatial distribution of facilities performing screening services to identify areas that underutilize colonoscopy screening. Next, we examined how the food and physical activity environment affects precursors of CRC by considering plausible pathways. Finally, we explored if access to health insurance reduced the racial disparity of receiving a timely surveillance colonoscopy after a CRC diagnosis.

We utilized the SC Ambulatory Surgery Discharge Database, an all-payer, population-based outpatient dataset with colonoscopy records from …

Social Networks, Social Support, And Contextual Factors That Affect Blood Glucose Control Among Individuals With Type 2 Diabetes Mellitus In Urban Ghana, Marian O. Botchway

Theses and Dissertations

This study used primary data from Kumasi, Ghana, to examine whether social networks, social support, diabetes-related stigma, religion, and traditional medicine affected blood glucose (HbA1c) control among adults with type 2 diabetes mellitus (T2DM). First, the study evaluated whether three social network characteristics (kin composition, household composition, and network density) were directly or indirectly (via social support) associated with HbA1c. Kin composition and household composition were significantly associated with social support. Neither network characteristics nor social support were associated with HbA1c, which suggests that social network characteristics may operate through mechanisms other than social support to affect HbA1c among study …

Role Of Heart Rate Variability Biofeedback In Cognitive Performance, Chronic Pain, And Related Symptoms, James P. Winstead

Theses and Dissertations

Over-modulation of the sympathetic nervous system and reduced heart rate variability (HRV) are commonly overlooked components of pain, poor cognition (decreased attention, recall, and cognitive processing), depression, stress, and fatigue. HRV Biofeedback (HRVB) training induces HRV coherence to balance the autonomic system. Paced breathing (~6 breaths/minute) increases HRV coherence. This randomized, controlled intervention trial tested the hypothesis that HRVB would improve HRV coherence, pain (severity, interference, and catastrophizing), cognitive performance, and reduce depressive, stress, and fatigue symptoms and pain medication use in veterans. Participants were randomized to previously established HRVB or control protocols. Each participant completed a Baseline Assessment, 6 …

Sociocultural Factors Influencing Cervical Cancer Prevention And Control Behaviors In Cusco, Peru, Venice Elizabeth Haynes

Theses and Dissertations

Cervical cancer is one of the most preventable types of cancer; however, it continues to pose significant health challenges for women in low and middle-income countries (LMICs), particularly in Peru. Studies previously conducted in Peru have examined factors associated with cervical cancer screening, screening access, availability, and geographical determinants on cervical cancer incidence and mortality. These studies have suggested the need to explore sociocultural factors and the roles of men and women in screening decisions associated with excessive cervical cancer burden and low rates of screening among Peruvian women. The goal of the dissertation research was to explore influences of …

Prevalence Trends Of Victimization Among High School Students By Race, Ethnicity, And Gender – Yrbss 2009-2017, Carlos Avalos

Theses and Dissertations

Introduction: Students who are victimized at school are more likely to report mental health, behavioral, and academic problems. Bullying and electronic bullying are types of victimization that are prevalent in US schools, with prevalence varying by race and ethnicity, gender, and age. Additionally, due to increases in bias-based harassment (such as being targeted due to race, ethnicity, or religious beliefs) in the country over the last few years, it is of interest to see how victimization behaviors in schools may have changed from 2015 to 2017.

Objective: To analyze trends of overall bullying, school bullying, electronic bullying, and other forms …

Evaluating Impacts Of A Multilevel Resilience-Based Psychosocial Intervention On Mental Health Of Children Affected By Parental Hiv In China, Yanping Jiang

Theses and Dissertations

Background: Children affected by parental HIV are commonly exposed to multiple risk factors, including parental illness and death, other traumatic life events, HIV stigma, and poverty, all of which in turn put them at elevated risk of experiencing poor mental health outcomes. Previous research has suggested the promise of psychosocial interventions in improving mental health for children affected by parental HIV through an integrated and multilevel resilience-based approach. However, there are few multilevel resilience-based interventions for this group, and the efficacy of such interventions on mental health outcomes has not been fully examined. Furthermore, very few studies have examined whether …

Exploring Breast Cancer Care Variation In Coc-Accredited Facilities, Sarah Grace Barron

Theses and Dissertations

INTRODUCTION: While improvements have been made in reducing breast cancer incidence and mortality over the past twenty years, disparities in breast cancer mortality remain. Understanding systematic differences in breast cancer treatment and quality of care remain at the epicenter of understanding breast cancer disparities. Needle biopsy is a less invasive and less expensive diagnostic test for breast cancer (as compared to excisional biopsy) and permits diagnosis while avoiding unnecessary surgery. This study was conducted to 1) examine how the National Quality Forum (NQF)-endorsed needle biopsy utilization measure varies geographically (i.e. state and region) and 2) determine the patient- and/or health …

Factors That Predict Lien Payouts, Viktoria Chudsky

Theses and Dissertations

The purpose of this research is to find ways to increase Medicaid collections in order to promote citizens’ access to government sponsored programs. This research paper is written to observe which variables increase reimbursement funds that will be reinjected into Medicaid and Public Assistance programs. The study looks at client and law firm characteristics such as the settlement amount, the client’s age, how long the case has been open in the MAESTRO system for, the client’s borough of residence, and the defending law firm’s location to identify if any of these characteristics influence the amount of recoupment. The firms’ names …

An Evaluation Of The Impact Of Leading Pedestrian Interval Signals In Nyc, Jeremy J. Sze

Theses and Dissertations

I evaluated the impact of the phased introduction of Leading Pedestrian Interval Signals (LPIs) on collision and injury outcomes at 12,987 signalized traffic intersections in New York City over the course of 25 quarters from 2012 to 2018. An intersection is treated when a LPIs is installed to give pedestrians lead time to cross the street before vehicles are allowed to move. Outcomes from NYPD’s Motor Vehicle Collisions data were matched to signalized intersections. I hypothesize that LPIs would reduce collisions and reduce injuries for pedestrians at intersections. A difference in difference fixed effects panel regression was used to identify …

Beyond The Sentimental Cliche: How Local Communities Impact Residents And Shape Public Opinion, Kate Brunk

Theses and Dissertations

The Trump administration has recently established a rule that will prohibit abortion services providers from receiving Title X funds for the non-abortion family planning services they provide. Little public opinion research has focused on family planning and reproductive health topics outside of abortion. I find statistically significant experimental evidence that increasing perceptions of local need for a local reproductive health clinic caused subjects to be more supportive of federal reproductive health funding for local clinics. I did not find statistically significant correlational evidence that objective measures of poor reproductive health at the county level influence public opinion on federal reproductive …

Expanding Immediate Postpartum Contraceptive Options: South Carolina’S Medicaid Policy, Amy Mattison-Faye

Theses and Dissertations

Offering contraceptives is essential to allow women the opportunity to plan for pregnancy and help prevent mistimed or unintended pregnancy. Intrauterine devices and implants, also known as long-acting reversible contraceptives (LARC), are the most effective methods of contraception. South Carolina Medicaid in 2012 launched an innovative policy expanding contraceptive access and coverage for women delivering in hospitals to have the option to receive a LARC immediately postpartum. However, in order for this policy to be successful, it relies on the capacity of hospitals and providers to adopt and implement without assistance. Identifying the provisions necessary in order for successful policy …

Identifying Predictors Of Racial Disparity In Treatment And Mortality Among Patients Diagnosed With Breast Cancer In South Carolina, Oluwole Adeyemi Babatunde

Theses and Dissertations

Introduction: Despite a lower incidence of breast cancer (BrCA) among Black women in the U.S. compared to White women, Black women experience consistently higher mortality rates. The aims of this study were 1) to assess the relationship between race and diagnosis-to-treatment times 2) to assess racial disparity in mortality among Black and White BrCA patients in SC and 3) assessment of the validity of the Mortality-to- incidence ration (MIR) as a proxy for survival and geospatial investigation of racial disparity among breast cancer (BrCA) patients.

Methods: Breast cancer cases diagnosed between 2002-2010 were obtained retrospectively from the SC Central Cancer …

Effect Of Severe Economic Recession On The Psychological Distress: Evidence Of Modifying Effect Of Risky Behaviors And Insurance Status, Lumi Bakos

Theses and Dissertations

The investigation identified the effect of the 2007-2009 economic recession on the level of psychological distress (PD) as modified by engaging in risky behaviors and insurance status. The objective was to determine if engaging in risky behaviors and insurance status had an impact upon the level of psychological distress experienced during a recession; the timeframe for the study is 2007 representing pre-recession to beginning of recession year, to 2009 representing the recession year, to 2012-2013 representing post-recession years. The study involved the use of a nationwide non- institutionalized adult population, the Mental Health and Stigma optional module found in the …

Factors Associated With Advance Care Plans And End-Of-Life Care Choices Among Elderly Americans: An Analysis Of Health And Retirement Study Data, Agha Ajmal

Theses and Dissertations

Introduction

Advance care plans (ACP) allow people to plan for their end-of-life care before they become incompetent to make their treatment decisions. The umbrella term Advance Care Plans (ACP) includes the three most commonly used end-of-life care plans: Advance Care Planning Discussions (ACP discussions) and two advanced directives: living will and Durable Power of Attorney for Health Care (DPAHC). The ACP discussions are the verbal discussions about end-of-life plans, whereas the advance directives are written documents.

ACPs are distinct nuances of end-of-life care planning. ACP discussions address a wide array of end-of-life care issues, including terminal care, funeral, burial and …

Adverse Birth Outcomes Among Women With Physical Disabilities: A Retrospective Cohort Study In South Carolina, Iffat Nahar

Theses and Dissertations

Motherhood is precious in women’s lives. Among women, ages 21-64, 12.5% are living with a disabling condition, according to the Disability Status report: SC 2008. Although childbearing among women with disabilities is increasing, there are limited publications about the pregnancy outcomes. The objective of this study is to document the adverse neonatal outcomes of the pregnancies and to evaluate if early prenatal care is a protective factor for low birthweight and prematurity among the women with physical disabilities. This study used a retrospective cohort study design, with data from linked hospital discharge records and vital records (birth certificates) for all …

Role Of Resources For Care In Improving Care Behaviors, Children’S Nutritional Status And Early Childhood Development In Low- And Middle-Income Countries, Sulochana Basnet

Theses and Dissertations

Poor child growth and suboptimal early childhood development are global health problems. Provision of appropriate care may help to achieve optimum child growth and development. Maternal resources for care such as education, knowledge, health, autonomy, reasonable workload, and social support may be needed to provide appropriate care behaviors, and improve children’s nutritional status, and early childhood development. The overall goal of this research was to understand the role of resources for care in improving care behaviors, child nutritional status, and early childhood development. The baseline Alive & Thrive household surveys from Bangladesh, Vietnam, and Ethiopia were used. We examined the …

Parenting And Child Self-Regulation As Mechanisms For The Relationship Of Household Food Insecurity With Child Dietary Behavior, Hoa Thi Mai Nguyen

Theses and Dissertations

Background: Food insecurity is both a nutritional problem and a stressful life experience of adults and children in households dealing with food shortage. Potential mechanisms of the associations between food insecurity and adverse outcomes in children’s health and development are through parenting and child self-regulation.

Objectives: We investigated parenting and child self-regulation as potential mechanisms for the relationship of food insecurity with child dietary behaviors with two specific aims. Specific aim 1 was to understand how food insecurity and its change over time relate to parenting in early childhood. Specific aim 2 was to understand the relationship of parenting in …

The Regulation Of Skeletal Muscle Fatigue During The Progression Of Cancer Cachexia, Brandon N. Vanderveen

Theses and Dissertations

Cachexia is the unintentional loss of body weight secondary to chronic disease and is prevalent is roughly 50% of cancer patients. The loss of body weight and skeletal muscle mass is reduced functional capacity associated with reduced life quality. The etiology of cachexia is multimodal and complex; however, cachexia has been linked to several systemic (e.g. chronic inflammation, hypogonadism, anemia, insulin resistance) and behavioral (e.g. anorexia, inactivity) changes that can compound to accelerate muscle mass and body weight loss. While several inflammatory cytokines are associated with cachexia’s disease progression, our laboratory has established that Interleukin-6 (IL-6) is a key regulator …

The Prescribing Patterns Of Gabapentin And Pregabalin In A Medicaid Population Amid The Opioid Epidemic, Sarah Sullivan

Theses and Dissertations

OBJECTIVE: Drug overdoses continue to be the leading cause of accidental death in the United States resulting in a nationwide crisis. Opioids, many of them prescription, are now the primary cause of drug overdose related deaths. Gabapentinoids are being promoted by the Centers for Disease Control and Prevention as a safer alternative to opioids and have steadily been rising in prescribing rates. However, growing concern is mounting on the potential for gabapentinoid misuse. The goal of this dissertation was to deepen the knowledge and understanding of how gabapentinoids are currently being prescribed, with an emphasis on their co-prescribing with an …

The Validity Of Microblogs As A Source For Idiopathic Pulmonary Fibrosis Patient-Reported Outcomes, Kim Tran

Theses and Dissertations

Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease which affects an estimated five million patients worldwide. Characterized by progressive respiratory failure and a median patient survival time of three to five years, this disease affects 150,000 patients in the United States (US) and results in 40,000 deaths annually. While the US mortality rate for IPF is similar to breast cancer, idiopathic pulmonary fibrosis remains characterized as a rare disease. Lack of awareness and information for lesser known diseases such as IPF can affect factors ranging from proper diagnosis to the advancement of the drug development pipeline. One platform which …

Social Emotional Learning Through Depression Education In A High School Setting, Antonette Minniti

Theses and Dissertations

Education on depression is an important part of social emotional learning. Lacking emotion regulation skills tend to lead to larger problems, such as academic struggles, disconnect from peers, strife at home and trouble in interpersonal relationships. Research in depression education or educational programs connected to mental health literacy are minimal, especially at the high school level. The purpose of this research will focus on examining the impact of one depression education program, John Hopkins Hospital’s Adolescent Depression Awareness Program (ADAP). ADAP is a three-day program that informs students about the facts of depression, how it is treated, and what to …

Project Palmms (Physical Activity Levels And Family Medical Histories): An Undergraduate Sample, Pierre Alexander Leon

Theses and Dissertations

Background: Physical inactivity has garnered significant attention as it is considered an emerging worldwide young adult problem. There is empirical evidence on predictors of low levels of physical activity (PA), such as an individual’s sex and/or socio-economic status. There are also other possible reasons for the decline in PA, such as an individual’s motivations and/or barriers for participation in physical activity and an individual’s understanding of their predisposition to chronic illnesses. This study seeks to identify perceptions of benefits/barriers to PA and motivating factors needed to increase physical activity in college populations. Methods: A survey gathering information on demographics, PA, …

Factors Associated With Hospital Readmissions Among United States Dialysis Facilities, Amber B. Paulus

Theses and Dissertations

Hospital readmissions are a major burden for patients with end stage renal disease (ESRD). On average, one in three hospital discharges among patients with ESRD are followed by a readmission within 30 days. Currently, dialysis facilities are held accountable for readmissions via the ESRD Quality Incentive Program standardized readmission ratio (SRR) clinical measure. However, little is known about facility-level factors associated with readmission. Additionally, unlike other standardized measures of quality in the dialysis setting, incident patients within their first 90-days of dialysis are included in the performance calculation. This study analyzed CMS Dialysis Facility Report data from 2013 to 2016 …