Public Health Commons^™

A Comparison Of Quality Indicators Between Medicare Accountable Care Organizations And Health Maintenance Organizations Using Publicly Available Data, William W. Campbell Iii

Theses and Dissertations

The purpose of this study is to explore differences in quality between Medicare Accountable Care Organizations (ACO) and Health Maintenance Organizations (HMO). Three outcomes measures reported by these plans use different methodologies but possess enough alignment to permit comparison: percent of diabetic patients with last HbA1c > 9.0%, colon cancer screening rate and ER visits per 1,000. These outcomes are the dependent variables (DV). A secondary purpose is to explore differences in quality based on the size of the beneficiary population served, using the same measures.

As the Medicare program faces threats to its solvency in coming decades, with 10,000 baby …

The Influence Of Clinically Meaningful Factors On The Performance Of The Recommended Annual Diabetic Foot Screening, Trisha A. Sando

Theses and Dissertations

Background: Diabetic foot ulcers are the result of multiple complications from hyperglycemia and lead to poor quality of life and high healthcare costs. The annual diabetes foot screening exam (ADFSE) and prevention interventions can reduce DFUs up to 75%. In 2015, 71% of the US population received the ADFSE.

Objectives: The main objectives of this dissertation were: 1) to determine the association between adherence to diabetes self-management behaviors and the ADFSE, 2) to determine the association between concordant and discordant comorbidities and the ADFSE and 3) to determine the association between the performance of diabetes preventive care processes, number of …

Queer Health Equity And Cervical Cancer: Identifying Social Determinants Of Papanicolaou Test Uptake In A Sample Of Sexual Minority Women And Gender Nonbinary Individuals, Ariella R. Tabaac

Theses and Dissertations

Sexual minority women (SMW) demonstrate lower rates of cervical cancer screening than heterosexual women. This is concerning as lesbian and bisexual women tend to engage in higher rates of substance-related cancer risk behaviors, unprotected sex, and tend to have higher body mass indices, all of which are risk factors for cancer development. Another major risk factor, screening avoidance, places SMW at increased risk for the development of high grade cervical lesions in the absence of early detection practices, which is likely to impact overall cervical cancer morbidity in this population. The aim of the present study was to utilize the …

Communicating Consent: An Investigation Of Predictors Of College Student Sexual Consent Communication, Erin L. Link

Theses and Dissertations

Often, sexual consent is only discussed and explored in the context of sexual assault. While consent is often the deciding factor to determine if a crime occurred, consent is also a vital part of an equally enjoyable sexual encounter. The present study examines a variety of variables effects on consent attitudes, norms, and communication behaviors to attempt to identify predictors of college student consent communication. Findings and recommendations are discussed that highlight the necessity of viewing consent as a communicative act.

Utilization Of Lung Cancer Screening And Molecular Testing To Improve Lung Cancer Outcomes, Jennifer Lynne Ersek

Theses and Dissertations

Despite progress in detection and treatment, lung cancer remains the leading cause of cancer-related death in the United States. The United States Preventive Services Task Force (USPSTF) recommends adults at high risk for lung cancer undergo annual low-dose computed tomography (LDCT) screening, however, lung cancer screening (LCS) uptake remains low. Qualitative research on family physician (FP) perceptions and experiences with LCS has been limited since USPSTF publication and Centers for Medicare and Medicaid Services (CMS) decision memo. We conducted a qualitative study to assess FP knowledge and perceptions of LCS and gain insight into their current experiences with LDCT. A …

Characterization Of Jet Fuel Combustion Emissions During A C-130 Aeromedical Evacuation Engines Running Onload, Michelle L. Page

Theses and Dissertations

The purpose of this research was to characterize jet fuel combustion emissions (JFCE) in an occupational setting. Prior research demonstrated that aircraft emit hazardous species, especially at engine start-up and ground idle. Complaints of eye, nose, and throat irritation from occupational exposures near aircraft exist. In this study JFCE were tested during an aeromedical evacuation engines running patient onload (ERO) on a C-130 Hercules at the 179^th Airlift Wing, Mansfield-Lahm Air National Guard. Ultrafine particles, VOC, formaldehyde, carbon monoxide (CO), sulfuric acid, and metals were sampled simultaneously in approximate crew and patient breathing zones. Testing methods were portable condensation …

The Effect Of Paid Sick Leave On Physician Office-Based Visits, Korvin Vicente

Theses and Dissertations

This paper uses a balanced sample of workers from cross-sections of the National Health Interview Survey to estimate the causal effects of paid sick leave on the medical care seeking behavior of individuals, as measured by physician office-based visits.

Impact Of Sexual Violence Prevention Programming At Rowan University, Emily Kofman

Theses and Dissertations

The primary purpose of this study was to explore the impact of sexual violence prevention programming on the main Rowan University campus. This study focused primarily on the Take Back the Night event on April 4, 2017. The study evaluated the impact of the event on those who attended as well as looking at Social Norm Theory. A total population of 167 Rowan students were surveyed at the event with the instrument Take Back the Night Survey. Results of the data revealed that students positively benefitted from attending the event and were able to increase their knowledge of the subject. …

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

Theses and Dissertations

Introduction

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

Optimal Configurations For Aerosol Monitoring With Multi-Rotor Small Unmanned Aerial Systems, Inna D. Chavez

Theses and Dissertations

Applicability of aerosol sampling on multi-rotor unmanned aerial systems (UAS) platform was investigated. Multi-rotor UAS have impacts of wind speed, turbulence, and orientation possibly contributing to sampling bias. The SKC IMPACT sampler, Tecora C.A.Th.I.A., and modified three-dimensionally printed Universal Inlet for Airborne-Particle Size-Selective Sampling were selected based on particle size-selectivity and operational independence to wind. Airflow visualizations concluded that below UAS fuselage was optimal sampler placement. Tests were conducted with Arizona Road Dust in a still-air chamber, and aerosolized sugar in a wind tunnel. Inlet mounting was evaluated in, upright, upside-down, and horizontal orientations. Horizontal orientations of all inlets resulted …

Establishing Sustainable Community Garden Interventions With Aid From Health Promotion Organizations, Rachel Joann Buenemann

Theses and Dissertations

Community garden interventions provide policy, system and environmental change at the community level to establish health behaviors, which act in contest to obesity risk factors. Limited research examines factors, which influence the sustainability of community garden interventions. Therefore, in this study, a sample of 10 Midwestern community gardens associated through funding from a health promotion organization in 2013, collected data through the interviewing and surveying of 10 garden administrators and surveying of 12 garden volunteers. The study identified garden benefits perceived by garden administrators and volunteers to include contributions to social justice, continued education, enhanced social cohesion, increased access to …

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

Theses and Dissertations

Purpose

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

Methods

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

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

Theses and Dissertations

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

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

Theses and Dissertations

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

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

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

Theses and Dissertations

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

Methods: A total of 101,449 and …

Designing Effective Messages To Promote Future Zika Vaccine Uptake, Jeanine Guidry

Theses and Dissertations

The Zika virus is associated with the devastating birth defect microcephaly, and while a vaccine was not yet available in early-2017, several were under development. It is imperative to identify effective communication strategies to promote uptake of a new vaccine, particularly among women of reproductive age. Moreover, though the Zika outbreak has received much social media attention, little is known about these conversations on Instagram. The purpose of this dissertation, therefore, was to understand current Zika-focused communication on Instagram and to inform effective communication strategies to promote future Zika vaccine uptake intent.

The study aims were: (1) explore Zika conversations …

Depressive Symptoms Among College Students: An Exploration Of Fundamental Cause Theory, Peter A. Carrico

Theses and Dissertations

Fundamental Cause Theory suggests that socioeconomic and demographic factors are causal to various illnesses, including depression. However, no known previously existing research has used Fundamental Cause Theory to create a model of depression among college students. To do this, the present study conducted a stepwise binomial logistic regression to examine how socioeconomic status and the sociodemographic variables of Gender, Race, and Sexual Orientation, and others predict depressive symptoms in a large sample of undergraduates when controlling for stressful life events and social support (N = 2,915). Results support the hypothesis that socioeconomic disparities in depressive symptoms are the result …

Internet-Based Behavior Of It Professionals: Implications For Online Ergonomic Education To Prevent Work-Related Musculoskeletal Disorders, Priyadarshini Pattath

Theses and Dissertations

INTERNET-BASED BEHAVIOR OF IT PROFESSIONALS: IMPLICATIONS FOR ONLINE ERGONOMIC EDUCATION TO PREVENT WORK-RELATED MUSCULOSKELETAL DISORDERS

By Priyadarshini Pattath, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University, 2017 Director: Dr. Robin Hurst, Assistant Professor of Adult Learning, Teaching and Learning,

School of Education

The purpose of this study was to explore the preferences of medium of ergonomic education and views about self-directed online training modules to prevent musculoskeletal disorders in computer professionals and understand their perspectives and experiences about online health information seeking using a …

Health Aid In Africa: Placement, Service Utilization, And Benefit, Carrie Dolan

Theses and Dissertations

While the health sector has attracted significant foreign aid, evidence on the effectiveness of this support is mixed. This dissertation examines the allocation of health aid within the context of placement, service utilization, and benefit. The first paper examined the sub-national allocation of Chinese development aid projects across Africa. I determined how political preferencing of Chinese aid specifically, allocating aid to the birth region of the current political leader differs across sectors such as health, education, and transportation. I find some evidence that aid, more broadly defined, is subject to political preferencing in recipient countries, which could potentially limit its …

An Algorithm To Improve Deformable Image Registration Accuracy In Challenging Cases Of Locally-Advanced Non-Small Cell Lung Cancer, Christopher L. Guy

Theses and Dissertations

A common co-pathology of large lung tumors located near the central airways is collapse of portions of lung due to blockage of airflow by the tumor. Not only does the lung volume decrease as collapse occurs, but fluid from capillaries also fills the space no longer occupied by air, greatly altering tissue appearance. During radiotherapy, typically administered to the patient over multiple weeks, the tumor can dramatically shrink in response to the treatment, restoring airflow to the lung sections which were collapsed when therapy began. While return of normal lung function is a positive development, the change in anatomy presents …

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

Theses and Dissertations

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

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

Theses and Dissertations

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

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

Theses and Dissertations

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

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

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

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

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

Theses and Dissertations

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

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

Theses and Dissertations

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

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

Theses and Dissertations

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

A Possible Mechanism For Leptin’S Role In Lung Function Independent Of Body Mass Index: Investigating Leptin’S Genotype, Dna, Methylation, And Serum Protein Levels, Mitra Yousefi

Theses and Dissertations

Background: Leptin, initially believed to simply be a satiety hormone responsible for obesity, is now recognized as a pleiotropic cytokine that is involved in many biological processes; including the body’s host inflammatory response. Clinically, leptin may affect lung function although research in this area is limited. It is also known that the leptin receptor is necessary for the activation of the leptin protein, making it an important protein to consider. Furthermore, single nucleotide polymorphisms (SNPs) and DNA methylations of the leptin and leptin receptor genes (LEP and LEPR respectively) may provide important insight on the relationship that leptin has …

“An Uphill Battle”: Psychosocial Health And Self-Care Among Advocates Who Work Against Gender-Based Violence In South Carolina, Ebru Cayir

Theses and Dissertations

Gender-based violence (GBV) is one of the most pressing public health and human rights issues in the United States overall, and more specifically, in South Carolina (SC). SC consistently ranked among the highest in the nation in terms of female homicide rates. Non-profit organizations (NPOs) that focus their work specifically on GBV constitute an essential component of prevention and mitigation efforts in SC. Advocates who work for GBV-specific NPOs experience a wide range of psychosocial health and well-being benefits and risks due to their work. This study aimed to: 1) Identify the relationships between engaging in paid GBV-specific advocacy and …

Involvement Of Men In Responsible Parenthood In Croatia, India, And Mexico: Major Factors, Correlates, And National Policy, Salima Kasymova

Theses and Dissertations

For this research I explored the association between men's gender attitudes and their endorsement of paternity leave policies as a way to begin to understand the determinants of men’s support of paternity leave policies. In addition, in order to understand factors that influencing paternal involvement, I examined the association between men’s gender attitudes and their actual involvement in caregiving among a sub-sample of fathers. I also explored whether men's leave-taking when their child was born mediated the association between their gender attitudes and involvement in child care. Considering the importance of national policy documents for promotion men’s participation in childcare, …

Analysis Of Food Exposures In Foodborne Disease Outbreaks, Alecia T. Alianell

Theses and Dissertations

Foodborne illness remains a serious public health problem in the United States in general as well as South Carolina in particular. Obtaining good food ingestion histories as well as possible risky environmental exposures is one of the earliest, most important tasks to complete in any foodborne outbreak investigations. Because time is of the essence in investigations, we have evaluated a rarely used biostatistical method, Random Forests, to data obtained from DHEC. Random Forests has the potential to facilitate more rapid identification of foods or environmental exposures that may be associated with outbreaks. We also examined previous cases of salmonellosis using …