Public Health Commons^™

Low-Intensity Physical Activity And Cardiometabolic Risk Factors Among Older Adults With Multiple Chronic Conditions, Yueyao Li

Theses and Dissertations

Introduction:

Cardiovascular disease (CVD) is the leading cause of death among older adults in the Unites States and is driven largely by cardiometabolic risk factors including elevated blood pressure and blood glucose. Studies have found the protective effect of moderate intensity physical activity (MIPA) and vigorous intensity physical activity (VIPA) on cardiometabolic risk factor; however, the association between light physical activity (LIPA) and cardiometabolic risk factor among older adults is not clear.

Objectives:

1. Examine the association between LIPA and cardiometabolic risk factors.
2. Examine whether the association between LIPA and cardiometabolic risk factor is moderated by multiple chronic conditions. …

Examining Infant Health Outcomes Impacted By South Carolina's Regionalized System Of Perinatal Care, Michael Grady Smith

Theses and Dissertations

Perinatal regionalization systems have been shown to reduce the risk of neonatal mortality when very low birth weight infants are delivered in Level III hospitals with neonatal intensive care units, sub-specialist staffing, and adequate experience caring for high-risk pregnancies and neonates. However, studies to date examining the association between delivery in Level III hospitals and neonatal mortality have not accounted for censoring due to fetal deaths. Furthermore, studies of perinatal regionalization to date have not adequately assessed the association between delivery hospital level of care and the infant’s hospital length of stay. This dissertation examined 8,594 very low birth weight …

Conversations About Sexuality On A Public University Campus: Exploring Perspectives From Campus Ministry Leaders And Students, Charis Rebecca Davidson

Theses and Dissertations

Since the 1800s, religious organizations have been a presence on public universities. However, there is limited research on the influence these organizations may have on student health communication and behaviors. Prior research on campus ministries has focused primarily on the culture of individual organizations. In this study, researchers explored the goals and experiences of USC leaders related to communication around sexuality with their students, as well as student perceptions of these messages, and how students incorporate religious messages about sexuality into their lives. The present study had four aims:

1. Assess whether students participating in campus ministries at USC differ …

Variation In Restaurant Sanitary Scores In New York City, Kyle Gregory

Theses and Dissertations

The purpose of this study was to determine whether restaurants that are homogenous in nature would exhibit substantially different hygiene scores based on the underlying consumer learning behaviors present in the neighborhoods in which the restaurants are located.

Beyond The Millennium Development Goals: An Evaluation Of The War On Hiv / Aids In Kenya, Robert G. Nyaga

Theses and Dissertations

HIV/AIDS remains a threat to Kenya and other developing nations. This thesis aimed at assessing the HIV/AIDS situation in Kenya by examining the knowledge of Kenyans towards infection and spread HIV/AIDS, attitudes towards people living with HIV/AIDS, involvement of community opinion leaders in the HIV/AIDS campaigns, sharing of HIV/AIDS information, and government efforts to control HIV/AIDS. A sample of Kenyans (N= 103) was surveyed and asked to respond to several scales assessing each of the above items. Quantitative and qualitative methods reveal the knowledge and attitudes portrayed by Kenyans and show that, although much has been achieved, there is need …

Using Artificial Neural Networks To Predict Disease Associations For Chemicals Present In Burn Pit Emissions, Amanda R. Taylor

Theses and Dissertations

In June of 2015, 27,378 of the 28,000 returning Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans report being exposed to burn pits. According to Barth et al. (2014), 9,660 returning OIF/OEF veterans were diagnosed with respiratory diseases, to include asthma, bronchitis, and sinusitis, thus strengthening the need to develop decision support tools that can be used to understand the relationships between chemical exposure and disease. In this study an Artificial Neural Network (ANN) was used to predict the chemical-disease associations for burn pit constituents. Ten burn pit constituents were tested using varying hidden layers, similar chemical structure relationships, and three …

Neck Injury Criteria Development For Use In System Level Ejection Testing; Characterization Of Atd To Human Response Correlation Under -Gx Accelerative Input, Craig M. Zinck

Theses and Dissertations

The use of Helmet Mounted Displays is ubiquitous in the field of aviation, adding operational capability, increasing head-supported weight and potential neck injury risk. Developing neck injury criteria to evaluate and quantify neck injury is important to ensure ejection systems are produced within acceptable standards. An ATD to human transfer function is developed that quantifies the difference between ATD and human neck response from -Gx accelerative tests, and demonstrates how this function can be applied to ATD test data to make previously developed human risk functions directly applicable to interpreting ATD data with a human based neck injury criterion. A …

Examining The Relationship Among Patient-Centered Communication, Patient Engagement, And Patient’S Perception Of Quality Of Care In The General U.S. Adult Population, Jumee Wang

Theses and Dissertations

Introduction: Patient-centered care is a major focus of healthcare organizations, policy makers, and researchers. Patient-centered communication by the provider and patient engagement are important components of patient-centered care. Despite increasing attention to these topics, we do not fully understand how patient-centered communication and patient engagement relate to perceived quality of care as reported by patients. This study takes some initial steps in exploring these relationships. The study also identifies patient-related factors such as sociodemographic, health-related, and health system factors that are associated with patient-centered communication, patient engagement, and perceived quality of care.

Method: This study used survey data …

Influence Of Thyroid Disorders On Pregnancy Outcomes, Brittany Sullivan

Theses and Dissertations

Objective: The objective of this thesis is to investigate the effects of maternal thyroid dysfunction on maternal pregnancy outcomes.

Setting and Participants: The NICHD Consecutive Pregnancy data set contains information on a total of 114,679 pregnancies from 51,086 women who delivered ≥ 20 weeks of gestation. The data come from 20 different hospitals throughout the state of Utah and were collected between the years of 2002 to 2010.

Main Outcomes: Main outcomes of interest included: breech presentation, chorioamnionitis, gestational diabetes, gestational hypertension, hemorrhage, inductions, placental abruption, placental previa, preterm birth, premature rupture of membranes (PROM), preeclampsia, and …

Demand And Supply Factors Affecting Maternal Healthcare Utilization Pattern In Nigeria, Dumbiri Joy Powell

Theses and Dissertations

Given poor maternal services utilization and associated high maternal mortality risk in Nigeria, we document policy-amenable supply and demand factors impacting women’ use of skilled ANC and institutional delivery services. Using a cross-sectional design, we analyzed data from the Nigeria State Health Investment Project health facility and household surveys on 418 health facilities and 3,726 women with a pregnancy within 24 months prior to survey living in 241 geographic wards of two states. Logistic regression was used to study associations of women’s use of each maternal service with ward facilities’ ANC outpatient satisfaction, healthcare staff job satisfaction, surveyorverified facility infrastructure, …

Prevalence, Incremental Cost And Resource Utilization Associated With Opioid Overdoses, Batul Electricwala

Theses and Dissertations

Background –

An increase in opioid prescribing has led to an increase in opioid overdoses.^1,2 No study has estimated the incremental costs subsequent to an opioid overdose event in prescription opioid users, or the prevalence and costs of overdose events in family members of prescription opioid users and in overdose victims with no identifiable source of prescription opioid. The latter group will be referred to as “others”.

Objectives –

The first objective of this study was to estimate the prevalence of opioid overdoses in aforementioned groups. The second objective was to estimate the incremental costs and resource utilization associated …

Chronic Pain Causal Attributions In An Interdisciplinary Primary Care Clinic: Patient-Provider And Provider-Provider Discrepancies, Bryan Jensen

Theses and Dissertations

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed …

Influence Of Public Insurance On Healthcare Access And Cancer Care, Wafa W. Tarazi

Theses and Dissertations

Medicaid expansion under the Affordable Care Act (ACA) facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Tennessee’s Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults in 2005. Pre-ACA expansions were associated with better access to and utilization of healthcare services. However, little is known about the effect of these policy changes on improvement in health outcomes for women diagnosed with breast cancer, access to care for cancer survivors, and the effect of generosity and duration of expansion on access to care.

This dissertation has three …

Development And Evaluation Of A Peer-To-Peer Intervention To Increase Self-Management Among Adult In-Center Hemodialysis Patients, Jennifer J. St Clair Russell

Theses and Dissertations

Background: Peer-to-peer (P2P) support programs have the potential to assist ESRD patients in managing their disease and improve outcomes. Yet, there is little research examining P2P programs’ impact on psychosocial outcomes and disease management behaviors.

Methods: A 4-month P2P mentoring intervention was designed and piloted in a facility serving 249 in-center hemodialysis patients in Lynchburg, Virginia. Preceded by a social marketing effort, which included a program naming contest and participant recruitment, the intervention included: (1) mentor training, (2) pairing of mentees and mentors, (3) kick-off social mixers, (4) ongoing meetings between mentees and mentors, (5) mentor training booster, and (6) …

Cancer Health Literacy And Hospitalization In The First Five Years Following A Cancer Diagnosis, Laura A. Cartwright

Theses and Dissertations

BACKGROUND: The field of health literacy research has been focused recently on developing more accurate measurement tools and understanding the relationship between health literacy and health outcomes. Individuals with lower levels of health literacy have worse health outcomes, including hospitalization rates, compared to those with adequate health literacy. This relationship has yet to be examined in the cancer patient population, although significant relationships between health literacy and cancer knowledge, screening behavior and quality of life have been found. This study is the first to examine the relationship between health literacy and hospitalization rates in a cancer patient population, and the …

Progesterone-Only Oral Contraceptive Pill, Breast Cancer, Heart Disease, And Stroke, Marsha Ema Samson

Theses and Dissertations

There is evidence from earlier studies that oral contraceptive pills may be a risk factor for certain chronic diseases, including heart disease, stroke, and breast cancer. Previous studies mainly focus on the estrogen component of combined (estrogen+ progestin) oral contraceptives (COCs) due to their popularity. This focus limits our understanding of progestin-only contraceptives and its relationship to commonly occurring chronic diseases. To provide insight into alternative methods of oral contraception, this dissertation explores the relationship between progestin-only oral contraceptive (POC) pills and heart disease, stroke, and breast cancer. We hypothesize that women using POCs are less likely to have certain …

Social Capital And Social Networks: The Importance Of Social Ties For Health Among Residents Of Disadvantaged Communities, Stephanie Child

Theses and Dissertations

Access to social capital via social networks is important for health and may be linked with chronic disease, including obesity and hypertension. Socioeconomic status (SES) may influence access to social capital and social network characteristics, and may also moderate the relationship between social capital, social networks, and health. Yet few studies have explored relationships between social capital, social networks, and chronic disease among resource poor individuals.

Respondent-driven sampling was employed to recruit participants (n=430) from low-income communities in the US South for a household survey as part of the Greenville Healthy Neighborhoods Project. The survey collected information about participants’ SES …

Depression Among Pregnant Latinas In South Carolina, Andrew Fogner

Theses and Dissertations

The aim of the study was to determine the prevalence of depression among pregnant Latinas. To bring to light the importance of prenatal depression prevention, we assessed the effect of the quality of healthcare providers among South Carolina Latinas (n=171). Women answered a validated CES-D and were categorized as depressed (score >16). In multivariate analyses, good perception of quality of healthcare was more likely among women who were not depressed; adjusted odds ratio of 0.75, 95% confidence interval 0.37 – 1.55. The findings show the need for tailoring healthcare to Latinas with prenatal depression prevention. It is imperative to understand …

The Influence Of Fine Particulate Matter On Inflammatory Bowel Disease In South Carolina: An Ecological Analysis, Joshua Eric Sellner

Theses and Dissertations

Background. The Inflammatory Bowel Diseases, including both Ulcerative Colitis and Crohn’s Disease, are lifelong disorders of the Gastrointestinal tract. In recent years, both conditions have become much more prevalent and recognized as major public health issues. Environmental factors have become the focus of recent research around the cause of these diseases. Although shown to have detrimental effects on diseases similar to that of the Inflammatory Bowel Diseases, fine particulate matter’s role in these diseases has not been adequately investigated.

Aim. The purpose of this study was to test the relation of fine particulate matter with hospitalizations attributable to …

A Qualitative Study Of How Communities Think About And Act Upon Hunger In The Presence Of A Food Banking System, Eliza Miriam Fishbein

Theses and Dissertations

Hunger is often addressed by providing food directly to those experiencing symptoms of food insecurity and hunger. Even with the availability of government food assistance programs, food insecurity and hunger rates continue to rise. Many local community organizations (e.g., small food banks, faith-based organizations, schools) across the country have come together to create and implement a variety of nongovernment food programs. Although there is no evidence these programs lower food insecurity and hunger rates, community organizations appear to be strongly committed to sustaining these programs. Little is known about the basis for this commitment, i.e., “ the will to act …

Implementation Processes And Impacts Of School Store Policies In South Korea, Seul Ki Choi

Theses and Dissertations

With the concern of unhealthy school food environments, the South Korean government enacted two school nutrition policies to reduce unhealthy foods in school stores. The first policy banned on soft drinks sales in school stores enacted in 2007. The second policy restricted energy-dense nutrient-poor (EDNP) food sales in school stores enacted in 2009. This study aims to examine the changes in adolescents’ food intake and foods sold in school stores due to the two policies and to understand the policy implementation processes.

The Korea National Health and Nutrition Examination Surveys were used to examine trends in adolescents’ energy intake from …

Spatio-Temporal Analysis Of The Occupational Fatal Victimization Of Law Enforcement Officers In The Us, Xueyi Xing

Theses and Dissertations

The models with constant coefficients of the covariates across space and time are commonly used in spatio-temporal analyses. However, the associations between risk factors and the outcome could have locally differential temporal trends in many cases. In this study, a Bayesian latent cluster modeling strategy is employed to identify potential spatial clusters in which locally specific sets of temporally varying coefficients of covariates are allowed. A state-level panel data of police officers occupational fatal victimization for the years 1979-2010 is used. To accommodate overdisperson and excess zeros, a negative binomial model and zero-inflated Poisson/negative binomial models are also utilized. A …

The Roots Of Perspective In The American Context: News Media Discourse And Stakeholder Perspectives About The Supplemental Nutrition Assistance Program, Nicholas Younginer

Theses and Dissertations

The Supplemental Nutrition Assistance Program serves 46 million people but is controversial. The media is positioned to influence political and public opinions about SNAP policy. This study identifies the SNAP media discourse and investigates perspectives of SNAP participants and frontline workers about the program.

I employed a mixed-methods design with two aims. Aim 1 gathered 295 articles across six news outlets, semi-inductively coding the articles for characters, assignment of responsibility, and framing of the article. I then ran chi-square tests for difference between employed frame and responsibility and employed frame and political ideology.

Aim 2 collected a sample of 20 …

Healthcare Utilization And Expenditure Patterns Among Older Adults With Functional And Medical Decline, Ashley Shields Robertson

Theses and Dissertations

Purpose. As the aged population of this country grows, the U.S. healthcare system will face increased pressure to provide long-term care services and supports to increasing numbers of elderly Medicare beneficiaries. Studies have indicated that unmet long-term care need can lead to increased, unnecessary utilization of the healthcare system, thus further taxing the Medicare system. Little is known about how type of long-term care, as well as how long-term care policies—specifically payment policies—affect health care utilization. The objective of this original dissertation research was to examine the effects of place of residence (community versus residential long-term care facility) and …

Relationships Of Chronotype, Social Jetlag, Sleep, Physical Activity And Diet With Mood, Perceived Stress, Obesity, Blood Pressure And Prostate Cancer, Daria M. Mcmahon

Theses and Dissertations

Background: Chronotype, social jetlag, poor sleep, proinflammatory diet, and low physical activity have been associated with increased risk of chronic diseases: obesity, diabetes, cardiovascular disease, depression and cancer. Yet the relationships between these factors have not been extensively investigated in prospective studies.

Methods: Two studies were conducted. The first study followed 390 healthy men and women ages 21-35 for two years. Social jetlag [SJL] and sleep measures (total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO]), sleep efficiency [SE]), were derived from physical activity personal (armband) monitoring. The participants wore the armband for 4-10 …

Sustainability Of Food And Nutrition Security Policies During Presidential Transitions: Integrating Socio-Political And Nutritional Sciences, Jessica Liana Escobar-Alegría

Theses and Dissertations

Presidential transitions are uncertain periods in which relationships among power, accountability, and electoral support of a democratic process do not hold. Transitions challenge collaboration towards implementing policies contributing to food and nutrition security (FNSP). Sustaining these policies during transitions is critical for reaching long-term goals. Knowledge gaps remain on how to perform strategic multisectoral work during transitions to maximize FNSP sustainability.

This study aimed to examine what determines FNSP sustainability during presidential transitions and responded to the questions: How do policy actors define sustainability? What are the mechanisms determining policy sustainability? What are the implications of terminal logic behavior (TLB) …

Contextualizing Multilayered Sexual Subjectivities Of Heterosexual Black Female Undergraduate Students At A Predominantly White Institution In The South, Amarachi Rossana Anakaraonye

Theses and Dissertations

This study uses an intersectional theoretical framework to examine Black college women’s sexual health by focusing on how they engage in sexual decision making within their social contexts. This qualitative study analyzed 20 individual in-depth interviews of Black female undergraduate students, ages 18-22, who attend a predominantly white institution (PWI) in the Southeastern United States. The themes that emerged from qualitative data analysis include Black female undergraduate students’ perceptions of the sexual culture of their campus and the protective strategies they employ to navigate the sexual culture in order to achieve and/or maintain physical, emotional, and social well-being. Key findings …

The Association Between Physical Activity And Serum Immunoglobulin G (Igg) Antibodies Against Periodontal Bacteria, A. Paige Anderson

Theses and Dissertations

The purpose of this study is to add more research and evidence to the mechanisms surrounding periodontal disease, periodontal microorganisms, and physical activity. The main objective of this study is to evaluate and explore the association between physical activity and serum IgG antibodies, which are grouped into four distinct clusters, formed from species specific 19 periodontal antibody titers. This cross sectional study divided physical activity into three categories: adequately physically active, inadequately physically active, and inactive based on MET scores. Certain models were adjusted for confounders including age, sex, race/ethnicity, income-to-poverty ratio, years of formal education, smoking, alcohol intake, BMI, …

Sleep Disorder Trends, Epigenetic Markers, And Genetic Variation Of Circadian Genes In Adenomatous Polyp Formation, Melannie Alexander

Theses and Dissertations

Introduction: Sleep disturbances and sleep quality have fluctuated over time in the United States (US). Virtually every physiological process follows a circadian pattern, and cellular processes (i.e., cell proliferation, DNA damage response, and apoptosis) are often disrupted by sleep disturbances and other factors, potentially giving rise to adverse health outcomes such as cancer. Additionally, both genetic variation and epigenetic patterns within clock genes, which may affect sleep quality, also may increase one’s risk for developing cancer. The role of sleep disturbances in the formation of adenomas, precursor lesions to colorectal cancer (CRC), has been explored previously; however, little is …

Enhancing Parent-Child Communication And Promoting Physical Activity And Healthy Eating Through Mobile Technology: A Randomized Trial, Danielle E. Schoffman

Theses and Dissertations

Background

Although rates of pediatric and adult obesity remain high in the U.S., finding scalable and engaging ways to disseminate obesity prevention and treatment for families has been challenging. The purpose of the Motivating Families with Interactive Technology (mFIT) study was to test the feasibility, acceptability, and effectiveness of two remotely-delivered family-based health promotion programs for improvements physical activity (PA), healthy eating, and parent-child communication and relationship quality.

Methods

Parent-child (child age 9-12 years) dyads enrolled in a 12-week mobile intervention to increase physical activity and healthy eating, which included weekly email newsletters and the use of pedometers. Dyads were …