Public Health Commons^™

The Role Of Telehealth And Obstetrics Capacity On Maternal Health Care: A Mixed Methods Approach, Shanikque L. Barksdale

Theses and Dissertations

Background: The United States (US) is experiencing a maternal health crisis, with rising severe maternal morbidity and mortality rates and persistent racial, ethnic, and geographic disparities. While telehealth can address access challenges, there is limited evidence of its impact on access to maternity care and outcomes among rural and minoritized communities. The overall objective of this study was to analyze the disparities in maternal outcomes and user satisfaction by hospital-based telehealth and obstetric care availability.

Methods: A convergent parallel mixed methods approach was used. A multinomial logistic regression was used to analyze whether the changes in the proportions of hospitals …

Nutrition And Mental Health Related Factors Across Historically Black College And University Students, Nancy Anai Uriegas

Theses and Dissertations

The prevalence of food insecurity across college campus in the United States has been widely explored, with the primary focus placed on large, 4-year, primarily White institutions. Less is known about the prevalence of food insecurity and the impact it may have on health behaviors among minority serving institutions, including Historically Black Colleges and Universities (HBCU). Young adults attending college, and more specifically student-athletes (SAs), are typically in a new place, facing new stressors and high rates of food insecurity, which in turn may play a critical role in their current health status as it pertains to meeting their energy …

The Effect Of Covid-19 Restrictions On The Social Support Experiences Of Black Women Giving Birth In South Carolina Hospitals During The First Year Of The Covid-19 Pandemic (2020) As Compared To A Previous Birth, Tiffany Eva Byrd

Theses and Dissertations

The United States is experiencing a maternal health crisis, which disproportionately affects Black women. Black women die from pregnancy-related causes two to three times as often as their White counter parts, and the majority of maternal death are preventable. In recent years, public health and national governing authorities have devoted resources to monitoring the health crisis and raising the public’s knowledge of warning signs; however, maternal mortality rates continue to rise. Noted contributors to Black maternal mortality include, but are not limited to, racism, delayed treatment and response to health emergencies, and lack of social and emotional support during childbirth, …

Internalizing Mental Health Symptoms And Nicotine Use Among Adolescents In Canada, England, And The Us From 2020-2022, Emily E. Hackworth

Theses and Dissertations

Background: There is a well-established bi-directional relationship between cigarette smoking and internalizing mental health (IMH) symptoms (e.g., symptoms of depression, symptoms of anxiety). However, it is unclear whether IMH symptoms are associated with using different types of nicotine products among adolescents, as adolescents are using a variety of nicotine products, including combustible products (cigarettes), non-combustible products (e-cigarettes), or combinations of both types of products. This dissertation examines associations between IMH symptoms and current use of various types of nicotine products across three countries from 2020-2022.

Methods: Data come from the 2020-2022 waves of the International Tobacco Control (ITC) Adolescents Tobacco …

Associations Between The Use Of Ssri Medication In Older Adults And Cognitive Decline And Impairment, Paige Jones

Theses and Dissertations

Previous research has indicated that depression is a risk factor for dementia. Since SSRI medication is the most common treatment for depression, it is important to determine if SSRIs are associated with reduced dementia and better cognitive outcomes. Using longitudinal data from the 2004-2014 waves of the Health and Retirement Study merged with the 2005 Prescription Drug Study, we examined potential associations between SSRI and TCA medication and cognitive impairment and cognitive decline. The study population consisted of 1,775 older adults who participated in the PDS in 2005. We found that SSRIs were associated with significantly higher odds of cognitive …

Impacts Of Covid-19 And Taliban Takeover On U.S. Afghan Refugee Women’S Mental Health: A Socio-Ecological Approach To Resilience Resources, Atefeh Aghaei

Theses and Dissertations

In response to the escalating global refugee crisis, intensified by ongoing conflicts and environmental changes, this dissertation research focuses on the mental health of Afghan refugee women in the United States (U.S.), particularly in the context of the COVID-19 pandemic and the 2021 Taliban takeover. With over 114 million people displaced globally, Afghan refugees, notably women, encounter heightened mental health risks due to violence, deprivation, systemic persecution, and the challenges of migration. This vulnerability is exacerbated by recent mass traumatic events, including the pandemic and political upheaval in Afghanistan. Our study, conducted through semi-structured interviews with Afghan refugee women and …

Knowledge, Attitudes And Practices Regarding Sexually Transmitted Infections In South Carolina: A Cross-Sectional Survey And Comparison To Geographically-Associated Social Determinants Of Health, Sean Patrick Sweeney

Theses and Dissertations

Sexually transmitted disease (STD) rates are on the rise in the United States. South Carolina ranks consistently among the states with the highest STD burdens, especially for the bacterial diseases gonorrhea and chlamydia. This study sought to determine the opinions, beliefs, and knowledgebase of South Carolina citizens regarding STDs and sexual health/education. In doing so, the study seeks to identify areas of improvement for educators, healthcare workers, and public health employees. Using a web-based cross-sectional survey, this study contacted approximately 900,000 South Carolina residents for participation. Participants were asked a variety of questions focused on STD knowledge, opinions, and practices. …

Association Of Hiv Status And Other Minoritized Identities With Psychiatric Diagnoses Among Transgender And Gender Diverse Individuals In The All Of Us Research Program, Fanghui Shi

Theses and Dissertations

Background: Transgender and gender diverse (TGD) people, whose gender identities or expressions differ from the sex assigned at birth, are disproportionately affected by adverse health outcomes, including various psychiatric diagnoses such as depression, anxiety, stress, and substance use disorders. The Gender Minority Stress Model emphasizes that TGD people face both proximal stressors at a personal/individual level (e.g., internalized stigma) and distal stressors at a societal level (e.g., discrimination) due to their minority status, which largely contributes to their increased risk of psychiatric diagnoses. Despite these health disparities, there is a paucity of gender identity data collected in large population-based health …

Communicating About A Nicotine Reduction Policy Among People Who Use Little Cigars And Cigarillos, Charity Afi Ntansah

Theses and Dissertations

The U.S. Food and Drug Administration (FDA) has proposed rulemaking to reduce the nicotine content in cigarettes and other combusted tobacco products to non-addictive levels. A very low nicotine content (VLNC) policy aimed primarily at cigarettes could drive people to other combusted products like little cigars and cigarillos (LCCs), potentially undermining its effectiveness. Expanding the policy to include LCCs requires effective messages for people who use LCCs. This dissertation explores how to communicate the reduced nicotine policy to people who use LCCs. The research recruited four populations with the highest prevalence of cigar use: African American and White males and …

An Examination Of Self-Identity In Relation To Smoking And Vaping In South Carolina, Jaron Hoani King

Theses and Dissertations

BACKGROUND

This dissertation examines self-identity in the context of smoking and vaping among adults in South Carolina (SC) using data from the 2023 SC Adult Tobacco Survey (n=1370). The conceptual model created to guide this dissertation is called the “Smoker and Vaper Behavior-Identity Model” and draws constructs from theoretical frameworks in health behavior and social identity theories. Behavior was defined as lifetime and past 30 day cigarette or e-cigarette use. Self-identity was defined by asking respondents with a history of cigarette or e-cigarette use “Do you consider yourself a smoker/vaper”, respectively.

METHODS

First, this study assesses the prevalence of mismatching …

Social-Ecological Determinants Of Affective States Among College Students: A Cross-Cultural Ecological Momentary Assessment Study, Abhishek Aggarwal

Theses and Dissertations

Background: College students experience a complex and diverse array of stressors during their college life, making them vulnerable to severe mental health issues. Momentary affective states are linked to major mental health disorders and overall well-being; however, the current social-ecological model of affect lacks a temporal dimension, failing to account for within-person dynamics of affective states over time. This study disentangles the complex temporal dynamics among the momentary, multilevel social-ecological factors and affective states in the real-world setting of college students across the United States (US) and India. However, establishing invariance of the affect model across time, people, and cultures …

Understanding Cancer Grade And Survival Disparities Among Young Adults Diagnosed With Non-Hodgkin’S Lymphoma (Nhl) Residing In South Carolina, Prema S. Bhattacharjee

Theses and Dissertations

Introduction. Previous research has shown that age and cancer grade differences must be carefully considered when developing initiatives to improve outcomes for NHL among the young adult population. The aims of this study are 1) to examine differences between low vs. high grade in NHL by race/ethnicity, healthcare insurance, and geographic factors among YAs aged 18-39 years of age in South Carolina, 2) to examine delays in the first course of cancer treatment for NHL by race/ethnicity, healthcare insurance, and county of residence (urban vs. rural) among YAs aged 18-39 years of age in South Carolina, and 3) examine differences …

Deciphering The Microbial Fingerprint Of Covid-19: A Multi-Layered Exploration Of The Oral And Gut Microbiome Dysbiosis, Iman Mostafa Sultan

Theses and Dissertations

The impact of SARS-CoV-2 infection on the human microbiome remains a dynamic and intricate puzzle. This study delves deeper into this mystery by revisiting the oral and gut microbial compositions of 53 COVID-19 patients before and after viral clearance, alongside comparisons to 76 healthy individuals. Through a comparative lens, we have emploed two distinct differential abundance methods – DeSeq2 and ANCOM – while drawing upon the thorough SILVA database encompassing the full-length 16S rRNA gene. The analysis underscores the crucial role of a diverse methodological choir in microbiome research. In certain instances, the congruence between DeSeq2 and ANCOM may exhibit …

The Inflammatory Exposome Of Major Depressive Disorder In An Egyptian Sample, Reem Deif

Theses and Dissertations

Major depressive disorder (MDD) has been recognized as a global public health concern affect-ing the lives of 264 million people with increasing prevalence worldwide. Inspired by the expo-somic research, this study aims to investigate the dynamic and complex interplay between dif-ferent demographic, lifestyle, environmental factors and bimolecular factors that are potentially involved in the pathology of MDD in a sample of Egyptian adults living in Cairo. This is in an attempt to acknowledge the biological underpinnings of MDD without underestimating the role of environmental influences. The context of Egypt provides richness to the current study given the national transition from …

Pricks And Pills, Anna A. Charles

Theses and Dissertations

"Pricks and Pills" is a collection of audio pieces designed for an online platform where individuals with diabetes can listen to and find emotional support from others who share their experiences. This audio project provides an intimate look into the lives of people navigating the challenges of diabetes. Through heartfelt interviews with individuals and their families, the podcast highlights their journeys, showcasing both their struggles and triumphs.

Bayesian Estimation Of Reproduction Numbers From Distributions Of Outbreaks Sizes: Branching Process Approach, Alberta Araba Johnson

Theses and Dissertations

The Generalized Poisson distribution is useful in modeling epidemiological processes as a branching stochastic processes problem. Our goal is to construct accurate and reliable estimators for the reproduction number (R0) (i.e., the number of secondary infections), particularly in the context of disease outbreaks modeled by a Galton-Watson process. Towards this goal, we construct the classical Bayes estimator, the Maximum Likelihood estimator, and the Empirical Bayes (EB) estimator under the Square Error Loss function in Chapter II. We prove that the Empirical Bayes estimator is asymptotically optimal and estimate the rate of convergence. We then proceed to monotonize the Empirical Bayes …

Association Between Direct Access Laws And Physical Therapy Use And The Effect Of Change In Physical Therapy Use On Subsequent Healthcare Spending, Utilization, And Opioid Use, Dakshu Jindal

Theses and Dissertations

Background

Physical therapy (PT) has been recommended as the first-line treatment for patients with incident musculoskeletal conditions without severe trauma. Initial or early use of PT may help address some of the nation’s most pressing health policy challenges, including escalating healthcare spending and an ongoing opioid epidemic, by encouraging the use of physical therapy as a substitute for expensive surgeries and the use of opioids. Yet, state scope of practice laws have historically restricted the diagnosis and treatment of medical conditions to physicians. Traditionally, patients seeking care from a physical therapist had to obtain a referral from a physician first. …

Personal Dosimeter Testing For High Altitude Air Crew, Seth D. Bacon

Theses and Dissertations

In 2014 the Thermo Scientific N2 electronic personal dosimeter became the aircrews’ sole means to record ionizing radiation dose. The production of this dosimeter was discontinued in July of 2021, motivating the Air Force to seek a flight-certifiable replacement. The Thermo Scientific Trudose NG, Mirion DMC 3000, and Fuji NRF-51 electronic personal dosimeters, as well as the Landauer InLight optically stimulated luminescent dosimeter, were subjected to mixed gamma and fast neutron fields simulating a high-altitude flight environment. Dosimeters are evaluated on their consistency and accuracy in reporting dose and compared to the current N2 dosimeter’s reported dose.

Utilization Of The System Engineering Design Process To Design And Test A Low-Cost Infectious Aerosol Control Mechanism For Patient Aeromedical Evacuation, Sara Shaghaghi

Theses and Dissertations

The aeromedical evacuation of military patients is a critical component of care for Armed Forces members. The Air Force’s ability to transport patients relies on the technology and systems available. A vital transport responsibility is keeping the patient and medical personnel safe during transport. The historical and legacy systems provide reliable transport mechanisms for the Armed Forces’ patients infected with high-level biological agents, but drawbacks must be considered. This dissertation will discuss the development, conceptual design, and initial evaluation of a new low-cost, litter-mounted patient transport system, Biological-Mitigation in Patient Transport (B-MIPT), using the “V” model of the system engineering …

Radiological Decontamination Methodologies On Litter-Bound Patients In Arctic Environments, And The Associated Airborne Risks Posed To First Responders, Juan S. Alb

Theses and Dissertations

This study was conducted to determine if air-based decontamination (decon) methods would be effective at both treating patients exposed to dry, radiological contamination as well as reducing its re-aerosolization during the disrobing process, such that these methods could be applied on litter-bound patients in extreme cold environments. A litter-bound, full-size mannequin dressed in a set of standard military issue extreme cold weather jacket and pants coated in 27 g (1 Tbs) of Copper Oxide (density 6.315 g/cm³ ) was given one of three treatments for dry aerosol decon. The three cleaning treatments included high-efficiency particulate air (HEPA) vacuum, a …

Retrospective Cohort Study Of Pure Tone Audiometry Hearing Changes From Ototoxic Metalsand Solvents, Continuous Noise, And Impulse Noise Exposures At Hill Air Force Base From 2005 To 2019, Zachary I. Johnson

Theses and Dissertations

This retrospective cohort epidemiological study investigated the relative risks of hearing loss associated with ototoxicants in combination with noise exposure. Utilizing Department of Defense (DoD) industrial hygiene and hearing conservation data, this research expanded on a 2020 thesis conducted on Tinker Air Force Base (AFB), applying a similar methodology to Hill AFB, adding 893 evaluated individuals. Grouped into twelve exposure combinations with a minimum of three years of exposure duration, the study assessed various hearing loss indicators, including DoD Standard Threshold Shift (STS) and NIOSH STS. Ototoxic substances consistently elevated relative risk (RR) compared to noise-only exposure groups, but none …

Measuring The Comparative Performance Of Usaf Behavioral Health Clinic Operations: Emphasis On Capacity, Daniel L. Straw

Theses and Dissertations

This research examines the operations of behavioral health clinics in Air Force Continental United States facilities, with a focus on operational efficiency and capacity through Data Envelopment Analysis. Most facilities operate near capacity, demonstrating efficient resource usage, but concerns arise with the potential of increased demand. Days-to-care and leakage are identified as major sources of inefficiency, suggesting that addressing these issues can enhance operations and reduce costs. The study also explores the impact of COVID-19 on care delivery.

An Investigation Of Torso Muscle Fatigue And Its Relation To Discomfort During Vertical Vibration Exposure, Nathan H. Hodges

Theses and Dissertations

Military and civilian helicopter pilots often experience back pain attributed to vibration exposure during flight and sustained poor posture, known as the "helicopter hunch." This study investigated torso muscle activation using surface electromyography (EMG) to assess the relationship between discomfort and muscle fatigue. Eight subjects were exposed to different vibration frequencies over two-hour periods, with EMG data collected every five minutes. Significant differences in muscle activation were observed before and after vibration exposure, suggesting increased muscle activation during vibration compared to prolonged seating alone. Discomfort surveys indicated higher discomfort during vibration.

The Brain Drain Of The Egyptian Physicians: A Look From Both Sides, Hebatalla Ahmed Mohamed Ismail

Theses and Dissertations

The brain drain of well-educated and trained workers is a problem that faces many nations. The pandemic revealed the importance of being ready with all resources, especially the healthcare workers. In Egypt, according to records of the Egyptian medical syndicate, half of the registered physicians in the syndicate are working abroad. In this study, we aimed to understand the relationship between individual satisfaction regarding work or family, his capability factors, and his intention to leave the country to work in another one. A quantitative approach was used by a self-administered online questionnaire. The results showed that 66.4% of physicians who …

Practice Patterns And Medical Provider Perceptions Of Ketamine In The Treatment Of Psychiatric Disorders: A Nationwide Survey, Amna M. Aslam

Theses and Dissertations

Background: Major Depressive Disorder (MDD) significantly impacts society, with a prevalence of 8.4% in the U.S., highlighting the need for effective treatments for treatment-resistant depression (TRD). Ketamine, while not FDA-approved for TRD, shows promise in treating mental health disorders and is used in specialized clinics, though evidence of effectiveness is scarce. Objectives: This study investigates the use of off-label ketamine for TRD and other disorders, focusing on ketamine clinic operations where the drug is administered, treatment methods, patient characteristics, and ketamine's impact on psychiatric care, from providers' perspectives. Methods: The survey was distributed to over 1,000 ketamine providers across the …

Intersectionality, Racial Discrimination And Oral Healthcare Utilization Among Black Adults In Baltimore City, Maryland, Briona M. Phillips

Theses and Dissertations

INTRODUCTION: Oral health is essential for overall well-being, yet disparities persist, particularly among marginalized populations including Black adults. Limited access to and underutilization of oral healthcare services exacerbate these disparities. Discrimination, both individual and systemic, acts as a significant barrier to accessing care, contributing to disparities in oral health outcomes. Individuals facing discrimination experience mistrust and fear within oral healthcare settings, leading to delayed or avoided care. Therefore, investigating and addressing discrimination among Black adults is essential for promoting equitable access to oral healthcare, improving overall oral health outcomes, and lessening existing disparities.

PURPOSE: The purpose of this dissertation was …

Cardiometabolic Genomics And Pharmacogenomics In Filipino Americans: A Cross-Sectional Study, Khalifa Y. Alrajeh

Theses and Dissertations

Background: Heart disease remains a leading cause of death in the country, with significant ethnic disparities. Filipino Americans (FAs), the third-largest Asian subgroup in U.S., face an elevated burden of dyslipidemia, a primary modifiable risk factor for heart disease. Objectives: This community-based study addresses critical knowledge gaps by characterizing the cardiometabolic and genetic factors contributing to dyslipidemia among FAs and implications for personalized cardiovascular drug therapies, particularly statin pharmacogenomics (PGx). Methods: We characterized dyslipidemia prevalence in FAs and major ethnic subgroups using nationally representative NHANES data. We examined associations between uric acid (UA) levels and lipid profiles, …

New York City’S Health Governance And Activism From The 1950s To The 1970s, Andres Valcarcel

Theses and Dissertations

New York City's expansive network of hospitals and preventative health services has an intense history outside of the popular narratives of biomedical and technological advancement. This thesis will discuss the period between the 1950s and 1970s and the various movements and parties that shaped the city's health and hospital system. During this period, New York City's healthcare delivery system became increasingly privatized and commercialized; processes that improved the quality of healthcare yet simultaneously barred the poorest from accessing it. Communities, healthcare workers, and civil rights organizations worked to address perceived faults and extend their agency in health and hospital policy; …

A Scoping Review Of Perceptions And Fears Experienced By Families With Children With Developmental Disabilities In Sub-Saharan Africa., Isaac Twum Boamah

Theses and Dissertations

The prevalence of perception and fear surrounding families with children with developmental disabilities in Sub-Saharan Africa reveal a complex interplay of cultural, social, economic, and healthcare factors. This interplay of factors results in stigma, which often leads to societal misconceptions and discrimination, exacerbating the challenges faced by affected families. This study seeks to identify the individual and family perception of developmental disabilities, document the stigma experienced by the individual and their families, and document the resources available to help alleviate the plight faced by the individuals and their families. It further seeks to find gaps in the literature on developmental …

Social Networks As Predictors Of Musculoskeletal Injury In U.S. Army Soldiers (Snap-Mski), Kristen L. Zosel

Theses and Dissertations

INTRODUCTION: Musculoskeletal injuries (MSKIs) are the leading cause of medical non-readiness among U.S. Army Soldiers, costing the Military Health System an estimated $4.7 billion annually in direct and indirect costs. Current MSKI mitigation efforts focus on individual attributes such as body mass index and gender. However, emerging research highlights the significance of social ties on health outcomes and behaviors. This study examined the patterns of MSKI within military social networks and how social interactions, along with health behaviors such as sleep, physical activity (PA), and diet, co-occur in Soldiers with and without MSKI. METHODS: Phase 1 involved a cross-sectional sociocentric …