Public Health Commons^™

The Contribution Of The Residential Environment To Indoor Air Pollutants, Jessica Deslauriers

Public Health Theses

Rationale: Little is known about the home environment and associated indoor exposures to brown carbon and black carbon, components that make up fine particulate air pollution.

Objective: Identify how features of the residential environment contribute to indoor measurements of brown and black carbon.

Methods: Between November 2012 and December 2014, 125 veterans who were part of a COPD cohort were recruited for this study. At roughly 3 month intervals, participants received a particle sampler to measure air pollutants in their home for a 1-week period. The filters within the samplers were analyzed for levels of black and brown carbon using …

Quantifying Influenza Exposure Within Hospitals And Nursing Homes, Drew Taylor Dickinson

Public Health Theses

Abstract

Background: Influenza acquisition in hospitals and nursing homes (NHs) highlights the need for infection prevention to protect patients from contagious diseases while under the care of a healthcare facility. We quantified influenza exposure in both settings and compared facility-onset influenza rates in order to determine if risks of acquiring influenza differed by type of healthcare facility since infection prevention practices are less standardized and less rigorous in NHs.

Methods: We conducted a retrospective cohort study of California hospital and NH inpatients during the 2015-2016 influenza season, defined as the peak influenza month, plus the two adjacent months, using claims …

Proximity To Nearest Major Road And Time To Pregnancy In The Early Pregnancy Study, Nina Hatch

Public Health Theses

Purpose: Current literature suggests that air pollution may affect reproductive outcomes, but little research has evaluated the association between air pollution and fertility. Our aim is to further examine the relationship between distance to major roadway, a proxy for traffic-related air pollution, and fecundability.

Methods: Our analysis was conducted within the North Carolina Early Pregnancy Study (n=221). Our outcome was pregnancy attempt time, an estimate of fecundability, or the per cycle probability of conception. Our primary definition of conception included early pregnancy loss, spontaneous miscarriage, ectopic and molar pregnancy, and singleton or twin pregnancies. In a secondary analysis, we defined …

Gaps In Mental Healthcare Use And Perceived Quality Between Privately Insured Lgb And Heterosexual Individuals In The United States, Yuki Hayashi

Public Health Theses

Previous research has identified significantly heightened levels of mental health issues and psychological distress among lesbian, gay, and bisexual (LGB) individuals in the U.S., as well as greater mental health service utilization among this population. Using a nationally representative sample of privately insured adults in the U.S., we investigate differences in mental healthcare utilization, characteristics of mental healthcare received, and perceived quality of care between LGB and heterosexual individuals. Key results find that privately insured LGB men and women are significantly more likely than their heterosexual counterparts to have used outpatient mental healthcare as well as out-of-network (OON) outpatient mental …

Multi-State Analysis Of Unconventional Oil And Gas Development And Rates Of Sexually Transmitted Infections In The United States, Nicholaus Peter Johnson

Public Health Theses

Background

Advances in unconventional oil and gas development (UOGD), including hydraulic fracturing and horizontal drilling, have helped position the United States as a world leader in the production of both crude oil and natural gas hydrocarbons. This significant increase in production would not have been possible, however, without the assemblage of a workforce that is predominantly young, male, and mobile. This is significant given that a number of studies have associated similar types of mobile workforces – especially those employed by resource extractive industries – with impacts on the sexual health of the host communities in which these workers operate …

Perspectives Of Type 2 Diabetes Patients On Their Interactions With Providers, Marleen Z. Jones-Pool

Public Health Theses

Effective patient-provider communication has been shown to help achieve optimal health results, particularly in patients with diabetes. While previous studies have identified patient-perceived barriers in communicating with their providers, this study highlights factors in the patient-provider interaction that may contribute to effective health communication. As part of a larger mixed-methods study, 10 semi-structured interviews were conducted with patients with self-reported diabetes at a primary health center. These interviews sought to understand patient-perceived communication factors that influenced their interactions with their providers. Interviews were recorded and transcribed verbatim. Interview transcripts were then coded and analyzed utilizing a grounded theory approach. Findings …

The Association Between Self-Reported History Of Experiencing Violence & Mental Health Status Among Urban Refugees And Asylum Seekers In Malaysia, Rayne Soyoung Kim

Public Health Theses

Background: In displaced populations, studies have shown that there are significant associations between exposure to violence and reporting mental illness. There is little known regarding this relationship in countries like Malaysia, which serves as a transitional point where refugees wait to be resettled.

Objective: To assess the cross-sectional association of exposure to violence with mental health status in the urban refugee and asylum-seeking population in Malaysia.

Methods: 286 self-identified refugees and asylum seekers, recruited by using time-location sampling, were given interviewer-administered surveys, including questions regarding exposure to violence and mental health symptoms. Multivariable logistic regression analyses were performed to evaluate …

Evaluating The Feasibility And Effectiveness Of Self-Monitoring Of Health – A Pilot Study Among Samoan Women, Erica Kocher

Public Health Theses

Background:

Samoa, like many low- and middle-income countries, faces a high burden of obesity and non-communicable disease. Self-monitoring technologies to help individuals track their health have proven effective in high-income countries, but have not generally been tested in low-income settings. To investigate the feasibility and potential effectiveness of using step-counters and digital scales in Samoa, we conducted a pilot randomized controlled trial.

Methods:

The trial enrolled 44 Samoan women (31-40 years) without chronic conditions (non-hypertensive, non-diabetic, etc.) and who reported motivation to become more active. After a 1-week baseline period to measure physical activity in the absence of any feedback, …

Nonmydriatic Fundus Photography In A High-Risk Population Of Samoans With Diabetes: The Soifua Manuia Eye Screening Program, Lauren Carmela Lamonica

Public Health Theses

IMPORTANCE Novel methods of detecting eye disease are needed due to the challenges associated with service delivery in resource-limited settings.

BACKGROUND The objective of this study is to determine whether clinically gradable fundus images can be obtained using a low-cost, handheld non-mydriatic fundus camera by a non-ophthalmic provider in a remote setting.

DESIGN Cross-sectional study

PARTICIPANTS Two-hundred and six individuals (412 eyes) in the Pacific Island nation of Samoa with pre-diabetes and diabetes (HbA1c ≥5.7% or FBG ≥110 mg/dl).

METHODS Participants underwent non-mydriatic fundus photography with the PanOptic iExaminer System, along with an assessment of near vision, medical, and ophthalmic …

Older Adult Spouses’ Emotional Responses To Reminiscing About Their First Encounter: Associations With Mental Health, Marital Satisfaction, And Cardiovascular Reactivity, Hanzhen Lan

Public Health Theses

Objectives: While there has been growing interest in how close relationships affect older adults’ health, not much research has examined how emotional experiences in older married couples’ positive interactions relate to individual and relational well-being and physical health. The present study hypothesizes that positive emotional responses to older couples reminiscing about first encounter are associated with each spouse’s higher marital satisfaction, fewer depressive symptoms, and healthier cardiovascular reactivity (blood pressure and heart rate variability).

Method: One hundred and one couples completed a background questionnaire at home and then participated in a laboratory session in which they discussed how they first …

Association Between Engagement In A Community-Based Home Visitation Program And Birth Spacing Between First And Second Children, Hing Ting Connie Li

Public Health Theses

OBJECTIVE: To identify patterns in engagement in the Connecticut-based home visitation program, Nurturing Families Network (NFN), and to determine whether associations exist between various engagement patterns and birth-to-pregnancy intervals between first and second children.

METHODS: Repeated measures latent class analysis was employed to identify patterns in program engagement among 5,248 families enrolled in NFN with available home visit information. Maternal socio-demographic characteristics were examined to identify potential predictors of engagement patterns. Propensity score matching was used to identify firstborn children of families in Connecticut with comparable eligibility and tendency to enroll in NFN. Survival analysis was conducted to assess the …

What Does It Meme? A Qualitative Analysis Of Adolescents’ Perceptions Of Tobacco And Marijuana Messaging, Jessica Liu

Public Health Theses

With increasing popularity of e-cigarettes and legalization of marijuana, messaging from online sites and platforms are shaping product perceptions and use. Quantitative studies have examined social media statistics of posts; however, there is a lack of research explaining the aesthetic appeal of these advertisements from the adolescents and young adults (AYA) perspective.

Twenty-four participants were recruited from a larger study of adolescents' perceptions and tobacco use (N=772 high school students). Participants were grouped by whether or not they had used tobacco or marijuana products before, with N=8 non-users and N=16 users. Data were collected through individual semi-structured interviews, where participants …

Associations Between Cannabis Use, Medication Status And Panic-Anxiety Disorder Symptoms Among Us Adults, Diane Tran Ma

Public Health Theses

The existing body of literature focuses on the onset of panic disorders or other side effects as an association with cannabis use, but does little to address how possible concomitant cannabis use affects symptom presentation in already-diagnosed patients. The present project aims to take a closer look at adults with a lifetime history of DSM-5 diagnosed anxiety disorders, their prescribed (non-cannabis) medication use, cannabis use frequency, and associated symptom severity.

In general, we find that cannabis use is associated with higher panic-anxiety symptom severity across panic disorder without agoraphobia, generalized anxiety disorder, and people with combined anxious-distress diagnoses, after controlling …

Wholesome Wave Communities Market Approach, Nikita Mehta

Public Health Theses

In 2017, approximately 1.2 million residents, or 14.4% of the population, in New York City were identified as food insecure, which is higher than the national rate of 11.8%. Wholesome Wave is a non-profit organization based in the Northeastern region of the United States that develops programming for consumers to make healthier food choices through increases in affordable access to healthy, locally and regionally grown foods. Wholesome Wave makes fruits and vegetables affordable through their Wholesome Communities initiative which includes the SNAP Double Value Program and the FVRx. This report builds a strategic go-to-market approach by identifying key funders, partners, …

Predictors Of Intense End-Of-Life Care Among Children And Young Adults With Advanced Hematologic Malignancies, Sophia Mun

Public Health Theses

Background: Studies suggest that children, adolescents, and young adults (AYAs) with advanced cancer receive intense end-of-life (EOL) care. This is particularly true for patients with hematologic malignancies. Yet, it is unclear who is at highest risk for receiving intense care.

Methods: We used the Premier Healthcare Database to perform a population-based analysis of patients aged 0-39 years at death with hematologic malignancies who died between 2010-2017. We defined intense EOL care as: receipt of cardiopulmonary resuscitation (CPR), intubation, hemodialysis, or tracheostomy within the last 30 days of life; more than one emergency room (ER) visit within the last 30 days …

Assessing The Effect Of The Fto (Rs9939609) Gene On Weight Loss Among Breast Cancer Survivors Enrolled In The Lifestyle, Exercise, And Nutrition (Lean) Study, Hien Thai Nguyen

Public Health Theses

Abstract: Background: A single nucleotide polymorphism (SNP) of the Fat, Mass, and Obesity associated (FTO) gene, rs9939609, is significantly associated with obesity and individual variability in weight loss achieved by diet/lifestyle interventions. However, study results on the effect of the FTO gene on weight loss remains inconsistent. This study aims to examine the moderating effects of the FTO SNP rs9939609 on weight loss achieved by a lifestyle intervention in breast cancer survivors. Methods: Breast cancer survivors with a body mass index (BMI) > 25 kg/m2 were randomized to the LEAN 6-month intervention, which included eleven 30-min counseling sessions focused on reducing …

The Effects Of Rurality And Cost Of Transportation On Time Of Evolution And Disease Complexity At Diagnosis For Cutaneous Leishmaniasis In Colombia, Miguel Paredes

Public Health Theses

Patients in Colombia affected by cutaneous leishmaniasis (CL) face significant geopolitical and socioeconomic barriers to accessing diagnosis and treatment. This study aimed to understand how the geosocial characteristics of a patient’s area of residence affect time to medical consultation and disease status at consultation. An observational cross-sectional study was performed of individuals with CL who consulted at a local clinical referral center (CIDEIM) in Cali and Tumaco, Colombia. Descriptive, bivariate, and multivariable simple and ordinal logistic regression analyses were done to examine how area of residence (urban or rural) and cost of transportation to the nearest urban center may influence …

Randomized Trial Of Weight Loss On Ghrelin Levels Among Breast Cancer Survivors, Leah Puklin

Public Health Theses

Purpose: Obesity is associated with increased breast cancer risk and mortality. Ghrelin is a hormone that participates in a negative feedback loop to regulate body weight. Understanding the impact of an individualized, sustainable, dietary and exercise weight-loss intervention on circulating ghrelin levels could provide insight on weight control mechanisms among overweight and obese breast cancer survivors.

Methods: The Lifestyle, Exercise, and Nutrition (LEAN) randomized controlled trial was a 6-month weight loss trial conducted to examine the effect of a weight loss intervention versus usual care on outcomes in 151 breast cancer survivors with BMI ≥ 25 kg/m2. Fasting blood samples …

Associations Between Mindful Eating Techniques And Gestational Weight Gain, Yuqing Shang

Public Health Theses

Abstract

Objective: To investigate the extent to which the use of mindful eating techniques is associated with gestational weight gain among a clinic-based sample of pregnant women.

Methods: Four hundred and forty-eight pregnant women in their second trimester of pregnancy participated in the Expect With Me group care study and were selected for this secondary analysis. Sociodemographic and general health data was collected at baseline. Mindfulness practice was measured based on frequency of performing mindful thinking and mindful eating techniques in the third trimester. The main outcome was excessive average weekly gestational weight gain, which was determined using the guidelines …

Analysis Of Entomological Surveillance Data To Predict West Nile Virus Cases In Connecticut, Lena Marie Tayo

Public Health Theses

INTRODUCTION: Since 1999, West Nile Virus (WNV) has been identified in a wide variety of mosquito species. Seasonal epidemics occur in the summer in all regions of the United States, with varying degrees of intensity and spread. In Connecticut, the state mosquito surveillance system for WNV has been conducted since 2000, collecting entomological and site data, and acting as an early warning system for potential human disease risk.

AIMS: Re-analysis of the epidemiology of WNV in Connecticut after years of established endemicity will be conducted using recent mosquito surveillance and human case data. A predictive model will also be developed …

Strengthening Maternal, Infant And Young Child Feeding Training And Education Delivery In Ghana, Madelynn Raye Tice

Public Health Theses

Objective: To document the maternal, infant and young child feeding (MIYCF) training and education system within Ghana and identify key factors influencing MIYCF training and education delivery by health care providers.

Design: A qualitative study that utilized in-depth interviews.

Setting: The study was conducted within the Central Region of Ghana.

Participants: Fourteen health care providers that served as MIYCF trainers or educators were included in this study.

Analysis: Interviews were conducted in English, audio recorded, and then transcribed. A grounded theory approach was used to create a conceptual model of the themes that emerged from the interview. Half of the …

Nut And Peanut Butter Consumption And Risk Of Prostate Cancer In The Nih-Aarp Diet And Health Study, Mimi (Trucmai) Nu Ton

Public Health Theses

Background: While nuts and their related nutrients have been inversely associated with some cancers, the association between nut consumption and prostate cancer has been inconsistent.

Methods: We conducted an analysis of the association between nut and peanut butter consumption and risk of incident prostate cancer among 173,243 men in the prospective NIH-AARP Diet and Health Study. There was a total of 18,619 incident prostate cancer cases during the 16 years of follow-up. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression for intake of nuts, peanut butter, and total nuts (nuts plus peanut butter), …

Average Time To Negativity Of New Alere Ultra-Sensitive Rapid Diagnostic Test After Treatment For Malaria., Azan Zahir Virji

Public Health Theses

Malaria remains one of the most challenging infections globally. Malaria RDTs have had the largest impact on malaria detection in recent years with almost 245 million RDTs delivered globally. (1) They work by detecting either the histidine-rich protein (HRP2) or the Plasmodium lactate-dehydrogenase (pLDH). (2) Following a malaria infection, the HRP2 and pLDH antigens often circulate in the blood stream for several weeks. (3) As new RDTs are constantly being developed, each with a better sensitivity, specificity and lower limit of detection than its predecessor, the need to understand the persistence of their positivity, following a malaria infection, remains. The …

Exploring Pharmaceutical Waste Prevention And Disposal Practices In Nurse Populations, Natasha Wasim

Public Health Theses

Objective: This research study aimed to explore pharmaceutical waste prevention and disposal practices in nurse populations.

Methods: A descriptive, cross-sectional survey was employed through the Qualtrics survey system. The survey questions were designed to probe knowledge, behavior, and attitudes of nurses towards pharmaceutical waste. Participants included intensive care unit nurses

and perioperative nurses in the Yale New Haven Health System.

Results: A total of 104 surveys were collected. Nurses were asked about the importance of proper waste disposal, and 95.2% of nurses (N=99/104) believed that appropriate waste disposal is important to “protect the environment health.” The survey also asked about …

Prion Epidemiology And The Npdpsc’S Experience With Rt-Quic, Aleksandra Wrona

Public Health Theses

Prion diseases, or transmissible spongiform encephalopathies, constitute a wide array of invariably fatal rapidly progressive neurodegenerative illnesses that affect both humans and animals. The gold standard of diagnosis for these diseases is through neuropathologic examination of brain tissue following autopsy. In September 2018, the Centers for Disease Control and Prevention (CDC) added positive real-time quaking-induced conversion (RT-QuIC) test result as a likely indicator of certain human prion diseases. With high sensitivity and specificity approaching 100%, RT-QuIC has quickly become one of the most powerful antemortem diagnostic tools.

This paper will demonstrate why changes in diagnostic criteria and reporting metrics are …

State Vaccination Policies And Coverage For Adolescent Vaccines In The United States, 2017, Anthony Edward Yakely

Public Health Theses

Background: The wide-ranging nature of state vaccination requirements for school entry allows for suboptimal coverage of adolescent vaccination as well as missed opportunities where some adolescent vaccinations are received but not all of them. Variation exists both in the types of exemptions that are allowed and the process that is required to obtain an exemption. State-level policies have been shown to be associated with childhood vaccination coverage, but far fewer studies have examined adolescent vaccine coverage.

Methods: HPV, MenACWY, and Tdap vaccine receipt and demographic data from the 2017 National Immunization Survey-Teen (NIS-Teen) Public Use Dataset were combined with data …

Modeling The Policy Impact On The Dynamics Of Tobacco Product Use, Tianzhou Yu

Public Health Theses

Abstract

Objective

Smoking is the leading cause of preventable death. While the proportion of the U.S. population that uses combustible tobacco products has been declining over the past decade, use of e-cigarettes among youth and young adults has risen. Our objective was to model the prevalence of tobacco product use in 10 years given the current policy environment and project product use patterns if new policies are adopted.

Methods

Using data from the literature, we constructed a microsimulation model for the period 2015 – 2025 with the following Markov states: combustible use only, e-cigarette use only, dual use, former use, …

Epigenetic Silencing Rna Methylation Machinery Fto And Mettl3 Associate With Patient Survival In Renal Clear Cell Carcinoma, Jiaxun Zhao

Public Health Theses

Purpose: RNA methylation eraser FTO and writer METTL3 play important roles in human diseases by regulating gene expression. However, the potential of FTO and METTL3 as markers in renal clear cell carcinoma (CCRCC) is still unknown. The purpose of this study is to investigate differential expression of FTO and METTL3 in CCRCC vs. normal kidney tissues, the association of FTO and METTL3 expression and methylation with and their interaction of FTO and METTL3 expression in patient survival in CCRCC.

Method: FTO and METTL3 expression and methylation, the clinicopathologic data were retrieved from a publicly accessed dataset of The Cancer Genome …

Using Volatile Organic Compounds In Exhaled Breath As A Biomarker For Early Lung Cancer Detection: A Systematic Review, Jieqiong Zhou

Public Health Theses

Lung cancer has become the most commonly diagnosed cancer and the leading cause of cancer deaths globally. The major problem of the high mortality rate is the late diagnosis. Conventional methods utilized for clinical detection of lung cancer have employed expensive and invasive medical procedures that cause stress, discomfort, and pain to patients, and have demonstrated low sensitivity, substantial false negatives, and risk of radiation exposure. The drawbacks obviate their applicability to large-scale, population-wide screening efforts. This paper reviews the applications of using volatile organic compounds (VOCs) in exhaled breath as a potential approach for early lung cancer detection.

An …

A Comprehensive Evaluation Of Breast Cancer Risk Prediction Using Uk Biobank Data., Xiaorui Zhu

Public Health Theses

Introduction: Both genetic and clinical risk factors play roles in breast cancer onset. Developing comprehensive and accurate breast cancer prediction model will enable effective identifications of individuals at high risk, and facilitate personalized decision on screening and preventive strategy.

Objectives: Develop a risk prediction model for breast cancer including both genetic and clinical risk factors, and quantify the benefit of adding polygenic risk score (PRS) in risk prediction.

Methods: Analysis was based on data collected through the UK Biobank which consist of 13,851 breast cancer cases and 206,865 controls. The clinical factors that we considered include baseline demographics, lifestyles, family …