Public Health Commons^™

Association Between Rheumatoid Arthritis Severity And Mental Health In A Prevalent Cohort Of American Adults, 2013-2022, Nicole-Anne Ballesteros

Public Health Theses

Objective/Purpose: The severity of rheumatoid arthritis and its association with depression and anxiety among a prevalent cohort of American adults has been neither well-researched nor backed by real-world data. This investigation seeks to test the hypothesis that there is an association between disease severity and the aforementioned psychological conditions, both of which are commonly observed in patients with rheumatoid arthritis.

Methods: Real-world data from OM1 Inc.’s rheumatoid arthritis registry (2013-2022) was used for this analysis. Disease severity (low, medium, and high), categorized using disease activity scores, was the main exposure, while depression and anxiety were the study’s two primary outcomes. …

Adverse Childhood Experiences & Breastfeeding - Pakistan, Paola Bojorquez-Ramirez

Public Health Theses

Rationale: Prior studies have found that a history of adverse childhood experiences (ACEs) is associated with breastfeeding, but the evidence is inconsistent. Despite low and middle income countries (LMICs) carrying a disproportionate amount of poor maternal and infant health outcomes, little research has assessed the relative impact of ACEs on breastfeeding initiation and exclusive breastfeeding in LMICs.Objective: The study investigates whether maternal ACEs are associated with breastfeeding initiation and exclusive breastfeeding at 3 and 6 months postpartum among a cohort of women from rural Pakistan. Methods: The cross-sectional analysis included 869 women 18-45 years of age from the Bachpan Cohort …

Circadian Factors And Cancer Survivorship: A Mini Review, Jiaqi Cui

Public Health Theses

Circadian clocks are molecular clocks that govern the temporal control of physiology to preserve homeostasis. The disruption of the circadian rhythm is important in carcinogenesis and aids the development of cancer hallmarks. On the other hand, carcinogenic activities disrupt circadian rhythms directly. In cancer treatment, pharmacological regulation of core clock genes is a novel approach. The use of circadian biology in cancer research opens up new avenues for improving cancer treatment effectiveness. This mini-review provides an overview of relationship between circadian factors including circadian gene expression, circadian genotype, circadian disruption and circadian gene methylation and the cancer survivorship. The review …

“She Trusts Us To Love Her, You Know?”: Using A Love Ethic Framework To Explore Faith Navigation And Acceptance Processes Among Mormon Mothers Of Lgbtq+ Individuals, Nandini Milind Deo

Public Health Theses

Parental acceptance is a key factor in bolstering the health and well-being of LGBTQ+ individuals across their lifespan (Needham & Austin, 2010; Ryan, 2010; Jin, 2020; Clark et al., 2021). One factor known to influence parental acceptance is family religiosity, which has typically been associated with conflict and/or rejection (Ryan, 2010; Johns & Hanna, 2012; Roe, 2017). The purpose of this study was to better understand faith navigation and acceptance processes among active Mormon mothers of LGBTQ+ individuals in an effort to inform public health engagement with highly religious parents of sexual and gender minority children. In-depth qualitative interviews were …

Support Or Interference: Relational Influences On Mother’S Exclusive Breastfeeding Practices In Ghana, Georgiana Esteves

Public Health Theses

Childhood malnutrition is a challenge that needs to be understood as a global health threat. Exclusive breastfeeding (EBF) is recognized as the best practice to improve a child’s growth and cognitive development in the first months of life. The World Health Organization recommends EBF until 6 months. Mothers need family support to adhere to EBF practices. This study aimed to understand the interpersonal level relational influences of fathers, grandmothers, and other family members on the mother-child dyad adherence to EBF practices, as well as document community and societal influences on EBF. This study took place in the Central Region of …

Proximity And Parental Interaction: Examining The Relationship Between Proximity Data And Mother-Infant Interaction Among Mothers With And Without Depression, Paige Farrenkopf

Public Health Theses

Background: There is a lack of data on response behaviors among young mothers in low- and middle-income countries. Emerging passive sensing technology has been increasingly allowing researchers to collect this type of day-to-day behavioral data.

Methods: We administered PHQ-9 depression surveys and the Observation of Maternal-Child Interaction (OMCI) measure to young mothers between the ages of 15-25 in the Chitwan region of Nepal, and conducted key informant interviews with all mothers selected for participation.

Results: Among 54 mother-infant dyads, we found that there was no statistically significant correlation between maternal responsiveness and proximity. When we stratified participant groups by depression …

The Role Of Childhood Trauma In Intergenerational Trauma (Igt), Audrey Huang

Public Health Theses

Emerging research has focused on the intersection of personal and parental trauma within intergenerational trauma (IGT) transmission, specifically offspring adverse childhood experiences due to trauma-related parenting behaviors. However, the role that offspring childhood trauma and its various subtypes may play in moderating or mediating IGT transmission, as well as the impact of caregiver sex, are still remains largely understudied. We examined how the transmission of PTSD between survivors of the 1994 genocide to their offspring might be either (a) mediated by overall and subtypes of offspring childhood trauma, or (b) moderated by overall and subtypes of offspring childhood trauma, and …

Comparing Dog And Owner Pfas Exposures Using Fresh Air Samplers, Emily Elizabeth Johnson

Public Health Theses

Per- and polyfluoroalkyl substances (PFAS) have gained attention given their prevalence and persistence in the environment and in our bodies. PFAS have been detected in water, food products, and consumer products. Furthermore, companion animals may be exposed to elevated PFAS levels due to sources from pet products as well as household items. A growing number of studies have been conducted to better understand the toxicological and public health impacts of legacy PFAS resulting from ingestion and dermal exposure pathways in both humans and domesticated animals. As alternative replacement PFAS emerge in the market, these compounds are shorter chain which allows …

Exploring Climate Policy And Health Perspectives In Samoa: A Mixed Methods Study, Erika-Ann Fumiko Kim

Public Health Theses

Background: Greenhouse gas emissions have driven human-induced climate change, bringing several impacts to small island nations in the Pacific. Samoa, a small island developing state located in the south Pacific Ocean, is at disproportionate risk from impacts of climate change such as rising surface temperatures, rising sea levels, increases in frequency and degree of heavy precipitation events, and increases in the frequency of droughts. Simultaneously, Samoan populations possess a high prevalence of non-communicable diseases such as diabetes, heart disease, and hypertension. For multiple decades, the Government of Samoa has framed climate change as a key issue that threatens the lives, …

How Medical Student Perceptions Of Faulty Interactions Influence Burnout, Meghan Elizabeth Lindsay

Public Health Theses

Objective: To assess the relationship between the perceptions of student-faculty interactions and self-reported burnout scores during professional medical education. Design: Cross-sectional study. Setting: 140 accredited US medical schools by the Association of American Medical Colleges in 2016 and 2017. Participants: 26,464 of 30,651 graduating medical students who completed the Association of American Medical Colleges’ Graduation Questionnaire in 2016 and 2017 and who had complete questionnaires for all aspects of our related measures. Main outcome measures: Exploratory factor analysis was used to identify latent constructs underlying 14 measured students’ perception of faculty interaction variables and develop factor based scales. The association …

A Prediction Model Of Rotavirus Vaccine Performance Based On Meta-Analysis And Variable Selection, Yueqi Li

Public Health Theses

Background: Rotavirus is the leading cause of diarrheal diseases worldwide and is responsible for substantial morbidity and mortality among children younger than 5 years of age. The introduction of national immunization programs against rotavirus has greatly reducedhospital admissions and deaths from rotavirus gastroenteritis, but vaccine efficacy and effectiveness vary substantially between high- and low-income settings. Given the disparity of vaccine performance across countries, we built a model to predict how well the vaccines would work in settings without vaccine introduction. Methods: Data on vaccine performance and relevant predictor variables were extracted from the literature and repositories. We performed a meta-analysis …

Evaluating The Cost-Effectiveness Of Varied Vaccination Strategies For Ebola Virus Disease In The Democratic Republic Of The Congo, Rachel Amanda Lobe-Costonis

Public Health Theses

Introduction: The 2018 outbreak of Ebola virus in the Democratic Republic of Congo was the first to occur in the context of an ongoing complex humanitarian emergency. Despite optimism for an effective response given the efficacious one-dose Merck vaccine (ERVEBO), the immense challenges to public health efforts caused by the ongoing armed conflict posed unprecedented complications to the recommended ring vaccination strategy. In the end, contract tracing efforts for ring vaccination reached only 82% of individuals at best estimate, and the outbreak lasted 89 weeks with a total cost of $734 million. In comparison, transmission dynamic modeling has shown the …

“I Still Have My Sorrows With Me.” A Qualitative Study Exploring How Nepali Adults Engage In Meaning-Making Following Suicide Experiences, Risika Mohanty

Public Health Theses

Background: Of all the global reported suicides, 78% of them occur in low and middle-income countries and 39% specifically occur in the Southeast Asia region. Nepal’s suicide rate was ranked 8th in the world by WHO estimates in 2014, with the third-highest suicide rate for females. While we know of certain suicide risk factors pertaining to Nepal, we have yet to understand how individuals make meaning of life following suicide experiences. Purpose: This study uses a narrative thematic analysis approach to understand how adults with lived experiences of suicide (ALES) navigate their internal and interpersonal lives following their suicide experience. …

Evaluation Plan For A Mortality Surveillance System In Northwest Syria, Hanna Peterson

Public Health Theses

AbstractIntroduction: Cause-specific population mortality data is one of the most useful metrics used to monitor and evaluate the severity of a crisis. However, the unique context of fragile and protracted armed conflicts creates obstacles for establishing a mortality surveillance system. When CRVS are not feasible, VA can be used to generate high-quality mortality rate estimates. There is currently little documentation of implementation and evaluation of mortality surveillance systems in conflict settings, and guidance for both is extremely limited. This thesis aims to contribute to these two knowledge gaps by providing an evaluation plan for a mortality surveillance system in Northwest …

Xylazine In The Drug Supply: Emerging Threat In Connecticut And Lessons Learned From Philadelphia, Thomas A.G. Quijano

Public Health Theses

Background: Xylazine, a sedative analgesic drug approved as an animal tranquilizer but not for human use, has become an adulterant in the supply of heroin/fentanyl.(Greene & Thurmon, 1988) Between 2019 and 2020, prevalence of xylazine in overdose death reports increased by 44.8% nationally.(Friedman et al., 2021) The three jurisdictions in 2020 with the highest prevalence of xylazine were Philadelphia (25.8%), Maryland (19.3%), and Connecticut (10.2%).(Friedman et al., 2021) Not much is known about how xylazine’s impacts on service provider’s practices and the people they serve.

Objectives: Use a multiple methods approach to understand xylazine’s presence and impact in Connecticut, and …

Navigating A Patchwork Maze: Individuals’ Experience Of Administrative Burden When Accessing Homeless Assistance Services, Leah Robinson

Public Health Theses

Despite significant efforts to address the issue of homelessness in the United States over the past several decades, over 500,000 individuals still experience homelessness on any given night. A large portion of this persistent and high rate of homelessness can likely be attributed to the shortage of affordable housing options, the eviction crisis, and limited financial support for rental assistance found throughout the country. However, administrative burdens may also contribute to the high rate of homelessness being seen.Our study explores this question by examining 28 individuals’ experience of administrative burden when navigating the landscape of homeless assistance services in New …

Effects Of Depression And Discrimination During Pregnancy On Postpartum Healthcare Utilization Among Women In Detroit, Mi And Nashville, Tn, Janet A. Rojina

Public Health Theses

Objectives: This study seeks to document how both depression and discrimination during pregnancy may impact postpartum healthcare utilization (e.g. attendance of the 6-week postpartum appointment and maternal emergency room (ER) visits within 6 months after birth) among women in Detroit, MI and Nashville, TN. We also investigate how race may be associated in the relationship between depression during pregnancy and healthcare use. Methods: Descriptive, stratified, and logistic regression (univariate and multivariate) analyses were conducted using SAS 9.43. Data was drawn from the Expect with Me (EWM) study, a multisite prospective longitudinal matched-cohort that included 951 pregnant women from Detroit, MI …

“We Just Need Help”: A Qualitative Study On Information Channels And Knowledge Gaps On Eviction Resources During The Covid-19 Pandemic, Kalla Maxine Pascual Sy

Public Health Theses

BackgroundThe COVID-19 pandemic led to record levels of mass unemployment and wage losses in the United States, placing numerous households at greater risk of housing insecurity. Government bodies and non-profit organizations have responded accordingly by enacting eviction moratorium protections and rental assistance programs to help households in need. However, knowledge gaps pose challenges to successful uptake of eviction moratorium policies and rental assistance programs during the pandemic. Very little is known about tenants’ experience navigating eviction moratorium policies and assistance programs during the COVID-19 pandemic and any knowledge gaps that arose.

ObjectivesTo examine the channels of information for eviction-related resources …

Association Between Household Chaos And Childhood Overweight-Obesity: A Cross-Sectional Study Among Young Samoan Children, Ruiyan Michelle Wang

Public Health Theses

AbstractObjective: Household chaos – sustained disorganization, disorder, and hurriedness in the home setting – has been shown to be associated with a variety of adverse health effects for children. The present study examines the relationship of household chaos with childhood overweight and obesity among Samoan children aged 5 to 12 years. Additionally, the present study explores characteristics of the home environment that may be captured by the household chaos measure. Methods: This analysis uses data from the third wave (2019-2020) of data collection in the Ola Tuputupua’e cohort study. Height and weight were used to construct the childhood overweight/obesity outcome …

Per- And Polyfluoroalkyl Substances (Pfass) In Household Dust From North China: Occurrence, Contribution, And Human Exposure, Yakun Zhou

Public Health Theses

Measurements and analysis of an emerging contaminant of poly- and perfluoroalkyl substances (PFAS) and adverse health effects associated with PFAS have received increasing attention around the world. In this study, 64 participants’ household dust were collected in Jinan, China during September 2018 and January 2019, conducted as part of the Biomarkers of Air Pollutants Exposure in the Chinese aged 60-69 (China BAPE) study. Concentrations and composition profiles of 7 individual PFASs were determined and estimated daily intakes of PFASs via dust ingestion for children and adults were calculated. By using a dimension reduction method − principal component analysis (PCA) and …

An Agent-Centered Approach To Covid-19 Vaccinations, Nila Venkat

CMC Senior Theses

The rise of COVID-19 has dramatically affected the global economy, healthcare systems, and individuals’ daily lives. One of the most controversial attempts to ameliorate the effects of the virus in the United States has been the distribution of COVID-19 vaccinations. In this thesis, I propose a novel agent-centered approach to motivating COVID-19 vaccinations. I begin by exploring the origins and evolution of the virus, along with the growing demographic of “vaccine-hesitant” Americans, to contextualize the debate surrounding vaccinations. I then propose two potential action-based response strategies for vaccine motivation: a vaccine mandate and nudges. Concerning a mandate response strategy, I …

Planning Patient Safety: Philosophical, Political, And Economic Changes Required For Preventable Death Abolition, Catherine Kiani

CMC Senior Theses

Preventable medical errors are an epidemic. Between 250,000 and 400,000 people die from preventable errors each year in the USA. This investigation questions mechanisms for quality care improvement to eliminate preventable fatalities. I evaluated current patient safety protocols, analyzed their shortcomings, and with additional research recommended actions for better results. Such actions to improve patient safety are explored from three different perspectives: philosophical, economical, and political aspects. In chapter one, improvements within hospitals are reviewed – namely cultural changes needed from both physicians and hospital leadership. Abolishing hierarchical systems which preclude healthy collaboration among medical teams, diverting focus to patient …

Bridging The Gaps: Exploring Factors Associated With Goal Achievement Within An Accountable Care Organization Care Coordination Program, Jessica L. Polk

College of Graduate Studies: Theses & Dissertations

Background: Healthcare cost in the U.S. has been increasing at an unsustainable rate due to the growing population diagnosed with multiple chronic conditions and a fragmented healthcare system. The high-risk patient population includes persons who over utilize the healthcare system with frequent avoidable hospitalizations, emergency room visits, and exacerbations of their chronic conditions. This high-risk population makes up five percent of the U.S. but accounts for over fifty percent of all healthcare spending. Care coordination models have emerged to focus proactive health interventions for the highest-risk patient populations to reduce overutilization and empower patients to improve long-term health. Evidence has …

Factors Associated With Intention To Disclose Concussive Symptoms In Active Duty Soldiers, Carly Beck

College of Graduate Studies: Theses & Dissertations

Background: Concussion disclosure is a heavily researched topic, and while previous literature has explored predictors of concussion disclosure in numerous populations, research within the active duty Soldier population is limited. This study further explored predictors of concussion disclosure to a medical professional or leadership in the active duty Solider population through the lens of the Theory of Planned Behavior. Methods: A cross-sectional electronic survey was distributed to 181 active duty Soldiers. Descriptive statistics were used to report frequency of high intention to disclose concussive symptoms among demographics, and a multivariate regression model was used to assess significant predictors of intention …

The Risk Factors For Hiv In African American Transgender Women In Connecticut, Oliver Kunda

Walden Dissertations and Doctoral Studies

AbstractThe human immunodeficiency virus (HIV) incidence rate is 70 times higher for African American transgender women than in the general population. Despite decades of outreach and intervention effort to reduce HIV incidence in the transgender community by the lesbian, gay, bi-sexual, transexual, queer, plus (LGBTQ+) community and public health organizations, the HIV prevalence rate for transgender women remains high at 38%. The purpose of this qualitative exploratory case study was to gain insights into how attitude, subjective social norms, and perceived behavioral control influence HIV risk behaviors of African American transgender women in Connecticut. Ajzen’s theory of planned behavior provided …

An Evidenced-Based Nursing Education Discharge Plan For Prescription Opioids, Josephine J. Messelmani

Walden Dissertations and Doctoral Studies

The reported number of prescription opioid overdoses justifies the need for providing patients with opioid discharge information and follow-up care as recommended. To prevent any misuse of prescription opioid drugs, it was critical for patients to receive a thorough review of their medications prior to being discharged. The purpose of the project was designed to educate nurses on the importance of delivering essential information to patients prescribed opioids. Implementation of an opioid discharge plan integrated with the teach back method increased patients’ understanding of how to properly take prescription opioids compared to the patients who did not receive opioid education …

Use Of The Hester Davis Falls Risk Assessment Scale In Medical-Surgical Patients, Gideon M. Nyakundi

Walden Dissertations and Doctoral Studies

AbstractIdentifying and containing patient falls before they happen, reporting fall occurrence, and analyzing fall causes could increase patient safety to achieve the triple aim of improved quality, reduced cost, and accessibility in healthcare. Patient falls within the medical-surgical population continue to present challenges to patients, families, hospitals, and society, despite the use of fall-related predictive analysis tools. The purpose of this quantitative study was to determine the extent to which the overall score on the Hester Davis Falls Risk Assessment Scale (HDS), comprised of patient-related factors such as medications, volume/electrolyte status, age, last known fall date, mobility, toileting needs, communication/sensory …

Knowledge And Experiences Of African American Women With Polycystic Ovary Syndrome, Kristy L. Vance

Walden Dissertations and Doctoral Studies

While polycystic ovary syndrome (PCOS) is a nationwide phenomenon, African American or Black women often have little to no information on the education and support available to manage the condition. PCOS is one of the most poorly understood disorders among patients which has led to limited resources and management. The lack of education could contribute to increased risks to many health issues for African American women with PCOS. The purpose of this basic qualitative study was to explore and examine the level of health knowledge related to PCOS among African American women living in or around the Northern Region of …

Effects Of Socioeconomic Status, Demographic Characteristics, And Education On Sarcopenic Obesity, Moruf Oladele Olaleye

Walden Dissertations and Doctoral Studies

The general problem is that although the body of research about obesity is robust, there is a lack of research addressing the problem of sarcopenic obesity. Specifically, there is a lack of research examining the statistical significance of the relationship between the independent variables of socioeconomic status, demographic characteristics, and education and the dependent variable of sarcopenic obesity. This research may advance practice and policy by lending support for developing interventions to address factors that have a statistically significant relationship with sarcopenic obesity. The purpose of this quantitative causal-comparative study was to identify independent variables among socioeconomic, demographic, and education …

Experiences Of Critical Care Nurse Managers In Addressing Nurses' Work-Related Stress, Mariana Tsucuneli

Walden Dissertations and Doctoral Studies

AbstractNurses who work in the critical care unit are more likely to experience work-related stress, fatigue, understaffing, undesirable performance outcomes, and compromised workplace safety than general care nurses. Nurse managers in these units possess insights into nurses' stress-inducing challenges, in addition to managerial and administrative perspectives. Yet there is a lack of available knowledge about the experiences of critical care nurse managers in addressing nurses' work-related stress. The purpose of this study was to explore critical care nurse managers’ experiences of potential strategies to effectively address work-related stress among nurses. The job-demand resource model was the theoretical framework for the …