Public Health Commons^™

Use Of The Decipher Genomic Classifier Among Men With Prostate Cancer In The United States, Nicholas G. Zaorsky, James A. Proudfoot, Angela Y. Jia, Raed Zuhour, Randy Vince Jr., Yang Liu, Xin Zhao, Jim Hu, Nicola Schussler, Jennifer L. Stevens, Suzanne Bentler, Rosemary D. Cress, Jennifer A. Doherty, Eric B. Durbin, Susan Gershman, Iona Cheng, Lou Gonsalves, Brenda Y. Hernandez, Lihua Liu, Bozena M. Morawski, Maria Schymura, Stephen M. Schwartz, Kevin C. Ward, Charles Wiggins, Xiao-Cheng Wu, Jonathan Shoag, Lee Ponsky, Alan Dal Pra, Edward M. Schaeffer, Et Al

School of Medicine Faculty Publications

Background: Management of localized or recurrent prostate cancer since the 1990s has been based on risk stratification using clinicopathological variables, including Gleason score, T stage (based on digital rectal exam), and prostate-specific antigen (PSA). In this study a novel prognostic test, the Decipher Prostate Genomic Classifier (GC), was used to stratify risk of prostate cancer progression in a US national database of men with prostate cancer. Methods: Records of prostate cancer cases from participating SEER (Surveillance, Epidemiology, and End Results) program registries, diagnosed during the period from 2010 through 2018, were linked to records of testing with the GC prognostic …

Food Insecurity And Residential Segregation Among Adults In The United States: The National Health And Nutrition Examination Survey 2017- March 2020 Pre-Pandemic Data., Chandre' L. Chaney

Electronic Theses and Dissertations

Food insecurity is when a household has insufficient food supply due to limited economic resources. It is a public health issue that continues to persist. The health, social, and economic impact affects millions of people nationwide. Residential segregation is a primary cause of inequities and health disparities. It shapes the differences in socio-economic conditions between Blacks and Whites living in the U.S. This country is segregated across racial lines in many of our most populated metropolitan cities. Americans worship in different churches, learn in disparate schools, and live in separate neighborhoods. Residential segregation has consequences that impact the economy, professional …

Impact Of A Cancer Education Curriculum On Appalachian Kentucky Middle And High School Students, Lauren Hudson‑Rose, L. Todd Weiss, Nathan L. Vanderford

Markey Cancer Center Faculty Publications

Appalachian Kentucky is disproportionately affected by elevated cancer incidence and mortality rates. This disparity is driven by inequities in health behaviors and social determinants of health including decreased education attainment levels that cause lower health literacy. To increase cancer literacy in the region, a three-part cancer education curriculum was designed for Appalachian Kentucky middle and high school students. This study was designed to evaluate the effect the curriculum had on students’ cancer literacy. The curriculum lessons were disseminated to Appalachian Kentucky middle and high school teachers who engaged 223 students with the material. For each lesson, students filled out a …

Weighted Mean Difference Statistics For Paired Data In The Presence Of Missing Values, Yuntong Li, Brent J. Shelton, William St Clair, Heidi L. Weiss, John L. Villano, Arnold Stromberg, Chi Wang, Li Chen

Markey Cancer Center Faculty Publications

Missing data is a common issue in many biomedical studies. Under a paired design, some subjects may have missing values in either one or both of the conditions due to loss of follow-up, insufficient biological samples, etc. Such partially paired data complicate statistical comparison of the distribution of the variable of interest between the two conditions. In this article, we propose a general class of test statistics based on the difference in weighted sample means without imposing any distributional or model assumption. An optimal weight is derived from this class of tests. Simulation studies show that our proposed test with …

Investigation Of The Protein Components In A Periplasmic Mechanism Regulating Bacterial Morphology, Alexandra Pulliam

Electronic Theses and Dissertations

Salmonella is a leading bacterial cause of foodborne illness worldwide. During a previous study investigating the enzymes responsible for regulating cyclic-di-GMP concentrations, a mutant in the cyclic-di-GMP-specific phosphodiesterase STM3615 was identified that displayed a phenotype characterized by decreased survival on agar plates and a shorter bacterium length. I was able to determine that the periplasmic domain of STM3615 was responsible for this phenotype, not the enzymatic phosphodiesterase domain. Based upon a bioinformatic analysis of the protein, I then hypothesized that the periplasmic domain of STM3615 was interacting with a periplasmic protein to give rise to this phenotype. To identify this …

Overdose Prevention Behaviors And The Rural Risk Environment Among People Who Inject Drugs In Rural Appalachia, Jody Teel

Electronic Theses and Dissertations

Introduction: The entire United States has felt the effects of the overdose epidemic, but rural Appalachia has experienced disproportionate overdose deaths. This variation in overdose mortality can be attributed to the risk environment for overdose in rural Appalachia. Overdose prevention behaviors are individual level behaviors that people who inject drugs can implement that may have the potential to reduce their risk of overdose, however limited research exists regarding the utilization of those behaviors. It is important to consider how the risk environment can influence the utilization of overdose prevention behaviors among people who inject drugs. Therefore, the purpose of this …

African-American Parents’ Cultural Understandings Of The Concept Of Autism And Implications For Parental Communication And Health Management, Kellie J. Fennell

Communication & Theatre Arts Theses

In 2023 the Centers of Disease Control reported that around 1 in 36 children are diagnosed with Autism in America and that the prevalence has increased by 178% since 2000 (CDC, 2023). Despite increases in awareness and diagnosis past research finds that the discussions of ASD in African American communities is minimal (Fombonne, 2003; Yeargin Allsopp et al., 2003). This disparity is important considering that African American children receive an ASD diagnosis years later than their white counterparts and are much more likely to be misdiagnosed (Mandell et al., 2009, 2002).

Given the history of a lack of representation of …

Clinical And Environmental Factors Affecting The Survival Outcomes Among Stage 1a Tn0m0 First Primary Non-Small Cell Lung Carcinoma Patients In The United States., Naiya Patel

Electronic Theses and Dissertations

Background: Lung cancer is the second leading cause of death in the United States (U.S.). The most prevalent histological type of lung cancer is Non-Small Cell Lung Cancer (NSCLC), which has an overall five years survival of 5% if left untreated. Therefore, early treatment of NSCLC is vital to improve overall survival (OS) outcomes. Several factors affect survival outcomes, which can be categorized as modifiable or non-modifiable. The difference in timely receipt of guideline-concordant treatment affects the survival outcomes of patients with stage 1A NSCLC. This dissertation explored factors that affect treatment and survival outcomes among stage 1A NSCLC patients …

Incidence And Determinants Of Hypertensive Disorders Of Pregnancy In The Us: Hospitalization Discharge Rate For Preeclampsia, Eclampsia, And Gestational Hypertensions, 2016-2018., Kahir S. Jawad

Electronic Theses and Dissertations

Background: Hypertension remains one of the most prevalent medical issues in pregnancy. It contributes considerably to maternal and fetal morbidity and mortality, making it one of the most significant public health problems. Although various epidemiological studies have been conducted over the past decades to assess the disease incidence and key risk factors associated with hypertensive disorders of pregnancy, current incidence rates and trends are lacking. This is a novel and significant study because there are no current population-based incidence estimates of hypertensive disorders of pregnancy and their subtypes and very few studies with the power to explore a wide range …

Prevalence And Factors Associated With Sexual And Reproductive Health Literacy Among Youth Living With Hiv In Uganda: A Cross-Sectional Study, Benedicto Mugabi, Miisa Nanyingi, Richard Kabanda, Juliet Ndibazza, Peter Elyanu, John Baptist Asiimwe, Gorret Nazziwa, Gilbert Habaasa, Adeodata Kekitiinwa

School of Nursing & Midwifery, East Africa

Background

Adequate sexual and reproductive health literacy (SRHL) among young people has been linked to informed sexual behaviours. Studies on SRHL have largely been conducted among the general adolescent population. Little is known about youth aged 15-24 years living with human immunodeficiency virus (YLHIV). There is a possible lack of SRHL in this population, considering the high rate of teenage pregnancies and unprotected sex reported by YLHIV. This study aimed to assess the prevalence and associated personal and environmental factors for SRHL among YLHIV at a high-volume urban HIV Clinic in Uganda.

Methods

Through a cross-sectional survey, YLHIV receiving routine …

Rare Genetic Variants Associated With Sudden Cardiac Arrest In The Young: A Prospective, Population-Based Study, Lauri Holmstrom, Ninad S Chaudhary, Kotoka Nakamura, Harpriya Chugh, Audrey Uy-Evanado, Faye Norby, Ginger A Metcalf, Vipin K Menon, Bing Yu, Eric Boerwinkle, Sumeet S Chugh, Zeynep Akdemir, Evan P Kransdorf

Faculty, Staff and Student Publications

No abstract provided.

T-Cell Receptor Beta Variable Gene Polymorphism Predicts Immune-Related Adverse Events During Checkpoint Blockade Immunotherapy, Bettzy Stephen, Joud Hajjar, Shrutii Sarda, Dzifa Yawa Duose, Jeffrey M Conroy, Carl Morrison, Anas Alshawa, Mingxuan Xu, Abdulrazzak Zarifa, Sapna P Patel, Ying Yuan, Evan Kwiatkowski, Linghua Wang, Jordi Rodon Ahnert, Siqing Fu, Funda Meric-Bernstam, Geoffrey M Lowman, Timothy Looney, Aung Naing

Faculty, Staff and Student Publications

BACKGROUND: Immune checkpoint inhibitors have revolutionized cancer treatment. However, they are associated with a unique spectrum of side effects, called immune-related adverse events (irAEs), which can cause significant morbidity and quickly progress to severe or life-threatening events if not treated promptly. Identifying predictive biomarkers for irAEs before immunotherapy initiation is therefore a critical area of research. Polymorphisms within the T-cell receptor beta (TCRB) variable (TRBV) gene have been implicated in autoimmune disease and may be mechanistically linked to irAEs. However, the repetitive nature of the TCRB locus and incomplete genome assembly has hampered the evaluation of TRBV polymorphisms in the …

The Importance Of Acculturation Orientation In Understaanding The Impact Of Pre- And Post-Migration Stressors On Behavioral Health: Evidence From A Crisis Migrant Sample, Christopher P Salas-Wright, Michael G Vaughn, Mildred M Maldonado-Molina, Melissa Bates, Eric C Brown, María F García, José Rodríguez, Seth J Schwartz

Faculty, Staff and Student Publications

OBJECTIVE: We examine the interplay of acculturation orientation, cultural stress, and hurricane trauma exposure with behavioral health among Puerto Rican crisis migrants who relocated to the US mainland after Hurricane Maria.

METHOD: Participants were 319 adult (Mage = 39 years; 71% female; 90% arriving in 2017-2018) Hurricane Maria survivors surveyed on the US mainland. Latent profile analysis was used to model acculturation subtypes. In turn, ordinary least squares regression was executed to examine the associations of cultural stress and hurricane trauma exposure with behavioral health while stratifying by acculturation subtype.

RESULTS: Five acculturation orientation subtypes were modeled, three of which-Separated …

Age Dependency Of Cardiovascular Outcomes With The Amyloidogenic Pv142i Transthyretin Variant Among Black Individuals In The Us, Senthil Selvaraj, Brian L Claggett, C Cristina Quarta, Bing Yu, Riccardo M Inciardi, Joel N Buxbaum, Thomas H Mosley, Amil M Shah, Sharmila Dorbala, Rodney H Falk, Scott D Solomon

Faculty, Staff and Student Publications

IMPORTANCE: Hereditary transthyretin cardiac amyloidosis is an increasingly recognized cause of heart failure (HF) with distinct treatment. The amyloidogenic pV142I (V122I) variant is present in 3% to 4% of Black individuals in the US and increases the risk for atrial fibrillation (AF), HF, and mortality. Since hereditary transthyretin cardiac amyloidosis demonstrates age-dependent anatomic penetrance, evaluation later in life may identify survivors at particularly high risk.

OBJECTIVE: To estimate age-dependent risks for cardiovascular events with the variant.

DESIGN, SETTINGS, AND PARTICIPANTS: This cohort study analyzed Black participants from the Atherosclerosis Risk in Communities (ARIC) study attending visit 1 (1987-1989) (followed up …

Dimension Reduction Of 911 Good Samaritan Laws: Drawing Inferences From Policy Surveillance, Shane W Reader, Ellen D Breckenridge, Wenyaw Chan, Gretchen H Walton, Stephen H Linder

Faculty, Staff and Student Publications

Background: 911 Good Samaritan Laws (GSLs) extend legal protection to people reporting drug overdoses who may otherwise be in violation of controlled substance laws. Mixed evidence suggests GSLs decrease overdose mortality, but these studies overlook substantial heterogeneity across states. The GSL Inventory exhaustively catalogs features of these laws into four categories: breadth, burden, strength, and exemption. The present study reduces this dataset to reveal patterns in implementation, facilitate future evaluations, and to produce a roadmap for the dimension reduction of further policy surveillance datasets.

Methods: We produced multidimensional scaling plots visualizing the frequency of co-occurring GSL features from the GSL …

Post Sbirt Implementation - Input From The Field To Improve Fins Engagement, Substance Use Screening & Referral To Treatment, Institute For Public Health And Justice, Screening And Assessment

Policy & Position Papers

No abstract provided.

Artificial Light At Night And Social Vulnerability: An Environmental Justice Analysis In The Us 2012-2019, Qian Xiao, Yue Lyu, Meng Zhou, Jiachen Lu, Kehe Zhang, Jun Wang, Cici Bauer

Faculty, Staff and Student Publications

BACKGROUND: Artificial Light at Night (ALAN) is an emerging health risk factor that has been linked to a wide range of adverse health effects. Recent study suggested that disadvantaged neighborhoods may be exposed to higher levels of ALAN. Understanding how social disadvantage correlates with ALAN levels is essential for identifying the vulnerable populations and for informing lighting policy.

METHODS: We used satellite data from the National Aeronautics and Space Administration's (NASA) Black Marble data product to quantify annual ALAN levels (2012-2019), and the Center for Disease Control and Prevention's (CDC) Social Vulnerability Index (SVI) to quantify social disadvantage, both at …

Interrogations Of The Tumor Microenvironment Using Magnetic Resonance Imaging, Tianzhe Li

Dissertations and Theses (Open Access)

Both tumor acidosis and tumor hypoxia are characteristics commonly found in the microenvironment of solid malignant tumors. Accurate characterization of the two phenomena could provide important information to clinicians for devising suitable treatment plans. Tumor acidosis and hypoxia are closely linked to each other. Tumor acidosis is caused by the inclination of cancer cells towards anaerobic respiration, and one of the main contributing factors for the avoidance of aerobic respiration is tumor hypoxia. Both phenomena can indicate the high metastatic potential of cancers and can also cause resistance of the cancer systems against anti-cancer therapies. Therefore, developing novel molecular imaging …

Spanish-Speaking Limited English-Proficient Patient Satisfaction And Comfort When Comparing Spanish-Speaking Provider To An Interpreter, Cindy Hernandez

Dissertations and Theses (Open Access)

A large population of Americans have limited or no English proficiency (LEP) with about 64% of those being Spanish-speaking. This creates challenges in navigating the American healthcare system, where the majority of providers are solely English-speaking. Studies have demonstrated that when patients have language discordant appointments without interpreters, they are more likely to feel less understood, have questions and comments ignored, and are less likely to receive patient-centered care in communication. It is expected that interpreters improve access to healthcare, especially for Spanish-speaking patients. However, the patient comfort and satisfaction in language discordant genetic counseling appointments has not yet been …

Risk And Risk Factors For Colorectal Subsequent Malignancies In Survivors Of Childhood Cancer: A Report From The Childhood Cancer Survivor Study, Constance A. Owens

Dissertations and Theses (Open Access)

Survivors of childhood cancer are at risk for colorectal subsequent malignant neoplasms (SMNs); notably, these cancers are amenable to screening. To identify at-risk survivors that may benefit from early screening, descriptive and risk factor analyses were performed to ascertain risk factors for colorectal SMN in childhood cancer survivors. In particular, we explored detailed radiation therapy (RT) data – colorectal and substructure dose-volume metrics – as risk factors for colorectal SMN risk; metrics that have yet to be thoroughly investigated. We developed a novel population-based anatomical colorectal model with substructures for RT dosimetry in late effects studies of childhood cancer survivors; …

Integrative Prognostic Machine Learning Models In Mantle Cell Lymphoma, Holly A Hill, Preetesh Jain, Chi Young Ok, Koji Sasaki, Han Chen, Michael L Wang, Ken Chen

Faculty, Staff and Student Publications

Patients with mantle cell lymphoma (MCL), an incurable B-cell malignancy, benefit from accurate pretreatment disease stratification. We curated an extensive database of 862 patients diagnosed between 2014 and 2022. A machine learning (ML) gradient-boosted model incorporated baseline features from clinicopathologic, cytogenetic, and genomic data with high predictive power discriminating between patients with indolent or responsive MCL and those with aggressive disease (AUC ROC = 0.83). In addition, we utilized the gradient-boosted framework as a robust feature selection method for multivariate logistic and survival modeling. The best ML models incorporated features from clinical and genomic data types highlighting the need for …

Polypharmacy And Prescription Medication Use In A Population-Based Sample Of Adolescent And Young Adult Cancer Survivors, Andrea C Betts, Caitlin C Murphy, L Aubree Shay, Bijal A Balasubramanian, Christine Markham, Marlyn Allicock

Faculty, Staff and Student Publications

PURPOSE: We examined prescription medication use and identified correlates of polypharmacy-taking multiple medications-in adolescent and young adult cancer survivors (AYAs), who experience early-onset chronic conditions.

METHODS: Our cross-sectional study pooled data (2008-2017) from the national Medical Expenditure Panel Survey. We estimated prevalence of polypharmacy (≥ 5 unique prescription medications over an approximate 1-year period) in AYAs (age 18-39 years with a history of cancer) and age- and sex-matched controls, overall and by sociodemographics, clinical factors, and health indicators. We compared survivors' and controls' medication use across therapeutic classes. To identify correlates of polypharmacy among AYAs, we included factors with p …

An Updated Report On The Prevalence Of Prior Cancer Among Persons Newly Diagnosed With Cancer In The Surveillance, Epidemiology, And End Results Program, Caitlin C Murphy, Guillermo A Tortolero, David E Gerber, Sandi L Pruitt

Faculty, Staff and Student Publications

This cohort study uses population-based data from the National Cancer Institute Surveillance, Epidemiology, and End Results program of cancer registries to estimate prevalence of prior cancer among adults diagnosed with an incident cancer in 2019.

Parent-Reported Clinical Utility Of Pediatric Genomic Sequencing, Hadley Stevens Smith, Bart S Ferket, Bruce D Gelb, Lucia Hindorff, Kathleen D Ferar, Mary E Norton, Nuriye Sahin-Hodoglugil, Anne Slavotinek, Kristen Hasmiller Lich, Jonathan S Berg, Heidi V Russell

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVES: Genomic sequencing (GS) is increasingly used for diagnostic evaluation, yet follow-up care is not well understood. We assessed clinicians' recommendations after GS, parent-reported follow-up, and actions parents initiated in response to learning their child's GS results.

METHODS: We surveyed parents of children who received GS through the Clinical Sequencing Evidence Generating Research consortium ∼5 to 7 months after return of results. We compared the proportion of parents who reported discussing their child's result with a clinician, clinicians' recommendations, and parents' follow-up actions by GS result type using χ2 tests.

RESULTS: A total of 1188 respondents completed survey …

Healthcare Built Environment And The Covid-19 Pandemic, A Mixed-Method Study, Mohammad Saleh Nikooopayan Tak

All Theses

The outbreak of COVID-19 presented an unparalleled risk to public health, leading to urgent scientific efforts in understanding transmission mechanisms and mitigating risks, especially in healthcare settings. This mixed-methods study examines knowledge advancement regarding indoor air quality in healthcare facilities during the pandemic. A systematic literature review of 163 post-COVID studies identifies key research thrusts and 31 recommendations related to building ventilation, air filtration, surface disinfection, and monitoring. Comparison with over 200 pre-pandemic publications reveals both reliance on established infection control principles and unique contributions, such as detecting viral RNA in air and surface samples indicating potential airborne and fomite …

Household Environments And Functional Decline Among Middle-Aged And Older Adults In China, Dandan Zhao

All Theses

This thesis investigates the associations between household social, economic, and physical environment conditions and the trajectory of self-reported functional limitations over time among middle-aged and older adults in China. Despite the increasing interest in the impact of household environments on functional decline, most existing studies are cross-sectional or concern changes in functioning observed in two waves of surveys, and they primarily focus on the influence of one condition. This thesis explores how the trajectory of functional decline is influenced jointly by multiple household factors, including living arrangement, annual living expenditure per capita, indoor air pollution resulting from solid fuels, and …

Effects Of Immunosuppressive Treatment On Patient Outcomes After Immune Checkpoint Inhibitor-Related Gastrointestinal Toxicity, Malek Shatila, Weijie Ma, Yantong Cui, Sidra Naz, Anusha S Thomas, Enrico N De Toni, Helga-Paula Török, Najib Ben Khaled, Mehmet Altan, Bryan Schneider, Yinghong Wang

Faculty, Staff and Student Publications

Purpose: Immune checkpoint inhibitors (ICIs) are increasingly used in the treatment of certain cancers but cause immune-related adverse events (irAEs). Gastrointestinal irAEs may necessitate extended periods of steroid use and the initiation of selective immunosuppressive therapy (SIT) which could theoretically counteract the effect of ICIs. In this study, we aim to explore the impact of immunosuppression use and duration on cancer progression and progression-free survival (PFS).

Methods: This is a single-center retrospective review exploring cancer outcomes in patients taking ICIs who developed gastrointestinal irAEs within 1 year of ICI initiation. Cancer outcome and progression free survival (PFS) were measured and …

Ancestral Diversity In Lipoprotein(A) Studies Helps Address Evidence Gaps, Moa P Lee, Sofia F Dimos, Laura M Raffield, Zhe Wang, Anna F Ballou, Carolina G Downie, Christopher H Arehart, Adolfo Correa, Paul S De Vries, Zhaohui Du, Christopher R Gignoux, Penny Gordon-Larsen, Xiuqing Guo, Jeffrey Haessler, Annie Green Howard, Yao Hu, Helina Kassahun, Shia T Kent, J Antonio G Lopez, Keri L Monda, Kari E North, Ulrike Peters, Michael H Preuss, Stephen S Rich, Shannon L Rhodes, Jie Yao, Rina Yarosh, Michael Y Tsai, Jerome I Rotter, Charles L Kooperberg, Ruth J F Loos, Christie Ballantyne, Christy L Avery, Mariaelisa Graff

Faculty, Staff and Student Publications

INTRODUCTION: The independent and causal cardiovascular disease risk factor lipoprotein(a) (Lp(a)) is elevated in >1.5 billion individuals worldwide, but studies have prioritised European populations.

METHODS: Here, we examined how ancestrally diverse studies could clarify Lp(a)'s genetic architecture, inform efforts examining application of Lp(a) polygenic risk scores (PRS), enable causal inference and identify unexpected Lp(a) phenotypic effects using data from African (n=25 208), East Asian (n=2895), European (n=362 558), South Asian (n=8192) and Hispanic/Latino (n=8946) populations.

RESULTS: Fourteen genome-wide significant loci with numerous population specific signals of large effect were identified that enabled construction of Lp(a) PRS of moderate (R

CONCLUSIONS: …

Variability In Anesthesia And Its Implications For Improving Patient Safety, Joshua Michael Biro

All Dissertations

Improving patient safety in anesthesia has proven to be an arduous and challenging task. Despite the many strategies and interventions to improve patient safety that have been employed, patient harm in anesthesia remains a problem. The struggle to reduce patient harm in anesthesia is both attributable to and representative of the complexity of the anesthesia system. In navigating this complex system, anesthesia providers have different approaches to how they accomplish their work, which results in variability in anesthesia practice. This variability provides an immense challenge to designing and implementing efforts to improve patient safety, as rigid interventions are often met …

Assessing The Role Of Distance To Level I Trauma Units On Atv Rollovers, Tractor Rollovers, And Machinery Entanglement Outcomes, Andrew K. Schissel

Capstone Experience: Master of Public Health

All-Terrain Vehicle (ATV) rollovers, tractor rollovers, and machinery entanglements cause traumatic injuries to agricultural workers. Response time of first responders combined with travel to trauma units can take a significant amount of time in rural areas, potentially leading to an increased risk of fatal outcomes for those involved in these incidents. The aim of this study is to determine if distance to a level I trauma unit is a factor in the outcomes of these incidents. ATV rollovers, tractor rollovers, and machinery entanglement injuries and fatalities, collected from a 7-state Midwestern region were entered into a GIS system along with …