Public Health Commons^™

The Ticking Clock: Understanding Time Toxicity While Treating Older Patients With Metastatic Breast Cancer, Swarali Atre

Public Health Theses

Aim: We aimed to investigate the association between age at diagnosis and time spent seeking care for Metastatic Breast Cancer (MBC) and to identify the major components of acute and outpatient care contributing towards time lost in seeking cancer treatment i.e., time toxicity. Methods: We conducted a longitudinal retrospective cohort study in MBC patients aged 67 or older who initiated treatment from 2010-2017 using the SEER-Medicare linked database. We calculated the cancer-related encounter days by summing up the patients' healthcare system interactions within one year of initiating cancer treatment for each category. We used a Poisson model with days alive …

Exploring The Perceptions Of Genetics, Genetics Testing, And Science In People Of African Descent, Maame-Owusua Boateng

Public Health Theses

Background: Historical injustices towards Black populations in the United States have impacted how communities interact with medicine and public health such as medical experimentations, scientific racism, medical racism, and eugenics. Black communities are underrepresented in human genomics projects compared to those that identify as white or of European ancestry. Prior research has demonstrated that Black people are less likely to know about the availability of genetic testing for diseases and have less confidence in the benefits of genetic testing. These disparities make it imperative to understand the perspectives of people of African descent. Methods: The Black Genome Project is an …

“So We Create Happy Synergies” How An Overall Enabling Environment Helped Lao Pdr Legislate The Who Code On Breastmilk Substitutes: Lessons Learnt, Devina Buckshee

Public Health Theses

ABSTRACT

Background: Exclusive breastfeeding rates in Lao People’s Democratic Republic (Lao PDR) remain at 44% against a global goal of at least 50%, partly due to a weak understanding of the multifactorial and multilevel determinants of breastfeeding (UNICEF, 2021). Therefore, evidence-based advocacy efforts call for a systems approach to improve the enabling environment around breastfeeding. Aim: This study aims to stitch together the comprehensive patchwork of actors and dynamic ‘gears’ in the socio-ecological environment that came together to develop a much more enabling environment to improve child nutrition through breastfeeding promotion and protection in Lao PDR. Further, it aims to …

“You Need To Give All Of Yourself To This Field Or It's Not Enough”: A Qualitative Study Of The Medical Education Experience Among Medical Students With Chronic Health Conditions, Peyton Cabaniss

Public Health Theses

Medical students with chronic health conditions are an underrepresented and often overlooked population in medical education. Previous research has described the dual roles these students hold as both health care recipients and providers and has detailed challenges they face related to accommodations and accessibility. However, less is known about how these students navigate the day-to-day requirements of medical school and how having a chronic health condition shapes the medical education experience on an interpersonal level. To address this gap in knowledge, I conducted semi-structured interviews with eighteen medical students with chronic conditions and examined data using reflexive thematic analysis. Findings …

Primary Liver Cancer In China From 2000-2020: Evolution Of Epidemiology, Clinical Disease, And Therapy, Wanqing Chi

Public Health Theses

Background & Aims: China contributed to 49% of all liver cancer deaths worldwide in 2020. We sought to investigate the relationship between clinical characteristics, antiviral therapy (ART), and multiple risk factors that affect the prognosis of primary liver cancer (PLC) patients over time to highlight proper chronic liver disease management.Methods: We identified 1322 PLC patients diagnosed between 2000 to 2020 in a major academic teaching hospital in Shanghai, China. We used descriptive epidemiology to characterize the evolution of liver cancer in China, and Cox proportional hazard models and Kaplan-Meier survival analysis to assess the relationship between evolving ART and survival …

Perceptions Of Hiv Pre-Exposure Prophylaxis And Correlates Of Interest Among Women At Shebeens In Rural South Africa, Arielle Kaminer Hazi

Public Health Theses

Background: South Africa has the highest HIV burden in the world. In KwaZulu-Natal province, 27% of adults are living with HIV and 25% of new cases are in adolescent girls and young women. High prevalence of hazardous alcohol use complicates delivery of HIV testing, care, and prevention services. Gaps exist in knowledge on alcohol use among rural women and the association with HIV outcomes. We sought to understand facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) initiation in women, focusing on local alcohol venues, called shebeens.Methods: Surveys and interviews conducted among women attending shebeens assessed alcohol use, HIV risk behaviors, …

Depression And Anxiety Among Plurisexual Teens In The U.S., Olivia Goodwin

Public Health Theses

Background: Little research focuses on the mental health consequences of stigma for plurisexual teens, with even less research comparing cisgender plurisexual youth to nonbinary plurisexual youth.Aims: To assess whether having both a marginalized sexual orientation and a marginalized gender identity is associated with greater risk or greater resilience in depression and anxiety outcomes among teens in the US. Methods: Data was analyzed from the 2022 LGBTQ Teen Survey. Inclusion in the study required being an English speaker living in the US, being 13-18 years old, and identifying as cisgender and plurisexual (n=1547) or gender nonbinary and plurisexual (n=1867). Statistical tests …

Longitudinal Associations And Trajectories Of Cognitive Decline By Blood Pressure Categories, Namuunaa Juramt

Public Health Theses

Objectives: This study aimed to examine the cross-sectional, longitudinal associations and trajectories between cognitive decline and blood pressure (BP) categories defined by the 2017 American College of Cardiology/American Heart Association guideline and to explore sex differences in cognitive decline trajectories in each BP category.Design, setting, and participants: The Atherosclerosis Risk in Communities study is a longitudinal cohort study (1987-2018). 10,456 of 15,792 participants (female 55.5%) were included in the analysis with a median follow-up time of 22.2 years. Exposures: Blood pressure (BP) was measured at 6 of the study visits and was categorized as normal BP (Systolic BP [SBP] < 120 and Diastolic BP [DBP] < 80 mmHg; n = 930), elevated BP (SBP 120-129 and DBP < 80mmHg; n = 853), hypertension stage 1 (SBP 130-139 mmHg, or DBP 80-89 mmHg; n = 1,142), and hypertension stage 2 (SBP >=140 …

Psychological Resilience In U.S. Military Veterans: Results From The 2019-2020 National Health And Resilience In Veterans Study, Michael Georgescu

Public Health Theses

Psychological resilience is the most common response following exposure to traumatic life events. To date, most research has focused on factors associated with adverse post-trauma mental health outcomes rather than understanding those associated with psychological resilience. In particular, little is known about factors associated with resilience in veterans, despite their high rates of trauma exposure, such as combat and military sexual trauma. To address this gap, we used a discrepancy-based psychiatric resilience (DBPR) analytic approach to operationalize resilience and to identify modifiable health and psychosocial factors associated with resilience in a nationally representative sample of U.S. veterans (N = 4,069). …

Protection Against Cholera From Killed Whole-Cell Oral Cholera (Kocv) Vaccines: Systematic Review And Meta-Regression Of Randomized Control Trials And Observational Studies, Helena Hojeong Kwon

Public Health Theses

Introduction: Although killed whole-cell oral cholera vaccines (kOCVs) are widely used as a part of cholera control strategy, mixed evidence around the vaccine induced protection remains.Objectives: The primary objective of this systematic review was to update estimates of kOCV protection: vaccine efficacy and effectiveness. A secondary objective was to estimate the waning dynamic of kOCV protection by duration of follow-up. Methods: On August 15th, 2022, we searched for randomized control trials and observational studies that reported kOCV protection in low- and middle-income countries on PubMed, EMBASE, Scopus, ISI Web of Science, and The Cochrane Review Library with a start date …

“Recovery Is About Change, So You Have To Change Everything” Exploring The Evolution Of Recovery Capital Among Women In Substance Use Disorder Treatment, Elizabeth Jadovich

Public Health Theses

Recovery capital is an emerging framework in the field of addiction that aims to understand substance use disorder recovery holistically by considering an individual’s access to resources across the four domains of human, physical, social, and community capital. The underrepresentation of women’s experiences in substance use research as well as the limited understanding of substance use disorder treatment’s effect on recovery capital development poses specific challenges to women’s development and maintenance of recovery capital resources while in treatment. This secondary qualitative analysis of data collected from the larger RENEW study explores the experiences of 19 women actively enrolled in substance …

A Dna-Extraction-Free Method For The Molecular Detection Of Streptococcus Pneumoniae Carriage In Saliva, Tzu-Yi Lin

Public Health Theses

Pneumococcal carriage is a prerequisite for pneumococcal disease and surveillance of carriage is crucial for evaluating and informing vaccination strategies. In recent years, molecular methods have improved the sensitivity of pneumococcal carriage detection as compared to the gold standard culture-based method. However, nucleic acid extraction from samples collected is resource-intensive, limiting scalability for extensive surveillance, particularly in low-resource settings. We previously developed a saliva-based PCR test for SARS-CoV-2, having identified that nucleic acid extraction can be omitted and replaced with a simple enzymatic lysis or heat treatment step without compromising the accuracy and efficiency of testing. Here, we compared pneumococcus …

Elucidating Metformin As A Scavenger Of 4-Hne, An Endogenously Produced Aldehyde Associated With Alzheimer’S Disease Progression, In Hek293t Cells, Miren Lopez Lascurain

Public Health Theses

Metformin, a first-line therapy for Type 2 Diabetes Mellitus (T2DM), has been shown to have numerous health benefits in neurodegenerative disease progressions, including Alzheimer’s disease (AD). Vasiliou et al. have recently proposed that metformin is able to scavenge endogenously produced aldehydes such as 4-hydroxy-2-nonenal (4-HNE), which are thought to contribute to the progression and development of AD. Preliminary in vitro and in silico studies demonstrate that metformin scavenges 4-HNE leading to adduct formation. Therefore, this study sought to determine if metformin adducts 4-HNE in a living system. We hypothesize that metformin can scavenge 4-HNE in HEK 293T cells and will …

"Hair-Esteem Toolkit For Black Girls": The Development Of A Self-Esteem Toolkit For Black Adolescent Girls Centering Hair As A Tool For Empowerment, Sydney Hussett-Richardson

Public Health Theses

Background: For Black adolescent girls, hair is a strong staple of gender and ethnic identity, influencing intrapersonal and interpersonal interactions. Gendered racism and Eurocentric beauty standards pathologize Black girls and their hair, leading them to experience high rates of hair harassment and discrimination. These experiences negatively impact the self-esteem of Black girls, which has important implications for a host of health behaviors. The purpose of this study was to explore the relationship between self-esteem and hair among Black girls and integrate findings into a culturally relevant digital toolkit to promote and develop hair-esteem and self-esteem among Black girls.Methods: This study …

The Ethical And Legal Considerations Of Ai-Driven Healthcare In Infectious Diseases, Natalie Makableh

Public Health Theses

Artificial intelligence (AI) has been rapidly growing in the healthcare sector, with the potential to improve patient outcomes, increase efficiency, and reduce costs. However, as with any technological advancement, AI-driven healthcare presents ethical and legal challenges that must be addressed to ensure the responsible and beneficial use of the technology. To the best of our knowledge this is the first study to examine the ethical and legal considerations of using AI technology in healthcare, with a particular focus on infectious diseases. With the growing use of AI in healthcare, it is crucial to evaluate its potential benefits and challenges in …

Variation In First-Line Therapy By Biomarker Expression Status In Patients With Advanced Non-Small Cell Lung Cancer, Yimeng Li

Public Health Theses

Background: Patients diagnosed with advanced non-small cell lung cancer (NSCLC) have a poor prognosis. To inform evidence-based care, this study aims to describe and quantify the first-line treatment variation of patients with NSCLC. Methods: A retrospective cohort study was conducted using Flatiron databases to analyze the treatment patterns of 18,979 patients with advanced NSCLC diagnosed between 1/1/2016 and 6/30/2020. Patients were categorized into groups by biomarker findings and performance status. The first-line treatment variations were measured using the Herfindahl-Hirschman Index (HHI), which provides an indication of the degree of variation in treatment. Bootstrapping was assisted in calculating 95% confidence intervals …

Assessment Of Environmental Injustice: Spatial Analysis Of Pennsylvania Drilling Waste Facilities And Community Demographics, Avery Naperala

Public Health Theses

Background: Unconventional oil and gas drilling practices have led to the production of technologically-enhanced naturally occurring radioactive materials (TENORM) and chemical waste products, with insufficient toxicological data to understand the health impacts of exposures to these waste materials (U.S. Energy Information Administration, n.d.; US EPA, 2015b; ALNabhani et al., 2016; Elliott et al., 2017). Environmental injustices occur when disadvantaged populations experience a disproportionate burden of exposure to environmental disamenities, such as waste facilities (US EPA, 2015a). This study aims to assess whether disparate exposure to drilling waste facilities is occurring in Pennsylvania based on several socioeconomic factors, as well as …

The Impact Of The Covid-19 Pandemic On Non-Typhoidal Salmonella Incidence And Exposures In Connecticut, 2015-2022, Adeline Morris

Public Health Theses

Background: During 2020, Salmonella incidence decreased by 22% in the United States.1 At the same time, many common activities were reduced or restricted, including travel and eating food prepared at restaurants or events, which are known risk factors for Salmonella infection. Methods: A descriptive analysis using Salmonella surveillance data collected in Connecticut between 2015 to 2022 was performed to characterize the changes in travel and outside food exposures. Frequencies of exposures were compared before the pandemic, during the pandemic, and after the vaccine was implemented and restrictions eased. Rate ratios of observed to expected cases were calculated to explore trends …

Early Life Growth Patterns Among Infants Of Mothers With Diabetes, Hedy Ludwig

Public Health Theses

AbstractObjective: Exposure to diabetes during pregnancy increases the risk of insulin resistance, obesity, and cardiometabolic disease in offspring. Limited research exists regarding early postnatal growth patterns among moderate preterm and term infants. This study aims to evaluate growth patterns during the early postnatal period among term and moderate preterm infants of mothers with and without diabetes during pregnancy. Methods: In a prospective longitudinal analysis using data from Yale New Haven Hospital (YNHH), characteristics from term and moderate preterm infants were compared between diabetes exposure groups (n=148). Percent change in weight from birth to hospital discharge was compared between diabetes exposure …

Impact Of The Covid-19 Outbreak On Mental Health And Public Practices In Rural Communities In China, Wenxin Liang

Public Health Theses

Coronavirus disease (COVID-19) has significant impact on people’s mental health. However, no nationwide study has investigated the mental health among rural residents during the COVID-19 outbreak in China. This study was aimed to investigate the impact of the COVID-19 outbreak on the mental health and public practices for controlling and preventing the COVID-19 in rural communities in China. An anonymous online survey was sent to participants through WeChat, the most widely used Chinese social-networking app, from March 2 to 11, 2020. We recruited 4607 individuals from 11 representative provinces in mainland China. The analytical sample was 2159 rural residents. The …

Menopausal Status, Age At Menopause, And Associations With 1-Year Angina Burden Among Women In Recovery From Acute Myocardial Infarction Enrolled In The Virgo Study, Tamara Dorothy Mehta

Public Health Theses

Background: Current knowledge is limited on the association between early age at menopause (AAM) and angina during recovery from acute myocardial infarction (AMI) in young women. We assessed the differences in 1-year angina burden post-AMI among women in pre/peri-menopause phases compared to post-menopausal women stratified by their AAM. Methods: Among patients in the VIRGO study, 1,948 women were categorized into four groups: a reference group of those in their pre/peri-menopause phase (n=917), post-menopausal women who reached AAM at 40 years or younger (n=337), AAM between 41-49 years (n=476), and AAM between 50-55 years (n=218). Angina burden was assessed from Seattle-Angina …

Sexual Show-And-Tell: Correlates Of Sex Communication And Active Modes Of Consent, Samantha Nardella

Public Health Theses

Sexual consent communication is a critical component in ensuring healthy and satisfying sexual experiences. The communication of consent can take many forms and be affected by a variety of factors, ranging from gender and sexual orientation, to type of sexual behavior and familiarity with a partner. The current study sought to examine the ways in which different factors affected how one communicated consent in their last sexual encounter. College students (N = 211) completed an online cross-sectional survey examining engagement in sexual behaviors, feelings in sexual encounters, and aspects of their most recent sexual experience. Individual- and situational-level correlates were …

Epidemiology Of Human Hookworm (Necator Americanus) Infection In Rural Ghana: Investigating Host-Parasite Factors That Mediate Infection, Savanna Randi

Public Health Theses

Abstract

Introduction: Hookworms are soil-transmitted helminths (STHs) that cause significant morbidity in high-risk populations, posing a global health concern in locations of rural poverty [1-5]. While there have been ventures by the World Health Organization to eliminate hookworms in Africa by 2030, there is variability in the effectiveness of current chemotherapy regimens. Studies have shown that benzimidazole anthelmintics have reduced effectiveness, and people living in endemic areas are quickly reinfected [6]. Critical gaps remain in understanding parasite-host interactions within communities, further challenging successful disease control. A study initiated in 2022 investigated the epidemiology of human hookworm infection in Beposo, Ghana. …

Antibiotic Prophylaxis For Prevention Of Surgical Site Infections In Orthopedic Surgery, Edwin Ruiz Fuentes

Public Health Theses

Background: In the past decades, there has been an increase in the proportion of orthopedic surgical site infections (SSIs) caused by gram-negative bacilli in various healthcare settings. SSI prevention guidelines suggest that gentamicin can be added to prophylactic antibiotic treatment to target gram-negative bacilli. However, the effectiveness of this strategy remains to be confirmed in orthopedic surgery.

Methods: A retrospective cohort study was conducted to investigate the association between antibiotic prophylaxis with adjunctive gentamicin and SSI rates in orthopedic surgeries. 5,571 patients who underwent hip, knee, spine, and hip fracture surgeries between January 2019 and July 2021 at Yale-New Haven …

Associations Between Patient Sociodemographic Factors And Risk-Aligned Prostate Cancer Clinical Management, Madison Jewel Novosel

Public Health Theses

Although definitive treatment is associated with improved survival for aggressive prostate cancer and is supported by clinical practice guidelines, a significant number of patients do not receive definitive treatment. To identify gaps in practice, we sought to evaluate sociodemographic factors associated with treatment of localized prostate cancer across clinically relevant risk strata. We performed a retrospective study of patients with prostate cancer using the National Cancer Database. A total of 954,591 patients diagnosed with localized prostate (cT1-4N0M0) cancer from 2010 to 2020 were included in the analysis. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with …

Examining The Impacts Of Stress And Negative Affect On Eating And Weight Outcomes: A Meta-Analysis, Taylor Spadory

Public Health Theses

Overweight and obesity have become incredibly pressing public health issues in the United States. Rising rates of prevalence pose grave risks to population health and underscore the need for a greater understanding of the underlying mechanisms that contribute to increased eating and weight gain. While stress and negative affect (NA) have been recognized as possible predictors, the literature is inconsistent and experimental studies have produced mixed results. Therefore, we conducted a comprehensive quantitative meta-analysis to assess the prospective effects of stress and NA on eating and weight outcomes, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We …

From Theory To Practice: Zoonotic Spillover, One Health And The Role Of Local Indigenous Communities, Pranav Prabhu Savanur

Public Health Theses

This paper discusses the impact of zoonotic spillovers on public health and the need for a One Health approach to preventing future pandemics. Zoonotic spillovers occur when pathogens are transmitted from animals to humans, facilitated by anthropogenic land changes, migration or trade, increased human-animal contact, and poor biosafety. However, anthropogenic land use change is the primary driver for zoonotic spillovers. Most emerging infectious diseases in humans are of zoonotic origin, and the impact of these spillovers on public health is significant. The paper emphasizes the need to prevent spillover events for primary pandemic prevention, which requires a coordinated and collaborative …

The Impact Of Controlling Language And Source Similarity On Psychological Reactance, Caroline Yarbrough

College of Graduate Studies: Theses & Dissertations

Persuasive health messages are frequently advertised throughout the pandemic to decrease the spread of COVID-19 while increasing the likelihood of immunity. However, research demonstrates that persuasive health messages may be ineffective because they have the potential to elicit psychological reactance. Reactance is characterized by a state of unpleasant motivational arousal and often occurs when individuals experience or perceive threats to their freedom, and it can be evoked through controlling language (Frey et al., 2021; Grandpre et al., 2003). Additionally, research has shown that similarity is associated with liking (Cialdini & Trost 1998) and people are often more inclined to comply …

Medical Providers' Use Of Maternal Mental Health Screening Tools During Prenatal Appointments In Southeast Georgia, Andreka Ewing

College of Graduate Studies: Theses & Dissertations

In the United States, maternal mental health disorders are the most common comorbidities experienced during pregnancy and after childbirth. In particular, the state of Georgia reports that 1 in 7 Georgian mothers experience depression, anxiety, obsessive-compulsive disorders, or psychosis related to these disorders. Research suggests that untreated maternal mental health can have adverse effects on the mother and unborn child. Conditions such as autism, mixed handedness, reduced cognitive ability, and affective disorders can develop while the child is in the womb of a depressed mother. Routine maternal mental health screening using a validated screening tool has been recommended to help …

What Could Go Wrong? Patient And Hospital Characteristics Associated With Pediatric Quality Of Inpatient Care And Pediatric Adverse Events, Michael H. Samawi

College of Graduate Studies: Theses & Dissertations

This study aims to analyze associations between hospital and patient characteristics with pediatric adverse events (PAE) in the inpatient hospital setting, utilizing the framework of pediatric quality indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ) indicators. Three PDIs were identified and utilized for this purpose: NQI 03 Neonatal Blood Stream Infection, PDI 09 Postoperative Respiratory Failure, and PDI 10 Postoperative Sepsis. The data used for the study is based on an analysis of discharge data from the Healthcare Cost and Utilization Project (HCUP) Kid’s Inpatient Databases (KID) for the year 2019. The findings contribute to the growing …