Public Health Commons^™

Investing In The Development Of The Next Generation Of Mch Leaders, Karen A. Mcdonnell, Jamal Percy, Lisa Anders, Monique J. Brown Ph.D., Mph, Alice R. Richman, Julianna Deardorff, Monica S. Ruiz, Jihong Liu Sc.D., Kelli Russell, Audrey Snyder, Cassondra Marshall

Faculty Publications

The public health landscape is constantly evolving to address the strengths and needs of the community. Training for the public health workforce is leading the way, establishing an ecosystem approach that integrates individuals within social, political, and environmental contexts to promote health equity within a framework of social justice. One area of public health that is innovatively preparing the next generation of leaders is maternal and child health (MCH). In the United States, key indicators of health disparities within MCH remain stagnant, highlighting the need for training programs that develop future MCH professionals from diverse backgrounds. These professionals will deliver …

Associations Between County-Level E-Cigarette-Inclusive Tobacco 21 Law Population Coverage And E-Cigarette Use Behaviors Among United States Adolescents In Monitoring The Future, James H. Buszkiewicz, Catherine A. Vander Woude, Yanmei Xie, Steven Cook, Bukola Usidame Peters, Megan E. Patrick, Michael R. Elliott, James F. Thrasher Ph.D., Ma, Ms, Nancy L. Fleischer

Faculty Publications

Background and aims: In the United States (US), Tobacco 21 (T21) laws set the minimum legal sale age for all tobacco products to 21 years. This study aimed to examine whether e-cigarette-inclusive T21 laws were associated with e-cigarette use behaviors and related disparities among US adolescents. Design: We used nationally representative, repeated cross-sectional Monitoring the Future data to compare self-reported current e-cigarette use (2014–2022) and first e-cigarette initiation (2015–2022) among adolescents in counties with 100% ('full') versus < 100% ('partial or no') e-cigarette-inclusive T21 law population coverage using modified Poisson regression, examining differences by sex, race and ethnicity, parental educational attainment and college educational expectations through interactions. Setting: United States. Participants: 8th, 10th and 12th graders. Measurements: County-level e-cigarette-inclusive T21 law population coverage was determined using Tobacco 21 Population Coverage Database and US Census Bureau population data. Current e-cigarette …

Healthcare Providers’ Perspective On Hiv Testing And Hypothetical Mhealth-Connected Linkage To Care Among Men Who Have Sex With Men (Msm) In South Carolina, Tony Brown, Prince Nii Ossah Addo, Monique J. Brown Ph.D., Mph, Xiaoming Li, Oluwafemi Adeagbo

Faculty Publications

Background: HIV continues to be an important public health concern in South Carolina (SC). However, an examination of providers’ willingness to use mHealth technologies to address ongoing barriers to HIV care and prevention strategies, particularly among men who have sex with men (MSM) is currently lacking in SC. We therefore explored HIV care providers’ perceptions of HIV testing and treatment uptake among MSM, and providers’ willingness to use mHealth technology to address barriers to HIV testing and treatment in SC. Methods: Between August and December 2021, we conducted semistructured virtual interviews with 10 HIV care providers recruited purposively based on …

Sars-Cov-2 Detection And Persistence In A Remote Amazonian Settlement, Glauco M. Silva, Roberto C. Ilacqua, Franciely G. Gonçalves, Carla M. Santana, Felipe T. Jordão, Paula R. Prist, Melissa S. Nolan Ph.D., Mph, Andreia F. Brilhante, Marcia A. Sperança, Gabriel Z. Laporta

Faculty Publications

Background: COVID-19 continues to pose a major global health challenge. Despite its geographic distance from Brazil’s major urban centers, Acre state has experienced notable outbreaks. This study assessed the detection and persistence of SARS-CoV-2 in the rural settlement of Santa Luzia, located in the remote municipality of Cruzeiro do Sul, Acre state, Brazil. Methods: In July 2022, a cross-sectional survey was conducted at 40 sites from an ongoing environmental study, selected by deforestation patterns and proximity to health posts. Saliva samples were collected from residents aged 5–90 years, followed by nucleic acid extraction and multiplex RT-qPCR for SARS-CoV-2 detection. Results: …

Dirty Water, Breanna Booker, Michael S. Sinha

All Faculty Scholarship

Plastics are taking over. Every day, humans are exposed to plastic pollutants in a variety of ways. From the water we use to water crops in the field, to the water in our taps, to the liquids we drink from plastic containers, it can be found virtually anywhere you look. Not only is it everywhere in the environment, but it is also within us. It builds up in our bodies. Plastics have become a major public health concern; researchers estimate that the total healthcare cost related to plastic chemicals may be as much as $250 billion.[1]

Water has always …

Barriers To Seeking Medical Care And Their Effects Among Fat Patients With A Fat Liberation Praxis In The United States, Christina Seiko Cook

College of Graduate Studies: Theses & Dissertations

Weight stigma and weight bias have significant effects on the health of individuals (Alberga et al., 2019; Pearl, 2018; Puhl & Heuer, 2010; Schwartz et al., 2003; Udo et al., 2016). These biases can show up in the form of fatphobia or anti-fat bias. Physicians who hold anti-fat bias can affect their relationship with their patients, leading to poorer health outcomes and worse patient experiences for larger-bodied and fat people (Phelan et al., 2015). The purpose of this study is to contribute to the current literature regarding the positive and negative experiences of fat patients with a fat liberation praxis …

Retour Et Maintien Durable Au Travail En Contexte De Petites Et Moyennes Entreprises, Iuliana Nastasia, Marie-France Coutu, Valerie Lederer, Alexandra Lecours, Romain Rives, Marie-Elise Labrecque

Rapports de recherche scientifique

L’incapacité au travail reliée aux troubles musculosquelettiques (TMS) constitue un fardeau important à l’échelle mondiale. La gestion des invalidités et le retour et maintien durable au travail (RMDT) sont essentiels pour prévenir l’incapacité au travail. Des principes de la gestion des invalidités et des bonnes pratiques de RMDT sont établis pour la grande entreprise. Même si plusieurs recherches indiquent l’existence de contraintes particulières pour les petites et moyennes entreprises (PME), peu d’études décrivent les actions de prévention d’incapacité au travail ou les principaux facteurs de difficulté et de succès pour un retour et maintien durable au travail (RMDT) dans ce …

Substitution Du Dichlorométhane, Caroline Couture, Jérôme Lavoué, Philippe Sarazin, Isabelle Valois, Maximilien Debia

Rapports de recherche scientifique

L’exposition aux solvants organiques est une préoccupation majeure en santé et en sécurité du travail. Selon CAREX Canada, 22 000 travailleuses et travailleurs canadiens étaient exposés en 2016 au dichlorométhane (DCM), incluant 5 600 travailleuses et travailleurs québécois. Le DCM est notamment utilisé comme solvant dans les décapants à peinture et les dégraissants, comme milieu réactionnel dans la synthèse de produits pharmaceutiques et de pesticides et comme solvant pour l’extraction de substances organiques. En plus de ses effets irritants et cancérogènes, le DCM peut être responsable d’une carboxyhémoglobinémie par production endogène de monoxyde de carbone lors de sa transformation métabolique. …

Facteurs Facilitants Et Défis Liés À L'Implantation D'Une Intervention Visant La Prévention Des Troubles Musculosquelettiques En Contexte De Travail Saisonnier : Une Étude Dans Le Secteur De La Transformation Alimentaire, Marie-Ève Major, Hélène Clabault, Isabelle Feillou, Nicole Vézina, Audrey Goupil, Nicolas Roux

Rapports de recherche scientifique

Les troubles musculosquelettiques (TMS) sont largement répandus dans les pays industrialisés. La population des travailleurs saisonniers serait particulièrement touchée et le secteur de la transformation alimentaire ne fait pas exception. Ceci peut s’expliquer par une activité marquée par des conditions de travail difficiles où s’entremêlent de fortes contraintes organisationnelles et temporelles, et qui ont des conséquences sur les conditions physiques et psychosociales du travail qu’il est d’usage d’accepter, puisqu’elles sont perçues comme passagères le temps d’une saison. Un tel contexte est même identifié comme pouvant représenter une incompatibilité avec une prise en charge et un suivi des problèmes de santé. …

Évaluation Et Caractérisation De L'Exposition Aux Fumées De Soudage Et Leurs Composantes Métalliques Lors D'Activités De Soudage Au Québec, Michèle Bouchard, Jairo Buitrago-Cortes, Naïma El Majidi, Jonathan Côté, Denis Dieme, Marc Mantha, Philippe Sarazin, Capucine Ouellet, Loïc Wingert

Rapports de recherche scientifique

Problématique et objectifs :

Les fumées de soudage sont classées comme cancérogènes chez l’humain et sont associées à un risque accru de plusieurs autres effets sur la santé des soudeurs. L’objectif général de cette recherche était d’établir la nature et le niveau d’exposition aux composantes métalliques lors d'activités de soudage chez des apprentis soudeurs au Québec, en effectuant des mesures dans différentes matrices biologiques et dans l’air lors d’un suivi longitudinal.

Méthode :Cette recherche a été réalisée dans des écoles d'apprentis soudeurs de la région de Montréal, où les techniques de soudage les plus courantes sont utilisées. Elle a …

Factors Associated With Non-Transport For Ems Incidents Of Pediatric Head Injuries, Margaret Zhang

Public Health Theses

Background/Purpose:Emergency Medical Services (EMS) is a valuable resource for evaluating, treating, and coordinating care for individuals who have sustained a traumatic brain injury (TBI). Among adults with a TBI, there is frequent refusal of EMS transport. This raises a public health concern because it can put a burden on resource utilization and reveal misperceptions regarding risk following head injuries. Less is known about whether similar patterns of non-transport exist among children with TBIs. The purpose of this study is to describe the epidemiology of pediatric head injuries attended by EMS and to identify factors associated with non-transport for these patients. …

Enhancing Research Utilization Among Health Policymakers: Lessons From An Executive Certificate Program In Liberia, Felicia Annan-Mills

Public Health Theses

Evidence-based decision-making in health policy is a systematic and transparent approach to policymaking and program design using research evidence and other similar sources. It is essential for developing effective health policies and ensuring that programs align with political priorities and community needs and have strong empirical support for their efficacy and impact. Global health agencies like the World Health Organization and the West African Health Organization have developed guidelines for evidence-based decision-making in health for organizations to use as guiding tools in their policymaking. Regardless, there is still a gap in applying research evidence to practice programs for many countries …

The Village Determinants Of Self-Rated Health And Mental Health: A Multilevel Analysis Of Environments In Rural Honduran Villages, Marnen Elizabeth Decker

Public Health Theses

I investigated the associations of village structural, behavioral, and social environments with self-rated health and mental health among adults residing in remote rural villages in the mountainous Copán region of Honduras. I estimated nested multilevel logistic models with 17,318 adults in 174 villages. All models controlled for individual characteristics to distill true village-level effects, and nested structure was employed to facilitate direct comparison across models. Both poor self-rated health and mental health were inversely associated with village size and positively associated with coffee cultivation. Poor self-rated health was also positively associated with friend/adversary tie ratio, and poor self-rated mental health …

Assessing The Costs Of Illness Attributable To Leptospirosis, Alyssa Chetrick

Public Health Theses

Leptospirosis, caused by the spirochetes of the genus Leptospira, is a zoonotic bacterialdisease endemic to tropical regions and lower middle income countries (LMICs). Leptospirosis causes an estimated 1 million cases and more than 58,900 deaths annually.(Costa et al., 2015; Torgeson et al., 2015) In addition to human health, leptospirosis significantly impacts animal health and the livestock industry, particularly through reproductive losses, increased treatment costs, and decreased milk production, which exacerbates global insecurity.(Bennet, 2015; Torgeson et al., 2015) The estimated global cost loss to productivity due to disease is estimated at Int$ 29.3 billion. (Agampodi et al., 2023) Because of its …

Association Between Primary Covid-19 Vaccine Type And Booster Uptake Among Incarcerated People In Connecticut: A Retrospective Cohort Study, Michael Condon Elhardt

Public Health Theses

Importance: Booster doses of the COVID-19 vaccine are critical for maintaining protection against SARS-CoV-2, especially in high-risk settings such as correctional facilities. Understanding how initial vaccine type influences booster uptake can inform vaccination strategies in these and other underserved populations.Objective: To assess whether the type of COVID-19 vaccine received for the primary series—either viral vector (Janssen/Jcovden) or mRNA (Moderna/Spikevax or Pfizer-BioNTech/Comirnaty)—was associated with timing or likelihood of booster completion among incarcerated individuals. Design: Retrospective cohort study using survival analysis methods. The study period spanned from February 2, 2021, to May 31, 2023. Setting: Connecticut Department of Correction (DOC) facilities, including …

Exploring Harm Reduction In Treatment: A Qualitative Study Of Methods And Perceptions Among People In Substance Use Disorder Care, Carson Francis Ferrara

Public Health Theses

Amidst the ongoing opioid epidemic and rising overdose deaths, substance use disorder (SUD) treatment has historically prioritized abstinence over harm reduction, creating gaps in patient safety. This qualitative study explores harm reduction integration in formal treatment settings and participant perceptions through 48 semi-structured interviews with individuals enrolled in Project RENEW, a larger cohort study examining factors influencing people in treatment for alcohol use across Connecticut and Georgia. Participants (79% inpatient, 51% court-mandated) described their experiences with harm reduction methods and safety strategies while in treatment. Thematic analysis revealed four key findings: 1) inconsistent access to resources like naloxone and fentanyl …

Swift: Strong-Signal Weighted Prs Integration For Fine-Tuning, Yikai Dong

Public Health Theses

Polygenic risk scores (PRS) hold immense promise for personalized medicine but suffer from reduced accuracy in non-European populations, hindering equitable application. We introduce SWIFT (Strong-signal Weighted PRS Integration for Fine-Tuning), a novel framework to enhance cross-population PRS prediction by optimally combining base scores from diverse ancestries using only GWAS summary statistics. SWIFT employs a GWAS subsampling technique based on data fission to generate internal training and tuning sets, circumventing the need for external validation cohorts. A key innovation is its focus on strong genetic signals (p < 0.1) for estimating robust combination weights via cross-validation, which mitigates overfitting and significantly reduces computational burden. We evaluated SWIFT across 22 complex traits using data from five populations (EUR, AFR, AMR, EAS, SAS) and independent validation cohorts (UK Biobank, All of Us). Applied to state-of-the art base methods (PRS-CSx, X-Wing, JointPRS), SWIFT achieved predictive accuracy comparable or superior to the recent LEOPARD integration method and baseline implementations. Crucially, SWIFT demonstrated a 3.5- to 9.5-fold reduction in computational runtime compared to LEOPARD and exhibited robust performance even when using a single, unified LD reference panel. SWIFT provides an efficient, robust, and practical approach to improve the accuracy and applicability of PRS across diverse populations, representing a significant step towards more equitable genomic medicine.

Effect Of The Lifestyle, Exercise And Nutrition (Lean) Weight Loss Intervention On Stress Among Breast Cancer Survivors, Wenxin Gu

Public Health Theses

Background: Stress, experienced by over one-third of breast cancer survivors, not only leads to significant symptoms and mental health issues, but also increases the risk of breast cancer recurrence and impacts survival. While weight loss lifestyle interventions have been effective in helping breast cancer survivors with obesity lose weight and potentially enhance survival, their impact on stress levels has been inconsistent. The aim of the secondary analysis was to evaluate the effects of a 6-month diet and exercise weight loss intervention on perceived stress in breast cancer survivors.Methods: Breast cancer survivors with a BMI of 25.0 kg/m2 or higher (n=151) …

Environmental Justice Dimensions Of Orphaned Oil And Gas Wells In The United States, Grace Marie Hauser

Public Health Theses

Orphaned oil and gas (O&G) wells can leak methane and other hazardous pollutants,contributing to air and water contamination that threatens public health while also imposing financial burdens on local governments and taxpayers for remediation. However, the environmental and public health impacts remain understudied, in part due to limited understanding of the number and location of orphaned O&G wells. In this thesis we aimed to (1) create a national orphaned wells dataset covering years through 2024, (2) estimate the count and distribution of orphaned wells in the United States through 2024, and (3) evaluate the association between community environmental justice (EJ) …

Comparative Effectiveness Of Digital Breast Tomosynthesis And Digital Mammography In Detecting Invasive Lobular Carcinoma And Smaller Tumors Among Older Women, Sida Huang

Public Health Theses

AbstractBackground: Digital breast tomosynthesis (DBT) has demonstrated improved cancer detection and reduced false-positive and recall rates compared with digital mammography (DM) alone in trials of women aged over 50. However, its benefits for older women remain uncertain. We hypothesized that among women aged 67+, breast cancer detected via DBT are more likely to be invasive lobular carcinoma (ILC) and present at a smaller size at diagnosis, and this association persists among women aged 75+. Additionally, we hypothesized that DBT detects ILC at a smaller tumor size. Methods: We conducted a retrospective cohort study of women aged 67+ with screen-detected ER+/HER2- …

Environmental Gentrification And Health: An Exploratory Analysis Of New York City, Joyce Hu

Public Health Theses

Background: Environmental gentrification is an emerging field seeking to understand the integrated effects of environmental improvements and gentrification. To date, we have a limited understanding of how to analyze environmental gentrification with intersecting health impacts. Our exploratory study investigates this relationship in New York City, where environmental improvement policies coincided with gentrification between 2000-2016. Methods: Using a census tract-level index of gentrification and corresponding environmental exposure data on air quality and vegetation, we conducted a clustering analysis to group and label census tracts according to environmental gentrification patterns. We then performed covariate-adjusted multivariable regression analyses to evaluate the association between …

Effect Of The Lifestyle, Exercise, And Nutrition Weight Loss Intervention On Depressive Symptomatology Among Breast Cancer Survivors, Ziyuan Ma

Public Health Theses

Background: Breast cancer patients have up to a five-fold higher risk of depression compared with the general population, with an estimated prevalence of depressive symptoms of 25%. Depressive symptoms among breast cancer patients can affect treatment adherence, quality of life, and mortality. Some studies indicate lifestyle interventions can lower depression symptoms in general population samples; however, few studies have examined changes in depression among breast cancer survivors enrolled in lifestyle interventions. The purpose of this study was to examine the effect of a 6-month diet-and exercise-induced weight loss intervention versus usual care on depressive symptomatology among breast cancer survivors.Methods: 151 …

Joint Realities: Prevalence, Frequency, And Modality Of Cannabis Use By Sexual Identity In A Multi-State Brfss Sample (2022–2023), Meredith Audrey Rose Mcgee

Public Health Theses

Cannabis use has increased substantially among U.S. adults, yet disparities by sexual orientation and sex remain underexplored, particularly regarding frequency and consumption modality (Hammond et al., 2022; Dyar, 2022). Leveraging 2022–2023 Behavioral Risk Factor Surveillance System (BRFSS) data from eight U.S. states, this study examined patterns of past-month cannabis use among U.S. adults, stratified by sexual orientation–sex group (e.g., bisexual women, gay men).Guided by minority stress theory and prior research (Dyar, 2022; Meyer, 2003; Poole et al., 2021; Schofield et al., 2023), we hypothesized that sexual minority adults, especially bisexual individuals across both sexes, would report: (1) higher prevalence of …

Respirable Crystalline Silica In Stone Countertop Fabrication, Caitlin Mcgowan

Public Health Theses

Background: Artificial stone, a synthetic product that typically contains >90% silica mixed with resins and dyes, has become highly popular for kitchen and bathroom countertops. Meanwhile, silicosis outbreaks in workers who fabricate and install artificial stone countertops are increasingly being reported worldwide and in the US. Our objective is to better characterize work processes and exposures to respirable crystalline silica (RCS) among these workers in the United States. Methods: In collaboration with the Natural Stone Institute and the International Surface Fabricators Association, both trade organizations that represent the stone industry, an online survey was administered to stone countertop fabrication shops …

Life Satisfaction In Justice-Involved Opioid Users, Cassandra Michel

Public Health Theses

Life satisfaction—an individual’s overall evaluation of their life, including their feelings and attitudes toward it—has been linked to a range of psychological and physical health outcomes. While numerous studies have examined the factors associated with life satisfaction across various populations, such as healthy young and older adults, limited research has focused on individuals with substance use disorders or those involved in the criminal justice system. This study explored the relationship between psychosocial and structural factors and life satisfaction among justice-involved individuals with a history of opioid use disorder. Using cross-sectional survey data from a sample of 372 participants, I conducted …

Influenza Vaccine Coverage, Effectiveness, And Disease Burden Among Pediatric Sickle Cell Patients In Connecticut From 2021-2024: A Test-Negative Case-Control Study, Precious Nchekwube

Public Health Theses

Background: Vaccination is the primary strategy to reduce influenza burden. Limited data exist on the burden of influenza, vaccine coverage, and seasonal influenza vaccine effectiveness (VE) in children and adolescents with sickle cell disease (SCD).

Aim: To evaluate influenza vaccine coverage, effectiveness, and disease burden among pediatric and adolescent patients living with SCD for the 2021-2024 influenza seasons in Connecticut, USA.

Methods: This was a retrospective, test-negative case-control study to estimate influenza VE against laboratory-confirmed influenza infections among children 6 months to 21 years of age across 2021-2022, 2022-2023, and 2023-2024 influenza seasons (August 1, 2021, to July 31, 2024) …

Evaluating The Implications Of Class And Regional Stereotypes On Attributions Of Blame During Hurricane Helene: A Reflexive Content Analysis Of Tiktok, Abby Ong

Public Health Theses

Background and Objectives: Hurricane Helene devastated entire towns across the Southern and Appalachian U.S. Following the hurricane, people who lived in impacted regions were derided for their perceived failures in evacuating. Utilizing Bernard Weiner’s attribution theory of social motivation, this study sought to analyze potential implications of regional stereotypes on how people blamed or supported disaster victims. Primary objectives were to: (1) to analyze content regarding residents’ decisions to evacuate or not evacuate during the storm, (2) to document attributions of blame or support and how those experiencing the disaster and outside observers responded to these attributions, and (3) to …

From Success To Setbacks: A Case Study Of The Sex Wrap And The Impact Of Instagram's Evolving Policies On Sexual Health Education, Megan Piller

Public Health Theses

Due to the inconsistent and noncomprehensive nature of sexual health education across the United States, many adolescents and emerging adults are turning to digital platforms, specifically social media, for necessary information. The Sex Wrap (TSW), a podcast and Instagram-focused intervention, was established to fill critical knowledge gaps among these populations and empower them in their sexual decision-making. To serve as a case study, engagement metrics from TSW’s Instagram account between October 2020 and September 2021 were analyzed to determine which post types, tones, and thematic categories resonated most with users across the platform. However, Instagram, once a highly effective tool …

Effectiveness Of Wolbachia Introgression On Dengue Incidence In A Complex Urban Environment, Karthika Satyanarayanan

Public Health Theses

Dengue is an arboviral disease of increasing global public health importance for which more than half the world’s population is at risk. The burden of dengue has increased greatly in the last decade; in 2024, over 14 million cases and 10,000 dengue-related deaths were reported, marking a historical milestone. The endosymbiotic bacterium Wolbachia (wMel strain) offers a promising alternative to traditional control methods through its reduction of Aedes aegypti vector competence and introgression into wild Ae. aegypti populations. This thesis evaluated the dynamics of Wolbachia introgression and its effect on reducing dengue incidence up to 31 months after the completion …

Assessing Environmental And Sociodemographic Risk Factors For Leptospira Infection In A Urban Informal Settlements: A Study In Salvador, Brazil, Sebastian Alonso Salazar

Public Health Theses

Background: Leptospirosis is a neglected zoonotic disease that disproportionately affects people living in areas with poor sanitation, water contamination and rodent infestation such as urban informal settlements. More than one billion people worldwide reside in such communities, and with increasing urbanization, coupled with environmental change, the risk of Leptospira transmission continues to increase. Despite its global burden, this disease is often underreported due to diagnostic challenges and limited healthcare access, particularly in urban informal settlements. Understanding the incidence and risk factors in these settings is essential for improving public health interventions. This study aims to estimate the annual incidence of …