Public Health Commons^™

A Pilot Rct Of Mhealth & Chw Intervention For Art Adherence, Shivesh Shourya

Public Health Theses

Despite the availability of antiretroviral therapy (ART), only 66% of people with HIV in the U.S. achieve viral suppression, often due to suboptimal ART adherence. Barriers such as limited access to care and forgetfulness impact adherence, which must be ≥95% to prevent viral rebound. Combining community health worker (CHW) support with mobile health (mHealth) technologies may help address these barriers and improve outcomes. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of the remotely delivered Community Health Worker and mHealth to Improve Viral Suppression (CHAMPS) intervention, which combines the WiseApp, CHW support, and the CleverCap smart pill bottle. …

Under-Five Malaria And Malnutrition Syndemic In Rajasthan, Nandini Sinha

Public Health Theses

Background: The syndemic of severe acute malnutrition (SAM) and malaria in under-five children in Rajasthan presents a critical public health challenge. Current SAM and malaria programs are implemented as siloed interventions despite the potential benefits of integrated approaches. A better understanding of the interactions between these factors is important to strengthen the delivery of integrated services.

Objective: This study investigates the relationship between under-five SAM and malaria infections at the block level in Rajasthan to inform targeted, integrated interventions. By running regression analysis, we will identify associations between these co-occurring health threats to guide state-level policy integration. To the best …

Integrating Rare Variant Association Studies With Embedding-Based Methods: Simiskato, Changheng Wang

Public Health Theses

Understanding the genetic basis of rare diseases remains a central challenge in human genomics, especially when conventional methods rely on case-control labels that may oversimplify complex clinical variation. In this thesis, we introduce SimiSKATO, a novel approach that integrates phenotype embeddings with rare variant association testing. Using PERADIGM-generated similarity scores to represent clinical resemblance between individuals, SimiSKATO treats these scores as continuous traits within the SKAT-O framework. By applying this method to rare diseases in the UK Biobank, we demonstrate that SimiSKATO not only replicates known gene-disease associations but also identifies biologically plausible novel candidates missed by other methods. This …

Temporal Analysis In Connectivity Structure Of Human Disease Co-Occurance Network, Jingxuan Xu

Public Health Theses

Recent research on human disease networks (HDNs) has revealed the importance of jointly analyzing multiple diseasesand their interconnections, yet many existing approaches focus on molecular-based data and do not fully capture non-molecular relationships. Building on the concept of the phenotypical HDN, we leverage Medicare inpatient claims data to construct a comprehensive disease co-occurrence network. In our framework, two diseases are deemed interconnected if their observed probability of co-occurrence significantly deviates from that expected under independence. We adopt the weighted gene co-expression network analysis (WGCNA) framework to build our network, using a ϕ-correlation measure and a hard threshold to ensure a …

Predictors Of Viral Suppression Among People Living With Hiv (Plhiv) On Antiretroviral Treatment In Almaty, Kazakhstan, Ainur Kussainova

Electronic Theses & Dissertations (2024 - present)

ABSTRACT

Introduction

The Eastern Europe and Central Asia (EECA) region is experiencing the world’s fastest-growing HIV epidemic, with Kazakhstan among the countries most affected. Despite progress in HIV testing and treatment, Kazakhstan continues to face significant challenges in achieving optimal viral suppression among PLHIV. While 82% of PLHIV in Kazakhstan know their HIV status, only 73% are on ART, and just 67% of those on treatment achieve viral suppression. Adherence to ART remains a critical barrier, influenced by a complex interplay of individual, social, and structural factors, including mental health disorders such as depression, substance use, stigma and discrimination. Understanding …

Polygenic Risk Scores Of Grip Strength In Men And Women With Or At Risk For Hiv, Sreevidya Sadananda Sadasiva Rao

Electronic Theses & Dissertations (2024 - present)

Background: Adequate hand function among older adults is necessary for the successful completion of activities of daily living and can affect whether an older adult is able to live independently. Current research highlights grip strength, the strength people have in their hands, as a robust predictor of morbidity and mortality, and explores the decline in grip strength over time. A person’s family history and genes (DNA) affect how much grip strength they have. Previous studies have identified genes that affect grip strength, mainly in European ancestry populations. In this study, we examined whether these genetic elements predict grip strength in …

Non-Profit Hospital Spending On Community Health Improvement: Catalysts, Impediments, And Opportunities In New York State, Isaac H. Michaels

Electronic Theses & Dissertations (2024 - present)

This dissertation assesses the distribution and determinants of spending by non-profit hospitals in New York State on community health improvement services and community benefit operations. Utilizing the Social Ecological Model of Health, this study considers multiple levels of influence on this spending, including organizational and community characteristics. Using quantitative analysis, it examines cross-sectional, spatial, and longitudinal patterns in spending and identifies organizational and community-level factors influencing it. Qualitative analysis investigates operational factors affecting spending, including individual and interpersonal influences. The results of this mixed-methods study can inform hospital administrators, public health officials, policymakers, and communities in optimizing policies and decision-making …

Association Of Non-Communicable Diseases With Severe Covid-19 Among People Living With And Without Diagnosed Hiv/Aids In New York State, Ravi Kumar Balu

Electronic Theses & Dissertations (2024 - present)

Background: People living with diagnosed HIV (PLWDH) have a higher chance of co-infections and co-morbidities than the general population. When SARS-CoV-2 was first reported in China in December 2019 and later declared a pandemic, it was speculated that PLWDH might be more prone to SARS-CoV-2 infection and severe disease outcomes given their increased vulnerability to other respiratory infections like influenza, pneumococcal pneumonia and tuberculosis. However, several facets of COVID-19 disease in PLWDH are incompletely understood, including whether non-communicable diseases (NCDs) are strong risk factors for severe disease outcomes and death as they are in the general population.

Methods: The data …

Applying The Ecological Model Of Medical Encounters To Understand Patient-Centered Communication For Older Korean Migrants In The U.S., Seulgi Park

Electronic Theses & Dissertations (2024 - present)

Patient-Centered Communication (PCC) is defined as an approach that places patients at the center of communication with healthcare providers. PCC has been recognized as a strategy to address disparities experienced by minority populations. However, despite its associations with positive health outcomes and ethical significance, there has been a paucity of research on PCC in minority populations such as older Korean migrants in the U.S. Understanding PCC within this group may contribute to improving healthcare communication tailored to their needs. This dissertation aimed to (1) explore the expectations of PCC in primary care settings among older Korean migrants in the U.S., …

Food Rescue, Food Waste, And Policy In New York: A Mixed-Methods Study Of Food System Impacts, Mariana Torres Arroyo

Electronic Theses & Dissertations (2024 - present)

This dissertation investigates how food donation policies in New York State influence the recovery, redistribution, and waste of surplus fresh produce, with a focus on fruits and vegetables. Using an interdisciplinary, systems-based approach that integrates system dynamics modeling with qualitative, community-engaged research, the study analyzes the effectiveness and unintended consequences of three major policies: Nourish New York, the Farm to Food Bank tax credit, and the Food Donation and Food Scraps Recycling Law.

Chapter 2 uses simulation modeling to examine how the tax credit and waste ban affect produce recovery and redistribution. Results show that while both policies can boost …

Differences In Mental Health Care Use Between Urban And Rural Populations In New York State, 2017-2022, Anna J. Papa

Electronic Theses & Dissertations (2024 - present)

Objective

This study aimed to determine whether rural New York State residents receive mental health care at the same rate as urban residents, how poverty rates in New York State relate to rurality and mental health care use, and how pre-pandemic mental health care use rates compare to 2022 use rates. The goal was not to estimate the burden of disease, nor to estimate the number of patients engaged in care in each zip code, but to highlight the potential differences in service use between urban and rural New York State Office of Mental Health clients.

Methods

A secondary analysis …

Theoretical Foundations And Applied Performance Of Periodicity-Aware Imputation: Variable Bandpass Block Bootstrap Methods For Incomplete Time Series, Asmaa Ahmad

Electronic Theses & Dissertations (2024 - present)

Time series data are prevalent across a wide range of disciplines, including health surveillance, public policy, and environmental monitoring. In the presence of underlying cyclical patterns, the integrity of time series analysis depends critically on the ability to detect, model, and impute structured missing data without compromising the temporal structure. This dissertation introduces and validates a novel imputation framework that integrates the Variable Bandpass Periodic Block Bootstrap (VBPBB) into multiple imputation procedures, improving the accuracy, robustness, and interpretability of time series models under high rates of missingness and noise. The overarching goal of this dissertation was to develop and evaluate …

A Study Of Glyphosate, Pesticide Mixtures, And Metabolic Health Outcomes: Integrating Epidemiologic, Mechanistic, And Ecological Evidence On Environmental Drivers Of Metabolic Health, Sarah Otaru

Electronic Theses & Dissertations (2024 - present)

Glyphosate, the most extensively used herbicide worldwide, has become a ubiquitous environmental contaminant. Although initially considered safe due to its specific biochemical target in plants, emerging evidence suggests that chronic, low-level human exposure may disrupt metabolic processes. Simultaneously, the global rise in metabolic disorders such as metabolic syndrome (MetS), obesity, and type 2 diabetes, has created a pressing need to identify novel, potentially modifiable environmental contributors. This dissertation investigates the relationship between glyphosate and metabolic health through a triangulated framework that integrates individual-level epidemiological analysis, systematic synthesis of mechanistic evidence, and ecological evaluation of pesticide mixtures.

The first study employed …

Addressing Barriers To Preventive Healthcare Access Through Community Outreach In Underserved Populations, Deneisha Sparks

Theses and Dissertations

Access to preventive healthcare is a significant public health challenge, particularly for underserved populations in Muscogee County, Georgia. This project addresses systemic barriers such as transportation, limited health education, and economic constraints, which contribute to health disparities and reliance on emergency room services. Guided by the Social Determinants of Health (SDOH) framework and the Health Belief Model (HBM), the project aims to enhance access to preventive care, improve health literacy and identify barriers to healthcare access.

This program evaluation report examined a community-based initiative that utilized a mobile health unit to improve access to preventive healthcare in underserved areas of …

Examining Healthcare Access Disparities: Social Determinants And Patient Experiences At Valley Healthcare, Mikaila Larmond

Theses and Dissertations

Persistent disparities in healthcare access continued to affect low-income, rural, and underserved populations across the United States. This capstone project explored these disparities within Valley HealthCare, a regional provider in Columbus, Georgia, by examining how social determinants such as income, education, geography, and transportation shaped healthcare engagement among adult patients. A mixed-methods case study design was used to analyze survey data, patient satisfaction feedback, and organizational reports from a sample of 80 adult patients between January and March 2025.

The results showed that patients residing in lower-income or geographically isolated areas reported significantly higher rates of missed appointments. Individuals with …

Prevalence Of Hypertension Among Low-Income Individuals In Muscogee County Columbus, Georgia, Amelia K. Fallah

Theses and Dissertations

This study investigates the prevalence and predictors of elevated blood pressure (BP) among 409 low-income adults in Muscogee County, Columbus, Georgia—a population disproportionately burdened by hypertension. The findings reveal that elevated BP is significantly more prevalent among African Americans (71.4%) compared to non-African Americans (27.1%), highlighting the role of racial disparities influenced by systemic inequities, healthcare access, and chronic stress. Gender differences were modest, with females exhibiting a slightly higher prevalence (77.9%) than males (76.7%), potentially due to age-related hormonal changes post-menopause. Older adults (50+ years) represented most of the sample and showed significantly higher hypertension rates, consistent with established …

From Fields To Fast Foods: Food Culture, Identity, And Health In Puerto Rico Under The U.S. Empire, Ivanna Morales Mercado

CMC Senior Theses

Operation Bootstrap, launched in 1947, fundamentally altered Puerto Rico’s economy, just as much as its food culture. Prioritizing manufacturing over agriculture led to the collapse of the island’s farming sector, increasing reliance on food imports and leading to a rise in diet-related diseases such as obesity, type 2 diabetes, and cardiovascular issues. This thesis examines the legacies of Operation Bootstrap on Puerto Rico’s food system, health outcomes, and cultural identity by emphasizing the need to value intergenerational knowledge. The oral history research in this study highlights the importance of intergenerational knowledge in reclaiming sustainable agricultural practices and healthy, culturally significant …

Investigating The Impact Of Phthalate Exposures From Personal Care Products On Uterine Fibroid Incidence And Prevalence In Us-Born Black Women, Ella Brissett

CMC Senior Theses

Uterine fibroids are benign tumors composed of smooth muscle cells and connective tissue that develop within or on the walls of the uterus. Despite being non-cancerous, they can severely affect quality of life by causing heavy bleeding, chronic pain, and reproductive complications. Fibroids are typically found in women of reproductive age, but they disproportionately affect Black women, who experience higher incidence and severity. The underlying causes of this disparity is poorly understood; however, an emerging body of research is highlighting the role of phthalates, endocrine-disrupting chemicals found in many personal care products, in exacerbating fibroid development. Through a critical analysis …

Money Matters: Investigating The Emotional, Cognitive, And Biological Pathways Connecting Maternal Early Life Financial Insecurity And Parenting Quality, Elise Power, Stacey N. Doan

CMC Senior Theses

Early life adversity has been shown to have a variety of negative effects on adult functioning, including parenting quality, with implications for child wellbeing. Adverse early life experiences including poverty have been linked to long-term disruptions in emotional, cognitive, and physiological functioning that compromise the ability to provide sensitive, nurturing care. The present study investigated whether emotional regulation difficulties, physiological regulation, and cognitive function mediate the relationship between early life financial insecurity and parenting quality. A sample of 132 mother-child dyads completed self-report measures, biological samples, and cognitive assessments. A multiple mediation model ran in SPSS, revealed a significant indirect …

Impact Of The New York State Gender Recognition Act On Mental Health Outcomes Among Non-Binary Adults Served By The New York Public Mental Health System, Sahil Chaudhry

Electronic Theses & Dissertations (2024 - present)

This dissertation explores the impact of the 2021 New York State Gender Recognition Act (GRA) on mental health outcomes and service utilization among non-binary adults in the public mental health system. The GRA introduced pivotal legal reforms—including the option for an “X” gender marker and self-attestation for gender identity changes on state-issued documents—designed to affirm gender diversity and reduce structural barriers for transgender and non-binary populations. Guided by gender affirmation theory and minority stress frameworks, this study investigates how these legal shifts relate to changes in mental health service engagement and psychological well-being among non-binary individuals.

Using a difference-in-differences (DD) …

Molecular Epidemiologic Studies Of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (Me/Cfs), Anil Kumar

Electronic Theses & Dissertations (2024 - present)

Background: Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is a disabling multisystem complex disorder with no known etiology or approved treatment. Our studies aimed to assess the link between ME/CFS and autoimmune disease (AID) and cancer, and to identify potential biomarkers and biological mechanisms to further explore pathophysiology of this diseases.

Methods: All analyses were done using data from a case-control study of ME/CFS conducted by Dr. Roxana Moslehi and her collaborators. In our first study we estimated the cumulative incidences of AID and cancer among first degree relatives of 60 cases and 61 controls and compared cumulative …

Differences In Mental Health Outcomes In Immigrant Vs. U.S.-Born Populations In Urban Vs. Rural Areas In The United States, Zoë Gentles

Electronic Theses & Dissertations (2024 - present)

Background

The immigration process to the United States creates distinct mental stressors. These stressors are influenced by socioeconomic factors including income, education level and insurance status. In rural America, these factors are intensified due to a poor healthcare infrastructure that is limited. This study examines the relationship between urban-rural residence and mental health outcomes among immigrants vs. native-born residents in the United States.

Methods

Data from the National Health Interview Survey (NHIS) from 2019 and 2022 were used to examine the relationship. The exposure of interest was place of birth, and the outcome of interest was the presence of clinically …

Dual Inhibitor Of Mdm2 And Nfat1 For Experimental Therapy Of Breast Cancer: In Vitro And In Vivo Anticancer Activities And Newly Discovered Effects On Cancer Metabolic Pathways, Wei Wang, Marlene Aguilar, Sayantap Datta, Abigail Alley, Meheret Tadesse, Xinshi Wang, Xia Gao, Ruiwen Zhang

Faculty, Staff and Students Publications

INTRODUCTION: The oncogene MDM2 has garnered attention not only for its role in cancer as a negative regulator of the tumor suppressor p53 but also for its p53-independent oncogenic activities. MDM2 also involves metabolic reprogramming, such as serine metabolism, respiration, mitochondrial functions, the folate cycle, and redox balance. Traditional MDM2 inhibitors blocking the protein-protein binding between MDM2 and p53 have shown limited clinical success in various stages of clinical trials, most likely due to low efficacy, drug toxicity, and drug resistance, highlighting the need for a novel, p53-independent strategy to inhibit MDM2. The present study investigated the antitumor effects of …

A Scoping Review Of The Social Determinants Of Pediatric And Adolescent Obesity, Deepali K Ernest, Elizabeth A Onugha, Bipin Singh, Shreela V Sharma, Jayna M Dave

Faculty, Staff and Student Publications

Context: Social determinants of health (SDOH) play a large role in pediatric and adolescent metabolic health worldwide.

Objective: The study is aimed at exploring key SDOH related to childhood obesity, worldwide.

Methods: Primary research articles from PubMed, Embase, and Medline databases published between 2013 and 2023, had a study population of 0-19-year-olds, and examined the association between WHO-defined SDOH and childhood obesity were included. Non-English papers and those outside WHO-defined SDOHs were excluded. Two reviewers independently performed a blinded screening of titles and abstracts, followed by a full-text assessment of selected articles.

Results: Of the 703 initial articles, 22 duplicates …

Commentary: Impact Of Resistance Training Intensity On Body Composition And Nutritional Intake Among College Women With Overweight And Obesity: A Cluster Randomized Controlled Trial, Joshua L Keller, Sarah E Deemer, Gian Luca Di Tanna, Sherri L Pals, Kevin R Fontaine, David B Allison

Children’s Nutrition Research Center Staff Publications

No abstract provided.

Predictive Equation Derived From 6,497 Doubly Labelled Water Measurements Enables The Detection Of Erroneous Self-Reported Energy Intake, Rania Bajunaid, Chaoqun Niu, Catherine Hambly, Zongfang Liu, Yosuke Yamada, Heliodoro Aleman-Mateo, Liam J Anderson, Lenore Arab, Issad Baddou, Linda Bandini, Kweku Bedu-Addo, Ellen E Blaak, Carlijn V C Bouten, Soren Brage, Maciej S Buchowski, Nancy F Butte, Stefan G J A Camps, Regina Casper, Graeme L Close, Jamie A Cooper, Richard Cooper, Sai Krupa Das, Peter S W Davies, Prasangi Dabare, Lara R Dugas, Simon Eaton, Ulf Ekelund, Sonja Entringer, Terrence Forrester, Barry W Fudge, Melanie Gillingham, Annelies H Goris, Michael Gurven, Asmaa El Hamdouchi, Hinke H Haisma, Daniel Hoffman, Marije B Hoos, Sumei Hu, Noorjehan Joonas, Annemiek M Joosen, Peter Katzmarzyk, Misaka Kimura, William E Kraus, Wantanee Kriengsinyos, Rebecca Kuriyan, Robert F Kushner, Estelle V Lambert, Pulani Lanerolle, Christel L Larsson, William R Leonard, Nader Lessan, Marie Löf, Corby K Martin, Eric Matsiko, Anine C Medin, James C Morehen, James P Morton, Aviva Must, Marian L Neuhouser, Theresa A Nicklas, Christine D Nyström, Robert M Ojiambo, Kirsi H Pietiläinen, Yannis P Pitsiladis, Jacob Plange-Rhule, Guy Plasqui, Ross L Prentice, Susan B Racette, David A Raichlen, Eric Ravussin, Leanne M Redman, John J Reilly, Rebecca Reynolds, Susan B Roberts, Dulani Samaranayakem, Luis B Sardinha, Analiza M Silva, Anders M Sjödin, Marina Stamatiou, Eric Stice, Samuel S Urlacher, Ludo M Van Etten, Edgar G A H Van Mil, George Wilson, Jack A Yanovski, Tsukasa Yoshida, Xueying Zhang, Alexia J Murphy-Alford, Srishti Sinha, Cornelia U Loechl, Amy H Luke, Herman Pontzer, Jennifer Rood, Hiroyuki Sagayama, Dale A Schoeller, Klaas R Westerterp, William W Wong, John R Speakman

Faculty, Staff and Students Publications

Nutritional epidemiology aims to link dietary exposures to chronic disease, but the instruments for evaluating dietary intake are inaccurate. One way to identify unreliable data and the sources of errors is to compare estimated intakes with the total energy expenditure (TEE). In this study, we used the International Atomic Energy Agency Doubly Labeled Water Database to derive a predictive equation for TEE using 6,497 measures of TEE in individuals aged 4 to 96 years. The resultant regression equation predicts expected TEE from easily acquired variables, such as body weight, age and sex, with 95% predictive limits that can be used …

General Kernel Machine Methods For Multi-Omics Integration And Genome-Wide Association Testing With Related Individuals, Amarise Little, Ni Zhao, Anna Mikhaylova, Angela Zhang, Wodan Ling, Florian Thibord, Andrew D Johnson, Laura M Raffield, Joanne E Curran, John Blangero, Jeffrey R O'Connell, Huichun Xu, Jerome I Rotter, Stephen S Rich, Kenneth M Rice, Ming-Huei Chen, Alexander Reiner, Charles Kooperberg, Thao Vu, Lifang Hou, Myriam Fornage, Ruth J F Loos, Eimear Kenny, Rasika Mathias, Lewis Becker, Albert V Smith, Eric Boerwinkle, Bing Yu, Timothy Thornton, Michael C Wu

Faculty, Staff and Student Publications

Integrating multi-omics data may help researchers understand the genetic underpinnings of complex traits and diseases. However, the best ways to integrate multi-omics data and use them to address pressing scientific questions remain a challenge. One important and topical problem is how to assess the aggregate effect of multiple genomic data types (e.g. genotypes and gene expression levels) on a phenotype, particularly while accommodating routine issues, such as having related subjects' data in analyses. In this paper, we extend an existing composite kernel machine regression model to integrate two multi-omics data types, while accommodating for general correlation structures amongst outcomes. Due …

Principles Of Biomedical Research, Faina Linkov, Matthew C. Kostek

Open Education Materials

HLT 430/530

CC BY-NC-SA

Exploring The Impact Of Covid-19 And The Role Of The Church On African Americans’ Mental Well-Being In South Georgia, Adrian D. Lewis

College of Graduate Studies: Theses & Dissertations

The emergence of COVID-19 in 2020 disrupted the social dynamics of communities in the United States. Furthermore, public health mandates led to closures that changed how populations access faith. Historically, African Americans have utilized the church to cope with societal stressors. This study will explore the history of church utilization in the African American community, assess how COVID-19 public health mandates led to church closures for the first time in recent history and impacted this marginalized population, and provide a qualitative perspective on the quality of life during the closures and what changed after the closures for African Americans in …

Expertise Or Experience: Comparing Discussion Of Drought Between Audiences And Agencies In Nebraska, Kansas, Iowa, And Missouri, Cory L. Armstrong, Sharon E. Baldinelli, Kelly Helm Smith, Sharon J. Medcalf

Journal Articles: Epidemiology

Significant portions of the states in FEMA region 7 (Kansas, Nebraska, Missouri, and Iowa) were in drought in 2022–23. Culling data gathered from a prominent social media platform and from focus group discussions, this research examines how drought information was communicated between the public officials and the general public. Through the lens of the two-step flow of communication theory, the central research question explored the differences between public conversations about drought among individuals experiencing it and the viewpoints of experts who work on drought-related issues. Results from social media conversations were examined, along with insights from focus group discussions involving …