Public Health Commons^™

Effect Of A Weight-Loss Intervention On Oxidative Stress Biomarkers Among Breast Cancer Survivors In The Lifestyle, Exercise, And Nutrition (Lean) Study, Yiyi Li

Public Health Theses

Introduction: As the number of breast cancer survivors increases, ensuring quality of life during the survivorship period is important. Obesity may induce oxidative stress, which may be relevant mechanistically for adverse health outcomes among breast cancer survivors. Diet, exercise, and weight loss may mitigate oxidative stress, yet few lifestyle trials have investigated if these interventions have impacted oxidative stress. Therefore, we conducted a secondary analysis in a 6-month weight loss randomized controlled trial, the Lifestyle, Exercise, and Nutrition (LEAN) study, among breast cancer survivors with a body mass index (BMI) ≥ 25 kg/m2 to evaluate the effect of the intervention …

Exploring The Use Of Mobile Health Application To Promote Self-Managment Of Cardiovascular Disease: A Study Of Age-Related Differences And Technology Adoption Among Chinese Patients, Yunan Mei

Public Health Theses

Background: Cardiovascular diseases (CVD) are the leading cause of mortality globally, particularly in China's aging population. Mobile health (mHealth) technologies offer a promising avenue to address healthcare disparities and enhance CVD management among the elderly. This study aims to explore the acceptance of mHealth in improving self-management of CVD among older adults in China, focusing on its potential to mitigate accessibility and treatment challenges.

Methods: This cross-sectional study was conducted at the Xinhua Hospital of Shanghai Jiao Tong University. Data were collected using an online Qualtrics questionnaire from 225 participants who met inclusion criteria including being Chinese speakers, diagnosed with …

U.S. Hospital Readmissions Following Discharge For A Non-Fatal Overdose Among Adolescents, 2016-2020, Gabriela Mendoza Cueva

Public Health Theses

Importance: It is not yet known how many adolescents are readmitted within six months in the U.S. following a non-fatal overdose and the risk factors associated with all-cause readmission. Objective: To examine the risk of 6-month readmission following hospitalization for a non-fatal drug overdose among adolescents and the risk factors for readmission. Design, Setting, and Participants: This retrospective chart analysis utilized the Nationwide Readmission Database (NRD) from 2016 to 2020 to identify nonfatal overdose readmissions among adolescents aged 11 to 19. Exposures: Non-fatal prescription and illicit drug overdose. Main Outcome Measures: The study used weighted state-level discharge data to derive …

Indoor Air Pollution In Nomadic Himalayan Highlander Communities, Charles Minicucci

Public Health Theses

Indoor air pollution (IAP) from burning solid biomass fuel is a major global health challenge, especially in resource-limited settings without access to electricity or reliable fuel sources. In the Kingdom of Bhutan, where, despite a reported 99% of households having access to electricity, the vast majority of rural households still use biomass fuels for cooking and indoor heating. Given the resource limitations and access challenges associated with Bhutan’s remote highlander and herding communities, few solutions for or details about their exposure to IAP are available – especially during nomadic periods where families may spend months beyond the reach of infrastructure …

Exploring The Association Between The Supplemental Nutrition Program For Woman, Infants And Children (Wic) And Gestational Weight Gain, Oyinlola Obatolu

Public Health Theses

Background: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has been an impactful federal public assistance program that has provided nutrition education and support to millions of low income women and children around the country. Despite its positive impact on perinatal and birth outcomes, the precise mechanisms between WIC and these outcomes remain unclear. Past studies have looked at the relationship between WIC and gestational weight gain (GWG), a potential mediator of the effect of WIC on birth outcomes, but they have mainly focused on city or state level data or Medicaid enrollees. This study aims to …

“Their Body, Their Choice. Your Body, Your Choice. Your Baby, Your Choice.”: A Reflexive Thematic Analysis Of Vaccine Access And Acceptance Among U.S. Pregnant People On Reddit, Sydney Marie Perlotto

Public Health Theses

Compared to the general population, pregnant people and newborns are at a higher risk of contracting infectious diseases and experiencing worse adverse outcomes. Vaccines delivered during pregnancy, known as prenatal vaccines, represent a critical yet underused form of preventive care for these populations in the United States. Increasing successful prenatal vaccination uptake requires a focus on both access and acceptance, which pregnant people may experience differently than non-pregnant people due to their unique physiological and social state. Given the evolution of vaccine hesitancy following the COVID-19 pandemic, coupled with the recent expansion of the U.S. prenatal immunization schedule, this study …

Greening And Mental Distress: Effect Modification By Housing Tenure, Saira Prasanth

Public Health Theses

Access to high-quality residential greenspace is associated with improved long-term health, particularly mental health. However, many interventions to promote “greening” or increased greenspace in urban areas have been shown through numerous qualitative studies to exacerbate environmental and health inequities, primarily through green gentrification. Our objective was to quantify the association between greenspace and mental distress in the U.S. as well as evaluate whether the association between greenspace and mental distress is modified by housing tenure. We hypothesized that increased greenspace was associated with reduced mental distress, and that this effect was more protective among homeowners than non-homeowners. Mental distress and …

Macronutrient Intake In Us Adults: Race, Gender, Age, Education, Ana Karina Raygoza Cortez

Public Health Theses

Background: The US has seen a consistent increase in obesity rates over the last sixty years across all racial and ethnic groups, with similar trends even among privileged groups. This study examines Macronutrient intake trends in US adults from 1999-2018 and their association with demographic factors: race ethnicity, age, gender, and education.

Methods: We conducted a serial cross-sectional analysis of US adults using 24-hour dietary recall data from 10 NHANES survey cycles (1999-2018). Piecewise regression models identified significant dietary pattern changes over time, by demographic groups. Statistical analysis was done in R and SAS utilizing NHANES sampling weights.

Results: Study …

Hybrid Medical Practices In Malaria Management Among Sao Tome And Principe’S Elderly, Yihan Shi

Public Health Theses

Africa has the global heaviest burden of malaria. Sao Tome and Principe, a low-transmission island nation in the Gulf of Guinea with a population of about 200,000, has entered the malaria elimination phase. Despite this, the prevalence and mortality rates of malaria among the elderly in Sao Tome and Principe remain high compared to high transmission areas. This study employed a mixed-methods approach to explore the association between age and recommended malaria management strategies for adults in Sao Tome and Principe, with a focus on examining samples older than 50 years. All participants (N = 274) completed surveys, with in-depth …

Child And Adolescent Exposure To Environmental Chemicals And Mental Health Outcomes: A New Haven Study, Yunyue Shi

Public Health Theses

Child and adolescent mental health disorders, including anxiety, depression, and behavioral problems, contribute significantly to the global health burden. Exposure to toxic air contaminants such as semi-volatile organic compounds (SVOCs)—especially polycyclic aromatic hydrocarbons (PAHs) and phthalates—during critical developmental periods can have detrimental impacts on children’s brain development and function. This study aimed to identify potential associations between children and adolescents’ chemical exposure and mental health outcomes. The objectives were: 1) to characterize the distribution of individual environmental chemical exposures among children and adolescents using Fresh Air samplers and 2) to determine the association between chemical exposures, particularly PAHs and phthalates, …

Long-Term Exposure To Ambient Pm2.5 & Intentional Self-Harm, Caroline Elise Sutton

Public Health Theses

A growing body of literature is finding that air pollution exposure may contribute to disease onset of certainbrain disorders, including mental disorders such as depression, through mechanisms of neuroinflammation and oxidative stress1. However, even as there is increasing attention on the impacts of air pollution and mental illnesses, most studies focus on mental illness outcomes that might not represent severe or life-threatening symptoms (such as self-harm)2–7 , while a majority of studies focused on intentional self-harm assess the relationship between short-term air pollution exposure (as opposed to chronic and cumulative exposure) and self-harm outcomes8–13 . Given the barriers to treatment …

“I Don't Work For The Prison. I Don't Work For The Hospital Either. I’M Yours. Who Else Here Is Yours?” A Qualitative Analysis Of Facilitators And Barriers Of Launching Enhanced Perinatal Programs In Seven State Prisons, Karenna Thomas

Public Health Theses

The United States incarcerates women at the highest rate globally (Fair & Walmsley, 2022), while simultaneously failing to provide incarcerated individuals with adequate reproductive health care. Perinatal programs, including a combination of one-on-one and group prenatal and postpartum education, labor and birth support with a doula, separation support, and lactation care have been implemented as an alternative to standard care in around 21 states (Wilson et al., 2022). While the efficacy of these programs among incarcerated individuals has been established (Bard et al., 2016; Barkauskas et al., 2002; Schroeder & Bell, 2005; Shlafer et al., 2018; Shlafer, Saunders, Boraas, et …

Cost-Effectiveness Of Helicobacter Pylori Screenings In Asian Americans In The United States, Qin Wang

Public Health Theses

Background: Gastric cancer remains a significant public health concern, particularly for Asian Americans in the United States, who are at higher risk. Helicobacter pylori (H. pylori) infection is a known risk factor for gastric cancer (GC) and peptic ulcer disease (PUD), and its eradication has proven effective in preventing both conditions. Due to the lack of clinical standards in H. pylori screening for this high-risk group of Asian Americans, we explore whether population-based screening using carbon-13 urea breath test (C-UBT) and/or endoscopy is cost-effective in the United States for Asian Americans. Methods: We built a cohort state-transition Markov model to …

Birth Characteristics, Outdoor Artificial Light At Night, Ambient Air Pollution And The Risk Of Hepatoblastoma In Young Children, Peiyi Wang

Public Health Theses

Objective: The etiology of hepatoblastoma, the predominant malignant liver tumor in infancy and early childhood, is unclear. We assessed possible associations between birth characteristics, outdoor artificial light at night (ALAN), ambient air pollution (measured by particulate matter PM2.5), and the risk of hepatoblastoma.

Methods: Leveraging a population-based linkage of statewide birth records and cancer registry data in California, we conducted a case-control study that included 356 hepatoblastoma cases diagnosed at the age of 0-6 years during 1988-2015 and 17,800 controls frequency-matched by birth year. Restricted cubic spline transformation was employed to evaluate non-linear associations. Multivariable logistic regression models were used …

Assessment Of Suicide Risk In Emergency Department Settings For Adults In Nepal: Validation Of The Nepali Ask Suicide-Screening Questions, Pei Wang

Public Health Theses

Objectives: Suicide is a severe public health crisis around the globe. Low-middle-income countries (LMICs) bear 77% of the global suicide burden. Screening is a significant component of suicide prevention, but there is a dearth of suicide screening tools, especially in LMICs. This study focused on validating the Ask Suicide-Screening Questions (ASQ) within an adult Emergency Department (ED) population in Nepal. Although the validation occurred in an ED setting, the Nepali ASQ is designed with the flexibility to be useful in a variety of healthcare contexts, extending its applicability beyond just emergency care.Methods: We systematically translated and adapted the 4-item ASQ, …

Cost-Effectiveness Analysis Of Alternative Infant And Neonatal Rotavirus Vaccination Schedules In Malawi, Catherine Wenger

Public Health Theses

Rotavirus is the leading cause of cases and deaths related to diarrhea-related hospitalizations among children under five worldwide, especially in low- and middle- income countries. Although vaccination is proven to be the best strategy for preventing rotavirus, its impact has been suboptimal in LMICs.

The primary aim of this study was to evaluate the impact of and cost- effectiveness of the current Rotarix rotavirus vaccine, two alternative vaccine delivery schedules, and the next-generation vaccine (RV3-BB) in Malawi.

The cost-effectiveness of rotavirus vaccine strategies in Malawi was evaluated using moderate-to-severe and non-severe rotavirus cases derived from a mathematical model ofrotavirus transmission …

Randomized Trial Of Exercise Vs. Usual Care On Inflammatory And Metabolic Biomarkers In Women With Breast Cancer Taking Aromatase Inhibitors, Lingxiao Zhang

Public Health Theses

ABSTRACT

Background: The Hormones and Physical Exercise (HOPE) study demonstrated efficacy of exercise in reducing AI-associated arthralgia in breast cancer survivors. Yet, the underlying mechanism for this relationship remains unclear. Prior research among breast cancer survivors highlights improvements in metabolic and inflammatory biomarkers related to exercise. This secondary analysis of HOPE examined the potential role of metabolic and inflammatory biomarkers in mediating the effect of exercise vs. usual care on AI-associated arthralgia.

Methods: Our analysis included 80 participants (42 exercise arm, 38 usual care) enrolled in the HOPE study. The intervention was a year-long exercise program that included both supervised …

Do Rental Assistance Programs Relieve Overcrowding In U.S. Children?, Frank Zhu

Public Health Theses

Introduction: Crowded living conditions are associated with many negative health outcomes, with significant implications for children, as they are particularly shaped by their home environment and more likely to live in crowded conditions, given their larger household size. How rental assistance programs may shape and improve household crowding has not been previously explored. Methods: This study leveraged data from NHANES linked with HUD administrative rental assistance records. We examined changes in crowding measures in U.S. children using linear and logistic regression models stratified by different rental assistance program types. Results: There was a statistically significant 40 percentage point reduction in …

The Menstrual Cycle In Psychotherapy: Interventions, Therapist Engagement, And Blind Spots, Rozita Alaluf

Dissertations and Theses

There is a dearth of literature on psychotherapy and menstruation, except for the treatment and diagnosis of issues associated with premenstrual distress. This study aimed to bridge this gap by investigating the frequency and context of discussions about the menstrual cycle, the factors influencing therapists’ engagement with this topic, and the therapeutic approaches utilized to address the menstrual cycle within psychotherapy.

In phase 1, 118 psychotherapists from various theoretical backgrounds completed a survey on menstruation in clinical practice. The data was analyzed using descriptive statistics. In phase 2, semi-structured interviews were conducted with 7 psychotherapists, primarily identifying their theoretical orientation …

The Emergence Of Aedes Aegypti In California: Implications For Ecosystems And Public Health, Jose Ruiz

CMC Senior Theses

This literature review delves into the emergence and impact of Aedes aegypti, the yellow fever mosquito, in Southern California. My investigation begins with an exploration of the physical characteristics, historical background, and its significance as a vector. Notably, Aedes aegypti's historical role as a vector for yellow fever during the 19th century shapes the foundation for understanding its effectiveness in disease transmission and demonstrates the potential of its negative impact on Southern California residents. I examined the habitat preferences and behaviors of Aedes aegypti, emphasizing its adaptability to urban environments and its effect as a daytime feeder with a limited …

Hospital Surge Capacity In Co-Occurring Mass Casualty Incidents, Carolyn Solimine

Electronic Theses & Dissertations (2024 - present)

The COVID-19 pandemic has brought sweeping disruption and changes across healthcare systems. Examining how these changes have impacted surge capacity and capabilities is necessary to plan for future co-occurring surge-creating events in hospital Emergency Departments (EDs) and Intensive Care Units (ICUs). While there is extensive research on patient surge management, no study has looked at how the presence of a prolonged surge would impact the healthcare system’s ability to handle a concurrent acute patient surge. This study seeks to demonstrate the need for comprehensive planning for co-occurring patient surges in New York State using hospital capacity data from Health and …

Assessing Associations Between Emergency Room Visits For Respiratory And Cardiovascular Diseases And Criteria Air Pollutants Exposure In New York State, Tamba Solomon Lebbie

Electronic Theses & Dissertations (2024 - present)

Abstract

Air pollution is a major environmental health hazard for the general population. Approximately 90% of the global population is at risk of both indoor and outdoor air pollution, and it accounts for an estimated 7 million premature deaths every year according to the World Health Organization (WHO). Multiple studies including epidemiological and molecular analyses have confirmed the negative effects of air pollutants on human health even at levels within the WHO guidelines. This study examines the health impacts of releases of criteria air pollution from point sources in New York State (NYS). There is evidence from population studies that …

Optimizing The Community Health Worker (Chw) Program In Belize And Understanding Its Unique Intermediary Position Within The Health System: Perspective From The World Health Organization (Who) Health Systems Approach, Andrei R. Chell

Electronic Theses & Dissertations (2024 - present)

Human resources for health (HRH) are the backbone of a well-functioning and resilient health system. Issues related to HRH recruitment, retention, planning, leadership and governance have been amplified by the coronavirus disease 2019 (COVID-19) pandemic and have posed additional and unprecedented challenges in many countries. Community health workers (CHWs) in particular, are uniquely positioned to be frontline health care workers (HCWs) that are considered a vital link between communities and the formal health system. Globally, the benefits of CHW programs have been well documented, and there is substantial evidence of the efficacy and effectiveness of these programs. However, countries are …

Ribosome Hibernation Factor Induces Antibiotic Persisters Of Mycobacterium Tuberculosis In Neutrophil-Rich Lung Lesions, Jamie Corro

Electronic Theses & Dissertations (2024 - present)

Mycobacterium tuberculosis (Mtb), the etiological agent of tuberculosis, is a prescient global health threat and the leading cause of death by an infectious agent. Treatment of Mtb infection involves administering 2-4 antibiotics for a minimum of 6 months. This extended drug regimen is required to target a subpopulation of persistent bacilli. As their name implies, these bacteria can “persist” by acquiring nonhereditary and transient antibiotic tolerance. Although the precise mechanism is unknown, it’s often attributed to slowing cellular growth and metabolic processes. During zinc deprivation, bacteria can remodel their ribosomes by replacing their zinc-binding paralogues containing the CXXC motif (C+) …

The Effect Of Presenting Concerns On Providers’ Assessment Of Patients' Suicide Risk, Alexandria Brunkow

Electronic Theses & Dissertations (2024 - present)

Objective: Suicide is the 10^th leading cause of death in the U.S. with nearly 50,000 people per year dying by suicide. Public health approaches to suicide prevention focus on screening people in primary and mental health care settings and offering treatment to those who screen positive. Research shows that mental health providers may not recognize risk factors for suicide and miss opportunities to screen patients who may be at risk. Providers’ mental representations of suicide risk may be influencing their perception of patient risk and contributing to low screening rates. This study used an experimental vignette case design to …

A Descriptive Analysis Of Depressive Symptoms And Body Image By Race/Ethnicity And Nativity Status Among Adolescents, Radhika Prasad

Electronic Theses & Dissertations (2024 - present)

Previous research on the immigrant health paradox among children and adolescents show a mental health advantage yet it is unclear if this applies in a similar magnitude to females (Fillion et al., 2018; Zarei et al., 2023). Immigrants may be exposed to stressors related to immigration and acculturation. Some research suggests that females respond more to stress through internalizing symptoms relative to males (Hall-Lande et al., 2007; Adkins et al., 2009). Given these gender differences in stress response, female immigrants may be particularly vulnerable to the psychological consequences of immigration related stressors. The immigrant health paradox has also overlooked subjective …

Branched-Chain Amino Acid Accumulation Fuels The Senescence-Associated Secretory Phenotype, Yaosi Liang, Christopher Pan, Tao Yin, Lu Wang, Xia Gao, Ergang Wang, Holly Quang, De Huang, Lianmei Tan, Kun Xiang, Yu Wang, Peter B Alexander, Qi-Jing Li, Tso-Pang Yao, Zhao Zhang, Xiao-Fan Wang

Faculty, Staff and Students Publications

The essential branched-chain amino acids (BCAAs) leucine, isoleucine, and valine play critical roles in protein synthesis and energy metabolism. Despite their widespread use as nutritional supplements, BCAAs' full effects on mammalian physiology remain uncertain due to the complexities of BCAA metabolic regulation. Here a novel mechanism linking intrinsic alterations in BCAA metabolism is identified to cellular senescence and the senescence-associated secretory phenotype (SASP), both of which contribute to organismal aging and inflammation-related diseases. Altered BCAA metabolism driving the SASP is mediated by robust activation of the BCAA transporters Solute Carrier Family 6 Members 14 and 15 as well as downregulation …

Association Of Circulating Ketone Bodies With Cognitive Performance And Dementia In The Multi-Ethnic Study Of Atherosclerosis (Mesa), Parag Anilkumar Chevli, Christopher L Schaich, Alexis C Wood, Luqman A Tk, Anurag Mehta, Vardhmaan Jain, Margery Connelly, Suzanne Craft, Elad Shemesh, José A Luchsinger, Kathleen M Hayden, Bonnie Colleen Sachs, Timothy M Hughes, Michael D Shapiro

Faculty, Staff and Students Publications

Introduction

Growing interest centers on the association between circulating ketone bodies (KB) and cognitive function, notably in aging and neurodegenerative diseases.

Methods

Associations of plasma KB with incident dementia and cognitive performances were examined among Multi‐Ethnic Study of Atherosclerosis (MESA) participants. KB were measured using plasma samples collected following an overnight fasting at Exam 1 (2000–02) and detailed cognitive testing at Exam 5 (2010–2012, N = 4392), Exam 6 (2016–2018, N = 1838), and in MESA‐MIND (2019–2021, N = 2060).

Results

Over 16.7 years, a doubling of total KB was associated with a greater risk of incident dementia (hazard ratio …

Autophagy Determines Distinct Cell Fates In Human Amnion And Chorion Cells, Mary Elise L Severino, Lauren Richardson, Ananth Kumar Kammala, Enkhtuya Radnaa, Kamil Khanipov, Leslie Michelle M Dalmacio, Indira U Mysorekar, Marian Kacerovsky, Ramkumar Menon

Faculty, Staff and Students Publications

Human fetal membranes (amniochorion) that line the intrauterine cavity consist of two distinct cell layers; single-layer amnion epithelial cells (AEC) and multilayer chorion trophoblast cells (CTC). These layers are connected through a collagen-rich extracellular matrix. Cellular remodeling helps support membrane growth and integrity during gestation and helps to maintain pregnancy. Preterm prelabor rupture of the human amniochorionic (fetal) membrane (pPROM) is antecedent to 40% of all spontaneous preterm birth. Oxidative stress (OS) induced activation of the p38 MAPK due to various maternal risk exposures and the amniochorion cells' senescence are reported pathological features of pPROM. Our transcriptomics analysis implicated dysregulated …

Critical Dialogue And Capacity-Building Projects Reduced Alcohol And Substance Use In A Randomized Clinical Trial Among Formerly Incarcerated Men, Liliane Cambraia Windsor, Ellen Benoit, Carol Lee, Alexis Jemal, Kari Kugler, Douglas C Smith, Rogério M Pinto, Salma Musaad

Faculty, Staff and Students Publications

Background:

Rates of alcohol and/or substance use (ASU) among residents of predominantly Black and marginalized communities are similar to ASU rates in White communities. Yet ASU has worse consequences in predominantly Black and marginalized communities (e.g., higher incarceration).

Objective:

We randomized participants to one of 16 intervention conditions using a 2⁴ full factorial design to optimize a multilevel intervention reducing ASU among 602 formerly incarcerated men with substance-use-disorders (SUD). Candidate intervention components included (1) critical dialogue (CD; six weekly 2-hour-long group sessions vs. no CD sessions), (2) Quality of Life Wheel (QLW; six weekly 1-hour-long group sessions vs. no …