Clinical Epidemiology Commons^™

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Prevalence Of Grip And Leg Strength Asymmetries In U.S. Youth, Elyse M. Deschryver

Theses and Dissertations

Early-life physical activity is important for building muscular strength, supporting healthy growth and disease prevention, and for establishing physical activity and strength habits that often track into adulthood. Although grip strength asymmetry is a well-documented risk factor in older adults, evidence in children and adolescents is limited and largely based on small, sport-specific samples. PURPOSE: To describe grip and leg extension strength asymmetries in a nationally representative sample of U.S. youth aged 6–15 years using the National Youth Fitness Survey (NNYFS). METHODS: The analysis included 1,214 participants (606 boys, 608 girls) with valid grip or leg extension data. Age, sex, …

Increasing Pediatric Hpv Vaccination Rates, Brooke A. Nicholas

Dissertations

Increasing Pediatric HPV Vaccination Rates

Abstract

Problem: The human papillomavirus (HPV) is a sexually transmitted infection that affects more than 80% of the population within the United States (Eisenhauer et al., 2020). HPV can develop into cervical, anogenital, and oropharyngeal cancers (Eisenhauer et al., 2020). About 4,000 individuals die from cervical cancer alone each year (O’Leary, 2022). The HPV vaccine, though recommended by the ACIP and AAP, is below national vaccination rates in comparison to other vaccines (O’Leary, 2022).

Methods: This quality improvement project is a non-randomized controlled trial that observed HPV vaccine dose completion rates for patients aged 9-14 …

Symptom Clusters And Their Association With Health-Related Quality Of Life In Pediatric Cancer Survivors After Treatment Completion, Krishtee Napit

Theses & Dissertations

A critical area of cancer research, symptom management, has evolved from focusing on individual symptoms to recognizing the complexity of co-occurring symptoms, commonly referred to as symptom clusters. However, most studies on pediatric cancer symptom clusters have focused primarily on the treatment phase or long-term survivorship, overlooking the early post-treatment period. This dissertation examines the prevalence of multiple symptoms and symptom clusters in pediatric cancer survivors post-treatment; factors associated with the total number of symptoms and symptom clusters; and the association of the total number of symptoms and symptom clusters with health-related quality of life (HRQoL). We developed and tested …

A Comprehensive Evidence-Based Educational Initiative For Improving Hand Hygiene, Lyanna L. Chan

Master's Projects and Capstones

Abstract

Problem: Healthcare-associated infections (HAIs) are a persistent concern in assisted living facilities, often resulting from inconsistent hand hygiene practices. Although national guidelines exist, adherence remains suboptimal, especially where staff training and compliance monitoring are limited.

Context: This project took place in a 53-bed assisted living facility without a formal system to track or reinforce hand hygiene. The aim was to improve staff knowledge and promote infection prevention through education.

Interventions: A Clinical Nurse Leader (CNL) led an evidence-based hand hygiene education program. The intervention included interactive training, visual reminders, personal sanitizers, and leadership support during clinical huddles.

Measures: Pre- …

Evaluating The Impact Of Medicaid Expansion On Non-Small Cell Lung Cancer Care And Health Disparities, Marvin Idoteyin Okon

All Dissertations

Persistent disparities in non-small cell lung cancer (NSCLC) outcomes reflect broader structural inequities shaped by race, place, and socioeconomic conditions. This dissertation examined trends in NSCLC outcomes over the past two decades and evaluated the impact of Medicaid Expansion (ME) under the Affordable Care Act on improving outcomes and reducing disparities, especially in marginalized communities.

Using nationally representative datasets, three interrelated studies were conducted. The first assessed trends in NSCLC incidence, early-stage diagnosis, and 3-year survival from 2002-2021, stratified by metropolitan status, deprivation (Social Deprivation Index), and segregation (Index of Concentration at the Extremes). While incidence declined and early-stage diagnosis …

Schistosoma Haematobium Infection In Ethiopian Children: Evaluating Praziquantel Efficacy, Nutritional Effects, And Diagnosis Using Flukecatcher, Louis Fok

Theses & Dissertations

Urogenital schistosomiasis continues to impact the wellbeing of hundreds of millions of people worldwide and remains a significant public health challenge across Ethiopia. Despite existing knowledge on the disease, there remain significant unanswered questions with regard to its treatment and diagnosis. This dissertation evaluated the efficacy of praziquantel at treating urogenital schistosomiasis, improving nutritional parameters among children and the performance of FlukeCatcher at detecting and determining the intensity of infection. In effecting this, a total of 977 children aged 5 through 15 from the Afar and Gambella regions of Ethiopia were screened for S. haematobium infection using urine filtration microscopy …

The Impact Of An Iron-Rich Diet On Fatigue In Menstruating Women With Non-Anemic Iron Deficiency, Meagan Seraydar, Lauren Latimer, Sam Miragliatto

Department of Nutrition Student Projects

Fatigue without diagnosed anemia is prevalent in menstruating women, with iron deficiency being a potential contributor. While iron supplementation is a standard intervention, dietary sources of iron may offer a sustainable alternative. This study aims to assess the impact of an iron-rich diet on fatigue levels in menstruating women. A 12-week randomized controlled trial (RCT) will be conducted, assigning participants to either an iron-rich diet group or a control group following their usual diet without specific iron recommendations. Fatigue will be measured using the Fatigue Severity Scale (FSS) at baseline, six weeks, and twelve weeks, alongside iron status biomarkers, including …

Improving The Rates Of Sexually Transmitted Infection Diagnosis By Increasing Provider Knowledge About Testing, Lauren Cunningham

Student Scholarship & Creative Works

There has been a significant increase in sexually transmitted infection (STI) rates since 2021. Though this issue is nationwide, rural providers require education regarding testing, screening, and transmission of disease processes. The infections with the most significant increase are gonorrhea, chlamydia, and syphilis. The purpose of this project was to provide education to providers regarding local STI statistics, in addition to when to and not to test for sexually transmitted STI infections. Education was provided to three Advance Practice Nurse Practitioners about disease signs and symptoms, transmission, and local STI statistic rates. STI testing rates were observed three months prior …

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Genomic Epidemiology Of Staphylococcus Aureus Sequence-Type 72, Sachitaa Senthilkumar

Honors Undergraduate Theses

Staphylococcus aureus (S. aureus, SA) is a gram-positive bacterial colonizer and pathogen commonly carried on the skin and in the anterior nares of humans. SA colonization may lead to a variety of non-invasive (e.g., skin and soft tissue infections, SSTIs) and invasive (e.g., bacteremia and osteomyelitis) infections. The SA population is comprised of multiple lineages that can be delineated through multi-locus sequence typing (MLST), which compares nucleotide sequences within seven housekeeping genes. Strains belonging to an MLST share a common evolutionary history and phenotypic characteristics like antibiotic resistance or virulence. As a result, the epidemiology of lineages can be …

Weighted Family History Density Of Substance Use: Influence On Participant Substance Use Onset, Escalation, And Duration, Carleigh A. Litteral

Theses and Dissertations--Psychology

Substance use disorders impose a staggering toll on the United States (U.S.), straining healthcare systems, destabilizing communities, and profoundly impacting both individuals and families. Approximately one in six Americans aged 12 and older had a past-year substance use disorder in 2022 (Key Substance Use, 2022), and nearly one-third of adults experience a substance use disorder in their lifetime (Wu, 2010), contributing to an economic burden exceeding $400 billion annually (National Drug Threat Assessment, 2011). Family history of substance use disorders is a key predictor of vulnerability, with individuals who have affected relatives being 2–8 times more …

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 …

Effectiveness Of Video-Observed Therapy In The Management Of Tuberculosis: A Multi-Centre Randomised Control Trial In Terengganu, Malaysia, Kartik Kaliyana Sundaram

Student Works (2020-2029)

Introduction: Tuberculosis (TB) remains the leading public health threat. In 2023, an estimated 10.8 million people developed the disease and 1.25 million died, making TB the world’s leading killer from a single treatable infection. In Malaysia, the notification rate of TB is 80.2 per 100,000 population and a rise of 5.5% from the previous year. Since its introduction in the early 1990s, Direct Observed Treatment, Short-course (DOTS) has been the standard of approach for TB treatment. While effective, DOTS is often logistically challenging for both patients and service providers. Daily clinic visits place significant time, travel, and staffing demands on …

Control And Management Of Type-Ii Diabetes Among People Living With Hiv (Plwh) Compared To Hiv-Negative Patients And By Clinic Type In The Bronx, Nyc, Aprielle Wills

Dissertations and Theses

ABSTRACT

Control and Management of Type-II Diabetes Among People Living with HIV (PLWH) compared to HIV-Negative Patients and by Clinic Type in the Bronx, NYC

by

Aprielle Wills

Advisor: Heidi E Jones, MPH PHD

Background: The Centers for Disease Control (CDC) estimated that approximately 1.3 million people in the United States (U.S.) were living with an HIV diagnosis by the end of 2021. With advancements of antiretroviral therapy (ART) and improved access to care, HIV has become a chronic condition in the U.S. As PLWH age, they are experiencing higher rates of other chronic conditions, specifically type-II diabetes (type-II …

Bayesian Beta-Binomial Mixed Models For Longitudinal, Clustered, And Spatiotemporal Data, Chun-Che Wen

MUSC Theses and Dissertations

Overdispersed binomial data arise in many clinical and public health research studies. Examples include timeline followback data (TLFB), which are used in addiction research to monitor recent substance use. This dissertation proposes novel beta-binomial (BB) mixed models to address the challenges associated with overdispersed binomial data, including zero-inflation, heterogenous effects, and spatiotemporal correlation. Motivated by a 12-week randomized controlled trial evaluating the efficacy of varenicline tartrate for smoking cessation among adolescents, Aim 1 develops a Bayesian zero-inflated beta-binomial (ZIBB) model to analyze longitudinal and bounded TLFB data — namely, the number of abstinent days in the past week. Because treatment …

Cardiovascular Disease Risk Reduction Program For Hispanics In The Us Midwest: A Culturally Adapted Intervention, Armando De Alba

Theses & Dissertations

Cardiovascular disease (CVD) represents the second leading cause of death in Nebraska (NE), accounting for approximately one in every five deaths. In the state, there are marked ethnic and rural-urban disparities in the prevalence of chronic diseases and resultant deaths. For instance, while the rates in NE of coronary heart disease and myocardial infarction between 2001 and 2010 decreased among non-Hispanic Whites, the rates for Hispanics almost tripled. There is little evidence of CVD risk factor reduction strategies being implemented in Midwestern areas and Hispanic populations.

One promising approach for reducing CVD risk involves health education and lifestyle modification programs …

Non-Tnfi Biologic And Targeted Synthetic Dmards In Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Comparative, Propensity Score-Matched Study Using National Veterans Affairs Data, Halie E. Frideres

Capstone Experience: Master of Public Health

Background/Objectives: There is a paucity of evidence on the safety and effectiveness of non- TNFi biologic therapies in RA-ILD, this study aimed to compare treatment outcomes in RA-ILD between rituximab, abatacept, IL-6i, and JAKi using the Target Trial Emulation Framework.

Methods: We emulated 3 trials comparing abatacept, IL-6i, and JAKi with rituximab (reference). Patients fulfilling validated RA-ILD algorithms initiating one of these non-TNFi b/tsDMARDs were propensity score (PS)-matched (1:1) using national Veterans Affairs (VA) data from 2006 to 2020. PS models included demographics, comorbidities, general health status indicators, and RA- and ILD-related severity measures. Study outcomes were death and respiratory-related …

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …

Cognitive Functioning In Well-Controlled Asthma, Erin Walsh

West Chester University Doctoral Projects

Asthma is a common lung disease that impacts lung functioning through inflammatory based mechanisms. Past research suggests that decreased blood oxygenation due to asthma attacks may impair cognitive capabilities (Irani et al., 2017). Moreover, the observed differences in cognition between those with and without asthma may be associated with disease severity or asthma control respectively in asthma populations. The current study explored differences in cognitive functioning between college students with and without self-reported asthma. Sociodemographic data, self-reported asthma severity, and measures of asthma control were collected. The current study did not find significant differences in measures of cognitive efficiency between …

Associations Between Physical Activity Levels And Physical And Mental Health In Military Veterans., Troy Hubert

Theses and Dissertations--Psychology

Research suggests that higher rates of health conditions are associated with lower levels of physical activity, but this association is not well characterized in U.S. Military Veterans. The current study utilized a sample of U.S. military veterans (n = 3,989) from the 2019-2020 National Health and Resiliency in Veterans Study (NHRVS). Physical activity levels (insufficient, moderate, and active), physical and mental health were evaluated with a variety of self-report questionnaires. After controlling for covariates, veterans with any disability, asthma, chronic pain, diabetes, high cholesterol, and stroke were significantly less likely to report sufficient physical activity compared to insufficient physical …

Recent Trends In Stimulant Prescribing In Kentucky, 2021-2023, Jordan Shannon

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Abstract

Introduction

Prescription stimulants have a long history of clinical use dating as far back as the 1930s. In the United States stimulant prescribing rates have steadily climbed over the last 3 decades. The primary objective is to describe recent (2021-2023) prescribing trends of stimulant medications in the Commonwealth of Kentucky

Methods

Prescription data collected from Kentucky’s prescription drug monitoring (PDMP) database known as the Kentucky All Schedule Prescription Electronic Reporting System (KASPER). Annual and quarterly trends in stimulant prescribing between 2021-2023 were calculated, examined by age, sex, and geographic location.

Results

Stimulant prescribing increased by ~15% where the majority …

Implementing A Nurse-Driven Clostridium Difficile Screening Protocol, Sandrela Magnuson

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Background: Clostridium difficile infection (CDI) is a prevalent infection often contracted in hospitals. CDI is also increasingly originating from community settings. In addition to the health risks associated with CDI, diagnosis of a hospital-acquired CDI can have a significant financial impact on hospital systems. When hospital acquired, hospital systems are no longer reimbursed by payers. Secondary to the increasing prevalence of community-acquired CDI, mechanisms for early detection and isolation are warranted.

Local Problem: J.W. Ruby Memorial Hospital has an integrated Clostridium difficile (C. difficile) electronic health record (EHR) screening questionnaire that requires updating to align with current guidelines.

Purpose: …

Differences In Health-Related Quality Of Life Among Breast Cancer Survivors By Hispanic Origin In A Cross-Sectional Study, Meera Lakshmanan

Honors Undergraduate Theses

Breast cancer is the second leading cause of cancer-related death among American women. Research has examined the health-related quality of life (HRQOL) among breast cancer survivors of various races/ethnicities, reporting that Hispanic women have lower levels of HRQOL compared to non-Hispanic whites. Hispanics are not a homogenous population, and subpopulations may have different lifestyles, socioeconomic status, and cultural/personal/social ideals that could affect their HRQOL after treatment of breast cancer. The objective of this study was to examine the differences in HRQOL by Hispanic origin among breast cancer survivors in Central Florida.

Patient data was obtained from the Florida Cancer Data …

Understanding Guardian Perceptions Of Whole-Foods Plant-Based Diets As Interventions In Pediatric Medicine, Vijay R. Luthra

Honors Undergraduate Theses

The obesity epidemic is widespread in American society, often affecting children who bear its consequences innocently. Due to a lack of nutrition knowledge, children rely on caregivers to meet their nutritional needs and instill healthy habits. This study examines parents' attitudes, knowledge, and behaviors, as well as perceived barriers to adopting a whole-foods plant-based diet (WFPD) for their children. Using a modified survey instrument by Morton et al., this study focused on parents and children regarding dietary choices. Participants were recruited from the waiting area of a pediatric clinic at the Medical College of Georgia between April and May 2023. …

Unraveling The Effects Of The Covid-19 Pandemic On Staphylococcus Aureus Carriage: A Comparative Research Of Pre- And Post-Pandemic Samples, Catherine G. Johnston

Honors Undergraduate Theses

The COVID-19 pandemic brought about significant changes in the epidemiology of Staphylococcus aureus carriage and disease. This study aims to assess these changes by leveraging respiratory samples collected from a longstanding cohort, comparing the genomic characteristics of S. aureus isolates from pre- and post-pandemic periods. We analyzed S. aureus genomes and phenotypically determined macrolide resistance to characterize population structure, antibiotic resistance, and virulence profiles. Changes in S. aureus carriage rates, macrolide resistance, disease occurrence, and population structure between samples collected pre- and post-pandemic were examined. By using respiratory samples, chart reviews, and risk factor questionnaires of 498 children from a …

Quality Of Life And Unmet Needs Of Late-Stage And Metastatic Colorectal Cancer Survivors, Krista Brown

Theses & Dissertations

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in both men and women and is the second leading cause of cancer deaths when men and women are combined. CRC survivors are living longer with an increase in 5-year survival, rising from 52% in the 1980s to 62% in the 2000s. The objective of this dissertation was to explore the QoL and unmet needs of stage III and IV CRC survivors and contribute to the field of survivorship research through an integrative literature review of the state of the science and a sequential, explanatory mixed methods study.

The …

Genome-Scale Methylation Analysis In Blood And Tumor Identifies Immune Profile, Age Acceleration, And Dna Methylation Alterations Associated With Bladder Cancer Outcomes, Ji-Qing Chen

Dartmouth College Ph.D Dissertations

Bladder cancer patients receive frequent screening due to the high tumor recurrence rate (more than 60%). Nowadays, the conventional monitoring method relies on cystoscopy which is highly invasive and increases patient morbidity and burden to the health care system with frequent follow-up. As a result, it is urgent to explore novel markers related to the outcomes of bladder cancer. Immune profiles have been associated with cancer outcomes and may have the potential to be biomarkers for outcomes management. However, little work has been conducted to investigate the associations of immune cell profiles with bladder cancer outcomes. Here, I utilized the …

‘Safe Couch, Safe House’ Program (Scshp): Reducing Exposure To Toxic Flame Retardants For Children In A Low-Income Public Housing At Hunters View, Bayview-Hunters Point, San Francisco., Aliza Khan

Master's Projects and Capstones

Since the 1970s, flame retardants have been used extensively in consumer goods, including furniture, textile, and electronics, to meet California’s flammability standards. (Gibson et al.,2019) Polybrominated Diphenyl Ethers (PBDEs), once the most widely used flame retardants being used in consumer products, were phased out from use in manufacturing as evidence emerged about PBDEs persistence and toxicity. (Hoffman et al.,2017) PBDEs were replaced by Organophosphate Flame Retardants (OPFRs), which has proven to be a case of ‘regrettable substitution’ as exposure to OPFRs is ubiquitous and pervasive in humans due to their volatility and propensity to leach from products into the environment. …

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

Electronic Theses and Dissertations

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