Epidemiology Commons^™

Early Life Factors And Health Outcomes In Children And Mothers, Olubunmi Olufunke Orekoya

Theses and Dissertations

This dissertation focused on early life exposures and their impact on children and mothers’ health. It consists of three distinct studies with an overarching goal of understanding how early life factors influence health outcomes among children and mothers. The broad aims are: 1) to examine the association between maternal gestational weight gain and offspring weight at 1 year, while assessing the mediating role of birth weight; 2) to determine the association between breastfeeding practices and development of allergic conditions (eczema/skin allergy, hay fever/respiratory allergy, and asthma); and 3) to examine the association between breastfeeding and postpartum weight retention at 12 …

Effectiveness Of Community-Based Eibi Treatment: A Longitudinal Analysis Of Adaptive Behavior And Language Outcomes, John Kuntz

Theses and Dissertations

Autism spectrum disorders (ASDs) are a group of lifelong, neurodevelopmental disorders characterized by deficits in social interaction, communication, relationship development and by the presence of repetitive or stereotypical behaviors including restricted interests. Continued advances in understanding treatment outcomes and broadening access to effective treatment is critical to improving the quality of life of children with autism and their families and minimizing the cost associated with care. The overall aim of this study is to assess the effectiveness of a community-based implementation of an Early Intensive Behavioral Intervention (EIBI) treatment program through a large-sample, longitudinal secondary analysis of administrative data. Additionally, …

The Impact Of Autoimmune Disease On Breast Cancer Survival, Samantha Truman

Theses and Dissertations

Background Breast cancer is the second leading cause of cancer death for women in developed countries, while autoimmune disease effects approximately 10 million people in the United States, of which approximately 80% are female. Both diseases are associated with hormonal risk factors and are related to the divergent effects of the cellular and humoral immunity that is associated with the T-helper 1 and T-helper 2 immune response. To investigate the potential implications that autoimmune disease may have on breast cancer-specific mortality, we have conducted a population-based retrospective cohort study of women who were diagnosed with breast cancer between January 1, …

Trends In Gestational Weight Gain In South Carolina, 2004 - 2015, Marilyn Elizabeth Wende

Theses and Dissertations

Objective: Excessive and inadequate gestational weight gain (GWG) are associated with a myriad of adverse pregnancy outcomes. The objective of this study was to examine secular trends in GWG in South Carolina (SC) from 2004 to 2015. We hypothesized that there was a trend of higher GWG z scores (GWGZ) over this 11-year time period after adjusting for changes in population characteristics. We also hypothesize that a trend of higher mean GWGZ at higher percentiles is more apparent for African Americans, rural women, and women who are overweight or obese before pregnancy.

Data and Methods: Data came from SC …

Association Of Gestational Weight Gain During Twin Gestations And Adverse Maternal Outcomes, Kerry Spillane

Theses and Dissertations

Objective: To examine the association between gestational weight gain (GWG) in twin gestations and the odds of adverse maternal outcomes.

Setting and Participants: Study population included 3,081 women with a twin gestation delivered between 23-42 gestational weeks from 19 hospitals across the United States (2002-2008) participating in the Consortium on Safe Labor (CSL) study.

Main Outcomes: Main outcomes of interest included: gestational hypertension, preeclampsia, gestational diabetes mellitus, and cesarean delivery.

Methods: Quantile regression estimated the 25th and 75th percentiles of total GWG, respective of pre-pregnancy BMI and gestational age at delivery, and was used to create our new total GWG …

Inflammatory Properties Of Diet And Glucose-Insulin Homeostasis In A Cohort Of Iranian Adults, Nazanin Moslehi, Behnaz Ehsani, Parvin Mirmiran, Nitin Shivappa, Maryam Tohidi, James R. Hébert, Fereidoun Azizi

Faculty Publications

We aimed to investigate associations of the dietary inflammatory index (DII) with glucose-insulin homeostasis markers, and the risk of glucose intolerance. This cross-sectional study included 2975 adults from the Tehran Lipid and Glucose Study. Fasting plasma glucose (FPG), 2-h post-load glucose (2h-PG), and fasting serum insulin were measured. Homeostatic model assessment of insulin resistance index (HOMA-IR) and β-cell function (HOMA-B), and the quantitative insulin sensitivity check index (QUICKI) were calculated. Glucose tolerance abnormalities included impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes (T2DM). DII scores were positively associated with 2h-PG (β = 0.04; p = 0.05). …

Sleep Disruption And Cancer Incidence In A Southeastern Veteran Population, Alexandria F. Delage

Theses and Dissertations

Sleep disruption influences biological processes that can facilitate carcinogenesis. However, studies examining the relationship between sleep disruption and cancer risk have been inconclusive. This retrospective cohort study used de-identified data from the Veterans Administration (VA) electronic medical record to test the hypothesis that sleep disorder diagnoses among Veterans seeking care in the Southeast United States Service Network are associated with increased risk for cancer of the prostate, breast, colorectum, or total cancer (1999-2010, N=663,869). Sleep disorders were defined as patients with an in- or out-patient diagnosis as specified by the International Classification of Sleep Disorders. Cancer cases were defined as …

Low-Intensity Physical Activity And Cardiometabolic Risk Factors Among Older Adults With Multiple Chronic Conditions, Yueyao Li

Theses and Dissertations

Introduction:

Cardiovascular disease (CVD) is the leading cause of death among older adults in the Unites States and is driven largely by cardiometabolic risk factors including elevated blood pressure and blood glucose. Studies have found the protective effect of moderate intensity physical activity (MIPA) and vigorous intensity physical activity (VIPA) on cardiometabolic risk factor; however, the association between light physical activity (LIPA) and cardiometabolic risk factor among older adults is not clear.

Objectives:

1. Examine the association between LIPA and cardiometabolic risk factors.
2. Examine whether the association between LIPA and cardiometabolic risk factor is moderated by multiple chronic conditions. …

Smoking-Related Stigma: A Public Health Tool Or A Damaging Force ?, Paula A. Lozano

Theses and Dissertations

Cigarette smoking is the leading cause of preventable death in the world. In an effort to address the tobacco epidemic, the World Health Organization’s Framework Convention on Tobacco Control (FCTC) has formulated a number of policies that are thought to reduce cigarette consumption by making smoking socially unacceptable. It is possible that tobacco control policies that aim to make smoking socially unacceptable may also result in the stigmatization of smokers. Social factors such as social norms and socioeconomic status may also influence the development of smoking-related stigma. While some researchers suggest that smoking-related stigma may be an important public health …

Effectiveness Of Community-Based Eibi Treatment: A Longitudinal Analysis Of Adaptive Behavior And Language Outcomes, John Kuntz

Theses and Dissertations

Autism spectrum disorders (ASDs) are a group of lifelong, neurodevelopmental disorders characterized by deficits in social interaction, communication, relationship development and by the presence of repetitive or stereotypical behaviors including restricted interests. Continued advances in understanding treatment outcomes and broadening access to effective treatment is critical to improving the quality of life of children with autism and their families and minimizing the cost associated with care. The overall aim of this study is to assess the effectiveness of a community-based implementation of an Early Intensive Behavioral Intervention (EIBI) treatment program through a large-sample, longitudinal secondary analysis of administrative data. Additionally, …

The Association Between Physical Activity And Serum Immunoglobulin G (Igg) Antibodies Against Periodontal Bacteria, A. Paige Anderson

Theses and Dissertations

The purpose of this study is to add more research and evidence to the mechanisms surrounding periodontal disease, periodontal microorganisms, and physical activity. The main objective of this study is to evaluate and explore the association between physical activity and serum IgG antibodies, which are grouped into four distinct clusters, formed from species specific 19 periodontal antibody titers. This cross sectional study divided physical activity into three categories: adequately physically active, inadequately physically active, and inactive based on MET scores. Certain models were adjusted for confounders including age, sex, race/ethnicity, income-to-poverty ratio, years of formal education, smoking, alcohol intake, BMI, …

Influence Of Thyroid Disorders On Pregnancy Outcomes, Brittany Sullivan

Theses and Dissertations

Objective: The objective of this thesis is to investigate the effects of maternal thyroid dysfunction on maternal pregnancy outcomes.

Setting and Participants: The NICHD Consecutive Pregnancy data set contains information on a total of 114,679 pregnancies from 51,086 women who delivered ≥ 20 weeks of gestation. The data come from 20 different hospitals throughout the state of Utah and were collected between the years of 2002 to 2010.

Main Outcomes: Main outcomes of interest included: breech presentation, chorioamnionitis, gestational diabetes, gestational hypertension, hemorrhage, inductions, placental abruption, placental previa, preterm birth, premature rupture of membranes (PROM), preeclampsia, and …

Progesterone-Only Oral Contraceptive Pill, Breast Cancer, Heart Disease, And Stroke, Marsha Ema Samson

Theses and Dissertations

There is evidence from earlier studies that oral contraceptive pills may be a risk factor for certain chronic diseases, including heart disease, stroke, and breast cancer. Previous studies mainly focus on the estrogen component of combined (estrogen+ progestin) oral contraceptives (COCs) due to their popularity. This focus limits our understanding of progestin-only contraceptives and its relationship to commonly occurring chronic diseases. To provide insight into alternative methods of oral contraception, this dissertation explores the relationship between progestin-only oral contraceptive (POC) pills and heart disease, stroke, and breast cancer. We hypothesize that women using POCs are less likely to have certain …

Depression Among Pregnant Latinas In South Carolina, Andrew Fogner

Theses and Dissertations

The aim of the study was to determine the prevalence of depression among pregnant Latinas. To bring to light the importance of prenatal depression prevention, we assessed the effect of the quality of healthcare providers among South Carolina Latinas (n=171). Women answered a validated CES-D and were categorized as depressed (score >16). In multivariate analyses, good perception of quality of healthcare was more likely among women who were not depressed; adjusted odds ratio of 0.75, 95% confidence interval 0.37 – 1.55. The findings show the need for tailoring healthcare to Latinas with prenatal depression prevention. It is imperative to understand …

The Influence Of Prenatal And Early Life Factors On Bmi Z Scores And The Risk Of Being Obese In Early Childhood, Junxiu Liu

Theses and Dissertations

Childhood obesity is a serious public health challenge. The underlying causes behind the rising levels of childhood obesity might be driven by prenatal and early life factors. Recently, several studies have examined the association between gestational weight gain (GWG) and the risk of obesity in the pediatric population. Findings on the association of both inadequate and excessive GWG with offspring obesity are inconsistent and vary by maternal prepregnancy body mass index (BMI) status. Inconsistent findings also exist for the association of GWG and BMIZ as a continuous outcome. Nevertheless, existing studies mainly focus on the BMIZ upper centiles using logistic …

Relationships Of Chronotype, Social Jetlag, Sleep, Physical Activity And Diet With Mood, Perceived Stress, Obesity, Blood Pressure And Prostate Cancer, Daria M. Mcmahon

Theses and Dissertations

Background: Chronotype, social jetlag, poor sleep, proinflammatory diet, and low physical activity have been associated with increased risk of chronic diseases: obesity, diabetes, cardiovascular disease, depression and cancer. Yet the relationships between these factors have not been extensively investigated in prospective studies.

Methods: Two studies were conducted. The first study followed 390 healthy men and women ages 21-35 for two years. Social jetlag [SJL] and sleep measures (total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO]), sleep efficiency [SE]), were derived from physical activity personal (armband) monitoring. The participants wore the armband for 4-10 …

Sleep Disorder Trends, Epigenetic Markers, And Genetic Variation Of Circadian Genes In Adenomatous Polyp Formation, Melannie Alexander

Theses and Dissertations

Introduction: Sleep disturbances and sleep quality have fluctuated over time in the United States (US). Virtually every physiological process follows a circadian pattern, and cellular processes (i.e., cell proliferation, DNA damage response, and apoptosis) are often disrupted by sleep disturbances and other factors, potentially giving rise to adverse health outcomes such as cancer. Additionally, both genetic variation and epigenetic patterns within clock genes, which may affect sleep quality, also may increase one’s risk for developing cancer. The role of sleep disturbances in the formation of adenomas, precursor lesions to colorectal cancer (CRC), has been explored previously; however, little is …

The Influence Of Fine Particulate Matter On Inflammatory Bowel Disease In South Carolina: An Ecological Analysis, Joshua Eric Sellner

Theses and Dissertations

Background. The Inflammatory Bowel Diseases, including both Ulcerative Colitis and Crohn’s Disease, are lifelong disorders of the Gastrointestinal tract. In recent years, both conditions have become much more prevalent and recognized as major public health issues. Environmental factors have become the focus of recent research around the cause of these diseases. Although shown to have detrimental effects on diseases similar to that of the Inflammatory Bowel Diseases, fine particulate matter’s role in these diseases has not been adequately investigated.

Aim. The purpose of this study was to test the relation of fine particulate matter with hospitalizations attributable to …

Influence Of Built Environment On Physical Activity Outcomes Among African Americans In Community-Based Obesity Intervention Studies, Amanda Sue Thomas

Theses and Dissertations

More than sixty-five percent of people in the U.S. are considered overweight or obese. African-Americans in the U.S. have a higher risk of obesity than any other racial group. One way to reduce this statistic is physical activity. Recreational green spaces (parks) can serve as an avenue to complete the 150 min/wk of recommended physical activity for adults by the ACSM. Data from SISTAS and HEALS interventions, that recruited overweight/obese African-Americans from Columbia and Florence, SC, was used to assess the association of recreational green space (parks) around a residence and physical activity. Physical activity measures of RAPA questionnaire (self-report), …

Physical Activity And Breast Cancer In South Carolina, Chisom Onyeuku

Theses and Dissertations

This study examined the relationship between breast cancer incidence and recreational physical activity. It was one of the first studies in the southeastern US to examine incident breast cancer and physical activity in an ethnically diverse cohort of women. In terms of physical activity, both lifetime and recent physical activity were analyzed. All physical activity data were from validated self-reported surveys. The study examined BMI, menopausal status and race as key confounders and effect modifiers. The study found evidence that for Black women, there was a positive relationship between the amount of lifetime physical activity and the odds of incident …

Genetic And Epigenetic Variations In Asthma And Wheeze Illnesses, Todd M. Everson

Theses and Dissertations

Asthma, a chronic respiratory condition, is common worldwide with no cure and limited effective prevention strategies. It is well recognized that asthma has a multifaceted etiology, though many of the underlying mechanisms involved in asthma development, persistence and remission are still convoluted. Epigenetic mechanisms, such as DNA methylation, regulate gene-expression but are not related to changes in the actual DNA sequence. Recently, differential patterns of DNA methylation within many genes have been associated with asthma, particularly within genes involved in the differentiation of pro-inflammatory T-helper 2 (Th2) cells. DNA methylation patterns within less known biologic pathways undoubtedly are involved in …

Individual- And Neighborhood-Level Determinants Of Emergency Department Utilization Among Patients With Diabetes In South Carolina, Charity B. Breneman

Theses and Dissertations

AIM: The primary aim of this study was to evaluate the geographic variation in emergency department (ED) use in South Carolina using geographical information systems (GIS) and to examine the effects of both individual- and neighborhood-level characteristics on frequent ED use among patients with diabetes. METHODS: ED discharge data for 2013 was geocoded based on patients’ residential ZIP code using GIS. Frequent ED use among patients with diabetes was defined as three or more ED visits between January 1, 2013 and December 31, 2013. The boundaries for each neighborhood were defined by the U.S. Census Bureau ZIP Code Tabulation Areas …

Dietary Patterns And Prostate Cancer Aggressiveness In African-American And European-American Men, Lara Ryan Schneider

Theses and Dissertations

Several foods and nutrients have been linked to prostate cancer risk, but the effect of overall diet on prostate cancer outcomes is not well understood. Previous research has primarily examined a posteriori dietary patterns in relation to prostate cancer; studies that have used a priori dietary patterns and their relationship with prostate cancer have been inconclusive. Furthermore, racial differences in prostate cancer incidence and aggressiveness are not well understood. Data from the case-only North Carolina-Louisiana Prostate Cancer Project (PCaP) was used to examine the association between overall dietary pattern, as measured by the Mediterranean Diet (MED) score and the Dietary …

Low-Intensity Physical Activity And Cardiometabolic Risk Factors Among Older Adults With Multiple Chronic Conditions, Yueyao Li

Theses and Dissertations

Introduction Cardiovascular disease (CVD) is the leading cause of death among older adults in the Unites States and is driven largely by cardiometabolic risk factors including elevated blood pressure and blood glucose. Studies have found the protective effect of moderate intensity physical activity (MIPA) and vigorous intensity physical activity (VIPA) on cardiometabolic risk factor; however, the association between light physical activity (LIPA) and cardiometabolic risk factor among older adults is not clear. Objectives 1). Examine the association between LIPA and cardiometabolic risk factors. 2). Examine whether the association between LIPA and cardiometabolic risk factor is moderated by multiple chronic conditions. …

Diagnostics And Model Selection For Generalized Linear Models And Generalized Estimating Equations, Chelsea Boquet Deroche

Theses and Dissertations

The use of generalized linear models and generalized estimating equations in the public health and medical fields are important tools for research, specifically for modeling clinical trials, evaluating preventive measures, and secondary data analysis. It is important for these researchers to have the necessary tools to analyze and model their data correctly. This dissertation focuses on a penalized maximum likelihood estimation method for generalized linear models, measures of association such as the coefficient of determination and R² for generalized estimating equations, and a modified quasi-likelihood information criterion for generalized estimation equations.

Common problems that arise during estimation of generalized …

Smoking Cessation In Pregnancy And Gestational Weight Gain In South Carolinian Mothers, 2009-2011, Laquenta Latreese Weldon

Theses and Dissertations

Purpose: To determine if smoking cessation during pregnancy is associated with excessive gestational weight gain (GWG).

Methods: Data came from the 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing population-based survey of live births in South Carolina (n=2,603). Participant smoking status was classified as nonsmoker (did not smoke before or during pregnancy), persistent smoker (smoked before and throughout pregnancy), or quitter (smoked before but quit during pregnancy). Multinomial logistic regression model was estimated to examine the association between smoking status and meeting the 2009 Institute of Medicine guidelines, while linear regression model was used for the continuous outcomes such …

Prostate Specific Antigen (Psa) Growth Curves: A Method To Improve Prostate Cancer Screening, Azza Shoaibi

Theses and Dissertations

Prostate cancer (PrCA) screening aimed at detecting aggressive disease represents a significant public health issue. Development of biomarkers to predict PrCA that is likely to kill if left untreated is a major challenge. This dissertation focused on analyzing existing repeated measures of prostatic specific antigen (PSA) to develop and validate a tool to improve both sensitivity and specificity of the PSA-based screening test to detect high-risk PrCA. We used the Prostate Lung Colorectal and Ovarian trial data (PLCO) for PSA growth model building. Using 6 years of annual PSA measurements we established the PSA growth curves for four groups of …

Association Between Nutritional Awareness And Diet Quality: Evidence From The Observation Of Cardiovascular Risk Factors In Luxembourg (Oriscav-Lux) Study, Ala'a Alkerwi, Nicolas Sauvageot, Leoné Malan, Nitin Shivappa, James R. Hébert

Faculty Publications

This study examined the association between nutritional awareness and diet quality, as indicated by energy density, dietary diversity and adequacy to achieve dietary recommendations, while considering the potentially important role of socioeconomic status (SES). Data were derived from 1351 subjects, aged 18–69 years and enrolled in the ORISCAV-LUX study. Energy density score (EDS), dietary diversity score (DDS) and Recommendation Compliance Index (RCI) were calculated based on data derived from a food frequency questionnaire. Nutritional awareness was defined as self-perception of the importance assigned to eating balanced meals, and classified as high, moderate, or of little importance. Initially, a General Linear …

Longitudinal Association Between Television Watching, Computer Use And Meal Frequency And Risk Markers In Diabetes Among Youth With Diabetes, Chao Li

Theses and Dissertations

BACKGROUND AND OBJECTIVES: Television watching and computer use are considered to be the main sedentary behaviors in children and youth. However, their longitudinal impact on HbA1c and serum lipids among youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) are under-studied. Sedentary behavior is normally assessed by questionnaire in large epidemiological studies, however, its measurement by questionnaire has not been evaluated among youth with diabetes. Also, no recent studies have evaluated the optimal meal frequency for glycemic control in youth with T1D and T2D; for this reason nutritional guidelines on meal frequency for youth with diabetes are vague. …

Geographic Accessibility To Health Services And Neonatal Mortality Among Very Low Birthweight Infants In South Carolina, Portavia Featherstone

Theses and Dissertations

Introduction: Infant mortality is commonly denoted as a marker of population health with more than half of all infant deaths occurring during the neonatal period (0-27 days) of infancy. Mortality for infants born very low birthweight (<1500 grams) is markedly higher than the babies born with normal birthweight (2500-4000 grams). The purpose of this research project was to assess geographic access to perinatal health services and the risk of neonatal death among infants born with very low birth weight. Data and methods: The linked birth and death records of a retrospective cohort of very low birthweight (<1500 grams) infants born in South Carolina between the years 2010 and 2012 were used (n=3191). We assessed the impact of travel time from maternal residence to delivery hospital and travel time from maternal residence to the nearest prenatal care provider (obstetricians/gynecologists, community health center, or rural health clinic). Logistic regression modeling was performed with adjustments for maternal characteristics (race, age, chronic/gestational hypertension, chronic/gestational diabetes mellitus, smoking, prenatal care), newborn characteristics (gestational age, birthweight, gender, NICU admission at birth), and the birth in a level III hospital. Results: There were a total of 563 neonatal deaths in this population and the neonatal mortality rate was 17.64 neonatal deaths per 100 live births. We did not find significant associations of travel time from maternal residence to delivery hospital and to a closest prenatal care provider with neonatal death after adjusting for confounders. However, we found that a one-week increase in gestational age (OR: 0.61 [95% CI: 0.57-0.65]) and non-Hispanic Black mothers (versus non-Hispanic White mothers) (OR: 0.65 [95% CI: 0.45-0.94]), were associated with the lower odds of neonatal death, while non-NICU admission at birth (OR: 5.99 [95% CI: 4.05-8.84]) was associated with an increased odds of neonatal death. Conclusion: Although we did not find that travel time was associated with neonatal mortality among very low birthweight infants, our study identified a few significant correlates for neonatal deaths in this birthweight group. Future studies should investigate the role of geographic access to care on mortality during other periods of infancy and among other birthweight groups.