Epidemiology Commons^™

The Long-Term Biological Toll Of Adverse Childhood Experiences And The Role Of Psychological Resilience, Jill Krier Desch

USF Tampa Graduate Theses and Dissertations

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that occur before age 18 such as physical, sexual, and emotional abuse, neglect, and household instability and are associated with the leading causes of adult morbidity and mortality in the United States. The mechanisms underlying these associations are not yet fully understood, but the link between ACEs, chronic stress, and allostatic load is one potential pathway. Although ACEs are associated with the leading causes of adult morbidity and mortality, many individuals continue to lead healthy lives through adulthood despite exposure to ACEs. This dissertation used data from Waves I – V …

Impact Of Statin Medication Use On Glycemic Control And Complications In Type 1 Diabetes, Ryan Bailey

USF Tampa Graduate Theses and Dissertations

Introduction: Hydroxymethylglutaryl-CoA enzyme inhibitors (statins) are frequently used to prevent cardiovascular events in individuals at high risk for cardiovascular diseases, including individuals with diabetes. Prior research has indicated that statins may increase the risk of developing type 2 diabetes (T2D) and may increase hyperglycemia among those previously diagnosed with T2D. To date, little research has investigated the impact of statins on glycemic control and diabetic complications associated with poor glycemic control in those with type 1 diabetes (T1D). The objective of this dissertation is to investigate the association between statin use and measures of glycemic control including hemoglobin A1c (HbA1c), …

The Barriers And Facilitators Of Maternal Influenza Vaccination, Rashida Karida Jones

USF Tampa Graduate Theses and Dissertations

Influenza remains a leading cause of morbidity and mortality in the United States, with Black individuals disproportionately affected. Pregnant women are particularly vulnerable due to their modulated immune state, placing them at increased risk of complications, hospitalization, and intensive care admission. Despite strong evidence supporting the safety and efficacy of maternal seasonal influenza vaccination (SIV), uptake remains suboptimal. This study employed a multi-method design to identify barriers and facilitators of maternal SIV uptake, with a particular focus on racial disparities.

Quantitative analyses utilized the Florida Pregnancy Risk Assessment Monitoring System (FL PRAMS) dataset from the years 2018–2022. In the fully …

Econometric Analyses Across The Continuum Of Care For Individuals With Hearing Loss, Teresa I. Anthony

USF Tampa Graduate Theses and Dissertations

Hearing loss affects individuals across the age span and, if left untreated, can lead to developmental delays and health and well-being concerns. This dissertation applies econometric analyses to investigate factors influencing diagnostic outcomes in the neonatal intensive care unit (NICU), intervention enrollment rates among babies with permanent childhood hearing loss (PCHL), and utilization and hospitalization outcomes among adults with sensory impairment (SI). The first study evaluates the cost-effectiveness of automated auditory brainstem response (aABR) versus transient evoked otoacoustic emissions (TEOAE) for newborn hearing screenings in a Thailand hospital NICU. Decision tree modeling and economic evaluation suggested that although aABR is …

Ecological Epidemiology Of The Fungal Pathogen Ophidiomyces Ophiodiicola In Southeastern U.S. Snake Populations: Distribution, Drivers, And Anthropogenic Risk Factors, Shivam Shukla

USF Tampa Graduate Theses and Dissertations

Studying wildlife diseases is an important conservation measure, as many pathogens are a critical threat to biodiversity worldwide. Ophidiomycosis is an emerging infectious disease caused by the invasive fungal pathogen Ophidiomyces ophiodiicola that affects a wide variety of snake species, often causing mortality. There has been limited surveillance for ophidiomycosis in the southeastern United States’ (US) snake populations and research into the effects of anthropogenic disturbance on disease spread is also lacking. Thus, this project aimed to quantify the distribution and drivers (taxonomic, anthropogenic, and morphological) of ophidiomycosis in Florida, Louisiana, and Mississippi’s free ranging snakes as well as study …

Life History Of Men Who Experienced Childhood Maternal Absence, Renice Obure

USF Tampa Graduate Theses and Dissertations

This dissertation project explored the impact of childhood maternal absence on the life history outcomes of adult men. An integrated theoretical model of developmental-evolutionary framework was developed to guide research design and conduct. This model combined sex-differentiated life history framework and fathering resource theory. The study consisted of three components: a scoping review of 29 relevant studies conducted in the United States between 1990-2023, a quantitative analysis of the National Longitudinal Study of Adolescent and Adult Health (Add Health) waves I and IV (n=6932), and a qualitative analysis of in-depth interviews with a sample of 22 fathers who experienced childhood …

Detecting Changes In Cancer-Related Cognitive Functioning Using Mixed-Effects Modeling And Study Design Simulations, Jonathan D. Clapp

USF Tampa Graduate Theses and Dissertations

The purpose of this dissertation is to utilize and compare two existing approaches for modeling nonlinear change in cognitive functioning in cancer patients over time and to assess alternative study designs to better capture chemotherapy-related cognitive impairment using simulation data. Using data from the Thinking and Living with Cancer study, trend analysis with orthogonal polynomials (OP) and piecewise (PW) regressions approaches used to analyze cognitive functioning trajectories. Simulated datasets tested the impact of study design parameters including measurement test-retest reliability (.6 or .8), sample size (100, 200, or 300), and the number of data collection time points (4 or 5) …

Baseline Factors And Their Association With Refractive Error And Control In A Pediatric Randomized Clinical Trial Of Overminus Therapy For Intermittent Exotropia, Julianne L. Robinson

USF Tampa Graduate Theses and Dissertations

Intermittent exotropia (IXT) is a condition resulting in an eye deviation away from normal alignment, potentially treatable with overminus lenses. These induce accommodation of the eye, combatting the eye drifting outward. Overminus lenses may help treat IXT but also potentially worsen refractive error. Analyses aimed to find associations of baseline factors as they relate to IXT control outcomes, as well as the risk of worsening spherical equivalent refractive error (SER). One hundred ninety-six participants aged 3 to <11 treated with overminus lenses for 12 months were analyzed to explore associations between age, sex, race, ethnicity, strabismus severity, accommodative convergence/accommodation ratio (AC/A), and baseline SER with outcomes of change in SER and change in control. Analyses included outcomes for both SER and control as continuous and binary outcomes, and a secondary combined outcome. More myopic baseline refractive error and older age were associated with a worsening in SER after 12 months, -0.08 diopters (D) worsening SER per 1 year age increase (95% CI -0.13 to -0.03), and -0.30 D worsening SER per additional 1 D of myopic refractive error (95% CI -0.39 to -0.21). A larger AC/A ratio was associated with better distance control (0.11 points improvement per D of AC/A, 95% CI 0.03 to 0.19). The combined SER and control outcome showed the same factors (age, baseline refractive error, and AC/A ratio) were significantly associated with improving outcomes. Overminus lens therapy may be beneficial for some patients, but further study is needed to explore the results of these exploratory analyses.

The Association Between Oral Microbiome, Oral Inflammation, Periodontal Disease, And Systemic Metabolism In Individuals With/Without Type 1 Diabetes, Mianli Xiao

USF Tampa Graduate Theses and Dissertations

This study explores the associations between oral microbiomes, periodontal disease (PD), and systemic metabolism in individuals with and without Type 1 diabetes (T1D). Data were obtained from 208 participants (99 with T1D, 109 non-diabetic) in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) pilot study and 283 participants from the Oral Microbiome ancillary cohort study. Both studies included the collection of saliva or subgingival plaque samples. Microbial DNA was extracted, and the V4 region of the 16S rRNA gene was sequenced using the Illumina MiSeq platform. Machine learning models, including Random Forest (RF) and Multi-layer Perceptron (MLP), were applied …

Childbirth, Later-Life Cardiovascular Disease, Mortality, And Health-Related Quality Of Life In Postmenopausal Women, Zailing Xing

USF Tampa Graduate Theses and Dissertations

Introduction: The associations between childbirth and future maternal cardiovascular disease (CVD) and mortality have been inconclusive. Limited studies have focused on the association between childbirth and HRQoL. Objective: We aimed to examine the long-term effects of parity and age at childbirth on women's CVD and mortality based on propensity score matching. Methods: This study used data from the Women’s Health Initiative study (1993-2022). We used propensity score matching to produce matched samples, then employed multilevel Cox proportional hazard models for hazard ratios (HRs) to estimate the associations of parity and age at childbirth with CVD and mortality. We used mixed-effects …

The Role Of Pregnancy Intendedness In Shaping Contraceptive Practices And Family Planning Experiences: Evidence From Sub-Saharan Africa, Otobo I. Ujah

USF Tampa Graduate Theses and Dissertations

Background: Despite the associated adverse health and economic implications associated with unintended pregnancy, there remains a paucity of literature examining the effect of unintended pregnancy on postpartum contraceptive and reproductive behavior in many parts of Sub-Saharan Africa (SSA), including Nigeria.

Aims: The overall aim of this doctoral dissertation was twofold. First, to quantitatively examine whether and to what extent the intendedness of a woman’s most recent pregnancy is linked to subsequent contraceptive behaviors and family planning experiences. Secondly, to disentangle the influence of compositional and contextual level factors on these study outcomes. In the first paper, I investigated the extent …

The Joint Effects Of Sleep And Pain, And Moderations By Work Characteristics, Christina Xuong Mu

USF Tampa Graduate Theses and Dissertations

Reactivity describes interindividual differences in the physiological or emotional responses following an antecedent stressor. For instance, higher stressor reactivity to shorter sleep (i.e., those who report greater stressor severity following shorter-than-usual sleep) and higher negative affective reactivity to stressors (i.e., those who report more negative affect following a stressful event) have worse mental and physical health. Pain reactivity to shorter sleep is a novel concept that describes differences in pain responses following a night of shorter-than-usual sleep. Higher pain reactivity to shorter sleep means that individuals report more pain locations or higher pain severity following shorter-than-usual sleep the previous night, …

Examining Childhood Trauma And Substance Use Problems Among Justice-Involved Adolescents In Florida, Skye C. Bristol

USF Tampa Graduate Theses and Dissertations

The purpose of this dissertation was to assess the relationship between childhood trauma and substance use problems as latent constructs among justice-involved adolescents (JIA). Additionally, racial differences and spatial analyses were examined. Previous research underscores the limitations of conceptualizing childhood trauma solely through Adverse Childhood Experiences (ACEs). This justified integrating child welfare involvement, or out-of-home placement, as an additional indicator to develop a comprehensive scope of childhood trauma among JIA. Furthermore, current literature established that childhood trauma is a key predictor of substance misuse among JIA. However, the lack of a standardized measure of substance misuse across juvenile justice systems …

Exploring The Associations Between Drug Resistant Mutations, Low-Level Viremia, And Virological Failure In Persons With Hiv In Florida, Adriana Campos

USF Tampa Graduate Theses and Dissertations

Virologic suppression is an essential part to a successful regimen for Persons with HIV (PWH) and the 95-95-95 initiative. Yet, PWH experiencing episodes of low-level viremia (LLV) may be more prone to experience virological failure (VF). Currently, studies debate the clinical relevance of LLV and its effect on virological outcomes, but none have explored its interconnectedness with drug resistant mutations (DRM) and antiretroviral treatment (ART) adherence – all integral elements in predicting virological outcomes.

The goal of the proposed study was to contribute to the knowledge gap regarding the interconnectivity of drug resistant mutations, low-level viremia, adherence, and virological failure …

Community-Centered Early Warning For Outbreaks In Humanitarian Emergencies: Evaluating Community-Based Surveillance For Priority Communicable Diseases Among Internally Displaced Populations In Iraq, Caitlin M. Wolfe

USF Tampa Graduate Theses and Dissertations

Background: Community based surveillance (CBS) is the organized and rapid collection of information from health events identified in the community and includes the systematic detection and reporting of events of public health significance. While used globally to enhance the detection of priority diseases, CBS has not been routinely deployed in Iraq, where a once-robust health system has been devastated by decades of war, international sanctions, and large-scale population displacement. During infectious disease outbreaks, it is imperative to quickly detect and isolate suspect cases, investigate confirmed cases, and trace and monitor the contacts of confirmed cases. The COVID-19 pandemic underscored the …

Gender Differences In Episodic Memory In Later Life: The Mediating Role Of Education, Sara Robinson

USF Tampa Graduate Theses and Dissertations

In the United States (U.S.), 14 million individuals aged 65+ are expected to be diagnosed with dementia by 2060, and women are nearly twice as likely to be diagnosed. Low education is a well-established risk factor for dementia and is hypothesized to partly explain the gender differences in late-life cognition. However, few studies have investigated education as a mediator of these gender differences. This study aims to investigate education as a mediator of gender differences in episodic memory using longitudinal data from the U.S. Health and Retirement Study (HRS). I used a sample of 35,721 respondents (20,190 women and 15,531 …

A Healthcare Claims Investigation Of Parasomnia Epidemiology, Associations With Attention Deficit/Hyperactivity Disorder, And Rem Sleep Behavior Disorder Correlates, Anh Thy Ha Nguyen

USF Tampa Graduate Theses and Dissertations

Parasomnias, such as sleepwalking and nightmare disorder, are abnormal behaviors and emotions emanating from sleep or wake to sleep transitions. Parasomnias can lead to significant adverse outcomes – sleepwalking can result in injuries and hospitalizations, frequent nightmares are associated with self-harm and suicidal thoughts, and rapid-eye movement (REM) sleep behavior disorder (RBD) is linked to neurodegeneration. Despite a history of fascination with abnormal sleep behaviors in the general and medical communities, epidemiologic understanding of parasomnias remains limited, in part due to their amnestic nature and presumption that they are benign childhood problems. This work used the MarketScan® Commercial Claims and …

Diet And Salivary Microbiome On Cardiovascular Risk And Glycemic Control In Participants With And Without Type 1 Diabetes: The Cacti Study, Tiantian Pang

USF Tampa Graduate Theses and Dissertations

Introduction: The prevalence of type 1 diabetes mellitus (T1DM) has been increasing drastically in the United States. People with T1DM are at a higher risk of developing diabetes-related complications, including cardiovascular disease (CVD). Diet is one of the most modifiable factors and healthy eating could reduce CVD risk among individuals with T1DM. The current 2015-2020 Dietary Guidelines for Americans focus on overall healthy eating patterns rather than individual foods and nutrients. A healthy dietary pattern or high-quality diet can be measured by diet quality indexes, and generally contains minimal ultra-processed foods (UPF). Although substantial evidence has linked poor diet quality …

Longitudinal Associations Among Life Values, Alcohol Use, And Alcohol Abuse Symptoms From Adolescence To Adulthood, Connor Habecker

USF Tampa Graduate Theses and Dissertations

Investigating life value trends, the pro-social and anti-social characteristics that play a role in decision making, is an understudied field in adolescents. In addressing adolescent alcohol consumption as a public health concern, life values may provide needed background in understanding and influencing adolescent behavior toward pro-social values and away from known risk factors, such as alcohol consumption. By modeling life value trends of adolescents and the associations between each life value and the outcomes of alcohol use and alcohol abuse, there may be primordial level intervention opportunities as opposed to the current, largely ineffective, tertiary level interventions. This thesis utilizes …

Characterizing And Explaining Prevalence And Factors Associated With Non-Fatal Opioid Overdose In Florida, Jesse M. Bell

USF Tampa Graduate Theses and Dissertations

Many factors contribute to the opioid epidemic in Florida, including, but not limited to, physician over prescribing, opioid manufacturer malfeasance (direct marketing to physicians, hospitals, and universities, as well indirect political contributions, and deliberately obfuscating the impact of the addictive properties of their various drugs), and as the epidemic approaches its 25th year, sociodemographic characteristics. This body of work examines three of these. First, because an opioid naïve persons’ typical initial encounter with the drug is through a physician, we sought to shed light on the impact of direct pharmaceutical marketing to physicians. We identified opioid providing physicians from the …

Nonparametric Estimation Of Transition Probabilities In Illness-Death Model Based On Ranked Set Sampling, Ying Ma

USF Tampa Graduate Theses and Dissertations

The ranked set sampling (RSS) design is applied widely in agriculture, environmental science, and medical research where the exact measurements of sampling units is costly, but sampling units can be ranked by a correlated concomitant variable. RSS is usually a cost-efficient alternate to simple random sampling (SRS) for selecting more representative samples. This study presents a novel methodology to investigate the nonparametric estimation of transition probabilities in illness-death model using the RSS design. We study the Aalen–Johansen estimator of transition probabilities in illness-death Markov model based on RSS design under random right censoring time and propose nonparametric estimators of the …

Serious Mental Illness In Nursing Homes: Quality Concerns, Dylan J. Jester

USF Tampa Graduate Theses and Dissertations

Objective: This dissertation is made of two academic papers followed by a chapter discussing policy implications of the findings. The objective of this dissertation is to better understand if high-serious mental illness (SMI) nursing homes (NHs) provide poorer quality of care (e.g., operationalized as staffing levels, NH Compare quality star ratings, and health deficiencies) and whether quality in high-SMI NHs is confounded by payer mix (e.g., the proportion of residents who are Medicaid-reimbursed). A modified Donabedian Structure, Process, Outcome (SPO) Model was used as the main theoretical framework.

Methods: Data came from the Certification and Survey Provider Enhanced Reports (CASPER) …

Mechanisms And Mitigation: Effects Of Light Pollution On West Nile Virus Dynamics, Meredith E. Kernbach

USF Tampa Graduate Theses and Dissertations

Light pollution, or the presence of unnatural light at night, is a pervasive and growing problem across the globe. While often pictured in urban centers, light pollution is far reaching and can affect seemingly safe and minimally developed environments. For example, agricultural communities with artificial lighting near facilities can generate such light pollution in rural areas. Further, streetlights and illuminated billboards along roads and highways can generate light pollution far from cities. Given how pervasive this anthropogenic stressor is, it is surprising that not much is known about how artificial light at night, or ALAN, affects humans or wildlife, especially …

Sleep Diagnoses And Low Back Pain In U.S. Military Veterans, Kenneth A. Taylor

USF Tampa Graduate Theses and Dissertations

Low back pain (LBP) is a common problem that is the primary contributor to years lived with disability worldwide. In the U.S. LBP is disproportionately experienced by military veterans. In recent years interest has grown in the impact of sleep and sleep-related diagnoses on musculoskeletal pain complaints (including LBP) and despite growth in the scientific literature investigating this, gaps in our understanding of how sleep diagnoses impact LBP remain. To that end, this dissertation uses administrative electronic health record data from veterans seeking care through the Veterans Health Administration in three manuscripts to address the following specific aims: (1) investigate …

Bait-And-Kill: Targeting A Novel Heme Biochemical Pathway In Hundreds Of Cancers, Christopher G. Marinescu

USF Tampa Graduate Theses and Dissertations

Cancer cells are characterized by their ability to grow and proliferate in rates that far exceed normal cells by modifying their iron/heme metabolisms to levels higher than normal. This imbalance of heme biosynthesis can lead to cancer cells having a flux of heme intermediates to the point where they enter a state called heme-overdrive. Heme-overdrive is a process unique to a variety of cancers but absent in normal tissues. With this enhanced production, heme can act as an epigenic regulator for signaling proliferation (18). Through the novel strategy called ‘bait-and-kill,’ cancer cells will be coerced into a state of heme …

Quantifying The Impact Of Chronic Stress On Racial Disparities In Cardiovascular Disease, Nnadozie Emechebe

USF Tampa Graduate Theses and Dissertations

Background: Despite declining mortality in cardiovascular diseases (CVD), racial disparities between non-Hispanic Blacks (NHB) and to non-Hispanic Whites (NHW) persist. Although the prevalence of traditional risk factors of CVD such as hypertension, is higher in NHB compared to NHW, adjusting for this difference does not eliminate the disparity completely. This suggests other factors might explain the persisting disparities. Thus, the purpose of this dissertation is to quantify the impact of chronic stress in explaining the racial disparities in cardiovascular diseases (CVD). This dissertation contains three studies that addressed the following Specific Aims: Specific aims: 1) To create and assess the …

A Review Of American College Campus Tobacco Or Smoke Free Policies: A Case Study Of A Large Urban University, Sarah E. Powell

USF Tampa Graduate Theses and Dissertations

Objective: A year after a tobacco free policy was passed, the University of South Florida (USF) was interested in the overall policy opinions and efficacy. To assess this a project was completed that included a survey and geospatial data. The survey measured tobacco policy enforcement behavior and a geographic information system (GIS) mapped tobacco policy violation. This project introduces an evaluation process that can efficiently assess an institutions tobacco-free policy. Methods: Using a cross-sectional survey sent to students, faculty, and staff, understanding of policy and resources, tobacco use observations, stage of change regarding policy enforcement, self-efficacy to enforce, and perceived …

Covid-19 And Quantitative Literacy: Focusing On Probability, Michael A. Lewis

Numeracy

The COVID-19 pandemic is arguably the worst crisis the world has faced, so far, in this new century. We haven’t seen a pandemic like this since the 1918 Flu at the beginning of the last century, and, as of this writing, there appears to be no end in sight. What those of us who’re focused on quantitative methods have noticed, in addition to the many people dying, becoming ill, and losing their livelihoods, is the importance of quantitative literacy to an understanding of what’s going on. That’s what this article is about. Specifically, it’s about how the COVID-19 pandemic is …

From R0 To The Herd: A Review Of The Rules Of Contagion, By Adam Kucharski, Nathan D. Grawe

Numeracy

Adam Kucharski. 2020. The Rules of Contagion: Why Things Spread--and Why They Stop; (London: Profile Books, Ltd.). Hardback ISBN 978-17-88-16019-3. E-book ISBN 978-17-82-83430-4.

Kucharski's well-timed Rules of Contagion provides an introduction to the mathematical and epidemiological principles behind contagious phenomenon. While the author's primary expertise stems from work on biological epidemics, the book points to examples from a wide range of fields including finance, psychology, computer science, and criminology. As such, selections of the book could be used by faculty in a wide range of classes to show how our recent experience with a viral epidemic might add to …

Non-Invasive Sex Determination And Genotyping Of Transgenic Brugia Malayi Larvae, Santiago E. Hernandez Bojorge

USF Tampa Graduate Theses and Dissertations

Lymphatic filariasis is a very painful and disfiguring helminth disease caused by the tissue nematodes Wuchereria bancrofti, Brugia malayi, and Brugia timori. This parasitosis is considered a Neglected Tropical Disease and it is a major public health burden for 72 tropical countries of Africa, Southeast Asia, the Caribbean, and South America. Despite the effectiveness of many control programs, there remains the need to develop new pharmacological agents to treat lymphatic filariasis, as most programs rely on a limited variety of drugs that are expensive, logistically difficult to obtain, and can lead to drug resistance. The Clustered Regularly Interspaced Short Palindromic …