Epidemiology Commons^™

Perceived Neighborhood Characteristics And Cognitive Function Among Older Adults: Examining The Role Of Depression, Allison Sullivan, Mph

Electronic Theses and Dissertations

Purpose: African American older adults have a greater risk of cognitive impairment compared to White older adults. While some research has established that neighborhoods are an important determinant of health, relatively little research has examined the relationship between perceived neighborhood characteristics and cognitive functioning among older adults. Moreover, little is known about how depression is implicated in the relationship between perceived neighborhood characteristics and cognitive functioning, and if racial differences exist. Thus, this thesis aims to determine the mediating and moderating role of depression in the association between perceived neighborhood characteristics and cognitive functioning in older African American and White …

Characterization Of Adiposity And Inflammation Genetic Pleiotropy Underlying Cardiovascular Risk Factors In Hispanics., Mohammad Yaser (Anwar)

Electronic Theses and Dissertations

The observed overlap between genetic variants associated with both adiposity and inflammatory markers suggests that changes in both adiposity and inflammation could be partially mediated by common pathways. The pervasive but sparsely characterized “pleiotropic” genetic variants associated with both adiposity and inflammation have been hypothesized to provide insight into the shared biology. This study explored and characterized the genetic pleiotropy underpinning adiposity and inflammation using genetic and phenotypic observations from the Cameron County Hispanic Cohort (CCHC). A total of 3,313 samples and >9 million single nucleotide polymorphisms (SNPs) were examined in this study. Mixed model genome-wide association studies (GWAS) were …

Investigation Of Factors Affecting The Hiv Continuum Of Care In Tennessee, Elaine Loudermilk

Electronic Theses and Dissertations

Introduction: Factors contributing to the HIV continuum of care (HCC) for adults in Tennessee (TN) have not been studied in depth with known predictors for HIV risk, specifically adverse childhood experiences (ACEs), among low annual income or sexual minority groups [lesbian, gay, bisexual, or transgender (LGBT)].

Methods: A mixed methods study design was used to assess factors related to the HCC. Quantitative analysis used the TN Behavioral Risk Factor Surveillance System data to examine at risk and ever tested for HIV, to (1) investigate ACEs among adults with low-income (<$25,000 annually) in 2016-2017 and (2) among LGBT in 2018. Descriptive statistics and multiple logistic regression (MLR) analysis stratified by TN grand division were performed. Qualitative analysis included 11 interviews with persons living with HIV (PLWH) receiving care at a local clinic to evaluate surveillance questions related to ACEs and the HCC to develop a culturally appropriate survey.

Results: Quantitative results found that among LGBT (N=262) and low-income …

Volatile Organic Compound Exposure And Cardiometabolic Syndrome Risk In A Nationally Representative Cohort., Stacey Lane Konkle

Electronic Theses and Dissertations

BACKGROUND: The relative importance of environmental exposures such as volatile organic compounds (VOCs) is one of the paramount public health priorities of our time, yet is presently unstudied. VOCs are ubiquitous in the environment and have been associated with numerous adverse health effects, including a number of cardiovascular and metabolic effects that are components of Cardiometabolic Syndrome (CMS). OBJECTIVES: To examine the relationship between CMS and individual-level exposures to VOCs, measured as urinary metabolites of VOCs (UM-VOCs), in a nationally representative sample. METHODS: Associations between urinary biomarkers of exposure to 19 parent VOCs and CMS were assessed using the National …

Association Of Perfluorinated Chemicals With Endocrino-Carcinogenetic, Obesogenic And Metabolic Health And With Markers Of Chronic Inflammation And Oxidative Stress, Ogbebor Enaholo Omoike

Electronic Theses and Dissertations

First, this study examined the association of perfluorinated chemicals with 1) cardio-metabolic health outcomes and 2) the association of phthalates with cardiometabolic health outcomes, and 3) cardio-metabolic health outcomes while assessing the possibility of additive interactions between perfluorinated chemicals (PFCs) and phthalates. Second, association with markers of chronic inflammation and oxidative stress were explored. Finally, this study examined the association of these chemicals with estrogenic cancers- Breast cancer, prostate cancer, uterine cancer and ovarian cancer.

Using data from the National Health and Nutrition Examination Survey (NHANES), logistic regression models were used to investigate the relationship between PFCs and the cardio-metabolic …

Tobacco Smoke Exposures And Fertility-Related Outcomes Among Females Seeking Fertility Care, And The Interaction With N-Acetyltransferase 2 (Nat2).., T'Shura S. A. Ali

Electronic Theses and Dissertations

Cigarette smoke contains thousands of harmful substances and is one of the leading preventable causes of mortality and morbidity in the United States. Past studies examining tobacco smoke exposures on fecundability and pregnancy outcomes are inconsistent. NAT2 is an important enzyme in the metabolism of xenobiotic substances found within tobacco smoke. This preconception cohort study examines associations between active smoking and secondhand smoke exposure (SHSe) on fecundability and spontaneous abortion (SA), and explores a possible interaction with NAT2 acetylator status. A total of 223 women seeking fertility care were followed for up to 2.3 years. Preconception tobacco smoke exposures were …

Probability Of Conception After Fertility Counseling And The Association Of Sexually Transmitted Infections With Pregnancy In The Loussi Study., Lindsey Adelle Wood

Electronic Theses and Dissertations

This study interrogated predictors of pregnancy and the effect of a history of sexually transmitted infection (STI) on probability of conception among a cohort of women seeking fertility counseling (N=170), using multivariable logistic regression and Cox proportional hazards models. There were 76 (44.7%) total pregnancies. 32 (39.0%) were achieved spontaneously by women who never received ART (N=82). Among women who did receive ART (N=88), 35 (39.7%) were achieved by ART and 9 (10.2%) achieved spontaneously. Among the full cohort (N=170), obesity was a significant negative predictor of pregnancy while history of human papilloma virus was a significant negative predictor of …

Heat Waves And Heat-Related Mortality In East Tennessee, Taiwo Adesoba

Electronic Theses and Dissertations

Heat waves represent a public health challenge that requires multiple responses and warnings to protect vulnerable populations. Although studies have reported an increasing trend of heat wave occurrence in many areas of the world, no clear trend exists in East Tennessee. Using data from Parameter-elevated Relationships on Independent Slope Models (PRISM), CDC WONDER and the United States Census Bureau, the relationship between mortality rates and year was estimated during heat wave events between 1999 and 2010. Five heat wave definitions were tested. Overall, 2007 and 2010 stand out as the years with the highest number of heat wave days in …

Public Health Policy: An Ethical Analysis Of Quarantine, Dina Alqahtani

Electronic Theses and Dissertations

As a public health measure quarantine has both historical and contemporary significance both in the United States and abroad. On the surface it represents a low-cost, low-tech way in which the spread of disease can be mitigated as its core requirement is that those who may have been exposed to an infectious agent are kept away from those who have not been exposed to that agent for enough time to determine whether or not infection has been spread. This has been utilized for centuries with both limited questions and scattered, inconsistent, or impossible to achieve oversight and goals. In understanding …

Evaluation Of The Health And Exposure Histories Of A Community Surrounded By Industry And Industrial Waste : A Mixed Methods Approach., Lindsay Koloff Tompkins

Electronic Theses and Dissertations

Environmental pollution is not distributed equally across members of society. Low-income individuals are more likely to live near waste sites and other sources of pollution, and, therefore, face greater exposure to environmental health hazards. One such community in Louisville, Kentucky, the Riverside Gardens neighborhood, consists of approximately 300 homes that are surrounded on three sides by industry and industrial waste, including a remediated Environmental Protection Agency Superfund site, a former coal-burning power plant and coal ash storage site, and multiple chemical, rubber, and plastic manufacturing companies. Residents have reported elevated rates of cancer and other chronic diseases and have requested …

Polydrug Use Among People Who Use Opioids, National Survey On Drug Use And Health 2002 To 2017., Diana Kuo Stojda

Electronic Theses and Dissertations

Introduction: Mortality due to overdose has been increasing since 2010 in the U.S., with an increase in the reported use of heroin and co-use of heroin and prescription opioids. Trends and correlates of polydrug use need to be analyzed to propose policies to reduce overdose risk. The overall objective of this study is to characterize high-risk polydrug groups among people who use opioids (PWUO) to understand the patterns of co-used substances and overdose risk factors. Methods: Publicly available data from the 2002-2017 National Survey on Drug Use and Health were analyzed to obtain weighted prevalence rates and trends …

The Shape Study : The Survey Of Health And The Perceived Environment Study., Colette Patrice Davis

Electronic Theses and Dissertations

Introduction: Few studies have considered how an individual’s perception of their built environment may be a risk factor for being overweight or obese. Adolescents may be particularly vulnerable in the context of “impoverished environments”, which they may perceive to be difficult, dangerous, resource deficient, and unaesthetic. This study aids in clarifying how the built environment influences the risk of obesity among adolescents residing in a neighborhood in Louisville, KY. Objective: The overall objective was to conduct a cross-sectional epidemiologic pilot study among adolescents aged 12-17 years residing in West Louisville, Kentucky to evaluate the association between perceptions of …

Adverse Childhood Experiences, Homeless Chronicity, And Age At Onset Of Homelessness, Joseph T. Tucciarone Jr.

Electronic Theses and Dissertations

Childhood adversity is associated with numerous negative outcomes across multiple domains, including mental and physical health, interrelationships, and social functioning. Notably, research suggests that childhood adversity has a dose-response relationship with these outcomes; that is, greater numbers of adverse experiences in childhood are associated with worse outcomes. These outcomes overlap with many risk factors of homelessness. This study sought to address two questions: 1) Does a dose-response relationship exist between childhood adversity and chronic homelessness? 2) Does childhood adversity negatively predict the age at which homelessness first occurs? Adults experiencing homeless who are accessing homeless services in the Tri-Cities area …

The Prevalence And Context Of Adult Female Overweight And Obesity In Sub-Saharan Africa, Ifeoma Ozodiegwu

Electronic Theses and Dissertations

Adult women bear a disproportionate burden of overweight and obesity in Sub-Saharan Africa (SSA). Precise information to understand disease distribution and assess determinants is lacking. Therefore, this dissertation aimed to: (i) analyze the prevalence of adult female overweight and obesity combined in lower-level administrative units; (ii) analyze the effect modification of educational attainment and age on the association between household wealth and adult female overweight and obesity; (iii) synthesize qualitative research evidence to describe contextual factors contributing to female overweight and obesity at different life stages. Bayesian and logistic regression models were constructed with Demographic and Health Survey (DHS) data …

Evaluation Of The Predictive Ability Of A Screening Instrument Used To Diagnose Co-Occurrence Of Anxiety In Children With High-Functioning Autism., Austin Zachary

Electronic Theses and Dissertations

Anxiety has shown to have a high co-occurrence in children with Autism Spectrum Disorder (ASD), but has been difficult to co-diagnose. This study analyzed the ability of the Screen for Child Anxiety-Related Emotional Disorders (SCARED) to predict positive ASD screenings of the Social Responsiveness Scale (SRS). Parents and children ages 8 to 18 years (N = 100) were screened for anxiety using the SCARED and autism using the SRS. Moderate correlation was found between parent-reported SCARED and positive screening of the SRS (r = .579), with weak correlation found in the child-reported SCARED (r = .105). LASSO regression was conducted …

Adolescent Sexual And Reproductive Health In The Gambia., Sandhya Lohani

Electronic Theses and Dissertations

Adolescence is a crucial period in human development. Knowledge and awareness about when to have children, when to have sex, and use of contraceptives impacts the chances of teenage pregnancy and risk of sexually transmitted diseases. The objective of this study is to determine the prevalence and associated risk factors related to age of sexual debut, teenage pregnancy, and use of contraceptives in the Gambia. This study also compares the data with 2014 survey research conducted in the Gambia. The total study population were 50 adolescents aged 13-21 years from Bafuluto and surrounding communities in the Gambia. Among 50 respondents, …

Lead And Crime: An Ecological Study Between Lead Contaminated Topsoil And Violent Crime., Brian Guinn

Electronic Theses and Dissertations

Lead is a known neurotoxicant. Human exposure to lead comes primarily through environmental exposures, including remnant lead paint, lead contaminated topsoil and lead contaminated water. Prenatal and early life lead exposure has been associated with numerous neurocognitive and neuropsychiatric disorders. This dissertation presents findings from an ecological study which evaluated the geospatial association between topsoil lead content and the incidence of FBI designated violent crime in Jefferson County, Kentucky. A total of 412 topsoil samples were collected along roadways (n=300) and from Louisville Metro Parks (n=112). Jefferson County crime data was obtained from the Louisville Metro Police Department – Crime …

Association Between Cigarette Smoking And Ovarian Reserve Among Women Seeking Fertility Treatment With Effect Modification By Race And Nat2 Genotype., Islamiat A. Oladipupo

Electronic Theses and Dissertations

Cigarette smoking in women has been associated with adverse reproductive outcomes such as reduced ovarian reserve, poorer in vitro fertilization (IVF) outcomes and increased adverse pregnancy outcomes. This study examined the association of smoking with ovarian reserve in a cross-sectional study of women seeking fertility treatment, and potential effect modification by race and NAT2 acetylator phenotype. Data from 265 women from the Louisville Tobacco Smoke, Genetic Susceptibility, and Infertility (LOUSSI) Study were analyzed. A total of 265 women were recruited through a single infertility clinic between September 2016 and June 2018. Information on current smoking status was assessed using a …

Is Macrolide And Beta-Lactam Combination Therapy Associated With Early Clinical Stability Or 30 Day Mortality In Hospitalized Patients With Pneumonia? An Assessment Of Confounding By Indication., Evangeline Pierce

Electronic Theses and Dissertations

Pneumonia and influenza are one of the leading causes of infectious disease-related deaths worldwide. Current guidelines for the treatment of hospitalized patients with community acquired pneumonia (CAP) include empiric antimicrobial therapy with a macrolide and a beta-lactam. There is little consensus among studies as to which antimicrobial regimen is best. The confusing results seen may very well be due to lack of assessment of confounding by indication (CBI). This analysis was a secondary analysis from Hospitalized Adults with Pneumococcal Pneumonia: Incidence Study (HAPPI). The study participants were those in HAPPI who had received either macrolide and beta-lactam combination therapy or …

Post-Diagnosis Quality Of Life And Mortality In Non-Hispanic White And Hispanic Women Diagnosed With Invasive Breast Cancer., Delvon T. Mattingly

Electronic Theses and Dissertations

The prevalence of breast cancer is increasing, and the health-related quality of life (HRQOL) of breast cancer survivors may help to further understand survivorship. This study evaluated HRQOL as a potential prognostic factor for mortality among Non-Hispanic White (NHW) and Hispanic women diagnosed with invasive breast cancer. Data were used from the Health, Eating, Activity, and Lifestyle (HEAL) Study. Data for 351 participants were analyzed for associations between HRQOL scores (subscale, component) and mortality. Cox proportional hazards regression was conducted to assess the relationship between HRQOL and mortality outcomes (all-cause, breast cancer-specific, non-cancer). Median follow-up time from HRQOL assessment (approximately …

Coal Ash Exposure And Behavioral Impairments Among Children In Louisville, Kentucky., Chisom Nmesoma Odoh

Electronic Theses and Dissertations

Introduction: Coal ash, generated from the combustion of coal is principally made up of fly ash, which consists of small particles and metals that can affect the development of children. Coal ash is predominately stored in landfills and surface impoundments, of which many are in proximity to residential areas. According to the Environmental Protection Agency, 25% of residents in proximity to electric power plants are children. Few studies have reported a positive association between coal ash and its by-products and neurobehavioral disorders. The purpose of this study was to explore the relationship between coal ash and its components and …

Hiv-Related Knowledge, Attitudes, And Behaviors In Two Low Resource Settings, Candice Lynn Collins

Electronic Theses and Dissertations

Two Human Immunodeficiency Virus (HIV) outbreaks occurred almost simultaneously in the United States (US) (2014-2015) and in Cambodia (2015). Information is lacking on HIV-related knowledge, stigmatizing attitudes, and high-risk behaviors (KAB) among the general population, which may affect the transmission of HIV and lead to outbreaks. The current study aimed to: 1) assess KAB among the general population in a high-risk county in the US, 2) analyze KAB among the general population of Cambodia, and 3) compare KAB across samples from a high-risk county in Northeast Tennessee and a province in Cambodia. Tennessee data were collected in 2017 and Cambodian …

Context, Delivery, And Providers’ Perspectives Of Family Life Education In Tn, Usa, Ruby Yadav

Electronic Theses and Dissertations

In 2015, TN had the 9^th highest teen birth rate in the United States. School-based sex education programs have shown promise in curbing teen pregnancy rates. In TN public schools, sex education could be taught by teachers of subjects like biology, health education, or invited guests from ministries, or national or local nonprofit agencies. The content, rigor, and approach of sex education taught by these diverse groups of providers remains unknown. This pilot study tested a survey questionnaire and methodology, while providing information on the providers’ sex education practices and perspectives.

We adapted validated measures from past sex education …

Effect Of Total Body Iron On Metabolic Dysfunction Among U.S. Females In The Nhanes 2003-2010, Aged 12-49., Joseph Michael Carhart

Electronic Theses and Dissertations

Experimental and epidemiological studies have reported positive associations between iron parameters and metabolic dysfunction including: Type 2 diabetes mellitus (T2DM) (1-6), metabolic syndrome (7-15), non-alcoholic fatty liver disease (NAFLD) (16-22) and insulin resistance (23,24) with a number of studies showing that reductions in total body iron via dietary modification (e.g., reducing red meat intake) or phlebotomy lead to increases in insulin sensitivity (25), decreases in insulin resistance (26), and reductions in the prevalence of complications associated with T2DM (5, 27), metabolic syndrome (28) and NAFLD (22, 29). Moreover, the risk associated with these outcomes and total body iron differ between …

Moving Mountains : A Study Examining Long-Term Impacts Of Mountaintop Removal Coal Mining On Mortality In The Appalachian Region Using Geographic Information Sciences Techniques., James Howard Kent Pugh

Electronic Theses and Dissertations

Over the last hundred years, the Appalachian region has been dominated by the coal industry. It has also been and currently is one of the unhealthiest regions in the United States. Recent scholarship has examined the relationship between coal mining and health and mortality rates in the Appalachian region. The first study incorporates air quality and pollution data to examine if coal mining counties have higher levels of pollution and if this pollution contributes to mortality disadvantage. In the second study, I construct a population-based coal-exposure measure to better evaluate the relationship between coal mining and health I find that …

Coal Ash Exposure And Asthma In Children., Jack Anthony Pfeiffer

Electronic Theses and Dissertations

This study examined the association between exposure to coal ash in the home among children aged 6-14 and asthma. Data was collected using personal modular impactors, lift tape samples, toe/finger nail samples, questionnaires, and peak flow meters. Laboratory methods used to analyze the samples included gravimetric analysis, scanning electron microscopy (SEM) / energy dispersive x-ray (EDX), and proton-induced x-ray emission (PIXE). Statistical methods used to analyze the data included the Chi Square Test of Independence, logistic regression, the Hosmer-Lemeshow Goodness of Fit test, Fisher’s Exact Test, and the Anderson-Darling Normality Test. Sample size was small, making statistical significance in calculated …

Prenatal Depression Screening Among A Diverse Healthy Start Population., Evangeline Pierce

Electronic Theses and Dissertations

Prenatal depression has been associated with adverse outcomes for both pregnant women and infants. Data was studied from Healthy Start (n=1093). Healthy Start participants were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy. Data reported included birthweight, gestational length, ethnicity, and sociodemographic variables. No statistically significant association was found between a positive EPDS screen and birthweight-low/normal (OR 1.02 [95% CI 0.53, 1.70]), birthweight-abnormal (OR 1.02 [95% CI 0.53, 1.70], or gestation-preterm/term (OR 1.29 [95% CI 0.68, 2.45]). An association was observed between a positive screen and race, ethnicity by region of origin, immigrant status, English as …

The Particulars About Particulates : Metal Exposure And Self-Regulation Of Children Living Near Coal Ash., Clara G. Sears

Electronic Theses and Dissertations

The use of coal combustion for electricity and the storage of coal combustion by-products known as coal ash occur across the United States and around the world. The most abundant type of coal ash, fly ash, contains small particles with metals, some of which are known neurotoxins. Fly ash is currently stored in open-air landfills and surface impoundments that allow fugitive dust to escape into surrounding communities, potentially exposing children to small neurotoxic particles. This dissertation uses preliminary data from a larger cross-sectional study to investigate the relationship between particulate matter exposure, metal exposure, and problems with self-regulation. Recruitment of …

The Effect Of Caffeine On Fecundability : Differences In Coffee, Tea, And Cola Consumption., Emily Kathleen Steinmetz

Electronic Theses and Dissertations

This study examined whether intake of caffeinated beverages (coffee, tea, and cola) was associated with fecundability (time to pregnancy) in a prospective cohort study. Data from 470 women from the Mount Sinai Study of Women Office Workers (1990-1994) were analyzed. Intake of coffee, tea, cola, and other variables were recorded in daily diaries and calculated as menstrual cycle level means for up to 20 cycles. Pregnancy was assayed using hCG and confirmed by physician diagnosis. The associations of caffeinated beverages with the probability of becoming pregnant during a given cycle were determined using discrete survival analysis, adjusted for potential confounders. …

Pediatric Anxiety And/Or Depression Problems : Associations With Pm10, Fly Ash, And Metal Exposure., Abby Nicole Burns Hagemeyer

Electronic Theses and Dissertations

Background: In the last several decades, the use of coal has become more prevalent in turn increasing the amount of coal ash being produced. Coal ash, the by-product of coal combustion, is composed of small particles that contain essential elements, hazardous metals, polycyclic aromatic hydrocarbons, and radioactive material. While a small proportion of coal ash is reused, the majority gets discarded in open-air landfills and ash ponds. Fly ash, the major component of coal ash, can become emitted into the air and potentially contribute to the air pollution and metal exposure in the surrounding community. Few studies, particularly in the …