Epidemiology Commons^™

Surveillance And Comparative Genomics Of Bacteria From Hospital And Human Reservoirs, Emily E. Benedict

WUSM Theses and Dissertations – All Programs

Bacteria are diverse and adaptable and, consequently, present in a wide variety of environments. They are capable of growing under intense pressures, including those brought on by the human immune system and disinfection strategies. To survive these pressures, bacteria develop resistances. Antimicrobial resistance, which occurs when a microbe is no longer responsive to the antibiotic intended to control it, is one such adaptation that presents an especially serious threat, as it limits treatment options for infections caused by antimicrobial resistant microbes. Similarly, the ability of bacteria to survive in environments subjected to heavy disinfection efforts, such as intensive care units …

Knowledge, Attitudes, And Practices (Kap) Of Parents Regarding The Prevention And Control Of Childhood Iron Deficiency Anemia In Egypt: A Cross-Sectional Study, Omnia Soliman

Theses and Dissertations

Childhood Iron Deficiency Anemia (IDA) remains a major public health challenge in Egypt, where its persistently high and rising prevalence carries substantial consequences for child growth, cognitive development, immunity, and long-term health outcomes. Globally, approximately 40% of children aged 6–59 months are affected by anemia (World Health Organization, 2025), and Egypt mirrors this burden, with national data showing a worsening trend in recent years. In Egypt, national strategies have traditionally focused on biomedical interventions such as iron supplementation and food fortification, while less attention has been directed toward behavioral and household-level determinants, particularly parental knowledge, attitudes, and practices (KAP) related …

Weathering The Divide: Social Determinants, Neighborhood Context, And Systemic Lupus Erythematosus Among African American Women, Vanessa Cl Morman

Electronic Theses and Dissertations

Background: Systemic lupus erythematosus (SLE) disproportionately affects African American women and contributes to racial health disparities in the United States. Although genetic susceptibility influences disease risk, growing evidence suggests that social determinants of health (SDOH), including neighborhood conditions, structural racism, and socioeconomic disadvantage, contribute to disease development and progression. Epigenetic mechanisms may provide a biological pathway linking adverse social conditions to chronic disease disparities. This dissertation examined the influence of SDOH on SLE disparities through evidence synthesis and empirical investigation to inform public health practice and policy.

Methods: This integrated learning experience consisted of three complementary manuscripts. Aim 1 was …

A Spatiotemporal Study Of Environmentally Associated Pulmonary Diseases In Georgia, Jason Raymond Baum

Walden Dissertations and Doctoral Studies

Exposures to particulate dust matter (PM10 and smaller) from aggregate comminution facilities (ACF) can lead to the onset of environmentally associated pulmonary diseases (EAPDs); acute and chronic asthma (Type I allergic hypersensitivity reaction), chronic pulmonary disease, interstitial lung disease (ILD), and lung cancer. In this environmental epidemiological research study, three primary spatial and spatiotemporal research questions related to nonoccupational exposures from 118 facilities across Georgia were evaluated. Secondary data analysis was conducted from the Centers for Disease Control and Prevention’s (CDC) 2018–2023 Behavioral Risk Factor Surveillance System (BRFSS) and the Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Metropolitan Divisions to …

Degree Assortativity And Estimation Of Degree Distribution In A Contact Network Of People Who Inject Drugs, Peter Geissert

Dissertations and Theses

This dissertation analyzes data from a respondent driven sampling (RDS) study of people who inject drugs in Portland, OR.  The objective was to assess assumptions for the use of weighted estimators to estimate a population physical contact (syringe sharing) network degree distribution.

Visualization of degree distribution for social and physical networks, Kolmogorov-Smirnov tests of difference, and kernel tests of equivalence were used for comparison of distributions. Spearman's rho and GAM non-parametric regression models were used to test for association and assess non-monotonic relationship. The validity of Markov chain assumptions for RDS was assessed using a transition matrix, Markov chain graphs, …

Relationship Between Sociodemographic Factors And Opioid Overdose Mortality In Milwaukee County, 2020-2021, Elizabeth David

Walden Dissertations and Doctoral Studies

Opioid overdose deaths increased significantly from 2020 to 2021, with Milwaukee County experiencing higher rates than the national and state averages. African American and Hispanic residents faced disproportionately high fatal overdose rates. The purpose of this quantitative retrospective cross-sectional study was to examine the associations among socioeconomic status, race, age, access to treatment (measured by emergency medical services [EMS] naloxone administration), and opioid overdose mortality among underserved minority populations in Milwaukee County. Guided by the social-ecological model, the study analyzed data from the Milwaukee Health Department and the Milwaukee County Medical Examiner's Office across 34 ZIP codes. Inclusion criteria for …

Self-Care Behavior And Diabetes Knowledge In African American Women With Type 2 Diabetes, Rena Renee Barron

Walden Dissertations and Doctoral Studies

African American women experience a disproportionate burden of Type 2 diabetes, and limited evidence exists regarding the relationship between diabetes knowledge and self-care behaviors, particularly among African American female veterans. The purpose of this quantitative, cross-sectional study was to examine the relationship between diabetes knowledge and diabetes self-care among African American women with Type 2 diabetes, including a subsample of African American female veterans, and to evaluate whether the COVID-19 pandemic (2017–2019 vs. 2021–2023) moderated this relationship. Additional variables included age, marital status, physical health, and mental health. Guided by the social-ecological model, de-identified data from the Behavioral Risk Factor …

Immigration Status And Lung Cancer Diagnosis In U.S. First-Generation Immigrants, Valeriya Lockwood

Walden Dissertations and Doctoral Studies

The healthy immigrant effect (HIE) is an observed phenomenon in which immigrants exhibit better health outcomes than native-born residents, though relatively few studies have examined its role in chronic diseases in the United States. The purpose of this quantitative cross-sectional study was to assess the associations between immigration status, age, sex, race/ethnicity, median household income, and geographic location and lung cancer diagnosis in first-generation immigrant adults aged 18 or older. The subsequent health trajectory model provided the theoretical framework for the study. Data were obtained from the SEER*Stat Database 1975-2022 (N = 1,993). Binomial regression analysis showed that immigrants were …

How Recent Medicaid Defunding Has Impacted San Bernardino County Residents Access To Health Care Services, Samantha I. Rios

Electronic Theses, Projects, and Dissertations

Background: Medicaid is a critical source of health insurance for low-income populations in the United States, providing access to essential preventative, primary, and reproductive health care services (Donohue et al., 2022). The Medicaid defunding of 2025 and policy changes that follow have raised concerns regarding increased barriers to care, particularly among low-income and vulnerable populations who rely on safety-net providers such as Planned Parenthood (Planned Parenthood, 2025). The purpose of this study was to examine how the 2025 Medicaid defunding has impacted access to general and reproductive health care services among residents of San Bernardino County, California.

Conclusion: The research …

Prevalence Of Type 2 Diabetes Risk Factors Among Landscaping Workers In El Paso, Texas, Valeria Fontes

Open Access Theses & Dissertations

Type 2 diabetes mellitus (T2DM) is a significant public health challenge worldwide, yet little is known about the prevalence of diabetes risk factors among landscaping workers, an understudied occupational group. The purpose of this pilot study was to estimate the prevalence of type 2 diabetes risk factors among landscaping workers in El Paso, Texas. A descriptive cross-sectional study was conducted using a convenience sample of 20 landscaping workers. Participants completed a structured questionnaire and underwent anthropometric measurements, blood pressure assessment, point-of-care lipid and glucose testing, and vitamin D screening. Sixteen type 2 diabetes risk factors were assessed across seven domains: …

From Fields To Flu: Mapping H5n1 Zoonotic Risk In California Rice Fields, Mariati Messinger

Walden Dissertations and Doctoral Studies

Highly Pathogenic Avian Influenza (HPAI) H5N1 threatens agriculture, wildlife, and public health in California, where flooded rice fields in the Central Valley provide surrogate wetland habitat for migratory waterfowl and may create ecological interfaces for viral spillover into poultry systems. This quantitative ecological study examined whether county-level rice acreage, Lesser Snow Goose activity, and their interaction were associated with poultry HPAI H5N1 outbreak incidence during complete winter seasons available for analysis. Guided by One Health and disease ecology frameworks, secondary data from USDA, eBird, PRISM, and public surveillance sources were analyzed for 36 county-winter observations using negative binomial regression, logistic …

Risk Factors For Metabolic Syndrome Among U.S.-Born And Non-U.S.-Born Hispanics In The United States, Banessa Maldonado

Walden Dissertations and Doctoral Studies

Current knowledge regarding risk factors for metabolic syndrome (METS) among Hispanic individuals of Mexican descent remains limited. Using data from NHANES 2017–2020, this study compared factors contributing to METS and included U.S.-born and non-U.S.-born Hispanic adults of Mexican descent aged ≥ 18 years living in the USA (N = 949) with assessed METS. Grounded in the social ecological model and social determinants of health, this research evaluated dietary habits, lifestyle patterns, and acculturation processes using multivariate logistic regression and stratified analyses. Educational attainment was associated with METS, but the association was not statistically significant in adjusted models p = 0.528. …

Association Between Opioids And Leukemia/Lymphoma In Adults Living In The United States, Brenda Sue Newberry-Colasanti

Walden Dissertations and Doctoral Studies

Opioid prescribing rates and opioid misuse remain high throughout the United States. Exposure to opioids has been positively associated with various cancers; however, research evaluating associations between opioid exposure and hematologic cancers like leukemia and lymphoma is limited. Using the Socio- Ecological Model as a foundation, this quantitative cross-sectional study aimed to analyze the association between medicinal opioid use, opioid misuse, and leukemia/lymphoma while exploring how selected social determinants of health (SDOH) may modify that relationship. Secondary data were pooled from the 2015–20-year United States National Survey on Drug Use and Health (NSDUH). One thousand three hundred and twenty binary …

Association Between Resource Availability And Wellbeing Of Autism Patients In Ghana, Kwabena Aduse-Poku

Walden Dissertations and Doctoral Studies

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that presents significant challenges for children and families in Ghana, where resources remain limited. Grounded in the social ecological model, this quantitative cross-sectional study examined the associations between autism management programs and wellbeing, defined briefly as independent functioning in daily life and learning of autism patients enrolled in selected institutions in Accra and Kumasi, Ghana. Data were collected from N=122 autism patients using structured questionnaires that were completed by caregivers and program staff. Binary logistic regression analyses were conducted to assess relationships between program type, regional location, and years of enrollment and …

Fecal Fatty Acids And Other Risk Factors Associated With Multiple Sclerosis Score, Progression And Diagnosis Among Hispanic Adults, Juliana Ayala-Viqueira

Walden Dissertations and Doctoral Studies

Multiple sclerosis (MS) is a chronic neurological condition with insufficient research regarding risk factors influencing MS severity score (MSSS), progression and diagnosis among Hispanic adults living in the United States. This cross-sectional study assessed factors associated with MS score, progression and diagnosis using secondary data from the International Multiple Sclerosis Microbiome Study (iMSMS). Guided by the ecological model, the study included N = 576 participants with MS. Manuscript 1 explored the association between body mass index (BMI), sodium consumption, and the MS severity score in a Hispanic adult population. A multiple linear regression was conducted to examine whether age and …

Spatiotemporal Patterns Of Vaccine Uptake For Measles Outbreaks In Katsina State, Nigeria, Zeenat Kabir Asma'i

Walden Dissertations and Doctoral Studies

Measles remains a public health concern in Nigeria despite the availability of effective vaccines, yet limited research has comprehensively examined spatiotemporal patterns and contextual determinants of vaccination coverage and measles incidence in Katsina State. Guided by the socioecological model, this quantitative ecological study examined spatiotemporal patterns of measles incidence among children aged 9–59 months of age across 183 wards in 34 local government areas of Katsina State, Nigeria, from 2018 to 2022. Confirmed cases (n = 376) were analyzed using negative binomial regression and spatial methods, including Moran’s I, SaTScan, and geographically weighted regression (GWR). Urban wards had higher incidence …

Assessing Hpv And Hpv Vaccine Awareness And Perception Amongst Undergraduate Students, Maura Hawkins

Honors Theses

Human Papillomavirus (HPV) is one of the most common sexually transmitted infections in the United States. Vaccination rates remain low among college-aged students despite an effective vaccine being available. This study investigates HPV and HPV vaccination-related knowledge, beliefs, and perceptions among undergraduate students to inform targeted intervention strategies. Participants included undergraduate students (n = 19) who attended one of three focus groups conducted in April 2025 at the University of South Alabama. Structured interview guides explored HPV knowledge, perceived risk and severity, attitudes towards vaccination, autonomy in health decision-making, trust in health information sources, and preferred educational strategies. Discussions were …

Bridging Gaps In Childhood Systemic Lupus Erythematosus Treated At An Outpatient Clinic, Allen M. Savedra

Walden Dissertations and Doctoral Studies

No abstract provided.

Bone Marrow Adiposity, Obesity, And Tumor Burden In Newly Diagnosed Multiple Myeloma, Ananya Deshpande

ETDs from 2020-2029

Multiple Myeloma (MM) is the second most common hematologic malignancy in the United States. It is characterized by the accumulation of clonally expanded plasma cells in the bone marrow, which leads to end organ damage and myeloma-defining events requiring treatment. The only modifiable risk factor for MM is obesity. However, associations between obesity, bone marrow adipocytes, and tumor burden at MM diagnosis remain unclear. We evaluated associations of bone marrow adipocytes, body mass index (BMI), and clinical features of tumor burden among 168 patients with histologically confirmed newly diagnosed multiple myeloma (NDMM) enrolled in the Integrative Molecular and Genetic Epidemiology …

Epidemiology And Outcomes Of Geriatric Trauma At Uab, Lindy Reynolds

ETDs from 2020-2029

Adults over the age of 65 are the fastest growing portion of the population and account for a growing percentage of the trauma patient volume at trauma centers around the country. Older adults experience longer length of stays, higher mortality and complication rates than their younger counterparts. As a result, there has recently been an increased focus on models of geriatric trauma care, one of which is the addition of geriatric medicine consults for older trauma patients. The primary objectives of this dissertation were to examine the effect of the consult policy on outcomes using an interrupted time series approach, …

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 Institutional Expected Practice Guidelines On Oral And Long-Acting Intravenous Antibiotic Use For Serious Bacterial Infections, William Bradford

ETDs from 2020-2029

Expected practice interventions are a type of antimicrobial stewardship intervention in which local guidelines regarding antimicrobial prescribing are developed and released at an institutional level to establish an institutional standard of care. An expected practice intervention to encourage use of oral and long-acting IV (PO/LAIV) antibiotics for serious infections was performed at the University of Alabama at Birmingham Hospitals in November of 2022. We conducted a quasi-experimental pre/post study using a difference in differences approach to evaluate the effect of these guidelines on a primary outcome of length of stay (LOS) and secondary outcomes of inpatient antibiotic days, 3-month readmission, …

The Association Of Motherhood And Maternal-Related Life Events And Cardiovascular-Related Health, Disease Events, And Mortality, Taishayla Mckitt

ETDs from 2020-2029

More than 40% of U.S. women have cardiovascular disease (CVD), and nearly half have at least one major risk factor. Sparse evidence exists related to the role of childrearing (regardless of prior pregnancy) on CVD. A recent literature review highlighted the influence of reproduction on CVD and health and identified opportunities for advancement. At present, it has yet to be discovered from prospective epidemiologic studies the extent to which parenting and maternal events have influence on cardiovascular health and clinical events. It has been demonstrated that parous women have greater prevalence of cardiovascular risk factors (e.g., short sleep duration and …

Exploring The Association Between Social Media Use Frequency And Violence-Related Behaviors Among U.S. High School Students: A Cross-Sectional Analysis Of The 2023 Youth Risk Behavior Survey, Luma Hammoudi

ETDs from 2020-2029

Youth violence remains a major public health concern in the United States (U.S.), with firearm injuries now the leading cause of death among children and adolescents. At the same time, social media use has become nearly universal among youth, raising concerns about how online interactions may influence violence-related behaviors. Social media platforms can facilitate peer conflict, electronic bullying, and public exposure to aggressive behaviors, which may extend into offline environments such as schools and communities. However, the relationship between social media use frequency and youth violence remains understudied. This study examined the relationship between frequency of social media use and …

A Predictive Coding Account Of Spatial Working Memory Following Prophylactic Levetiracetam Administration Prior To Traumatic Brain Injury, Omeima Mutwali

Dissertations, Theses, and Capstone Projects

Traumatic brain injury (TBI) symptom prevention and remediation is an important area of research that would benefit vulnerable groups, including active-duty and veteran soldiers. These patients can sustain penetrative forces in fields of combat or in training, which result in focal lesions that trigger inflammatory and degenerative processes in the brain. Both primary and secondary injuries are associated with changes to cognition, behavior and affective state. This disease poses increased risk of epileptogenesis, as well. Given these outcomes, prior research has evaluated levetiracetam (LEV) as a prophylactic treatment for seizures, cognitive deficits and negative emotionality. LEV acts as a presynaptic …

Effect Of The Sava Syndemic On Hiv Viral Suppression Among People Living With Hiv In The United States: A Scoping Review And Meta-Analysis, Jacquelyn Rodriguez

UNLV Theses, Dissertations, Professional Papers, and Capstones

The SAVA syndemic highlights the interconnected and mutually reinforcing nature of substance use, violence victimization, and HIV/AIDS. The synergistic interaction of these conditions creates structural and behavioral barriers that disrupt the HIV care continuum and contribute to significant health inequities. Achieving a suppressed viral load is a critical clinical outcome for people living with HIV, while viral non-suppression can be an indicator of poor health, elevated transmission risk, and disease progression. Still, the association between SAVA factors and viral suppression/non-suppression outcomes within U.S. populations remains inconsistently characterized due to heterogeneous methodologies and variable inclusion of high-risk groups. This mixed-methods study …

Healthcare Provider Trust As A Predictor Of Covid-19 Vaccine Hesitancy Among Nevada Residents, Joanna Joseph

UNLV Theses, Dissertations, Professional Papers, and Capstones

Trust in healthcare providers is one of the strongest predictors of vaccine hesitancy in the literature, yet it has not been examined as an independent predictor of COVID-19 vaccine hesitancy in Nevada. Nevada ranks last nationally in healthcare providers per capita and is among the lowest in immunization coverage for both adults and children. The COVID-19 pandemic exacerbated negative vaccine attitudes, and vaccine hesitancy continues to be a central public health issue. Prior Nevada analyses identified vaccine hesitancy across racial, political, educational, and economic groups but did not assess the role of provider trust in vaccine hesitancy. This cross-sectional study …

Quantifying Black Carbon Concentrations In Georgia And Analyzing Associated Public Health Risks, Khloe R. Osborne

Honors Theses

Quantifying Black Carbon Concentrations in Georgia and Analyzing Associated Public Health Risks

One of the most daunting challenges of the industrial world is air pollution. Within this broad spectrum, there is an inhalable particle group named PM2.5, which contains black carbon. Black carbon has evidence that supports the generation and worsening of adverse health impacts, which may include birth complications, cognitive deficits in children, pulmonary aggravation, asthma, cardiovascular issues, neurological degenerative patterns, and cancer risk. This is especially seen in vulnerable populations, like children, elderly, and those who already suffer from weakened health, many of which reside in the southern …

Barriers To Palliative Care Access In Rural South Dakota: A Policy And System-Level Analysis, Harshavardhan Kadarkaraisamy

Honors Thesis

Palliative care improves the quality of life for people living with serious illness. It helps by addressing symptoms, improving communication, and providing mental, physical, and spiritual support. However, in South Dakota access to palliative care is limited in rural areas. These challenges include geographic isolation, workforce shortages, healthcare infrastructure, reimbursement, and misunderstandings about palliative care. This thesis examines the key policy barriers that limit access to palliative care in rural South Dakota. This work involves engaging with South Dakota-specific literature, rural health research, policy sources, community education, telehealth expansion, and policy reform. By focusing on the rural context of South …

Associations Between Water Intake, Dietary Quality, And Beverage Consumption Among University Students, Mohammad A. Qazi

Electronic Theses, Projects, and Dissertations

Title: Associations Between Water Intake, Dietary Quality, and Beverage Consumption Among University Students

Background and Aims: Sugar-sweetened beverage (SSB) and ultra-processed food (UPF) consumption significantly contribute to chronic disease risk and is often more common in underserved and racially/ethnically diverse communities. Drinking water is a low-cost, calorie-free behavior that may support healthier beverage and dietary patterns. Previous studies show that increased daily water consumption positively correlates with better diet quality and is inversely correlated with SSB and UPF consumption. This study aims to examine whether (1) increased daily water intake is associated with self-reported diet quality and (2) self-reported hydration …