Epidemiology Commons^™

Socially Assigned Race, Reactions To Perceived Racial Discrimination And Type Ii Diabetes Mellitus, Jourdyn A. Lawrence

Theses and Dissertations

Background: Numerous studies have utilized race to document health inequities. As race is considered a social classification of persons based upon physical traits, studies have begun to consider socially assigned race defined as the race/ethnicity perceived by others. Socially assigned race may serve as the basis for differential or unfair treatment of persons ascribed to historically oppressed groups. Socially assigned race may also provide additional insight into racial health disparities, particularly among Latino populations who are commonly defined by their ethnicity. This study assesses the relationship between self-identified and socially assigned race/ethnicity and tests the moderating effects of emotional and …

Association Between Diabetes And Cancer In Indian And Us Populations Using Longitudinal Study Design, Shraddha S. Vyas

Theses and Dissertations

Background: There is growing evidence of association between diabetes and cancer. No studies have been conducted in India evaluating this association. With the current epidemiologic, nutritional and economic transition in India, it becomes extremely important to examine this association in an Indian population. Additionally, difference in association exists based on different cancer subtypes. Research has shown that diabetes is associated with an increased risk of colorectal cancer. However most of these studies suggest detection bias to be one of the probable reasons for this association. Additionally, the common risk factors shared by both these conditions are considered to one of …

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 …

Effects Of A Mindfulness Based Intervention On Diurnal Cortisol In Cancer Survivors, Susannah Small

Theses and Dissertations

Background. There are approximately 15.5 million individuals alive today in the U.S. with a personal history of cancer. For this large and growing population, ill effects associated with cancer diagnosis and treatment include both physical and psychosocial symptoms adversely affecting quality of life. One low-risk alternative to conventional pharmaceutical use in treating these symptoms is mindfulness practice. Research on self-reported measures provides strong evidence that this type of intervention improves quality of life for cancer survivors, but evidence of impact on objective measures is limited. Cortisol, the body’s primary stress hormone, is one relatively easy to measure indicator that …

Assessing The Relationship Between Periodontal Disease And Subsequent Inflammatory Responses And Headache Disorders, Bryn E. Davis

Theses and Dissertations

Headaches are the sixth leading cause of disability worldwide, and the third leading cause of disability amongst those aged 50 and older. Several headache disorders, including migraines, have been associated with nitric oxide production. It is widely accepted that the pain associated with headache disorders is due to the ability of nitric oxide to function as a vasodilator. While nitric oxide is a known vasodilator and has been linked to headache disorder, it is also produced in response to bacterial infections. Periodontal disease is the result of long term bacterial infections occurring in the gum line and nitric oxide is …

A Possible Mechanism For Leptin’S Role In Lung Function Independent Of Body Mass Index: Investigating Leptin’S Genotype, Dna, Methylation, And Serum Protein Levels, Mitra Yousefi

Theses and Dissertations

Background: Leptin, initially believed to simply be a satiety hormone responsible for obesity, is now recognized as a pleiotropic cytokine that is involved in many biological processes; including the body’s host inflammatory response. Clinically, leptin may affect lung function although research in this area is limited. It is also known that the leptin receptor is necessary for the activation of the leptin protein, making it an important protein to consider. Furthermore, single nucleotide polymorphisms (SNPs) and DNA methylations of the leptin and leptin receptor genes (LEP and LEPR respectively) may provide important insight on the relationship that leptin has …

Analysis Of Food Exposures In Foodborne Disease Outbreaks, Alecia T. Alianell

Theses and Dissertations

Foodborne illness remains a serious public health problem in the United States in general as well as South Carolina in particular. Obtaining good food ingestion histories as well as possible risky environmental exposures is one of the earliest, most important tasks to complete in any foodborne outbreak investigations. Because time is of the essence in investigations, we have evaluated a rarely used biostatistical method, Random Forests, to data obtained from DHEC. Random Forests has the potential to facilitate more rapid identification of foods or environmental exposures that may be associated with outbreaks. We also examined previous cases of salmonellosis using …

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, …

Understanding Over-The-Counter Medication Use And Decision-Making Among Community-Dwelling Us Older Adults: A Mixed-Methods Approach, Yoshita Paliwal

Theses and Dissertations

Introduction

Older adults are regular consumers of over-the-counter (OTC) medications. OTC medications are generally considered safe, and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers’ perceptions, beliefs, and their decision-making about OTC medication use. The main objectives of this study were: 1) to examine the prevalence and characteristics of OTC medication use among community-dwelling US older adults (65 years and older), 2) to explore older adults’ knowledge, attitudes, beliefs and experiences about OTC medications, and 3) to elicit the OTC medication decision-making process in …

The Role Of Social Networks In Breastfeeding Duration, Jordyn T. Wallenborn

Theses and Dissertations

Background: The United States has one of the lowest rates of breastfeeding in the world. Studies hypothesize that inadequate social support from healthcare providers, family members, and employers may have contributed to the low breastfeeding rate. This study aims to: 1) examine the importance of each individual (father, maternal grandmother, paternal grandmother, obstetrician, and pediatrician) within the social support network on breastfeeding initiation and duration, 2) determine the relationship between type of prenatal care provider and time to breastfeeding cessation, and 3) examine the role of breastfeeding intention and confidence as mediators in the association between workplace support and breastfeeding …

Person-Centered Treatment To Optimize Psychiatric Medication Adherence, Natalie Bareis

Theses and Dissertations

Objectives: Adherence to psychotropic medication is poor among individuals with bipolar disorder (BD). To understand treatment experiences and associated adherence among these individuals, we developed a novel construct of Clinical Net Benefit (CNB) using psychiatric symptoms, adverse effects and overall functioning assessments. We tested whether adherence differed across classes of CNB, whether individuals transitioned between classes over time, and whether these transitions were differentially associated with adherence.

Methods: Data come from individuals aged 18+ during five years of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Latent class analysis identified groups of CNB. Latent transition analysis determined probabilities of …

Socioecological Aspects Of Tobacco Use In College Populations, Michael D. Sawdey

Theses and Dissertations

Background: Although cigarette smoking is decreasing in the US and among college students, tobacco use remains a major public health problem. Specific socioecological gaps in the literature related to college tobacco use exist including: trends of tobacco use, combinations of polysubstance use, and availability of tobacco products around college campuses.

Objectives: The main goal of this research was the understand interrelationships that exist within a socioecological framework of college tobacco use. Specifically, this project aims to: 1) examine trends of tobacco and polytobacco use by gender and associations of polytobacco use and perceived peer tobacco use, 2) examine …

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 …

Development Of An Estrogen-Related Dietary Pattern And Lifestyle Score To Examine Breast Cancer Risk In Postmenopausal Women, Mark Andrew Guinter

Theses and Dissertations

Introduction: Studies examining the association between individual dietary components and breast cancer have been inconclusive. The use of dietary patterns is a holistic approach which may yield stronger associations. We sought to develop a dietary pattern based on an estrogen metabolite (EM) profile hypothesized to increase breast cancer risk (high unconjugated estradiol and low ratio of 2- to 16-hydroxylated EMs (2/16 ratio)). This estrogen-related dietary pattern (ERDP) was examined for associations with postmenopausal breast cancer in two study populations and was incorporated into an estrogen-related lifestyle score (ERLS) with other modifiable risk factors for breast cancer.

Methods: EM …

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, …

Inflammatory Potential Of Diet And Pancreatic Cancer Risk: Interaction And Mediation Analysis In Two Prospective Cohorts, Jiali Zheng

Theses and Dissertations

Background: Inflammation plays a pivotal role in pancreatic cancer etiology and can be modulated by diet. We aimed to examine the association between inflammatory potential of diet, assessed with the Dietary Inflammatory Index (DIITM), and pancreatic cancer risk in two prospective cohorts, the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and the National Institutes of Health American Association of Retired Persons (NIH-AARP) Diet and Health Study. We explored effect modification by important inflammation-related lifestyle factors, and investigated whether type-2 diabetes mediated the association in a pooled analysis of both studies.

Methods: A total of 101,449 and …

Coping Mechanisms Of Sub-Saharan African Female Immigrants With Breast Cancer, Ernest Opoku Agyeman

Walden Dissertations and Doctoral Studies

Coping mechanisms of breast cancer is a public health problem among African females, particularly, the Sub-Saharan African female immigrants. The purpose of this qualitative study was to explore the coping mechanisms of the research group that could be used to develop and implement an intervention program to promote the quality of adaptation to improve the quality of life. The study achieved the objective by the use of 1-to-1 interviews of purposive samples of 2 and 12 using Roy Adaptation Model. Interviewed data were collected from females diagnosed with breast cancer, in treatment, and with remissions. The pilot study (n = …

Sugar Intake And The Five Personality Traits Of Millennials, Flora Gashi

Walden Dissertations and Doctoral Studies

Sugar intake continues to be connected to an increased risk of heart diseases, diabetes, arthritis, and certain forms of cancers, depression, and schizophrenia. The purpose of the study was to examine if sugar intake is related to personality traits in the Millennial population. The health belief model was used as the theoretical framework for conducting the study. The research questions addressed in the current study were in regards to the relationships between Millennials daily sugar intake and openness, conscientiousness, extraversion, agreeableness, and neuroticism. This study was a cross-sectional design in which a panel of randomly selected United States Millennials (N …

Developing And Testing Quality Indicators For Seriously-Ill Home Care Clients In Ontario, Lisa Harman

Theses and Dissertations (Comprehensive)

Introduction Currently in Ontario, there is no set of quality indicators for use in palliative care settings. Palliative care research tends to focus heavily on those with cancer diagnoses, and therefore potentially misses those with other life limiting illnesses. The current study aims to develop a preliminary set of quality indicators relevant for seriously-ill individuals for use in the community. Methods Secondary analysis of Resident Assessment Instrument for Home Care (RAI-HC) data from 2006-2013 (n=263,767) was used to develop QIs thought to be relevant to the needs of seriously-ill home care clients. Seriously-ill clients were defined as those with a …

Exploring Job Satisfaction And Preceptorship Capacity Among Applied Epidemiologists, Jessica C. Arrazola

College of Graduate Studies: Theses & Dissertations

Job satisfaction is important to consider when developing strategies for recruitment and retention. The Public Health Workforce Interests and Needs Survey (PH WINS) conducted in 2014 was the first nationally representative assessment of the state public health workforce. Prior to this assessment, the job satisfaction of state agency public health workers and preceptor capacity had not been measured. This study fills the current research gaps by studying the job satisfaction among the applied epidemiology workforce, identifying factors influencing job satisfaction, and the describing the preceptorship capacity among epidemiologists. This research is based on the 2014 PH WINS data. The analysis …

Application Of The Misclassification Simulation Extrapolation (Mc-Simex) Procedure To Log-Logistic Accelerated Failure Time (Aft) Models In Survival Analysis, Varadan Sevilimedu

College of Graduate Studies: Theses & Dissertations

Survival analysis is the study of time to event outcomes. Accelerated Failure Time models (AFT) serve as a useful tool in survival analysis to study the time of occurrence of an event and its relation to the covariates of interest. The accuracy of estimation of parameters in a model depends upon the correct measurement of covariates. Considering that perfect measurement of covariates is highly unlikely, it is imperative that the performance of the existing bias-correction methods be analyzed in AFT models. However, certain areas of bias-correction in AFT models still remain unexplored. One of these unexplored areas, is a situation …

Drinking Motives Underlying Internalizing And Externalizing Pathways To Alcohol Misuse In College Students, Jeanne Savage

Theses and Dissertations

Alcohol misuse, including heavy episodic use and negative consequences, is a major public health concern and a particular problem among college students. The etiology of alcohol misuse is not well resolved, with multiple and often contradictory factors implicated in its development. Genetic factors influence alcohol misuse but few specific genes have been identified. A potential reason for these challenges is that alcohol misuse is phenotypically and genetically heterogeneous; that is, there are multiple causal pathways underlying its development. Previous typologies have suggested that distinct internalizing and externalizing pathways are involved, with corresponding differences in profiles of personality, temperament, and comorbid …

Health Aid In Africa: Placement, Service Utilization, And Benefit, Carrie Dolan

Theses and Dissertations

While the health sector has attracted significant foreign aid, evidence on the effectiveness of this support is mixed. This dissertation examines the allocation of health aid within the context of placement, service utilization, and benefit. The first paper examined the sub-national allocation of Chinese development aid projects across Africa. I determined how political preferencing of Chinese aid specifically, allocating aid to the birth region of the current political leader differs across sectors such as health, education, and transportation. I find some evidence that aid, more broadly defined, is subject to political preferencing in recipient countries, which could potentially limit its …

Depressive Symptoms Among College Students: An Exploration Of Fundamental Cause Theory, Peter A. Carrico

Theses and Dissertations

Fundamental Cause Theory suggests that socioeconomic and demographic factors are causal to various illnesses, including depression. However, no known previously existing research has used Fundamental Cause Theory to create a model of depression among college students. To do this, the present study conducted a stepwise binomial logistic regression to examine how socioeconomic status and the sociodemographic variables of Gender, Race, and Sexual Orientation, and others predict depressive symptoms in a large sample of undergraduates when controlling for stressful life events and social support (N = 2,915). Results support the hypothesis that socioeconomic disparities in depressive symptoms are the result …

Characteristics Of Hiv-Infected Children At Enrollment Into Care And At Antiretroviral Therapy Initiation In Central Africa, A Adedimeji, A Edmonds, Donald R. Hoover, Qiuhu Shi, J Sinayobye, M Nduwimana, P Lelo, D Nash, K Anastos, M Yotebieng

NYMC Faculty Publications

BACKGROUND: Despite the World Health Organization (WHO) regularly updating guidelines to recommend earlier initiation of antiretroviral therapy (ART) in children, timely enrollment into care and initiation of ART in sub-Saharan Africa in children lags behind that of adults. The impact of implementing increasingly less restrictive ART guidelines on ART initiation in Central Africa has not been described. MATERIALS AND METHODS: Data are from the Central Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) pediatric cohort of 3,426 children (0-15 years) entering HIV care at 15 sites in Burundi, DRC, and Rwanda. Measures include CD4 count, WHO clinical stage, age, and …

Completion Characteristics Of Non-Hispanic Blacks With Tuberculosis And Hiv, Vernard Darrell Green

Walden Dissertations and Doctoral Studies

Tuberculosis (TB) and human immunodeficiency virus (HIV) are difficult conditions to manage, in tandem they pose even more challenges to public health programs in identifying coinfection to ensure that all TB cases are treated to completion of therapy (COT). The purpose of this study was to test variables that predicted COT among the HIV/TB coinfected population of non-Hispanic, U.S.-born Blacks alive at the time of diagnosis. Social determinants of health were the theoretical foundation used to guide the study based on data from the Report of Verified Cases of TB (RVCT) between 2009 and 2014. Relationships were tested between ethnic/racial …

Individual And Socioeconomic Factors Associated With Childhood Immunization Coverage In Nigeria, Obinna Ositadimma Oleribe

Walden Dissertations and Doctoral Studies

Immunization remains one of the most successful and cost-effective public health interventions worldwide. The purpose of this study was to examine the individual and socioeconomic factors that influence childhood immunization coverage in Nigeria. The health belief model and the social ecological model were used as the theoretical framework for the study, which examined the effects of individual, parental, and socioeconomic factors on complete immunization among Nigerian children. Univariate, bivariate, and multivariate tests were conducted within a secondary analysis of 2013 Nigerian National Demographic and Health Survey was done. Of 27,571 children aged 0 to 59 months, 22.1% had full vaccination …

Intimate Partner Violence During Pregnancy And Prenatal Care Attendance In Abuja, Nigeria., Dorothy Ijeoma Ezekwe-Anya

Walden Dissertations and Doctoral Studies

Intimate partner violence (IPV) among women poses a significant threat to maternal mortality during pregnancy in Nigeria with a prevalence rate of 14% in the southern region versus 43% in the northern region. Early and adequate prenatal care is essential for improving pregnancy outcomes and the reduction of the maternal mortality rate. Previous studies in several countries have demonstrated a unique barrier to healthcare access among women exposed to IPV. This study assessed the association between IPV during pregnancy and prenatal clinic attendance, using a cross-sectional quantitative study design guided by the social learning theory. The modified Conflict Tactile Scale …

Factors Affecting Inadequate Growth During Early Childhood In Guyana, South America, Valescia Xenobia John

Walden Dissertations and Doctoral Studies

Children under 5 years of age in Guyana are at an increased risk for inadequate growth. According to the United Nations Development Programme, 1 out of 3 children of preschool age are undernourished globally. This is a major public health concern as undernourishment in children under 5 years can lead to lifelong health complications. The study assessed the relationship between inadequate growth and urban classification in children under 5 years in Guyana, South America, after controlling for the following variables: mother's level of education, mother's age at birth of the child, household size, wealth, and marital status. The study framework …

Unintended Pregnancies Among Married Women In Sindh Pakistan: Role Of Lady Health Workers, Sumera Aziz Ali, Unaib Rabbani

Community Health Sciences

Background: Unintended pregnancies, which pose substantial risks to both mothers and children, account for 24% of all pregnancies in Pakistan. Door to door visits and service provision by lady health workers (LHWs) may be related to the reduction of such pregnancies, particularly in rural areas. This study aimed to determine the association of knowledge about Lady Health Visitors (LHWs) and door to door visits by LHWs with unintended pregnancies among rural women.
Methods: We conducted a community-based, nested case-control study of 800 pregnant women, identified from the database of an active surveillance mechanism, which registers and follows all pregnant women …