Epidemiology Commons^™

Reviving Focused Scrutiny In The Constitutional Review Of Public Health Measures, Robert Gatter

All Faculty Scholarship

This article re-examines the "focused scrutiny" standard proposed by Prof. Scott Burris in 1989 and argues for its application particularly during an infectious disease emergency such as the COVID-19 pandemic. Focused scrutiny seeks to tie judicial review of the constitutionality of public health measures closely to the facts of the particular disease and to evidence of the efficacy of each governmental action to prevent the spread of that disease, even when courts adopt rational basis testing.

Short-Term Effects Of Ambient Ozone, Pm2. 5, And Meteorological Factors On Covid-19 Confirmed Cases And Deaths In Queens, New York., Atin Adhikari, Jingjing Yin

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

The outbreak of coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, has been rapidly increasing in the United States. Boroughs of New York City, including Queens county, turn out to be the epicenters of this infection. According to the data provided by the New York State Department of Health, most of the cases of new COVID-19 infections in New York City have been found in the Queens county where 42,023 people have tested positive, and 3221 people have died as of 20 April 2020. Person-to-person transmission and travels were implicated in the initial spread of the outbreaks, but factors …

Molecular Typing Of Rickettsia Akari, Marina E. Eremeeva

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Rickettsia akari is an obligate intracellular bacterium that causes smallpox rickettsia. Rickettsia akari is an atypical member of the rickettsia spotted fever (SFG) group because it circulates in gamasid mites; however, only limited data are available regarding the degree of genetic diversity of R. akari isolates. We examined 13 isolates of R. akari isolated from humans, rodents, and ticks in the United States, the countries of the former USSR, and the former Yugoslavia for the period from 1946 to 2003 for diversity in the composition of tandem repeats (TR) and intergenic regions (IGR). Using the Tandem Repeat Finder software (http://tandem.bu.edu) …

The Covid-19 Response In Nebraska: How Students Answered The Call, Sabrine Chengane, Anlan Cheney, Sierra Garth, Sharon J. Medcalf

Journal Articles: Epidemiology

The Student Response Team at the University of Nebraska Medical Center answered the statewide call to assist local health departments during the coronavirus disease 2019 (COVID-19) pandemic. As a voluntary student-led effort, the SRT assisted health departments to conduct contact tracing, monitor social media, and educate the public. Their experience demonstrates how students can increase the public health surge capacity of local health departments while gaining applied experience during public health emergencies. This call-to-action commentary proposes that SRTs should be formed, trained, and deployed through academic institutions across the nation and the globe, during and beyond the current pandemic.

Health Outcomes Associated With Gulf War Illness, Shannon K. Barth

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background:

Nearlythirty years after the 1990-1991 Persian Gulf War a definitive case definition for Gulf War Illness (GWI) is lacking. The objective is to explore health outcomes associated with GWI using currently accepted classifications in order to better understand GWI by examining pre-war medical conditions as predictors of probable GWI, mortality outcomes of veterans with probable GWI, and female-specific medical conditions among women with probable GWI. Additionally, we utilize an alternative GWI case definition.

Methods:

Data come from theDepartment of Veterans Affairs (VA)1995-1997 National Health Survey of Persian Gulf War Era Veterans, a population-based survey of deployed …

Disparities In Health Behavior Risks Among Employed And Disparities In Health Behavior Risks Among Employed And Unemployed Black And White Older Adults, M. Courtney Hughes, Tamara A. Baker, Hansol Kim

Faculty Articles, Papers, and Other Scholarship

Objective: Examine health behavior risk rates and disparities in health behavior risks related to race and employment among older adults.

Methods: A cross-sectional analysis of a representative sample of noninstitutionalized adults aged 65 and older (150,669 in 2015 and 168,011 in 2016) from the Behavioral Risk Factor Surveillance System. Self-reported health behavior risks were measured as well as multiple logistic regression analyses assessing the independent effects of demographic variables on health behavior risks.

Results: Employed older adults have greater health behavior risks than unemployed older adults. Black employed older adults have greater health behavior risks than Black unemployed older adults …

The Impact Of Dietary Intake On Mortality Risk In Colorectal Cancer Survivors, Ellen Chow

Walden Dissertations and Doctoral Studies

The colorectal cancer (CRC) survivor population is increasing in the United States. The lack of effective dietary recommendations in recurrence prevention undermines the health-related quality of life of survivors. Grounded in the socioecological model, dietary behavior is a personal-level risk factor that individuals may control. This study investigated the CRC-specific mortality risk as predicted by diet quality, dietary fiber intake, and dietary fat intake in hope of contributing to future dietary recommendations. A secondary analysis using data from 1,166 CRC survivors in the Multiethnic Cohort Study was analyzed via Cox proportional hazard regression models to estimate mortality risk. Results from …

Voluntary Male Circumcision And Risk For Human Immunodeficiency Virus In Homa Bay, Kenya, George Obhai Gabriel

Walden Dissertations and Doctoral Studies

The role played by the belief about voluntary medical male circumcision (VMMC) in predicting HIV status has not been examined. The purpose of this study was to investigate whether there were any differences between belief about VMMC, unprotected sex, age, number of sexual partners, relationship status, and HIV status among circumcised males aged between 18-49 years in Homa Bay County, Kenya. Drawing from the health belief model and case-control study design, 936 men were recruited based on their HIV status (468 HIV cases and 468 controls). A bivariate logistic regression was applied, and the results indicated that unprotected sex, age, …

Obesity, Snoring, Sleep Apnea, And Coronary Heart Disease, Maryam Khalilah Muhammad

Walden Dissertations and Doctoral Studies

Coronary heart disease (CHD) is a significant public health issue that affects communities across all socioeconomic and demographic groups. Risk factors for CHD include sleep apnea and snoring. Obesity with short sleep duration also places individuals at higher risk for CHD. Although limited research has been conducted on CHD and its relationship to obesity, sleep apnea, and snoring as individual risk factors for CHD, a gap exists as these factors had not been studied as paired in this study. The purpose of this quantitative, cross sectional study was to determine if a significant relationship existed between obesity, snoring, sleep apnea, …

Amyotrophic Lateral Sclerosis Patients' Sociological Resilience, Self-Determination, And Decision-Making For Life-Sustaining Treatments, Jeremy Jon Van Tress

Walden Dissertations and Doctoral Studies

People with amyotrophic lateral sclerosis (ALS) suffer from a rare, progressive, untreatable, and fatal neuromuscular disease. Their decision-making for life-sustaining treatments may not be fully self-deterministic. While researchers have examined resilience and self-determination in people with mental health problems and chronic illness, none have researched these variables in ALS patients from a socioecological framework. The purpose of this study was to explore the relationships between people with ALS socioecological resilience, self-determination, and decision-making for life-sustaining treatments. A cross-sectional concurrent mixed-methods design was used, with online surveys completed by 197 people with ALS who were solicited through the National ALS Registry. …

Association Of Common Chronic Pain Conditions To Incident Alzheimer’S Disease And Related Dementias In Two Cohorts Of Older Medicare Beneficiaries, Sumaira Khalid

Graduate Theses, Dissertations, and Problem Reports (ETD)

Objective: The purpose of this research was to study the collective and incremental association of common non-cancer chronic pain conditions (NCPC) to risk for Alzheimer’s disease and related dementias (ADRD); to explore the potential mediating influence of mood and sleep disorders; and to assess the potential synergistic effects of NCPC’s and multimorbidity on ADRD risk. This research also aimed to study the contribution of NCPC to ADRD risk in poor, rural, underserved United States populations who suffer a disproportionate burden of ADRD risk factors. To achieve these goals, this dissertation pursued three specific aims: 1) assess the association of …

Association Of Social Support And Depressive Symptoms Among African Americans, Jacketta Renee Cobbs

Walden Dissertations and Doctoral Studies

Depression affects over 120 million individuals worldwide; in the United States, depression is a leading cause of disability for individuals’ ages 15-44 years. Social support can affect both physical and depressive symptoms; therefore, most patients with heart failure (HF) need support from family and/or friends to effectively manage their health condition. This indicates family and/or friends are expected to be the core support system for long term care of those with HF. The purpose of this study was to determine whether social support contributes to depressive symptoms among African Americans with HF. The research questions examined the experience of different …

Hepatitis B In At-Risk Groups: Three Studies To Guide Education, Testing, And Vaccination Efforts In West Virginia, Stacy Tressler

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background and Objectives: For over a decade, West Virginia’s (WV) rate of acute hepatitis B has been the highest in the United States (US). In 2017, WV’s rate was 11.7 per 100,000 population, almost 12 times higher than the national rate. The increase in acute hepatitis B cases is largely due to substance misuse, including injection drug use (IDU). Hepatitis B is a vaccine preventable disease yet many at-risk adults remain unvaccinated and susceptible to infection. The objectives of our studies are to 1) describe yearly changes in acute hepatitis B incidence in WV and assess county-level impact of the …

Advanced Preparation Makes Research In Emergencies And Isolation Care Possible: The Case Of Novel Coronavirus Disease (Covid-19), David Brett-Major, Elizabeth R. Schnaubelt, Hannah M. Creager, Abigail Lowe, Theodore J. Cieslak, Jacob M. Dahlke, Daniel W. Johnson, Paul D. Fey, Keith F. Hansen, Angela L. Hewlett, Bruce G. Gordon, Andre C. Kalil, Ali S. Khan, Mark G. Kortepeter, Christopher J. Kratochvil, Luann Larson, Deborah A. Levy, James Linder, Sharon J. Medcalf, Mark E. Rupp, Michelle M. Schwedhelm, James N. Sullivan Md, Angela M. Vasa, Michael C. Wadman, Rachel E. Lookadoo, John-Martin J. Lowe, James V. Lawler, M. Jana Broadhurst

Journal Articles: Epidemiology

The optimal time to initiate research on emergencies is before they occur. However, timely initiation of high-quality research may launch during an emergency under the right conditions. These include an appropriate context, clarity in scientific aims, preexisting resources, strong operational and research structures that are facile, and good governance. Here, Nebraskan rapid research efforts early during the 2020 coronavirus disease pandemic, while participating in the first use of U.S. federal quarantine in 50 years, are described from these aspects, as the global experience with this severe emerging infection grew apace. The experience has lessons in purpose, structure, function, and performance …

Injury-Related Infant Mortality In West Virginia, 2010-2014, Wilson A. Koech

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background and objective

Infant mortality in United States is high relative to other more developed nations. Therefore, there is a need to curb this trend, especially in states with high infant mortality rates. Hence, this research investigated and examined characteristics associated with injury-related infant death in West Virginia. The objective of this retrospective study was to 1) investigate maternal and infant characteristics associated with injury-related infant deaths in West Virginia, 2) examine the relationship between unintentional-injury-related infant death and rurality in West Virginia, holding other variables in the model constant, and 3) compare differences in the unintentional-injury related infant mortality …

Changing Dynamics Of Opioid Overdoses In West Virginia And Impact Of Medication For Opioid Use Disorder And Recurrence Of Overdose On Reducing Mortality Among West Virginia Medicaid Beneficiaries, Zheng Dai

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background

With increasing number of opioid overdoses in West Virginia (WV) in recent years and limited number of people receiving treatment, the dissertation study aims to better understand fatal overdose problems in WV and the impact of medication for opioid use disorder (MOUD) in preventing overdose deaths.

Method

WV drug-related deaths from 2005 to 2018 was used to describe the involvement of fentanyl and FAs. WV Medicaid claim data was analyzed to describe the recurrent opioid overdose and the changes in receipt of MOUD. Further, a Medicaid opioid overdose cohort was created to evaluate the effect of occurrence of recurrent …

Mental Health Service Use In The Kingdom Of Saudi Arabia, Abdulaziz S. Alangari

Graduate Theses, Dissertations, and Problem Reports (ETD)

Objectives: The goal of this project was to increase knowledge concerning the current prevalence, needs and barriers to mental health service use in the Kingdom of Saudi Arabia (KSA). It’s purpose was to gather data that would help to inform future policy decisions aimed at optimizing the use and availability of these services in the KSA. There were three specific aims: 1) Examine the barriers to initiation and continuation of mental health treatment in people with a disorder diagnosed during the previous 12-months. 2) Explore the prevalence and predictors of mental health treatment dropout. 3) Examine the prevalence and patterns …

Multimorbidity, Immune Checkpoint Inhibitor Use, And Healthcare Expenditures Among Older Patients With Late-Stage Melanoma, Pragya Rai

Graduate Theses, Dissertations, and Problem Reports (ETD)

With decades of unchanged cancer care with no added survival benefit, immune checkpoint inhibitors (ICI) changed the treatment landscape of late-stage melanoma in 2011. A key factor in determining the use of ICIs is the presence of pre-existing chronic conditions, which can influence the outcome. However, the prevalence of multimorbidity (defined as presence of two or more chronic conditions) among older patients with late-stage melanoma remains unknown. It also remains unknown if the presence of multimorbidity factors into the use of ICIs. Hospital-related factors associated with ICI use have been studied. Yet, patient-level factors, such as age, sex, marital status, …

Persistent Reduction In The Age Adjusted Mortality Rate From Aortic Valve Surgery In The United State With Elimination Of Gender Gap In Recent Years., Mohammad Reza Movahed, Sara Etemad, Mehrnoosh Hashemzadeh, Mehrtash Hashemzadeh

Articles, Abstracts, and Reports

BACKGROUND: Advancement in the surgical techniques should translate into better outcome. The goal of this study was to evaluate mortality trends from aortic valve surgery in the United State using large inpatient database.

METHOD: The Nationwide Inpatient Sample (NIS) database was used to calculate the age-adjusted mortality rate from aortic valve surgery from 1988 to 2011 in the United State using ICD-9 coding for aortic valve surgery.

RESULTS: We found that age adjusted mortality rate from aortic valve surgery gradually decreased from 1988 until end of study in 2011 to the lowest level with elimination of gender gap that was …

Accounting For The Uncertainty Due To Chemicals Below The Detection Limit In Mixture Analysis, Paul M. Hargarten

Theses and Dissertations

Humans are exposed to multiple chemicals every day. Epidemiological studies have shown that chemical mixtures are associated with cancers, allergies, neurodevelopmental disorders, and other adverse health effects. To assess these associations, investigators are increasingly using chemical mixture approaches like weighted quantile sum (WQS) regression. In these studies, the research objectives are to determine whether a mixture of correlated chemicals is associated with an adverse health outcome and to identify the important chemicals. However, as experimental equipment measures each exposure to a chemical-specific detection limit, the exposures are unknown between zero and the detection limit. Indeed, the number of exposures below …

The Correlation Between Maternal Postpartum Depression And Child Psychopathology, T'Keyah I. Vaughan

Theses and Dissertations

Background: Postpartum depression (PPD) is a phenomenon that affects nearly 10-15% of pregnancies in the US. It is characterized by depressed mood or anhedonia and lasting for more than 2 weeks. PPD changes how moms interact with family members and child-rearing behavior. Depression is a phenomenon that is also known to affect the psychopathology of children. However, the specifics of how postpartum depression impacts children remains controversial. Many studies do not control for major depressive disorder which makes it difficult to disentangle the impact depression has within the first year of life. Furthermore, other PPD risk factors may be confounding …

Impact Of Chlorpyrifos Exposure On Colorectal Cancer In Agricultural Communities In Ohio, Vicky Knisley-Henry

Walden Dissertations and Doctoral Studies

Colorectal cancer (CRC) is the third leading cancer diagnosis in the United States, and second in Ohio, for both men and women. In 2019, there were an estimated 145,000 cases of new CRC diagnoses and will lead to more than 50,000 deaths. Results from a systematic review indicate that chlorpyrifos use in agriculture is linked to the incidence of breast and lung cancers and has a possible association with CRC. Grounded in the social-ecological model, this study investigated the association between exposure to chlorpyrifos and CRC rates in agricultural communities in Ohio. The quantitative cohort design method utilized secondary data …

Parental Characteristics And Lead Knowledge In The Minimization Of Environmental Lead Exposure, Trina Yvette Redford

Walden Dissertations and Doctoral Studies

A method for guiding lead intervention and minimizing lead exposures in Philadelphia, Pennsylvania (PA) is through understanding the relationship between lead knowledge and parental characteristics such as gender, age, income, marital status, and education attainment. Parental characteristic may play a significant role in the identification of population groups where knowledge pertaining to lead exposure is inadequate. Through awareness and intervention, preventive measures can be implemented to minimize and eliminate lead exposure. The theoretical concept used in this quantitative study was Krieger ecosocial theory. The ecosocial theory provides guidance and analyzes differences in existing health relationships, especially those with biological and …

The Caregiver Advise Record And Enable (Care) Act And Compassion Fatigue In The United States, Karen Marie Johnson

Walden Dissertations and Doctoral Studies

The transition from hospital to home can be complicated, leaving family caregivers in stressful situations that they may not know how to handle. The burden that is placed on these individuals has led researchers to focus on the public health implications of caregiving in hopes of identifying at-risk caregivers. This quantitative analysis identified what relationships exist between caregiver compassion fatigue among family caregivers and training or education received per the Caregiver Advise Record and Enable (CARE) Act and if education influences readmission rates. A purposive sample of 385 family caregivers participated in this study. The Care Transitions Measure (CTM-15), the …

Tetanus Immunity Among Adults In The Democratic Republic Of The Congo, Sue K. Gerber

Walden Dissertations and Doctoral Studies

Although tetanus is not a contagious disease, it can be deadly for people who are exposed and do

not have protective immunity against tetanus, which can be acquired only through vaccination.

Most studies on adult tetanus protective immunity are from high-income countries; limited

studies occur in Africa, and none has been reported from the Democratic Republic of the Congo

(DRC). This study sought to determine protective immunity against tetanus among adults in

DRC in relation to their age, sex, place of residence, and for women, antenatal care. The primary

purpose of this observational cross-sectional study using a nested serosurvey within …

Epidemiology Of Marijuana Use And Mental Health In The Context Of Changing Policies, David G. Harvey Ii

Walden Dissertations and Doctoral Studies

There is a growing body of evidence supporting the association between cannabis use and the development of mental health disorders, but few studies have addressed this association following the recent increase in marijuana legalization laws. Therefore, using the social ecological model and the self-medication theory of addiction as theoretical frameworks, the purpose of this retrospective database study was to assess the relationship between marijuana use and major depression and suicidal ideation in both adults and adolescents in 2008 and 2017. Data from the National Survey on Drug Use and Health were analyzed using logistic regression at the p < .05 threshold for statistical significance. Results demonstrated positive, statistically significant relationships between marijuana use and both major depression and suicidal ideation for both adults and adolescents in both 2008 and 2017. Further, the strengths of these relationships generally increased between 2008 and 2017, coincident with the increase in marijuana legalization laws. These findings provide empirical support to the association between cannabis use and the development of mental health disorders, and that the strength of these associations is increasing following the increase in marijuana legalization laws. This study has important implication for positive social change by identifying significant relationships between cannabis use and the development of mental health disorders and revealing that these relationships are strengthening over time, coincident with the increase in marijuana legalization laws.

Sociopolitical Determinants Of Parental Acceptance Of Childhood Vaccination In Abuja, Nigeria, Lawrence Madu Ohammah

Walden Dissertations and Doctoral Studies

Despite the efficacy of vaccines, some parents still reject vaccination of their children, resulting in low vaccination coverage, a greater burden of vaccine-preventable diseases, and high infant mortality. The purpose of this study was to investigate the sociopolitical determinants of vaccination status among children, aged 0-24 months, and identify the factors that drive vaccine hesitancy. The social ecological model served as the theoretical framework. The study research design was a quantitative cross-sectional survey. An interviewer-administered questionnaire was used to collect primary data from parents and caregivers in 384 randomly selected households from 48 settlements in the Abuja Municipal Area Council. …

Predictors Of Condom Use Among High School Students In North Carolina, Danielle Cierra Robinson

Walden Dissertations and Doctoral Studies

The spread of sexually transmitted diseases is a major ongoing public health issue in North Carolina. Adolescents between the ages of 13 and 19 years have consistently contributed to this trend. Researchers have found that condom use among high school students has decreased. High school students continue to engage in sex with multiple partners, with lack of knowledge about sexually transmitted diseases, even though sex education and prevention programs have been recommended. The purpose of this quantitative study was to evaluate the predictors of condom use among adolescents. The socioecological model theoretical framework was applied to guide this research involving …

Socioeconomic And Sociocultural Factors Associated With Parenting Choice And Fertility Experience Among Lesbian And Nonlesbian Women, Annette Silvia

Walden Dissertations and Doctoral Studies

Minorities including lesbians may face disparities that contribute to minority stress, which leads to adverse health outcomes. The purpose of this social epidemiology study was to examine the association between insured status, perceived stress, and parental status among lesbians and nonlesbians. The theoretical foundation was minority stress, and the design was quantitative with a convenience sample of women aged 18 years and older. Data on demographics, perceived stress, fertility quality of life, and lesbian identity disclosure were collected via online survey. Among the 314 respondents, 102 self-selected as lesbian (49% parents), and 212 self-selected as nonlesbian (73.1% parents). More than …

Predictors Of Hiv Testing Among African American Men Who Have Sex With Men, Jeanette Marie Higgins

Walden Dissertations and Doctoral Studies

Human immunodeficiency virus (HIV) infections affect more than 1.2 million people living in the United States and disproportionately affect African Americans (AA) men who have sex with men (MSM). The numbers of those who have HIV infections are likely higher due to lack of HIV testing by all individuals living at risk for HIV in the United States. Prior research has been inconclusive in determining the exact cause of the disparity among AA MSM. Therefore, the purpose of this quantitative secondary data study was to explore barriers to HIV testing within the AA MSM population. The sample for this study …