Community Psychology Commons^™

A Bundled Payment Profile For Head & Neck Cancer: Descriptive Statistics, Risk Assessment, And Pricing Recommendations For 1 Year Treatment Bundles Using A Large National Claims Database, Alexis Barboza Guzman

Dissertations and Theses (Open Access)

Bundled payments have the opportunity to promote care standardization and coordination while incentivizing efficiency and value-based healthcare delivery. However, bundled payments have been scrutinized due to challenges with defining the bundled lengths (also known as the episode of care period), limited inclusion/exclusion criteria, the absence of IT systems to support new payment models, and the lack of federal support. The objective of this study was to develop a profile for head and neck cancer, including descriptive statistics, risk assessment and bundled payment pricing recommendations using a large national claims database. The ability to assess pricing risks associated with head and …

The Mental Health Of Sexual And Gender Minority Adolescents Living In Texas, Sylvia Marie Lawler

Dissertations and Theses (Open Access)

Sexual and gender (SGM) adolescents face a higher burden of mental health disorders than their heterosexual and cisgender peers. SGM adolescents living in Texas are vastly understudied. Using three papers, this dissertation aimed to address this gap in knowledge concerning SGM adolescents in Texas. The aim of paper 1 was to analyze data from an online state-wide survey of SGM adolescents and adults in Texas to: 1) estimate the prevalence of anxiety, depression, and suicidal ideation; and 2) to determine which demographic, social support, and discrimination variables are associated with self-reported measures of depression, anxiety, and suicidal ideation. The aim …

A Narrative Review Of Factors That Contribute To Sustainability Of Community-Based Fall Prevention Programs, Stephanie Koweek

Dissertations and Theses (Open Access)

Falls are a significant problem for the geriatric population globally. As the population ages and elderly people continue to live longer with co-morbidites, they will continue to be at risk for falls. While several community-based fall prevention programs exist, they face chal lenges with sustainability. This paper is a narrative review of factors that contribute to the sustainability of community-based fall prevention programs as well as barriers to sustainabil ity. In total eight papers were included in this review. Findings from this review indicated that the following factors were keys to sustainability of community-based fall prevention pro grams: funding, external …

Geospatial Analysis Of Pediatric Tuberculosis In Bohol, Philippines: Disease Clusters And Access To Care, Lauren M. Leining

Dissertations and Theses (Open Access)

Worldwide, children represent approximately 10% of global tuberculosis (TB) cases. We recently reported a high tuberculin skin test (TST)-positive prevalence (355/5,476; weighted prevalence=6.4%) among children (<15 years) throughout the island of Bohol, Philippines, with some geographically isolated communities having prevalence as high as 29%. In this study, we conducted a secondary geospatial and hot-spot analysis of this household-based cluster survey to assess the association between access to care (distance to a health care facility) and TST-positive prevalence. Our analysis indicated that villages with high TST-positive prevalence (≥10%) were significantly further from Provincial Health Office based in the capital city of Tagbilaran in time-distance (p=0.0001, r=0.2387) and kilometers (p=0.0011, r=0.3170). Similarly, prevalence was positively correlated with distance to the municipal Rural Health Unit (RHU), where most receive their medical care, in time-distance (p=0.0055; r=0.0415); however, the association was not significant in kilometers (p=0.3315; r=0.0715). Distance to health care facilities could represent an obstacle to access to care, thereby limiting diagnosis and treatment and resulting in increased risk of transmission to others in the community. Health care outreach in geographically isolated areas is critical to treatment and control of efforts for pediatric TB.

Bayesian Estimation Under Informative Sampling: Investigating The Association Between Depression And Inflammation, Paula Lopez Gamundi

Dissertations and Theses (Open Access)

Survey data is often collected using complex sampling designs so that the probability of being included in the study is related to the outcome of interest (i.e. informative sample). Recently, a novel fully-Bayesian method has been developed for modeling data under informative sampling. Initial results indicate that this novel construction reduces bias in variance estimates compared to other pseudo-Bayesian techniques. The performance of this method has yet to be compared to traditional Frequentist approaches, which typically rely on Taylor series linearization (TSL) or resampling techniques for standard error (SE) estimation. Here, we modeled the relationship between depression and inflammation using …

A Mendelian Randomization Study Of Circulating Gamma Prime Fibrinogen And Total Fibrinogen Levels On Venous Thromboembolism And Ischemic Stroke Subtypes, Jillian Maners

Dissertations and Theses (Open Access)

Introduction: Fibrinogen is a key component of the coagulation cascade, and variation in its circulating levels may contribute to thrombotic diseases, such as venous thromboembolism (VTE) and ischemic stroke. Gamma prime (γ′) fibrinogen is an isoform of fibrinogen and has anticoagulant properties, including inhibiting thrombin and slowing platelet aggregation, that may affect clot formation.

Methods: Two-sample Mendelian randomization (MR) was applied to estimate the causal effect of total circulating fibrinogen and its isoform, γ′ fibrinogen, on risk of VTE and ischemic stroke subtypes using summary statistics from published genome-wide association studies of fibrinogen, VTE, and ischemic stroke, and an unpublished …

A Retrospective Analysis Of Claims Data To Determine Symptoms Associated With Ovarian Cancer, Denise Manon Langabeer

Dissertations and Theses (Open Access)

According to the American Cancer Society, approximately twenty percent (20% of women with ovarian cancer are diagnosed at an early stage (e.g. stage I or II), which subsequently means eighty percent (80%) of women diagnosed with this disease are at the late stage (e.g. stage III or IV) and are likely not to survive. No cure exists and, concurrently, studies show mixed results in utilizing blood tests and transvaginal ultrasounds to screen for ovarian cancer. While symptoms are not easily discernable, some oncologists have validated there are common symptoms women experience prior to diagnosis. As these symptoms are not routinely …

How Patient Cost Sharing Affects Tyrosine Kinase Inhibitors Adherence And Outcomes Among Commercially Insured Patients With Newly Diagnosed Chronic Myeloid Leukemia, Hsiao Ling Phuar

Dissertations and Theses (Open Access)

Untreated chronic phase chronic myeloid leukemia (CML) will eventually progress to advanced phase in 3 to 5 years. Treating CML with tyrosine kinase inhibitors (TKIs) has turned it into a chronic, manageable disease where most patients experience near normal life expectancy, particularly those diagnosed before age 65 years. Patients are required to continuously take their oral TKIs daily to produce the anticipated benefit of long-term survival. High out-of-pocket costs may lead to disparities in the initiation of and subsequent adherence to these expensive TKIs. Therefore, the goal of this dissertation is to assess the relationship between patient prescription cost sharing, …

Failed Initial Tumor Necrosis Inhibitor (Tnfi) Therapy – What Next For Rheumatoid Arthritis Patients?, Aliza Matusevich

Dissertations and Theses (Open Access)

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints affecting over 1.3 million Americans with annual societal costs estimated at $39.2 billion, rising faster than medical inflation. Therapy with tumor necrosis factor inhibitors (TNFi) has greatly improved the management of patients with rheumatoid RA; however, substantial numbers of patients do not experience an adequate response to these drugs, necessitating a change in treatment regimen. There are two basic approaches for TNFi failure: cycling (switching to a second TNFi) or swapping (to a drug with another mechanism of action) but the choice is controversial due to questions of comparative …

Testing Patterns For Syphilis And Other Sexually Transmitted Infections In Pregnant Women Presenting To Emergency Departments, Ifeoluwa Shoyombo

Dissertations and Theses (Open Access)

Following an initial decrease in the incidence of congenital syphilis from 2008-2012, the rate of congenital syphilis rose by 38% across the United States between 2012-2014 (2). This trend followed a 22% rise in primary and secondary syphilis cases in women during the same period.(1) Vertical transmission of syphilis is a significant public health concern, contributing to stillbirth, infant mortality, and neurologic and skeletal morbidities in survivors. (2) The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for sexually transmitted infections (STI) including HIV, syphilis, and hepatitis B at the first prenatal visit regardless …

Evaluating Religiosity Across The Lifespan And Fatalistic Beliefs Among Patients Of A Chronic Care Management Intervention Program With Type 2 Diabetes, Cindy Lynn Salazar

Dissertations and Theses (Open Access)

The overall goal of the present study was to assess the effect of fatalistic beliefs and lifetime religiosity on glycemic control and blood sugar monitoring behavior among Mexican-American participants of a chronic care management intervention program of the Rio Grande Valley. In order to achieve these aims, a mixed methods prospective longitudinal study design was utilized among approximately 500 participants of the Salud y Vida program. Qualitatively, a phenomenological approach was used to analyze semi-structured interview data assessing fatalism and religiosity and type 2 diabetes management among 15 participants stratified by engagement in the Salud y Vida program. Fatalistic beliefs …

Primary Care Shortage And Physician Migration In Texas: Analysis And Policy Implications, Adele Semaan

Dissertations and Theses (Open Access)

This study aims to gain a better understanding of primary care (PC) physician movements in Texas between 2010 and 2014. The first and second objectives were to identify the person- and place-specific factors associated with those physicians moving to PC shortage counties. The third objective was to clarify the policy landscape related to PC shortage and identify any associations these policies had with changes to PC physicians’ movements. The methods combined quantitative and qualitative approaches. The study used data on licensed physicians from the Texas Medical Board, and data on Health Professionals Shortage Areas from the Texas Health Professions Resource …

Big Tobacco. Big Marijuana? Longitudinal Trends And Multi-Directional Tobacco And Marijuana Use Among Youth And Young Adults In Texas, Shannon Rogers

Dissertations and Theses (Open Access)

Due to the pace of legal changes in marijuana policy, shifting trends in marijuana use, and emerging products in the tobacco product marketplace (e.g., ecigarettes), the cycle of risk between marijuana and tobacco use is not currently wellunderstood. I used longitudinal data from two parallel rapid response surveillance studies of youth (aged 12-19 years) and young adults (aged 18-25 years) living in the five counties (Bexar, Dallas, Harris, Tarrant, and Travis) that surround the four largest cities in Texas (Austin, Houston, San Antonio, and Dallas/Fort Worth). I used Generalized Linear Mixed Models (GLMMs) and six-panel cross-lagged regression models to analyze …

Evaluating The Impact Of Heal Pregnancy Intervention On Breastfeeding Initiation And Duration, Dolly Noel Rinehart

Dissertations and Theses (Open Access)

Despite nationwide improvements in breastfeeding behaviors, many minority, low-socioeconomic status women in the United States fail to follow breastfeeding recommendations. Healthy Eating Active Living (HEAL), a free antenatal program in Houston, Texas, teaches pregnant women healthy lifestyle behaviors and promotes breastfeeding. The objective of this paper was to determine the impact of HEAL on breastfeeding initiation and length of breastfeeding duration among predominantly low income, minority, underserved women in Houston, TX. Methods: HEAL is a natural experiment rooted in Social Cognitive Theory and Theory of Planned Behavior. Data was collected from two sources, the HEAL pregnancy post-delivery survey and the …

Assessing The Relationship Between University Environmental Health And Safety Program Resourcing And Ultimate Outcomes, Jason R. Shyu

Dissertations and Theses (Open Access)

College and university campuses contain a diverse set of potential health and safety risks mixed with a population that is equally varied. Such a combination requires effective risk management programs adapted to address these challenges. Methods currently exist to predict risk financing premiums and institutional risk control resources (inputs), but there are no models addressing relationships to final Environment Health & Safety (EHS) program outcomes (outcomes such as injuries or illnesses). Publicly available data obtained from the University of Texas System Office of Risk Management describing their 14 campuses was combined with publicly available data from the National Science Foundation …

Role Of Disinfectants In The Eradication And Propagation Of Clostridiodes Difficile Infection, Tasnuva Rashid

Dissertations and Theses (Open Access)

Introduction:

Clostridioides difficile is a motile, gram-negative, toxin-producing bacteria responsible for the majority of the nosocomial as well as community-acquired infection in the US and worldwide. A high rate of morbidity, mortality, recurrences, healthcare cost coupled with frequent epidemic outbreaks with drug-resistant strains has classified C. difficile as a pathogen with an urgent threat to human health. Current guidelines regarding disinfectant use are either limited or absent or are not effective in reducing the environmental burden of C. difficile. The aims for this study was first to determine the in vitro efficacy of select hospital disinfectants in eradicating the spores …

Machine-Learning And Statistical Subgroup Analyses Of Vasopressor Choice For The Treatment Of Non-Traumatic Subarachnoid Hemorrhage Using Electronic Health Records, Emy Anu Thomas

Dissertations and Theses (Open Access)

Abstract: Subarachnoid hemorrhage (SAH) is a life-threatening stroke caused by bleeding in the subarachnoid space. Delayed cerebral ischemia, a risk factor for death during non-traumatic SAH treatment, is often prevented by inducing hemodynamic augmentation through the administration of vasopressors. The three common vasopressors administrated to SAH patients are dopamine, phenylephrine, and norepinephrine. A recent study using Electronic Health Records (EHR) of nontraumatic SAH patients identified that the administration of phenylephrine is associated with lower hospital mortality; however, this study did not consider heterogeneity in treatment effects. Therefore, the goal of this paper is to study the heterogeneity in vasopressor treatment …

The Use Of Neoadjuvant Brachytherapy In Endometrial Cancer, Alison Yoder

Dissertations and Theses (Open Access)

Uterine cancer is the most common gynecologic malignancy in the United States with almost 62,000 cases expected in 2019. In general, treatment consists of primary surgery possibly followed by adjuvant radiation and/or chemotherapy. However, in cases with cervical involvement or when the patient is a non-surgical candidate, neoadjuvant treatment can be employed; specifically, neoadjuvant radiation with or without brachytherapy and/or chemotherapy. There have not been any large-scale studies looking at the addition of brachytherapy to external beam radiation in the neoadjuvant setting and whether or not its addition improves outcomes. In order to analyze this, the National Cancer Database was …

The Relationship Between Social Media Use And Depression In College Students: A Scoping Review, Susan Wu

Dissertations and Theses (Open Access)

Background: In 2017, 17.3 million adults in the U.S. (7.1% of all U.S. adults) have had at least one major depressive episode, with individuals ages 18-25 having the highest prevalence of major depression at 13.1%. Studies have looked at the association between social media (SM) use and depression with mixed findings. The goal of this research is to conduct a scoping review of existing evidence for the relationship between SM use and depression among college students.

Methods: Searches for articles published in the scientific literature were performed on PubMed, Embase and Scopus. Articles selected followed an inclusion criteria: studied SM …

Evaluating The Multivariate Relationship Between Breastfeeding, Early Childhood Obesity, Asthma, And Mental Illness In Dallas, Tx, Sitara Weerakoon

Dissertations and Theses (Open Access)

The aim of this study was to examine the associations between breastfeeding, asthma and mental illness in North Texas children aged two to five years, and to explore whether these associations are explained by the presence of obesity. The study population comprised of 1,174 children whose caregivers responded to a 2015 survey administered by Children’s Health and the Health & Wellness Alliance for Children. Information on breastfeeding, BMI, asthma, and mental illness were self-reported by primary caregivers. Of the 1,174 children, 61% were breastfed, 13% had asthma, and 17% had a mental illness. The odds of having asthma were 2.28 …

Numerical Study For Seamless Clinical Trials With Covariate Adaptive Randomization, Mengxi Wang

Dissertations and Theses (Open Access)

One important goal of the pharmaceutical industry is to evaluate new therapies in a time-sensitive and cost-effective manner without undermining the integrity and validity of clinical trials. Adaptive seamless phase II/III designs (ASD) have gained popularity for accelerating the drug development process and reducing cost. Covariate adaptive randomization (CAR) is the most popular design in randomized controlled trials to ensure valid treatment comparisons by balancing the prognostic characteristics of patients among treatment groups. Although adaptive seamless clinical trials with CAR have been implemented in practice1, the theoretical understanding of such designs is limited. In addition, current approaches to control the …

Long-Term Outcomes After Endovascular Stent Placement For Long-Segment Superficial Femoral Artery Lesions, Nader Zamani

Dissertations and Theses (Open Access)

Objective: Endovascular intervention is commonly pursued as first-line management of symptomatic, long-segment superficial femoral artery (SFA) disease. The relative effectiveness and comparative long-term outcomes among bare metal stents (BMSs), covered stents (CSs), and drug-eluting stents (DESs) for long-segment SFA lesions remain uncertain.

Methods: A retrospective cohort study identified patients with symptomatic SFA lesions measuring at least 15cm who successfully received an endovascular stent (BMS, CS, or DES). The outcomes were patency, patient presentation upon stent occlusion, amputation free survival (AFS), and all-cause mortality. Proportional hazards regressions and a multinomial logistic regression model were used to control for significant confounders.

Results: …

Lymphocyte-Specific Tyrosine Kinase Expression In Ovarian Cancer: A Valuable Prognostic Indicator, Emily Moss Hinchcliff

Dissertations and Theses (Open Access)

Cellular immune response, specifically tumor infiltrating lymphocytes (TILs), has been correlated to survival in epithelial ovarian cancer; however, specific gene expression patterns for this response remain poorly understood. The objective of this research was to investigate the prognostic and biologic significance of immune-related gene expression in high grade serous ovarian cancer (HGSOC). To do so, a panel of immune related gene expression was evaluated in HGSOC utilizing The Cancer Genome Atlas (TCGA) and validated in an independent cohort of ovarian tumors. Based on the strong association with survival, the cohort was grouped into LCK (lymphocyte specific tyrosine kinase) high and …

Clinical Diagnostic Whole Exome Sequencing For Infants In Intensive Care Settings: Outcomes Analysis And Economic Evaluation, Hadley Stevens Smith

Dissertations and Theses (Open Access)

Whole exome sequencing (ES) is an extensive form of genetic testing and increasingly used as a diagnostic tool. Clinical uptake of genome-scale sequencing occurred without clear guidelines for application or robust information regarding potential impact on patient health outcomes or cost of care. For infants in intensive care with suspected genetic conditions, ES can be especially powerful to identify a specific diagnosis and inform crucial decisions about medical care. However, little is known about the cost-effectiveness of ES compared to other diagnostic strategies. This project first assessed the literature on pediatric clinical ES. Then, using electronic medical record, diagnostic laboratory, …

Fire Department Support And Physical Activity Of Volunteer Firefighters: A Cross-Sectional Examination, Sarah Wagner

Dissertations and Theses (Open Access)

Greater health and fitness of volunteer firefighters protects them from cardiovascular disease-related deaths, reduces risk of injury, and improves job performance, which subsequently provides better protection for the majority of the U.S. population who is served by volunteers. Given the strong social support system characteristic of the U.S. fire service, there seems to be potential opportunity to influence the behaviors of firefighters by creating a culture that promotes healthy habits rather than unhealthy. Objective: Determine the association between fire department culture’s encouragement of physical activity and volunteer firefighters’ moderate- to vigorous-intensity aerobic activity. Methods: A cross sectional analysis was performed …

Evaluating The Impact Of Early Initiation Of Antiretroviral Therapy (Art) On Patient Outcomes Among Hiv-Infected Adolescents And Young Adults In Uganda, Hilda Sekabira Nakalema

Dissertations and Theses (Open Access)

Introduction: Since the introduction of anti-retroviral therapy (ART), treatment initiation criteria have continually been revised to start these lifesaving drugs before onset of advanced disease and optimize ART benefits for people living with HIV. However, little is known about the effect of these changes on treatment outcomes among young people. We evaluated the effect of such a policy change on long term adherence and treatment outcomes among young people, aged 15-24 years.

Methods: We conducted a retrospective cohort analysis of young people, 15-24years old, who started ART from January 2012 – December 2016. We used administrative data from the District …

Ends Device Types And Subsequent Use Of Combustible Tobacco Products Among Texas Youth, Aslesha Sumbe

Dissertations and Theses (Open Access)

The aims of the study were to determine whether ENDS device types (i.e., disposable devices, replaceable cartridges, and refillables) at initial, or first ENDS use is longitudinally associated with subsequent initiation of combustible tobacco products (cigarettes, hookah, cigars) and continued, past 30-day use of combustible and ENDS products. This study is a secondary analysis of data from the Texas Adolescent Tobacco and Marketing Surveillance system (TATAMS) study, a longitudinal cohort study of students who were in the 6th, 8th, and 10th grades (n = 3907) during the 2014-2015 academic year. Data were collected every 6 months, from 2014-2018. Using data …

Dynamic Competing Risk Model For Multi-Type Recurrent Events With Dependent Termination, Alokananda Ghosh

Dissertations and Theses (Open Access)

Cardiovascular disease (CVD), defined by the World Health Organization (WHO) as diseases that involve the heart and/or blood vessels is the number one cause of morbidity and mortality worldwide. In the United States more health care dollars are spent managing and treating CVD and/or its complications than any other disease process. Coronary heart disease (CHD) is the leading cause of deaths (43.8%) attributable to CVD, followed by stroke (16.8%), hypertension (9.4%) and heart failure (HF) (9%). CVD-related deaths and attendant morbidities, which include lifelong disability are in many cases preventable. This research proposes a dynamic risk model that handles multi-type …

Religious Identity Influence On Ethnic Minority Youth Risky Behavior, Laquitta Simpson

Honors Theses

Previous studies have assessed religious identity in adolescents, showing that stronger religiosity correlates with lower levels of stress, better occupational and academic performances, and overall better well–being in adolescents and young adults (Koenig et al., 2001). There is also evidence of differences across races in how religiosity influences areas of adolescent behavior. The purpose of the current study is to identify the association between the strength of religiosity in White and Black at-risk youths and their involvement in risky behaviors. Data was gathered from teens aged 16-19 who are currently enrolled in a military-style residential program (n = 80); …

Poetic Representation Of Immigrant Bengali Women From Queens, New York: A Qualitative Exploration Of Narrative In Relation To Physical And Cultural Migration, Tabashshum J. Islam

Publications and Research

Poetic Representation of Immigrant Bengali Women from Queens, New York: A Qualitative Exploration of Narrative in Relation to Physical and Cultural Migration is a qualitative poetic inquiry and collaborative creative writing project. Five participants were interviewed and invited to engage in a collaborative writing process with the themes of immigration, cultural negotiation, and oral family history. All participants identified as college-educated Bengali women with a connection to Queens, New York, as well as being an immigrant or relative of an immigrant in the United States. From transcriptions of one-on-one interviews and personal notes, research-poetry was created to center on the …