Health Psychology Commons^™

The Associations Between Fat And Clinical Outcomes Among Lung Cancer Patients: Dietary Intake And Genetic Determinants, Fang Yu Lin

Dissertations and Theses (Open Access)

Higher dietary fat intake and alterations in fatty acid metabolism may affect cancer development and progression. This dissertation conducted a series of studies examining whether dietary fat intake and genetic variants in fatty acid metabolism genes have an impact on clinical outcomes among non-Hispanic whites newly diagnosed with non-small cell lung cancer (NSCLC). First, a cohort of 2,262 NSCLC patients was prospectively examined for intakes of total, saturated, monounsaturated, and polyunsaturated fat in relation to overall survival and recurrence. Dietary fat intake at diagnosis was assessed with a previously validated food frequency questionnaire and categorized by Dietary Reference Intakes. Multivariable …

External Environmental Dimensions And Financial Performance Of Major Teaching Hospitals In The U.S, Karima Lalani

Dissertations and Theses (Open Access)

Background: Teaching hospitals have a unique mission to not only deliver graduate medical education, but to also provide both inpatient and ambulatory care, and to conduct clinical and medical research; therefore, they are under constant financial pressure, and it is important to find out what types of external environmental components affect their financial performance. No recent studies have been comprehensively conducted for all major teaching hospitals in the U.S. to examine if there is an association between the external environmental dimensions based upon Resource Dependence Theory (Munificence, Uncertainty, Complexity) and the short-term financial performance, measured by days cash on hand …

Access To Antibiotics Without Prescription For Travelers And Colombian Citizens At Community Pharmacies In Bogota, Colombia, Marie Kasbaum

Dissertations and Theses (Open Access)

The misuse of antibiotics has been shown to exacerbate the global antibiotic resistance crisis, which could have major consequences on public health worldwide (Auta et al., 2018). In Bogotá, Colombia, the non-prescription sale of antibiotics still occurs in pharmacies despite national regulations requiring a prescription from a physician or health agency before dispensing antibiotics to a patient (Vacca et al., 2011). The purpose of this study was to investigate the non-prescription sale of antibiotics in community pharmacies to foreign travelers and Colombian citizens in Bogotá, Colombia. Trained Simulated Clients (SCs) gathered experimental data in pharmacies distributed throughout 20 geographic districts …

Examining Differences In Physical Activity By Socio-Demographics, Employment, And Social Support Among U.S. Adolescents, Ashleigh Marie Johnson

Dissertations and Theses (Open Access)

The overall decline in physical activity levels during adolescence supports the examination of intrapersonal-, interpersonal-, and behavior-level factors that may influence physical activity behavior among this population. The three papers within this dissertation aimed to examine associations of socio-demographics and socio-environmental factors with physical activity among U.S. adolescents. Papers 1 and 3 used data from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. Paper 1 examined differences in adolescent physical activity by gender and race/ethnicity, and examined modification by grade and socioeconomic status (SES). Paper 3 examined the association of parent- and adolescent-reported parental social support with adolescent …

Nonlinear Functional Models On Causal Inference, Rong Jiao

Dissertations and Theses (Open Access)

Statistical analysis has experienced significant progress on association study, but it remains elusive to understand the etiology and mechanism of complex phenotypes. As a major analytical platform, association analysis may hamper the theoretic development of biomedical science and its application. Thus, many researchers suggest making the transition from association to causation. The mainstream of research in genetics and epigenetics data analysis focuses on statistical association or exploring statistical dependence between variables. Despite significant progress in dissecting the genetic architecture of complex diseases by genome-wide association studies (GWAS), the signals identified by association analysis can only explain a small proportion of …

Understanding The Relatlonships Between Survivorship Care Plans And Survivor Level Outcomes Among Breast And Colorectal Cancer Survivors, Jessica Danielle Austin

Dissertations and Theses (Open Access)

PURPOSE: Cancer survivors have complex journeys following the completion of active treatment. The Institute of Medicine and other high-profile organizations have recommended and mandated the use of a survivorship care plan (SCP) despite mixed evidence supporting the impact of SCPs on key survivor-level outcomes. The purpose of this dissertation was to understand the complex relationship linking the delivery of SCPs and to relevant survivorlevel outcomes. STUDY GROUP: This dissertation focuses on breast and colorectal cancer survivors because they comprise nearly 30% of the entire cancer survivor population in the US and are the two most prevalent cancers in men and …

Ashtanga For Addiction: A Qualitative Web-Based Open-Ended Survey To Assess Outcomes From Ashtanga Yoga Practice In Individuals In Long-Term Recovery From Substance Abuse Disorder, Shaun M. Jones

Dissertations and Theses (Open Access)

Over 72,000 people die from overdose or secondary health issues related to substance use disorder (SUD) annually. Studies support mind-body interventions in reducing stress, anxiety, depression, and craving symptoms. There is a growing body of literature supporting yoga as a mind-body intervention for individuals recovering from SUD. These interventions promote improved physical awareness, greater awareness of mental states, non-reactivity, and reduced perception of pain, allows for more successful coping with cravings. Ashtanga yoga (AY) is a tradition of yoga wherein students work on a one-on-one basis with highly qualified teachers following an invariant sequence of yoga postures. AY is characterized …

Mhealth Childhood Obesity Prevention: A Look Into The Hispanic Mother’S Perspective, Veronica Isabel Gonzalez

Dissertations and Theses (Open Access)

Along with increasing physical activity, improving nutrition is an important behavior to target to reduce the risk of obesity in children and adolescents. To date, a nutrition-focused mHealth intervention used to promote obesity prevention and healthy living among Hispanic children and adolescents has not been specifically developed for Hispanic mothers. The purpose of this study was to provide information on feasibility and acceptability of a mHealth child nutrition intervention among Hispanic mothers. The data was collected from an online survey and telephone interviews from 30 mothers of 8-12-year-old Hispanic girls. Most mothers were 40 years old or younger (70%), identified …

Climate Change And Chagas Disease In The Americas: A Qualitative Systematic Review, Brittany N. Graves

Dissertations and Theses (Open Access)

While many studies have found associations between climate change and factors affecting Chagas disease transmission, the future impact of climate change on the global spread of Chagas disease remains debatable. A qualitative, systematic review was conducted to assess the impact of climate change on Chagas disease transmission in the Americas (Central America, South America, and North America). The literature search was performed in January 2019 using the keywords climate, Chagas, and “trypanosoma cruzi” and the electronic databases PubMed, Scopus, and Ovid. Searches retrieved records from 1982 through 2019. The initial electronic database search identified a total of 191 record documents …

Perceived Discrimination From Providers On Latina Mothers’ Decision-Making On Hpv Vaccination Initiation And Completion In Houston, Tx, Fatima Frausto

Dissertations and Theses (Open Access)

Background: Human papillomavirus (HPV) is one of the most common sexually transmitted infections (STI) in the United States (US). Certain HPV strains have the potential to develop into cervical, anal, penile, vulvar, and throat cancers. Latinos in the U.S. have the highest rates of cervical and penile cancers compared to non-Hispanic Whites. Despite the availability of HPV9v, uptake of the vaccine is suboptimal in the Latino community. Previous research has found factors such as provider recommendation and communication are important in HPV vaccine series initiation and completion. Discrimination in the medical setting is linked to poorer health outcomes and delayed …

“He’S Not Too Young”: Empowering Parents In Child Language Development Through Upwords, A Parenting Education Program, Lynda Chima Aririguzo

Dissertations and Theses (Open Access)

Community-based early literacy intervention programs show promise in improving the home language environment, particularly for children at increased risk of language delays and poor school readiness. However, the literature on parents’ perspective of these programs is limited. This study investigated the perspectives and language scores of participants in upWORDS, a community-based literacy intervention program in Houston, TX. Through mixed-methods, this study aimed to describe the program’s impact on parents’ views on child development, changes in child behaviors, and continued application of information from the program. It also aimed to identify patterns in parent-reported measurements of children’s language skills over time. …

Uses Of Continuous-Time Markov Chain To Describe Longitudinal Patient-Reported Outcomes For Survival Prediction And Dimension Reduction, Ting-Yu Chen

Dissertations and Theses (Open Access)

A patient-reported outcome (PRO) is a type of outcome reported directly from patients, and it has been widely used in medical research and clinical trials to measure a patient’s symptoms, health-related quality of life, physical functioning, and health status. Previous studies have linked PROs to survival outcomes, but most of them only used the PRO information at baseline or at a specific clinical time point [1, 2]. Even though some of these studies collected longitudinal PROs, only few of them evaluated the association between the longitudinal PROs and a survival outcome. One of the major challenges in longitudinal PRO studies …

Hepatitis C Infection In Men Who Have Sex With Men, Jing Zhao

Dissertations and Theses (Open Access)

Hepatitis C virus (HCV) infection is the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation. Current treatment rates and efficacy are inadequate to manage the disease burden caused by HCV; thus, efforts are needed to control HCV transmission. Besides the well-known transmission routes, which are health-care-associated transmission and transmission through injecting drugs, HCV could also be transmitted by sexual contact, especially among men having sex with men (MSM). MSM also have higher drug use prevalence than the general population, which may contribute to HCV infection by sexual disinhibition and other risky behavior. Since 2000, there have been emerging reports …

Utilization Of Mind-Body Practices For Adults With Fibromyalgia: 2017 National Health Interview Survey, Jennifer Contreras

Dissertations and Theses (Open Access)

Fibromyalgia (FM) is a medical condition characterized by chronic pain and tenderness. Individuals with FM may experience burdensome symptoms, which impact their health-related quality of life. Treatment for FM includes pharmacological and non pharmacological practices. Non-pharmacological treatments for FM include dietary management, routine exercise, and physical and mind-body therapies. There is growing evidence that the utilization of mind-body practices is increasing in the United States, but there have been limited investigations done to observe the use of mind-body practices in the FM population. The purpose of this study is to identify predictors of the use of meditation and/or meditative movement …

The Impact Of Food Security Status On The Food Shopping Behavior And Patterns Of 2018 Brighter Bites Participants At Baseline, Sarah A. Crulcich

Dissertations and Theses (Open Access)

Households with children continue to have a greater prevalence of food insecurity compared to the national average. While the national food security rates have improved in recent years, it remains stagnant among children. The purpose of this study was to conduct a cross-sectional regression analysis on food shopping patterns and behavior among Brighter Bites participants stratified by food security status to offer more insight into how these households obtain fresh produce. We used baseline survey data from Brighter Bites participants completed during fall 2018. The results indicate that food insecure Brighter Bites households shop more frequently for produce at locations …

Novel Propensity Score Methods For Multiple And Continuous Treatments: Applications To Ehr Data, Derek W. Brown

Dissertations and Theses (Open Access)

Propensity scoring is often utilized to overcome the challenges posed by covariate imbalance to make causal inferences within observational studies. While methods for utilizing propensity scoring in a binary treatment case are well studied and established, generalizations to multiple unordered (multinomial) and continuous treatments are more complicated. In Aim 1, we developed and tested a novel multinomial treatment propensity score method, the GPS-CDF method, which derives a single scalar balancing score that can match and stratify subjects. Simulation results showed superior performance of the new methodology compared to standard multinomial propensity score methods. The proposed GPS-CDF method was also applied …

Tuberculosis Among Dairy Workers In Bailey County, Texas, Anabel Rodriguez

Dissertations and Theses (Open Access)

On January 2016, Texas State Department of Health Services (DSHS) Public Health Region 1 (PHR 1) conducted T-SPOT.TB tests in response to two requests to screen dairy workers potentially exposed to cattle infected with Mycobacterium bovis or bovine tuberculosis (bTB) in Bailey County, Texas. Out of 140 workers tested, 14 had confirmed latent tuberculosis infection (LTBI)—prevalence of 10.0%. This first study gave rise to questions concerning tuberculosis (TB) knowledge and exposure history among dairy workers in this same county. The second study focused on determining TB knowledge among dairy workers through a series of questions administered by research personnel on …

Assessing The Readiness Of Relatives To Undergo Cascade Genetic Testing For Inherited Predispositions To Cancer Using The Transtheoretical Model Stages Of Change, Erica M. Bednar

Dissertations and Theses (Open Access)

National guidelines recommend cascade genetic testing (CGT) for blood relatives after a cancer predisposition gene mutation is identified in an individual. Despite recommendations for CGT, only 30-60% of first-degree relatives (FDRs) complete CGT. The proportion of untested relatives who are planning to have CGT is unknown. We used the Transtheoretical Model to assess the readiness (stage of change) for CGT among living, untested FDRs at-risk for a hereditary predisposition to cancer. An anonymous, online survey was open to U.S. adults with an autosomal dominant, adult-onset, hereditary predisposition to cancer. Participants reported demographic information, their genetic testing information, and information on …

The Effect Of Hospital Engagement Network Participation On Central Line-Associated Bloodstream Infections And Readmission Rates, Tyler Wallace

Dissertations and Theses (Open Access)

In 2012, the Centers for Medicare and Medicaid Services (CMS) launched the Hospital Engagement Network (HEN) program to decrease patient harm events in United States’ (US) hospitals. The HEN program became the nation’s largest quality improvement collaborative (QIC) focusing on improving patient care. Results from the program’s formal evaluation were inconclusive on whether the HEN program was effective. There have been no other known studies on this program’s effectiveness. Even with the evidence lacking, the CMS continues to fund programs similar to the HEN program. This study’s research aim was to compare patient outcomes for HEN participants to nonparticipants to …

Evaluation Of Food Journal Application Validity In Comparison With Dhq Iii, Michael Roa

Dissertations and Theses (Open Access)

As chronic conditions associated with the high prevalence of obesity/overweight in the United States continue to rise, research focusing on nutrition has grown in recent years. The gold standard for collecting detailed nutritional information on individuals is food journals, mostly via pen and paper. Alternatively, smartphone food journal applications have become more popular and widely accessible in recent years. These applications allow the user to quickly make meal entries, often taking advantage of the application’s food and servings database.

This study compared the results of the third iteration of the Diet History Questionnaire (DHQ III) with a dietary journal data …

Epidemiology Of Tuberculosis In Internationally Displaced Children Resettling In Harris County, Gabriella S. Lamb

Dissertations and Theses (Open Access)

Background More than 300,000 refugees arrived in the United States (U.S.) from 2010-2015, and Texas accepts the 2nd highest number of refugees. Texas also accepts large numbers of asylees, parolees, and special immigrant visa holders. Additionally, a large proportion of trafficked persons in the U.S. live in or pass through Texas. Foreign-born children are disproportionately affected by tuberculosis (TB) and account for two-thirds of U.S. childhood TB cases. Children are at greater risk for progression from TB infection to disease and experience greater morbidity and mortality from TB disease. This makes screening for and treatment of TB infection in children …

Trends In Advanced Hiv Disease And Long-Term Outcomes Of Hivinfected Children Treated With Antiretroviral Therapy In Eastern And Southern Africa: 2003-2017, Peter James Elyanu

Dissertations and Theses (Open Access)

Despite the over 10-years’ experience providing pediatric antiretroviral therapy(ART) and implementing different WHO guidelines, data on updated trends (after 2010) in advanced disease at ART start, and on long-term survival of children receiving ART are scarce. Without these data, the impact of recent WHO guidelines on early treatment initiation and long-term survival remains unclear. First, we examined trends in advanced disease at ART start, then described 10-year survival and investigated risk factors of early mortality in children treated with ART and lastly examined the association between rapid ART initiation and outcomes (mortality and loss to follow-up) of HIV infected. We …

Cost-Effectiveness Of Collegiate Recovery Programs, Sierra Castedo De Martell

Dissertations and Theses (Open Access)

The prevalence of substance use disorders (SUDs) is greater among full-time college students and young adults regardless of enrollment status than it is among any other age group (1,2). These disorders represent substantial costs to both society and to institutions of higher education, both in terms of life years lost and in lost tuition revenue. The recent proliferation of collegiate recovery programs (CRPs) – supportive communities and resource centers for students seeking to maintain SUD recovery while pursuing a higher education – have the potential to help ameliorate some of these costs. While these CRPs are typically low-cost compared to …

Diagnostic Coding Of Physical Abuse Among Patients Evaluated By A Multidisciplinary Child Protection Team In A Pediatric Level I Trauma Center, Holly Hughes Garza

Dissertations and Theses (Open Access)

Child abuse is a substantial public health problem. Numerous studies have used hospital discharge data coded using the International Classification of Diseases, 9th and 10th Editions, Clinical Modification (ICD-9 and ICD-10) to identify cases of physical abuse seen in hospitals. Published studies on the sensitivity and specificity of ICD coding for physical child abuse are limited using ICD-9, and non-existent with ICD-10. This study examined the accuracy of ICD coding for physical child abuse, among patients less than 18 years of age, who were evaluated due to concern for physical abuse by a Multidisciplinary Child Protection Team (MCPT) during 2012-2013 …

The Prevalence Of Practicing Safety Professionals’ Knowledge, Involvement, And Competency Associated With Workplace Wellness Programs: Gauging The Safety Profession’S Engagement With The Total Worker Health Initiative, Jennifer C. Laine

Dissertations and Theses (Open Access)

The morbidity and mortality burden of occupational injuries and illnesses in the United States became such a public health concern that in 1970 the Occupational Safety and Health Act was signed into law. This law requires employers to provide workplaces “free from recognized hazards” and spurred the development of specific regulations along with the creation of academic and professional training programs to educate individuals about the safety sciences and careers in safety fields. Today there are an estimated 26,000 professionally trained and board certified safety professionals supporting workplace programs across the country, alongside numerous non-certified, but degreed, practicing safety professionals. …

Predictors Of On-Treatment Mortality Of Patients Undergoing Palliative Radiation Therapy: Improving The Quality Of End-Oflife Cancer Care, Matthew Stephen Ning

Dissertations and Theses (Open Access)

PURPOSE: Excessive medical treatment at end-of-life is an indicator of poor quality care. While radiation therapy (RT) is effective for palliation, some patients die shortly after or even during treatment. Any treatment that requires terminal patients to spend significant time in the hospital setting contradicts palliative goals. This study investigates patterns of end-of-life RT to inform quality improvement initiatives.

METHODS: All patients who died within 6 months of starting RT at a single large academic cancer center between 2015 through 2018 were identified through our institutional databases on an Institutional Review Board-approved protocol. Clinical factors including age, treatment service, number …

Measuring Goal Attainment In Chronic Disease Self-Management Within Clinical And Research Contexts: Development And Initial Testing Of The Goal Attainment Outcome Measure For Stroke (Gam-S), Barbara Kimmel

Dissertations and Theses (Open Access)

Background and Aims: Self-management (SM) skills help stroke survivors achieve behavior risk factors control. Goal setting and attainment are fundamental for SM. The most salient elements of SM effectiveness and measurements are just beginning to be understood. Investigation of measurement of goal attainment of SM risk factors has been the major aim of the study. My dissertation explores research questions concerning the goal attainment measure using data collected at the Veterans hospital.

Methods and Results: Introductory Chapters 1 and 2, include the background on stroke prevention through self-management interventions and a preliminary literature review of goal attainment in the context …

Social Capital And Health Services Utilization In Msm, Edward Tsai

Dissertations and Theses (Open Access)

While incidence of HIV has decreased overall and in most population subgroups, men who have sex with men (MSM) continue to remain at disproportional risk for new infection. In particular, MSM of color experience HIV incidence rates that continue to rise and represent the overwhelming majority of new cases each year. Evidence suggests greater risk among MSM may not be attributable primarily to individual behavioral level factors, but instead to structural and social environmental level factors such as access to health services. Access to health services represents a critical link in HIV and STI prevention, as health services provide serological …

Comparative Analysis Of Early And Late Tracheostomy Among Patients With Acute Heart Failure Exacerbation, Trends, Clinical And Economic Outcome Assessment, From 2005 To 2014 Nationwide, Min Ji Kwak

Dissertations and Theses (Open Access)

Heart failure is one of the leading causes of high morbidity and mortality. Acute exacerbation of heart failure may result in acute respiratory failure, which requires mechanical ventilator support. Despite supportive management, patients can fail extubation of the endotracheal tube and need a tracheostomy to continue mechanical ventilator support. However, optimal timing of tracheostomy has been controversial. Systemic study to assess the clinical and economic outcome of early tracheostomy among patients with acute heart failure exacerbation is lacking. The purpose of the study was to assess the national trend of tracheostomy among those who are admitted for acute respiratory failure …

Concurrent And Concordant Oral And Genital High Risk Human Papillomavirus Infections In The United States Population; Results From National Health And Nutrition Examination Survey (Nhanes), James M. Custer

Dissertations and Theses (Open Access)

Human papillomavirus (HPV) is a common sexually transmitted disease which infects various sites in the body including the genitals, oral cavity, and anal regions. Very little research has assessed the prevalence of concurrent and concordant high risk (HR) HPV oral and genital infections in the general United States population despite the fact that HR HPV oral pharyngeal cancers are on the rise in the US, particularly in men. To further our understanding of HR HPV concurrent and concordant infections we aim to estimate the prevalence of HR HPV concurrent and concordant infections in the U.S. population, and for men and …