Health Psychology Commons^™

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 …

Assessing Hospitalizations Due To Assaults At Dell Seton Medical Center (2015-2018), Stephani L. Curry

Dissertations and Theses (Open Access)

Physical assaults are a major public health concern in the United States, with rates being on the rise during the last couple of years (WISQARS Nonfatal Injury Reports, n.d.). In Austin at the Dell Seton Medical Center [DSMC], physical assaults are a main reason for hospitalization, making up nearly 10% of their hospitalizations, with around 250 patients per year. No subgroup of the population is risk free from physical assaults; however, national data suggest some sociodemographic groups are at higher risk than others (“Injury and Violence Prevention”, n.d.). Given the diversity of Austin, TX, it was unclear whether local sociodemographic …

The Association Of Cell Phones With Adolescents' Academic Performance, Sleep, Time Spent With Friends, And Cyberbullying Exposure, Johanna E. Peyton

Dissertations and Theses (Open Access)

This study examined the association between owning or having access to a cell phone with/without internet access and adolescent academic performance, whether they met the guidelines for recommended nightly sleep, the amount of time spent with friends outside of school and the presence and frequency of cyberbullying experienced by 8th and 11th grade participants in the 2015-2016 SPAN study in Texas. This study also examined the association between gender of the adolescent and the above-mentioned outcomes.

The study group consisted of 5,421 adolescents from 8th grade and 3,635 from 11th grade. The 8th grade sample contained 51.48% males(48.6% females) and …

Exploring Prenatal Risk Factors Among Hispanic Children With Autism Spectrum Disorders. – A Pilot Study In The Rio Grande Valley, Lauren Tien

Dissertations and Theses (Open Access)

Background: Peer-reviewed studies suggest that a hostile gestational environment is associated with delayed neurological development in infants. Autism spectrum disorder (ASD) is estimated to affect 1 in 59 children in the United States; however, few studies have specifically investigated risk factors for autism in Hispanic children. Purpose: The University of Texas RGV Hispanic Autism Research Center (HARC) studied Hispanic children with ASD and their biological mothers to identify potential environmental exposures and prenatal risk factors that could impact the risk for ASD through preliminary research in the Rio Grande Valley. Methods: This pilot study recruited 25 Hispanic mothers and their …

The Impact Of The Aca Cost-Sharing Elimination Provision On The Utilization Of Breast, Cervical, And Colorectal Cancer Screening Services Among Insured Individuals In The United States, Sara Salah Atallah

Dissertations and Theses (Open Access)

Preventive cancer screenings are essential to early detect cancer and subsequently save lives. However, out-of-pocket expenditures for cancer screening services deter individuals from obtaining them. In an effort to improve the utilization of cancer screening, the Affordable Care Act (ACA) implemented a cost-sharing elimination provision that removes all forms of cost sharing including copayments, co-insurance and deductibles from certain preventive care services that are recommended by widely known scientific figures such as the United States Preventive Services Task Force (USPSTF). This study evaluated the impact of the ACA cost-sharing elimination provision for preventive care services from 2008 through 2016 using …

Spatial Analysis Of Exposure To Soil Heavy Metals, Oral Bioaccessibility And Risk Assessment In Houston, Texas, Tsai Shu Chu

Dissertations and Theses (Open Access)

Chronic exposure to heavy metals could lead to adverse health effects such as cancer, neurological development diseases and immunological diseases. The ingestion pathway has been considered the major exposure route for heavy metal contaminated soils. Heavy metals may be proportionally bioaccessible for the human body to absorb. There are no risk assessment studies done in Houston to evaluate health risks from exposure to heavy metals and no spatial analysis done yet. The aims of this dissertation are (1) to characterize 13 heavy metals: magnesium (Mg), vanadium (V), chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), zinc …

Stochastic Search Variable Selection Applied To A Bayesian Hierarchical Generalized Linear Model For Dyads, Adriana Lopez Ordonez

Dissertations and Theses (Open Access)

In behavioral science research, many outcomes of interest can be influenced by interpersonal relationships (Gyarmathy & Neaigus, 2007). To assess such outcomes, data can be collected using dyads. Each dyad has two elements, an actor, who responds to a stimulus and a partner, who can potentially influence the actor (Kenny, Kashy, & Cook, 2006). One popular model for analyzing dyadic data is the Actor Partner Interdependence model (APIM). In this study, we proposed a variable selection method applied to a probit Bayesian Hierarchical Generalized Linear Model (Bayesian HGLM) to fit the APIM to dyadic data. The proposed method used stochastic …

Kolmogorov-Smirnov Type Tests Under Spatial Correlations, Wenjun Zheng

Dissertations and Theses (Open Access)

Kolmogorov-Smirnov test is a non-parametric hypothesis test that measures the probability of deviations, that the interested univariate random variable is drawn from a pre-specified distribution (one-sample KS) or has the same distribution as a second random variable (twosample KS). The test is based on the measure of the supremum (greatest) distance between an empirical distribution function (EDF) and a pre-specified cumulative distribution function (CDF) or the largest distance between two EDFs. KS test has been widely adopted in statistical analysis due to its virtue of more general assumptions compared to parametric test like t-test. In addition, the p-value derived from …

Stress Inoculation Training Outcomes Among Veterans With Ptsd And Tbi, Sarah E. Jackson, Matthew Baity, Jeannette Giorgio, Diane Swick

Faculty, Staff and Student Publications

Objective: Stress inoculation training (SIT) is a cognitive-behavioral treatment that has demonstrated potential as a nontrauma based intervention for veterans with posttraumatic stress disorder (PTSD). The purpose of this study was to explore the efficacy of a novel 3-phase group formulation of SIT applied to a naturalistic population of veterans with PTSD and traumatic brain injury (TBI). The goals were to reduce symptoms of PTSD and depression, improve perceived functioning, and increase treatment initiation among veterans who were reticent to initiate established evidence-based and trauma-focused therapies. Method: A program development and evaluation archival analysis of 65 veterans engaged in SIT …

Dynamic Prediction Of Survival Data Using Single Or Multiple Longitudinal Markers, Xuehan Ren

Dissertations and Theses (Open Access)

Recurrent events and time-to-event data occur frequently in longitudinal studies. In large clinical trials with survival endpoints, researchers collect a multitude of longitudinal markers. There is a growing need to utilize these rich longitudinal information to build prediction models and assess their prognostic performance. In this dissertation research, I propose a novel approach of integrating longitudinal markers in modeling the recurrent event or terminal event data, and conduct dynamic prediction of event risks. Under joint a model framework, I jointly model a longitudinal outcome and a recurrent event process with the two process correlated via shared latent function. The probability …

Characterizing Young Adult Exposure And Engagement With Social Media Tobacco And Nicotine Product Marketing And Messaging, Stephanie L. Clendennen

Dissertations and Theses (Open Access)

Tobacco use remains a critical public health issue in the United States. Young adults are disproportionately affected by high rates of tobacco use and heavily targeted by tobacco marketing. Social media has become an important source of exposure to tobacco and nicotine product marketing and messaging for young adults. This dissertation examined the prevalence and socio-environmental characteristics associated with young adults’ exposure to and engagement with tobacco-related social media (paper 1); the prospective associations between young adults’ exposure and engagement and tobacco and nicotine product use (paper 2); and young adults’ experiences with tobacco and nicotine product messaging on social …

Identifying Risk Factors Associated With Cardiovascular Disease Risk In Lesbians, Sofia S. Velazquez

Dissertations and Theses (Open Access)

Cardiovascular disease (CVD) is the leading cause of female deaths in the United States (1). While women, in general, are at risk for CVD, current research indicates that sexual minority women (i.e. lesbians and bisexual women [SMW]) may be at greater risk for CVD than heterosexual women. This heightened risk potentially stems from an increased prevalence of traditional CVD risk factors in SMW, creating health disparities between SMW and their heterosexual counterparts (2). Further research into this high-risk population is needed, in order to minimize these disparities.

The purpose of this study was to establish differences in the prevalence of …

Hemoglobin A1c Improvements And Better Diabetes-Specific Quality Of Life Among Participants Completing Diabetes Self-Management Programs: A Nested Cohort Study, Abhinav Khanna

Dissertations and Theses (Open Access)

Background: Numerous primary care innovations emphasize patient-centered processes of care. Within the context of these innovations, greater understanding is needed of the relationship between improvements in clinical endpoints and patient-centered outcomes. To address this gap, we evaluated the association between glycosylated hemoglobin (HbA1c) and diabetes-specific quality of life among patients completing diabetes self-management programs.

Methods: We conducted a retrospective cohort study nested within a randomized comparative effectiveness trial of diabetes self-management interventions in 75 diabetic patients. Multiple linear regression models were developed to examine the relationship between change in HbA1c from baseline to one-year follow-up and Diabetes-39 (a diabetes-specific quality …

Relationship Between Nursing Safety Culture And Patient Perception Of Safety In Inpatient Units Of An Academic Specialty Hospital, Miguel Angel Lozano Garcia

Dissertations and Theses (Open Access)

The objective of this research was to analyze the relationship between nursing safety work culture in inpatient nursing units of a specialty academic hospital and their patients’ perception of safety using quantitative and qualitative methods. The aim of the quantitative study was to quantitatively evaluate whether nursing safety culture, as measured on the Hospital Survey on Patient Safety Culture (HSOPS) safety questions of the institutional employee opinion survey, was associated with patients’ perception of safety during their inpatient care, as measured by responses on the inpatient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The aim of the …

Factors Contributing To Lower Cancer Screening Utilization In A Sub-Sample Of United Way 2-1-1 Callers, Jason M. Rhoton

Dissertations and Theses (Open Access)

This dissertation was a secondary analysis of data from a Cancer Prevention Research Institute of Texas (CPRIT)-funded [grant # PP100077 & PP120086] cancer-control intervention with The University of Texas Health Science Center at Houston (UTHealth) School of Public Health and United Way 2-1-1. The aims of the three dissertation papers were addressed by examining a sub-sample of 2-1-1 callers that were drawn from the parent study baseline data. Participants were required to need at least once cancer prevention service to be included in the parent study and dissertation analyses. This dissertation was a cross-sectional analysis of de-identified data examining the …

Sex-Specific Effects And Gene-Sex Interactions In Serum Metabolome Levels: The Atherosclerosis Risk In Communities Study, Zhe Wang

Dissertations and Theses (Open Access)

Metabolomic signatures associated with complex disease have been identified. Metabolomic profiling and the integration of genomic data have proven to be powerful tools to investigate genetic effects underlying intermediate phenotype levels and may facilitate improved understanding of pathophysiologic processes of disease. However, most published studies did not consider sex as an effect modifier, analyze sex-specific effects, nor gene by sex interactions. One reason can be incomplete knowledge of the power of statistical methods used in a given dataset.

I first investigated sex-specific genetic effects by performing sex-stratified exome-wide association studies for 271 chromatography-mass spectrometry measured metabolites in the Atherosclerosis Risk …

Relating Rsv Genetic Diversity To Global Transmission Dynamics, Rebecca J. Fisk

Dissertations and Theses (Open Access)

Many studies of Respiratory Syncytial Virus (RSV) have relied on analyses of the Major Surface Glycoprotein G gene (G gene). Global transmission patterns have not been well studied due to lack of systematic global surveillance efforts. This study used phylogenetic analysis of full genome data, categorized by geo-region, to determine the sources of RSV A and B infection in Chile and Houston, Texas. Additionally, disease severity studies have generally focused on outcomes associated with a single genotype. In this study we developed a statistical phylogenetic approach to explore the relationship between tree topology and disease severity. Disease severity data included …

Bayesian Based Semiparametric Multidimensional Approaches To Analysis Parkinson's Disease, Jun Zhang

Dissertations and Theses (Open Access)

In the slow progression of Parkinson's Disease (PD), impairments arise and affect multiple domains (e.g., motor, cognitive, and behavioral). Mixed types, multivariate longitudinal data are commonly used in PD studies. Challenges exist in assessing PD status and investigating disease progression due to lack of biomarkers and ubiquitous impairment in the disease. We proposed a model framework by combining the semi-parametric approach and multi- dimensional framework, and used the proposed model to investigate the heterogeneous disease development and the non-linear treatment effects in the multiple domains predefined in PD.

Furthermore, we extended the semi-parametric multidimensional approach to the data with multi-types …