Epidemiology Commons^™

Food Environment As A Moderator In The Relationship Between Ultra-Processed Food Intake And Mortality In The United States, Brandon Jerod Grandy

Walden Dissertations and Doctoral Studies

According to recent studies, the consumption of ultra-processed food is a major issue that leads to fatal outcomes within the United States, which is relevant because this type of food has become more accessible over the years. Using data from the National Health And Nutrition Examination Survey III (NHANES III), previous researchers found that frequent consumption of ultra-processed foods was associated with greater chances of all-cause mortality in U.S. adults, but little research has focused on factors that can impact ultra-processed food consumption, such as food environment. The purpose of this quantitative longitudinal study was to examine the effect of …

Relationship Between Maternal Language And Use Of Electronic Cigarettes In Pregnancy, Tara Halpern

Walden Dissertations and Doctoral Studies

Tobacco use has been a long-standing known modifiable risk factor to maternal health. Although there have been many efforts to encourage smoking cessation, use of electronic cigarettes in pregnancy has been increasing over the years. Understanding potential factors that may play a role in the increased use of electronic cigarettes is important to improve maternal and fetal health outcomes. The social ecological model provides the theoretical framework for this study. The purpose of this study is to determine whether a woman’s primary language and pregnancy health care factors (i.e., access to health care 12 months prior to pregnancy, access to …

Effect Of Treatment, Stage Of Lung Cancer, And Socioeconomic Status On Life Expectancy Within Marginalized Communities, Elsadig Ahmed Elsharif

Walden Dissertations and Doctoral Studies

Lung cancer is one of the most common cancers in the United States, and it accounts for 25% of cancer deaths. About 70% of cancer cases are diagnosed during late stages, leading to poor outcomes. An estimated 60% of cancer cases involve underserved and disadvantaged communities. However, there are limited studies had addressed effects of treatment, stage of lung cancer, and socioeconomic status on life expectancy within marginalized communities. Research questions examined effect of treatment, stage of lung cancer, and socioeconomic status on life expectancy of lung cancer patients between 2009 and 2019. This study was grounded in the deductive …

Age, Race/Hispanic Origin, And Covid-19 Mortality Among Sickle Cell Disease Patients In The United States, Joe Lamont Ndula

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic remains a global health challenge, with 6.7 million deaths worldwide as of January 2023. It has illuminated the health iniquities in underserved communities and populations like those with sickle cell disease (SCD). Researchers have associated the COVID-19 outcome among SCD patients in other regions of the globe. The purpose of this retrospective cross-sectional observational study was to investigate the relationship between age, race/Hispanic origin, and COVID-19 mortality among persons with SCD in the United States from January 2020 to March 2021. The Krieger ecosocial theory of disease distribution framed the study. Data were drawn from an existing …

Predictors Of Retention Among Individuals With Hiv Initiating Antiretroviral Therapy In Ghana, Ivy Ama Okae

Walden Dissertations and Doctoral Studies

Abstract Managing HIV requires lifelong therapy. Retaining clients on lifelong therapeutic antiretroviral therapy (ART) ensures the suppression of viral replication and better health outcomes. The time of the start of ART management is also a factor in determining better health outcomes for persons living with HIV. This study examined the association between initiation criteria (treat all, Option B+, and CDC T-cell count < 500) and retention on ART at 12 months for 17,974 randomly selected clients in the Ghana Health Service's HIV patient electronic database. Analyses controlled for age, gender, educational status, alcohol use, treatment/adherence monitoring, and tuberculosis disease treatment. Bronfenbrenner's ecological systems theory guided the interpretation of the findings. Results shows that retention was positively associated with all treatment initiation criteria. Clients initiated with CD4 count ≤ 500 criteria seemed to be retained at 12 months on ART at a higher rate than initiation criteria based on Option B+ and treat all. The study results may contribute to positive social change by supporting CD4 testing for clients before initiation of ART to improve retention and ensure the availability and use of adherence counseling, no tuberculosis disease and its prevention, and low use of alcohol among people living with HIV. The results of this study may also provide opportunities for public health policy intervention efforts requiring a personalized, group-based approach to service delivery at the intrapersonal level, interconnected with interpersonal, meso, and meta factors at the community level.

Food Environment As A Moderator In The Relationship Between Ultra-Processed Food Intake And Mortality In The United States, Brandon Jerod Grandy

Walden Dissertations and Doctoral Studies

According to recent studies, the consumption of ultra-processed food is a major issue that leads to fatal outcomes within the United States, which is relevant because this type of food has become more accessible over the years. Using data from the National Health And Nutrition Examination Survey III (NHANES III), previous researchers found that frequent consumption of ultra-processed foods was associated with greater chances of all-cause mortality in U.S. adults, but little research has focused on factors that can impact ultra-processed food consumption, such as food environment. The purpose of this quantitative longitudinal study was to examine the effect of …

Effect Of Treatment, Stage Of Lung Cancer, And Socioeconomic Status On Life Expectancy Within Marginalized Communities, Elsadig Ahmed Elsharif

Walden Dissertations and Doctoral Studies

Lung cancer is one of the most common cancers in the United States, and it accounts for 25% of cancer deaths. About 70% of cancer cases are diagnosed during late stages, leading to poor outcomes. An estimated 60% of cancer cases involve underserved and disadvantaged communities. However, there are limited studies had addressed effects of treatment, stage of lung cancer, and socioeconomic status on life expectancy within marginalized communities. Research questions examined effect of treatment, stage of lung cancer, and socioeconomic status on life expectancy of lung cancer patients between 2009 and 2019. This study was grounded in the deductive …

Gender Disparities: 5 Year Survival Rates Of Elderly Colorectal Cancer Patients With Depression, Riya Joshi

Walden Dissertations and Doctoral Studies

AbstractColorectal cancer (CRC) is a life-threatening health condition known to greatly affect the elderly than younger populations. CRC, if comorbid with mental condition such as depression, can seriously affect patients’ quality of life with a direct influence on the survival rate. There is a connection between depression and worsened cancer progression and survival rate of CRC, little is known on gender differences in survival rates on elderly CRC patients with pre-existing depression (PD). A socioeconomic model study was used to evaluate gender, initial diagnostic stage, and marital status (MS) at diagnosis as major independent variables and 5-years survival rate (5-YS) …

Driving After Marijuana Use Among Us College Students During The Covid-19 Pandemic, Yuni Tang

Graduate Theses, Dissertations, and Problem Reports

Introduction: Adolescents and college-aged adults account for a large proportion of the United States population and are susceptible to drugs, including marijuana. Since the late 1960s in the United States, numerous states have legalized marijuana for medical and recreational purposes. These recent policy changes may alter people’s attitudes and behaviors about marijuana use, particularly young adults. The expansion of state-level marijuana legalization may also increase accessibility in younger populations and increase reckless driving behavior associated with marijuana use, including driving after marijuana use. During the COVID-19 pandemic, adolescents and young adults experienced heightened stress and anxiety, which have significantly contributed …

The Geographic Pattern And Socioecological Factors Of Helicobacter Pylori Infections In The United States, Judith Ann Merryweather

Walden Dissertations and Doctoral Studies

AbstractHelicobacter pylori (H. pylori) is one of the most common human pathogens and may play a role in the development of several distinct diseases, which include gastric ulcer, duodenal ulcer, and gastric cancer. Studying geographic territories of the United States may reveal clusters with high rates of H. pylori infection and perhaps the prevalence of gastric cancer; however, geographic mapping of patterns in the United States is scarce. The purpose of this study was to investigate changes in H pylori infection patterns in the United States between two different time points (2000–2002 and 2016–2018). The primary hypotheses of this study …

Clinical And Economic Burden Of Inflammatory Chronic Conditions Among Adults In The United States: Evidence From Three Nationally Representative Surveys, Mohammad Ikram

Graduate Theses, Dissertations, and Problem Reports

A significant proportion of adults in the United States (US) suffer from various inflammatory chronic conditions (ICCs). They include a wide range of diseases such as diabetes, rheumatoid arthritis, asthma, and chronic obstructive pulmonary diseases. ICCs are not curable, and their management typically involves medications such as NSAIDs and corticosteroids. Recently, a whole health approach that places patients’ well-being at the center is increasingly being used for better management of ICCs. The whole health approach uses an integrated approach that includes multimodal management with complementary and alternative medicines (CAM) and prescription drugs. However, the use of CAM and prescription drugs …

Uncovering The Role Of Fat-Infiltrated Axillary Lymph Nodes In Obesity-Related Diseases With Statistical And Machine Learning Analyses, Qingyuan Song

Dartmouth College Ph.D Dissertations

The link between obesity and pathogenesis is a complex and multifaceted area of research that is yet to be fully understood. Ample evidence exists to demonstrate the direct relationship between excessive internal fat and various health conditions such as cancer, and metabolic and cardiovascular diseases. The infiltration of ectopic fat into axillary lymph nodes, observable on breast cancer screening images, has been shown to be correlated with body mass index (BMI) in women undergoing screening. This study aimed to explore the relationship between fat-infiltrated axillary lymph nodes (FIN) and obesity-related diseases, with the goal of evaluating the clinical value of …

How The Commonwealth Of The Northern Mariana Islands Stalled Covid-19 For 22 Months And Managed Its First Significant Community Transmission, Dwayne Davis, Stephanie Kern-Allely, Lily Muldoon, John M. Tudela, Jesse Tudela, Renea Raho, Heather S. Pangelinan, Halina Palacios, John Tabaguel, Alan Hinson, Guillermo Lifoifoi, Warren Villagomez, Joseph R. Fauver, Haley L. Cash, Esther Muña, Sean T. Casey, Ali S. Khan

Journal Articles: Epidemiology

OBJECTIVE: The Commonwealth of the Northern Mariana Islands (CNMI) is a remote Pacific island territory with a population of 47 329 that successfully prevented the significant introduction of coronavirus disease (COVID-19) until late 2021. This study documents how the response to the introduction of COVID-19 in CNMI in 2021 was conducted with limited resources without overwhelming local clinical capacity or compromising health service delivery for the population.

METHODS: Data from COVID-19 case investigations, contact tracing, the Commonwealth's immunization registry and whole genome sequencing were collated and analysed as part of this study.

RESULTS: Between 26 March 2020 and 31 December …

Overlooked Sex And Gender Aspects Of Emerging Infectious Disease Outbreaks: Lessons Learned From Covid-19 To Move Towards Health Equity In Pandemic Response, Lynn Lieberman Lawry, Roberta Lugo-Robles, Vicki Mciver

Journal Articles: Epidemiology

Sex and gender issues are especially important in emerging infectious diseases (EIDs) but are routinely overlooked despite data and practice. Each of these have an effect either directly, via the effects on vulnerability to infectious diseases, exposures to infectious pathogens, and responses to illness, and indirectly through effects on disease prevention and control programs. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the viral agent of coronavirus disease 2019 (COVID-19) has underscored the importance of understanding the sex and gender impacts on pandemics. This review takes a broader looks at how sex and gender impact vulnerability, exposure risk, and treatment and …

Accelerated Sars-Cov-2 Intrahost Evolution Leading To Distinct Genotypes During Chronic Infection, Chrispin Chaguza, Anne M. Hahn, Mary E. Petrone, Shuntai Zhou, David Ferguson, Mallery I. Breban, Kien Pham, Mario A. Peña-Hernández, Christopher Castaldi, Verity Hill, Yale Sars-Cov-2 Genomic Surveillance Initiative, Wade Schulz, Ronald I. Swanstrom, Scott C. Roberts, Nathan D. Grubaugh, Kendall Billig, Rebecca Earnest, Joseph R. Fauver, Chaney C. Kalinch, Nicholas Kerantzas, Tobias R. Koch, Bony De Kumar, Marie L. Landry, Isabel M. Ott, David Peaper, Irina R. Tikhonova, Chantal B. F. Vogels

Journal Articles: Epidemiology

The chronic infection hypothesis for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant emergence is increasingly gaining credence following the appearance of Omicron. Here, we investigate intrahost evolution and genetic diversity of lineage B.1.517 during a SARS-CoV-2 chronic infection lasting for 471 days (and still ongoing) with consistently recovered infectious virus and high viral genome copies. During the infection, we find an accelerated virus evolutionary rate translating to 35 nucleotide substitutions per year, approximately 2-fold higher than the global SARS-CoV-2 evolutionary rate. This intrahost evolution results in the emergence and persistence of at least three genetically distinct genotypes, suggesting …

Rural–Urban Otolaryngologic Observational Workforce Analysis: The State Of Nebraska, Frantzlee Lacrete, Kendra Ratnapradipa, Kristy Carlson, Elizabeth Lyden, Jayme Dowdall

Journal Articles: Epidemiology

Objective

To analyze the rural–urban access to otolaryngology (OHNS) care within the state of Nebraska.

Design

Cross-sectional study.

Methods

Counties in Nebraska were categorized into rural versus urban status based upon the 2013 National Center for Health Statistics urban–rural classification scheme with I indicating most urban and VI indicating most rural. The information on otolaryngologists was gathered utilizing the Health Professions Tracking System. Otolaryngologists were categorized based on the county of their primary and outreach clinic location(s). Travel burden was estimated using census tract centroid distance to the nearest clinic location, aggregated to county using weighted population means to determine …

Non-Alcoholic Fatty Liver Disease And Metabolic Syndrome: The Role Of Gender Differences And Menopausal Status Of Women, Kimberly Kushner

Walden Dissertations and Doctoral Studies

There are few studies that investigate the association between non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) predominantly in menopausal women. This quantitative study investigated the association between MetS and NAFLD while controlling for age, gender, ethnicity, and menopausal status of women. The theoretical framework that helps establish and guide the research was the diffusion of innovation (DOI). A multivariable logistic regression was conducted using secondary data from the National Health and Nutrition Examination Survey. There is a statistically significant association between MetS, and NAFLD after controlling for age (OR = 2.96, 95% CI = 2.319–3.778, p < 0.001). However, ethnicity was not statistically significant. After further controlling for gender, the relationship remained statistically significant and exhibited a decrease in risk for females compared to males (OR = -.734, 95%CI = .387–.596, p < 0.001). Lastly, focusing on women only, and further controlling for menopausal status, the association between MetS and NAFLD was still statistically significant (OR = 2.227, p < 0.001). Mexican Americans, other Hispanics, and Non-Hispanic Black women were at higher risk (95% CI 1.102–7.039, 1.321–5.351, and 1.255–3.013, respectively). Implications for positive social change include adopting proactive and preventative strategies that can improve the quality of life for vulnerable patients and reduce morbidity and mortality associated with MetS and NAFLD.

Evaluation Of Recovery Level And Surgical Site Infection For Hip Replacement Surgeries, Misha Foster

Walden Dissertations and Doctoral Studies

Surgical site infection (SSI) is one of the most common healthcare associated infections and is a major cause of morbidity and mortality. Existing studies have focused primarily on perioperative intervention strategies to reduce infection risks following total joint replacement (TJA) procedures. However, postoperative (post-op) SSI risk factors may account for a significant percentage of hospital readmissions due to infections at the surgical site. Therefore, the purpose of this study was to examine the association between post-op recovery level and SSI among patients who underwent primary hip arthroplasty procedures. Using the social ecological model, which conceptualizes health broadly and focuses on …

A Comparison By Ethnicity Of Usage Of Medication, Intubation Use, And Mortality Rates Of Covid-19 Patients In An Urban Hospital, Howard Rubin Baruch

Walden Dissertations and Doctoral Studies

Evidence from an urban hospital initially revealed that ethnicity had no bearing on treatment modalities or mortality among patients admitted and diagnosed with COVID-19 symptoms from January 1, 2020 to January 1, 2021. The purpose of this study was focused on answering three principal research questions concerning evidence at one hospital of differences in medication used, whether intubation was used, and mortality by ethnicity for those treated for COVID-19 while controlling for age, gender, and co-morbidities. The health belief model served as the theoretical framework. Data was collected from 1188 patient charts, and binary logistic regression was used to test …

Pancreatic Cancer: Quantitative Study Investigating The Regional Risk Factors In North Carolina, Holly Marie Myers

Walden Dissertations and Doctoral Studies

Pancreatic cancer is the fourth-leading cause of cancer-related deaths in the United States, killing more than 90% of individuals diagnosed within 5 years. Due to the lack of signs and symptoms, 82% of all pancreatic cancer cases are diagnosed in terminal stages. As such, the most powerful method to reducing the morbidity and mortality of pancreatic cancer is to further investigate the risk factors. According to the theoretical framework of the ecosocial theory, long-term exposure to exposures to unfavorable socioecological and environmental factors serve as a “web of causation” for adverse health outcomes. Using data from the North Carolina Department …