Recursos de colección

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SPH Theses and Dissertations

Mostrando recursos 1 - 20 de 27

  1. Maternal Diet, Arsenic Exposure, and Pregnancy Outcomes in Bangladesh

    Lin, Pi-i
    This study investigated the relationship between maternal diet, arsenic exposure and birth outcomes in the Bangladeshi administrative regions of Sirajdikhan and Pabna Sadar. First, the study assessed the validity of a dish-based food frequency questionnaire (FFQ) by comparing it with two 3-day food diaries (FD). Food and nutrient intakes measured by FFQ and FD were compared using Pearson’s and Spearman’s correlation, paired t-test, percent difference, cross-classification, weighted Kappa, and Bland–Altman analysis. Results suggested that the FFQ exhibited good ability to assess and rank long-term dietary intake for most food groups and nutrients. Using this FFQ, the study then evaluated the...

  2. Effect of Smoking Cessation and Other Lifestyle Modifications on Weight Gain and Risk of Stroke: An Application of the Parametric G-Formula

    Jain, Priyanka
    Developing public health policies for chronic disease prevention requires estimating the effects of long-term lifestyle interventions. In the absence of randomized trials conducted over long periods of time, the parametric g-formula can be used to estimate the risk of an outcome in a study population under hypothetical lifestyle “interventions” using observational data, under the assumptions of no model misspecification and no unmeasured confounding. In this dissertation, we apply the parametric g-formula to data from large prospective cohort studies to investigate the long-term effects of smoking cessation and other lifestyle modifications on weight gain and risk of stroke. In Chapter 1,...

  3. Understanding Psychological Well-Being From the Behavioral Perspective

    Or, Jun Lin Flora
    Despite the great burden of mood disorders, much of the treatment gap remains due to under-recognition. One way to alleviate this burden would be to target unhealthful behaviors that are more prevalent among those who experience symptoms of mood disorders. This dissertation aims to evaluate new ways to measure and to understand behaviors related to psychological well- being drawing from the fields of behavioral economics, marketing, and engineering in a systematic review (Paper 1), a mixed methods study (Paper 2), and an online survey and experiment (Paper 3). Paper 1 is a systematic review that evaluated the most up-to-date evidence...

  4. Summary Score-Based Confounding Control in Studies of New Drugs

    Bohn, Justin
    Epidemiological studies of newly marketed drugs are often undertaken to assess questions of safety and effectiveness that did not arise during a drug’s pre-approval studies. However, unlike in randomized controlled trials, such observational studies are prone to confounding., which can bias estimates of a drug’s effect on the study outcome. In this dissertation, we explore three challenges to confounding control in the study of new drugs. In Chapter 1 we propose a family of privacy-preserving, propensity scored-based methods that allow for adjustment for many confounders when not all confounders are physically stored in the same location. We evaluate the performance of...

  5. Child Nutrition: From School Nutrition Policy to Diet Quality

    AlJazzaf, Manar
    Overweight and obesity in children continues to be a concern in the US. Many factors play a role in this epidemic including decrease in physical activity, increase in sedentary time, and increase in the consumption of sugar sweetened beverages. Dietary behaviors develop in early childhood and these behaviors are influenced by individual experience as well as the larger environment. Paper 1 examines whether school district characteristics are related to school district compliance with the Massachusetts 2012 school competitive food and beverage standards. A linear mixed effects regression model with random effects for schools nested within school district is used to...

  6. Social Support and Older Adult Health in China

    Zhang, Lu
    Social support refers to the provision of support through the real or perceived existence of resources in social relationships, which is one of the main mechanisms through which social networks may influence health outcomes. Due to scant long-term care institutions with limited healthcare infrastructure in China, social support and the underlying social networks may be especially pertinent to older Chinese adults. Additionally, rapid population ageing accompanied by reductions in family size and intergenerational co-residence highlights the need to examine social support in relation to older adult health in China. We used the China Health and Retirement Longitudinal Study (CHARLS), which...

  7. Healthy Workforce, Healthy Baby? Quantitative and Political Analyses of Health Workers in Mexico

    Ladhani, Karima
    Each year, almost five million babies die within their first year of life, from largely preventable causes. Insufficient availability of health workers has been identified as one of the most common barriers to delivering effective newborn healthcare. This dissertation focuses on the allocation and effectiveness of health workers at improving child health in Mexico. The first two chapters of this dissertation use municipality-level fixed effects analyses to assess the relationship between health workers and child health, specifically infant mortality rate (IMR) and two key risk factors for infant mortality: preterm birth prevalence and low birth weight prevalence. In the first...

  8. Long-Term Use of Cardiovascular Medications: Identifying and Encouraging Optimal Duration

    Krumme, Alexis A.
    In the face of increasingly widespread availability and uptake of medications to treat and prevent cardiovascular disease, this dissertation is motivated by two broad research questions regarding the duration of cardiovascular therapy. First: how long should patients continue therapy when there are risks and benefits that may change over time? Second: how can continuation be encouraged when therapies are known to be safe and effective? In Aim 1, we compared exposure definitions of antiplatelet discontinuation versus continuation at 12 months after a drug-eluting coronary stent and associations with ischemic and bleeding events. We found that increasing restrictions on the definition...

  9. Comparative Safety of Antiretroviral Drugs to Treat HIV During Pregnancy

    Rough, Kathryn
    Each year, nearly 1.5 million women with HIV become pregnant, and require antiretroviral treatment to reduce risk of perinatal transmission of the virus and improve their own health. The safety of currently approved antiretroviral medications for the fetus is largely unknown; recommendations about preferred regimens during pregnancy are often based on a small body of clinical safety data, expert opinion, and programmatic considerations, including regimen harmonization across sub-populations. Therefore, there is a public health need to identify the specific antiretroviral drugs and combinations of drugs that are safest for use during pregnancy. Across the papers that comprise this Dissertation, we apply...

  10. Measuring the Quality of Reproductive Health Services in Mexico and the United States

    Holt, Kelsey
    A focus on quality of care in health services is important from both public health and human rights perspectives. From a public health perspective, a central premise underlying quality improvement work is that improving quality, including interpersonal aspects of care, will lead to better health outcomes. Good communication between providers and patients in various areas of health care has been shown to be highly correlated with adherence to treatment. From a human rights perspective, the Right to Health, as established by the United Nations Committee on Economic, Social, and Cultural Rights, entitles all people to healthcare information, services, and commodities...

  11. Utilization and Safety of Antipsychotic Medications in Special Populations

    Park, Yoonyoung
    Antipsychotic medications are widely used in the United States (US). Understanding the extent of use and comparative safety of antipsychotics is especially important for certain groups of people such as pregnant women or hospitalized patients, for whom the evidence on safety and effectiveness is limited. Previous studies lacked power to detect difference in safety endpoints or suffered from potential confounding bias. In this dissertation, we used large administrative claims databases to provide evidence for antipsychotic use among vulnerable population subgroups. In Chapter 1, we describe the pattern of antipsychotic utilization among publicly insured pregnant women in the US using a...

  12. Understanding Effects of Exercise and Diet to Improve Mental and Physical Health in Children With Behavioral Health Disorders

    Bowling, April B.
    Approximately 13%–20% of children living in the United States experience a diagnosable behavioral health disorder (BHD) in a given year. Children with BHDs have elevated risk of poor mental and physical health outcomes. It is established that diet quality and physical activity (PA) levels are predictors of both chronic disease risk and behavioral health. Unfortunately, children with BHDs experience increased risk of poor diet and low PA relative to typically developing peers. Given the high prevalence of BHDs and associated health disparities, this dissertation aims to help address major gaps in existing research. Chapter one investigates the effects on behavior...

  13. Neurological Soft Signs, Cognition in Childhood, Attention Deficit Hyperactivity Disorder and Lifetime Major Depressive Disorder

    Alamiri, Bibi
    Background: Neurological soft signs (NSS), subtle but abnormal motor and sensory signs and involuntary movements, have been implicated as risk factors for a number of psychiatric and neurodevelopmental disorders. Prior studies were based on small clinical samples, did not control for important confounding factors or examine domain or age specificity. Here we investigate the associations between NSS and multiple domains of cognitive functioning, Attention Deficit Hyperactivity Disorder (ADHD) and its subtypes and finally with lifetime diagnosis of major depressive disorder (MDD) and its age of onset in a large, population-based cohort, while adjusting for important confounding factors. Methods: We analyzed...

  14. Socioeconomic Status, Socioeconomic Context and Sexually Transmitted Infections

    Harling, Guy Duncan

  15. Socioeconomic Status, Socioeconomic Context and Sexually Transmitted Infections

    Harling, Guy Duncan

  16. Evaluating the Ability of Conditional Cash Transfers to Promote Human Capital Through the Protection of Health

    Velasquez, Esther
    Conditional cash transfer programs have diffused rapidly across the world since the mid- 1990s and have been adopted as a poverty-reduction tool in the majority of Latin American countries. This dissertation focuses specially on the Colombian conditional cash transfer program, Familias en Acción, and examines the relationship between social welfare policy and health in the Colombian context. The work is divided into three separate papers. Paper 1 assesses the impact of Familias en Acción on adult health outcomes that capture disruptions in daily life due to health conditions. The analysis utilizes data collected by the Colombian National Department of Planning for...

  17. Maternal and Child Health, Nutrition, and Hiv

    Smith, Emily Rose
    Reducing maternal and child mortality was established as a global priority with the signing of the Millennium Declaration in September 2000. Neonatal vitamin A supplementation and very early breastfeeding initiation are scalable interventions which may improve infant survival. Although breastfeeding has proven benefits for infant health, the potential health consequences of breastfeeding for HIV-infected women are not well studied. In paper one, “The effect of neonatal vitamin A supplementation on morbidity and mortality at 12 months: A randomized trial”, we assessed the efficacy of neonatal vitamin A supplementation (NVAS) in reducing infant morbidity and mortality. Using data from an individually randomized...

  18. Communication to Promote Healthier Behaviors – Understanding the Roles of Channels and Message Formats

    Hayashi, Hanae
    Communication has been used to change people’s health knowledge, attitudes and behaviors, and it is critical for improving people’s lives, especially those who are in a disadvantaged group. Many studies suggest that communication is a powerful tool when it is used effectively for these population groups. In this dissertation I explored the roles of channels and message formats among vulnerable populations. Paper 1 investigated interpersonal diffusion of health information, specifically health information mavenism among people over age 65 in Japan, identifying the characteristics of health information mavens and whether they behave more healthily or report better health status. The study...

  19. Nutritional and Lifestyle Factors for Cancer Incidence and Survival

    Zoltick, Emilie Sela
    Background: The association between meat consumption and breast cancer risk and the relationship between vitamin D and colorectal cancer risk have been examined in numerous studies, but questions still remain. For colorectal cancer survival, research into diet has been sparse. Methods: Chapter one is a pooled analysis of 22 prospective cohort studies examining meat and egg consumption and breast cancer risk overall and by estrogen and progesterone receptor (ER/PR) status using Cox proportional hazards models to estimate study-specific relative risks which were then pooled using random effects models. Chapter two is a pooled analysis of 17 prospective cohort studies in...

  20. The Neurodevelopment and Mental Health of Children Affected by HIV in Sub-Saharan Africa

    Chaudhury, Sumona
    This dissertation assesses neurodevelopment in children affected by HIV in Botswana, by examining associations between a range of factors and neurodevelopmental outcomes at 24 months of age and adjusting for potential confounders through linear regression. We followed children from birth to approximately 24 months to assess their neurodevelopment with an adapted version of Bayley Scales of Infant Development third edition (BSIDIII: cognitive, gross motor, fine motor, expressive and receptive language domains) and with the Development Milestones Checklist (DMC: locomotor, fine motor, language and personal-social domains), a parent-completed questionnaire. Chapter I compares neurodevelopment between HIV-exposed uninfected (HEU) children whose mothers took...

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