Browsing by Subject "Epidemiology"
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Item Assessment Of Racial And Ethnic Differences In Inferred Energy Expenditure Using Nationally Representative Data(2011) Amen-Ra, Nun; Velasco, Eduardo H.; Public Health and Policy; Doctor of Public HealthNun Sava-Siva Amen-Ra, Dr.PH, December 2011 Dissertation Chair: H. Eduardo Velasco, M.D., M.Sc., Ph.D. Department of Public Health Analysis As assessed by body mass index (BMI) African Americans exhibit higher rates of obesity than Caucasian Americans. Bodyweight is influenced principally by energy intake, voluntary energy expenditure (i.e. exercise) and basal metabolic rate (i.e. resting energy expenditure). Resting energy expenditure is, in turn, influenced by physiological factors that are largely (though not entirely) innate and therefore less amenable to alteration. Existing observational evidence indicates that Blacks exhibit lower resting energy expenditure than Whites. The present study sought to confirm this finding for the first time using nationally representative data. We hypothesized that other ethnicities and multiracial persons would, as a consequence of exhibiting an amalgam of Africoid and Europoid metabolic traits, exhibit an average resting energy expenditure intermediate between Blacks and Whites. We confirmed that Blacks exhibit lower resting energy expenditure than Whites--a difference of approximately 150 to 300 fewer kilocalories per day. This finding was significant in each permutation of our analysis--from the simple association of race and resting energy expenditure to our final regression model adjusted for common confounders (i.e. age, gender, income, and education), body fat content, diabetes, thyroid dysfunction, and weight loss in previous year. Further, we found that energy intake did not differ significantly between Blacks and Whites whereas Blacks were found to expend significantly more energy voluntarily than Whites. Blacks and Whites did not differ significantly in bodyweight, though Blacks were found to be leaner than Whites as evidenced by significantly lower body fat content in the former. Given their relatively low level adiposity, environmental factors such as stress ineluctably emerge as plausible explanatory postulates in disparate disease susceptibility among African Americans. Our findings further suggest that if rates of obesity are to be reduced in African Americans, recommendations would need to encourage lower levels of average energy intake than extant in the general populace and higher levels of activity energy expenditure than extant in the general populace. In short, African Americans would need to adopt more austere lifestyle regimens relative to the general populace in order to reduce their rate of obesity below present levels. Our finding that adiposity (as assessed by X-ray absorptiometry) is significantly lower in Blacks than Whites suggests that conventional classifications of adiposity based on such indirect measures as body mass index may be less applicable in African Americans presumably due to racial/ethnic differences in body composition. Lastly, our findings accord with theories of human evolution which posit that metabolic adaptations to environmental alteration entailing increased energy efficiency were essential to the survival of the human species.Item Characterization Of Demographic, Behavioral, Immunologic, And Virologic Factors Associated With Incident And Prevalent Hepatitis C Virus Infection Among Hiv-Infected Men: Analysis Of 1948 Hiv-Infected Men In Baltimore, Maryland(2016) Maina, Erastus Njuguna; Chen, Yun-Chi; Hill, Dwayne; Biology; Master of ScienceRecent reports around the world show that hepatitis C virus (HCV) infection rates among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) have increased in the past decade. The main goal of this thesis research was to characterize HCV infection among HIV-infected men with an aim of identifying new risk factors associated with HCV acquisition. This study assessed the cumulative prevalence of HCV and determined risk factors associated with prevalent and incident HCV infection. We employed a cross-sectional study evaluating 1948 HIV-infected men who had at least one HCV antibody test at Chase Brexton Health Care (CBHC) between 2011 and 2013. Multinomial logistic regression was used to establish crude and adjusted odds ratios at 95% confidence intervals (CI). The overall HCV prevalence for this sample of HIV-infected men was 24% (95% CI; 22ā26), 85% among those who reported injection drug use (IDU), and 9% among those who did not report a history of IDU. Bivariate analyses suggested that lower education was less likely to be associated with HCV incidence, and those with prevalent HCV infection were more likely to be unemployed. In multivariate analysis, IDU was the only significant risk factor associated with incident HCV infection. Being ā„ 40 years old, having a history of IDU, and previous exposure to hepatitis B virus were positively associated with prevalent HCV infection, whereas, being MSM was negatively associated with HCV prevalence. Traditional risk factors typically associated with prevalent HCV infection, excluding IDU, were not associated with HCV incidence. Our study suggests that there may be a change in HCV risk factors between prevalent and incident HCV infection. The permucosal route seems to be the new mode of transmission driving HCV infection among this sample of HIV-infected MSM. We also found that a significantly larger proportion of those with incident HCV spontaneously cleared HCV compared to those with prevalent HCV infection. To add, we observed a high rate of sustained virologic response (SVR) among those with incident HCV, which may correspond to the high treatment completion rate. Our findings point to a changing epidemiology of HCV infection among HIV-infected men in Baltimore and highlight the emerging issue of sexual transmission of HCV among HIV-infected MSM in this area.Item COVID-19 and Marylandās Older Adults(UMBC Center for Aging Studies, 2020-06-02) Millar, Roberto J.; Sahoo, Shalini; Yamashita, Takashi; Sociology, Anthropology, and Public HealthOlder Marylanders (80 + years old), who make a large majority of long-term care residents, have the highest risk of contracting and dying from COVID-19. Complying with the preventive measures suggested by the Maryland Department of Health is critical to protect Marylandās oldest old, both in communities as well as in long-term care facilities.Item Differences Between African Americans And Whites In Theprogression From First Full Cigarette To Nicotine Dependence(2010) Beharie, Roxanne Patrice; Wagner, Fernando A.; Public Health and Policy; Doctor of Public HealthThere are significant health disparities and social problems associated with nicotine dependence. While White adults have a higher prevalence of lifetime smoking, and current smoking than African Americans, African Americans suffer higher incidence rates from smoking-related health problems such as respiratory and cardiovascular problems, and cancer, than Whites. Research has shown racial/ethnic differences in the process of becoming nicotine dependent, with African Americans being more likely to become nicotine dependent than Whites. Data from Wave I of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used for this study (N=14,225). Nicotine dependence was operationally defined using DSM-IV criteria in the NESARC. The main independent variables for this analyses included race, gender, age at first nicotine use, and socioeconomic status (SES). Discrete time survival analyses and regression analyses were conducted using STATA version 10.0. Multivariate survival analyses showed African Americans had 17% lower hazards of becoming nicotine dependent than Whites (aHR=0.83; 95% CI=0.76-0.90; p< 0.001), adjusting for covariates and that Whites progressed to nicotine dependence faster than African Americans. The race by SES interaction showed that the race/nicotine dependence and SES/nicotine dependence associations seemed to be independent of each other which suggested that there may be a cultural component in the transition to nicotine dependence. African Americans suffer more adversely from smoking-related morbidity and mortality despite earlier smoking initiation and faster progression to nicotine dependence by Whites. The evidence from this study suggests that the origin of the tobacco-related health disparities is not rooted in differences in the incidence of nicotine dependence, but more likely derive from factors affecting the features and duration of nicotine dependence. This finding provides the platform for further research on factors associated with the duration of nicotine dependence. Based on the findings from this study, programs that reduce or delay the progression to nicotine dependence should be increased. Also, racial/ethnic-specific programs tailored to meet individuals' smoking prevention and cessation needs are important for the reduction of the impact of nicotine dependence health-related problems.āItem Examining The Association Of Substance Abuse And Violence With Incarceration Among Fathers: An Epidemiological Criminology Approach(2015) Smith, Jeris; Hossain, Mian Bazle; Public Health and Policy; Doctor of Public HealthIt is well documented that over half of males incarcerated in state and federal prisons are fathers. While many studies have demonstrated that incarceration has negative implications on families and family members who are associated with men with a history of incarceration; very little research has examined the effects of male incarceration on behavioral patterns or family factors. The primary objective of this study is to examine the association of substance about and intimate partner violence with incarceration among fathers using longitudinal data collected from The Fragile Families and Child Wellbeing (Fragile Families) Study, which investigates the association between incarceration risk behaviors (i.e. criminogenic risk factors) and incarceration outcomes among a cohort of fathers. This study consisted of approximately 4,700 families who were surveyed in part of the Fragile Families Study in 75 hospitals among 20 cities across the United States. In addition to univariate analysis, several simple and multiple discrete-time survival analysis was used to examine the association between criminogenic risk factors-- marital status, poverty level, educational attainment and race, intimate partner violence and drug use with incarceration among fathers. Results showed that Black father and fathers living below the poverty level were more likely to be incarcerated. After adjustments for intimate partner violence and family drug factors, it was found that the odds of incarceration remains higher and significant for Black fathers' when compared with White fathers. Fathers who were living below the poverty level when compared to fathers with a poverty range above the poverty level while adjusted for other covariates in the model. Results show family factors such as fathers' race, marital status, educational attainment, and poverty level are significantly associated with incarceration outcomes. Results of this study also demonstrated that intimate partner violence and family drug factors within a family system, modify the relationship between fathers' race, educational attainment, poverty level, with incarceration.Item Expanding Health Service Delivery in St. Marc, Haiti: A Case Study in Capacity Building and Infrastructure Development Within an Emerging Coalition(2019-03-29) Tolson, Shenell LaVonne; Barrett, Sharon E.; Terry, Raymond; Brown, Lawrence; Pierre-Louis, Dhierry; Public Health and Policy; Doctor of Public HealthThe purpose of this study was to examine the perceptions and actions of a cross- sector, transdisciplinary group of collaborators as they worked to enhance health delivery services in the region of St. Marc, Haiti. Areas needing improvements in health service delivery include access, health administration, and sustainability. Using a systems thinking approach, the group addressed these areas of improvement with increased capacity building and infrastructure development. Members of the group of collaborators included various members of the St. Marc community who were previously conducting public health work individually, as well as members of the educational community and local government. The research design is a single, embedded, case study. Results indicate that stakeholders in the collaboration relied heavily on the establishment of strategic partnerships to reach the groupās end goal. These strategic partnerships were formed based on interpersonal relationships and a collaborative willingness to serve the community. Because of the formation of the collaboration, doors were opened for future partnerships, thus, transforming the coalition into an emerging system of collaborations and relationships focused on continued capacity building and infrastructure development. One immediate outcome of the study was the establishment of an educational program for para-professionals which includes a curriculum for administrative services. Implications of the study support the effectiveness of a systems thinking approach when expanding health service delivery in an area with weak infrastructure.Item Investigating interactions between climate, host life history and viral diversity across a trans-hemispheric range of marine ecosystems(2022-01-01) Zhao, Mingli; Schott, Eric; Schreier, Harold; Marine-Estuarine Environmental Sciences; Marine-Estuarine-Environmental SciencesMarine infectious diseases and pathogens substantially impact the structure and function of marine communities by causing mortalities and altering host behaviors. The interactions between host and pathogen, determining the epidemiologicaloutcomes are affected by many factors including climate, host life history, and human activities. Studies on marine disease epidemiology and ecology, including both natural and anthropogenic transmission pathways, are necessary for better understanding how these factors potentially influence the host-pathogen interactions. A significant proportion of marine pathogens are viruses; they cause severe infectious diseases and mortalities in many marine organisms, including crustaceans. Virus-related diseases and mortalities have been identified and reported in the Atlantic blue crab, Callinectes sapidus, for more than half a century. With a wide geographic distribution across both hemispheres and a temperature-dependent variable life history, blue crab and its pathogenic viruses constitute a well-suited pathosystem for investigating the potential influences of climate, seasonality, and host life history on viral disease emergence and spread in marine ecosystems. This dissertations applied the "blue crab-virusā pathosystem, to investigate factors that potentially influence the interactions between blue crab and its viral symbionts. The studies mainly focused on three objectives: 1) Investigate the influences of climate, seasonality, and host life history on the prevalence and disease ecology of a virus that is pathogenic to blue crab. 2) Assess the influences of climate, seasonality, and host life history on viral genetic diversity and genetic structures across a wide spatial and temporal range. 3) Characterize genome sequences and biological characteristics of newly identified viruses in blue crabs. The studies encompassed in this dissertations demonstrate, in a single host species, that climate, temperature, and host life history traits drive patterns of virus species diversity and genetic variation across the entire range of the host. One significant revelation was the evidence of long-distance movement of virus pathogen genotypes by human transport of infected blue crabs between states in the United States. The dissertations concludes with a discussion of the potential for next-generation sequencing to discover and study the movement of known and newly discovered viruses in marine hosts.Item Investigating Stakeholders' Perceptions Of The Link Between High Std Rates And The Current Baltimore City Public Schools' Sex Education Curriculum(2013) Bolden, Shenell; Martin-Dunlop, Catherine; Advanced Studies, Leadership, and Policy; Master of ScienceThe purpose of this exploratory study was to examine key stakeholders' perceptions of the current Baltimore City Public Schools' (BCPS) sex education curriculum and to gain insight into how they believe the curriculum could be modified to be more effective. A mixed methods approach using qualitative and quantitative data collection consisting of a survey, focus group interview, and individual interviews was conducted to gather information on stakeholders' perceptions. The stakeholders included: (1) former students who received their sex education courses in the Baltimore City Public School system (BCPS); (2) teachers in BCPS who were affiliated with the sex education curriculum; (3) health care professionals who screened and/or treated East Baltimore City residents for a sexually transmitted disease (STD) and; (4) one policy maker who was responsible for creating sex education curriculum at the national level. Analysis of the quantitative data from former Baltimore City Public School students revealed a general satisfaction with the current sex education curriculum. However, qualitative data from the same group of stakeholders revealed several changes they thought should be implemented into the program in an effort to improve the current curriculum. Findings from the other groups after qualitative analysis of the interviews suggest three major themes in support of curriculum change: (1) a blended curriculum that integrates both the cognitive and affective learning domains; (2) knowledge of prevention of STD's and pregnancy; and (3) authentic teaching and learning. Results from this study strongly suggest that the Baltimore City Public School system is apathetic to the sexual health needs of students and, therefore, is inadvertently contributing to the high rate of sexually transmitted diseases among young people. Keywords: Abstinence, Affective domain, Indoctrination, Behavior Modification, Cognitive domain, Sex education curriculum, Sexually Transmitted DiseasesItem Oral Cancer In Maryland: The Correlation Between Dentist Knowledge And Practices Regarding Oral Cancer Examinations(2016) Itakpe, John Itakpe; Kamangar, Farin; Public Health and Policy; Doctor of Public HealthMaryland was ranked 7th among states with the highest oral cancer mortality rate in 1996 (Siriphant, Horowitz, & Child, 2001) and also had the highest disparity in oral cancer mortality rates for black males in all 50 states (Maybury, Horowitz, & Goodman, 2012). Currently, Maryland ranks 27th in the incidence of oral cancer when compared to other states (Maybury et al., 2012). This puts Maryland in the middle of the pack showing there is still a lot of work to be done to reduce the incidence of oral cancer. Horowitz, Drury, and Canto (2000) looked at the practices of Maryland dentists regarding oral cancer prevention and made some recommendations. These recommendations include continuing education for dental practitioners and a greater emphasis on oral cancer prevention and early detection in dental school curricula (Horowitz et al., 2000). This assumes that if dentists are knowledgeable about oral cancer, there will be a corresponding increase in the practices of oral cancer prevention and early detection. This research is a follow-up to the one done by Horowitz et al. (2000) to evaluate the effectiveness of Maryland dentist practices regarding oral cancer prevention and early detection. The objective of this study is to look at the correlation between Maryland dentist knowledge and practices regarding oral cancer prevention and early detection. This is a mixed methods study where the researcher analyzed both quantitative and qualitative data. Responses from survey questionnaires that were distributed to Maryland dentists were analyzed using univariate, bivariate, and multivariate analyses. The qualitative aspect involved in-depth interviews regarding the progress made in reducing morbidity and mortality rates in Maryland from the late 1990s' until now. The purpose of this dissertation was to answer the question: will knowledge of oral cancer prevention and screening among dentists in Maryland who participated in the study have an association with their provision of oral cancer. Results showed that dentists who had a medium or high knowledge index score were more likely to practice oral cancer examinations 100% of the time compared to those with a low knowledge score.Item Socioeconomic Status And The Aggressiveness Of Prostate Cancer Among Black Males(2015) Percy-Laurry, Antoinette; Kamangar, Farin; Public Health and Policy; Doctor of Public HealthProstate cancer, the leading non-skin malignant cancer among men, affects black men disproportionately. Black men are typically diagnosed at an earlier age and have a higher rate of aggressive tumors compared to other races. This study investigates the relationship of socioeconomic status on prostate cancer severity and mortality among black men. The purpose of the study is to determine whether prostate cancer risk, the aggressiveness of disease, and mortality differ by socioeconomic status. Two datasets were utilized. A total of 715 black men with a prostate cancer diagnosis were studied using individual-level data from the linked Surveillance, Epidemiology, and End Results National, Longitudinal and Mortality Study (SEER NLMS) database. Socioeconomic status was assessed and stage and grade of prostate cancer from the medical histories of study participants were used to determined severity. Descriptive statistics and chi-square (X2) tests were used to assess bivariate relationships. Logistic regressions were used to model the likelihood of receiving a high or low stage and grade. The NLMS general population was the second dataset accessed to obtain a larger sample of prostate cancer mortality cases which were analyzed using Cox proportional hazard regression. There were over 50,000 black men in the study sample. The results of the study showed minor differences in the severity of prostate cancer between black men of low and high socioeconomic status. Education was the only variable that showed some significance for both stage and grade. Within-race differences were found between the socioeconomic status variables and mortality among black men. The lower the socioeconomic status, the greater the risk of mortality compared to those of higher socioeconomic status. While socioeconomic differences among black men did not explain the onset or severity of prostate cancer, it did provide some explanation for the high mortality. Much research is needed to assess other external factors such as access to medical care and prostate health education, discrimination, stress exposures, and social norms that might be related to the severity of and mortality from prostate cancer among black men.Item The Association Between Asthma Episode In The Past 12 Months Among Adults And The Use Of Complementary And Alternative Medicine In The Past 12 Months(2009) Joubert, Ava; Bronner, Yvonne L.; Public Health and Policy; Doctor of Public HealthAmong adults with asthma and other chronic diseases CAM use in the United States has increased. As these individuals age, they are likely to have higher rates of comorbidities. The 2002 National Health Interview Survey (NHIS) included questions that allow an examination of patterns of CAM use, including practitioner based therapies as well as self-care based therapies. This study uses NHIS data to analyze the association between asthma episode during the past 12 months and patterns of CAM use within the same period among adults, controlling for comorbid conditions. The Health Belief Model serves as the theoretical framework for the study. Taken from the adult sample questionnaire and the Alternative Supplement (ALT), responses of those who had ever had asthma (N=3327) were analyzed in this cross-sectional, correlational study. The c2 test of independence was used to examine the relationships among the following variables: experiencing an episode of asthma in the past year; coexisting morbidities; demographic variables, and the odds of using CAM overall, practitioner based CAM, therapies, or self-care based CAM therapies. To determine the odds of using CAM given the report of an asthma episode within the past year, when modified by the presence of selected comorbidities, odds ratios were determined using logistic regression. Overall CAM use differed significantly by asthma status, with 49% of those with asthma episodes in the past year using CAM compared with 42% of those who did not have an episode in the past year (p<0.001). Self-care based therapies were more likely to be used than practitioner based therapies. In addition, the use of self-care therapies was significantly more frequent in adult asthma patients who had a comorbid condition (p<0.01) than those with no comorbidities. This study supports previous work indicating that disease severity--in this instance, asthma within the past year--is significantly associated with CAM use. It did not support prior studies showing greater CAM use in the presence of a greater number of comorbidities. Limitations inherent in cross-sectional studies prevent making conclusions regarding disease severity as a determinant of the selection of self-care based therapies as opposed to practitioner based therapiesItem Treatment of latent tuberculosis infection with isoniazid (INH) for nine months versus rifampin and pyrazinamide (RZ) for two months: A comparison of rate of liver injury in Baltimore City Chest Clinic during 1999--2001.(2011-05-18) Obiako, Emmanuel Chinasa; Hossain, Mian Bazle; Doctor of Public HealthItem Understanding The Utility Of Over-The-Counter (OTC) Medications And Emergency Department (ED) Chief Complaints Data In A Syndromic Surveillance System(2015) Russell, Jamaal; Rowel, Randolph H.; Public Health and Policy; Doctor of Public HealthIn April 2009 two pediatric cases of Influenza-Like-Illness (ILI) were reported in southern California and were positive for swine influenza A (H1N1) virus (MMWR, 2009). Heightened surveillance is needed to track and monitor this emerging pathogen. One of the main ideas to strengthen capacity was heightened surveillance or syndromic surveillance. Syndromic surveillance is the systemic and ongoing assessment of the syndromes, including the timely collection, analysis, interpretation, dissemination, and subsequent use of data. Surveillance of Over-The-Counter (OTC) medication sales and Emergency Department (ED) syndromic surveillance are just a few of the new methods developed for early detection of outbreaks. These new surveillance techniques utilize computer databases and statistical packages to store and analyze the data. New/seasonal outbreaks in Montgomery County in 2007-2010 were used to retrospectively interpret data. These outbreaks included novel H1N1, seasonal influenza, and seasonal norovirus that occurred in Montgomery County, Maryland. This study used data from the Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) syndromic surveillance system. Several syndromic categories were used and created to retrospectively determine at what point in time the outbreak would have been detectable. The categories include: Seasonal/H1N1 ILI, and Gastrointestinal Illness. Regression/Exponentially Weighted Moving Average (EWMA) 1.1 was used to analyze the Montgomery County Health Department's syndromic surveillance data. This research explored whether ED or OTC data provide an alert first and what is the temporal difference between the two. The hypotheses tested for this study was: 1) There is a temporal difference between the purchase of OTC medications and ED visits in a given community with ED visits alerts posting before OTC medications among Seasonal flu and H1N1 outbreaks. 2) Individual hospitals ED's with the smallest patient loads will have a different pattern of alerts than the larger ED's. This study found that an alert will not always appear in OTC data before it appears in ED data depending on the type of outbreak and alert criteria used by the epidemiologist. The alert criteria are crucial in determining when an outbreak is suspected and when to initiate a response from public health. Large hospitals mirrored countywide data. Smaller hospital's ED visits are too sparse to be representative of countywide trends. There is no way to determine whether ED data or OTC data will produce an earlier signal. The different symptomatology and type of outbreak will affect the timeliness of alerts from each data stream. The findings of this study will benefit local and state government agencies response to an outbreak/bioterrorist event. Understanding how OTC sales and ED data interact can lead to an early response that can limit the spread of an outbreak. The knowledge gained will enhance the response plans developed by health agencies to better address the unique needs of populations in Maryland.