Public Health Undergraduate Research Theses and Honors Research Theses

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Undergraduate Research Theses and Honors Research Theses from the College of Public Health. More about the College of Public Health Honors Program is available at:

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    A conceptual model for understanding how caste-based discrimination may underlie disparities of medical sterilization of SC/ST women in India
    (The Ohio State University, 2023-08) Smith, Sage; Singh, Parvati
    This literature review establishes the relationship between the Indian caste system and coercive reproductive suppression of lower-caste women in India through surgical sterilizations implemented by the Family Planning Program. It covers the history of the Indian caste system, the discrimination that members of the lower castes face, the history of India's Family Planning Program, and how it targets women using eugenic methods. The objective was to show how the Indian caste system has created a path for SC/ST women to be discriminated against and targeted for reproductive suppression through surgical sterilizations. In this way, the caste system is suppressing the births of these groups and utilizing eugenic methods.
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    COVID-19 Vaccine Attitudes Among Pregnant Women Receiving the Tdap Booster Suggest Differences by Age, Race, Insurance Type, and Education Level
    (The Ohio State University, 2023-05) Madan, Rushil; Dubey, Purnima
    Introduction: Routine vaccinations of the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine prevent the spread of Pertussis or whopping cough caused by the bacterial pathogen Bordetella pertussis. Current recommendations encourage pregnant women to receive the Tdap booster vaccine during each pregnancy in the third trimester (27-36 weeks) regardless of prior pregnancies. However, COVID-19 pandemic disruptions in the healthcare system and risks for COVID-19 infections have prompted pregnant women to consider the timing of routine vaccinations in the background of the COVID-19 pandemic. It is important to study how attitudes toward acceptance of the COVID-19 vaccine are reflected in the demographics and timing of pregnant women accepting a Tdap booster vaccine. Methods: In our study, pregnant women at two OB-GYN medical centers in Ohio completed a questionnaire prior to receiving a Tdap booster vaccination which collected data on race/ethnicity, age, vaccination history, and attitudes toward the benefits and risks of COVID-19 vaccination from January 27th, 2021- July 19th, 2022. The COVID-19 vaccine was available to pregnant women at these medical centers starting on March 4th, 2021, and the COVID-19 immunization record was collected with IRB approval. Results: All pregnant women who completed the survey received the Tdap vaccine, however, the proportion of pregnant women who expressed hesitancy to receiving the COVID-19 vaccine during their pregnancy was similar to those who were willing to receive the COVID-19 vaccine (48.3% vs 51.7%). This COVID-19 vaccine hesitancy was significantly correlated with not receiving the COVID-19 vaccine during the pregnancy or post-partum period (Fisher's exact test, p<0.00001). Of the pregnant individuals who eventually received the Tdap vaccine, (55.38%) received the primary COVID-19 vaccine series during pregnancy or in the post-partum period, and (47.62%) of these pregnant women did not receive the COVID-19 vaccine. The demographics associated with lower COVID-19 receipt were an education of a 12th-grade equivalent or less, public health insurance, an age younger than 24 years, and African American race. Among pregnant women who received both the COVID-19 vaccine and Tdap booster vaccines, (81.4%) of pregnant women received the COVID-19 vaccine prior to study enrollment and receipt of the Tdap booster. The first COVID-19 vaccine of the primary series was received on average 68 days prior to study enrollment (SD=66) and on average 81 days before the Tdap vaccine (SD= 67). Conclusions: All women received a Tdap booster as part of enrollment in the study, however, attitudes toward COVID-19 vaccination were polarized by age, race, education level, and health insurance type. This suggests that COVID-19 vaccine attitudes are distinct from general hesitancy to vaccines such as Tdap. Furthermore, the majority of women who received both vaccines appeared to prioritize the receipt of the COVID-19 vaccine over the Tdap vaccine in the timing of receipt. Continued outreach in these target demographic populations where low COVID-19 vaccination rates are evident is critical to protect the mother and infant.
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    Evaluating Geospatial, Human Behavioral, and Social Drivers of Mosquito Abundance and West Nile Virus Disease Risk
    (The Ohio State University, 2023-05) Robare, Sydney; Meuti, Megan; Odei, James
    Culex mosquitoes transmit West Nile virus (WNV) in the continental United States. Previous research has shown that Culex mosquitoes are more abundant in low-income areas, possibly leading to inequitable disease burdens across a wealth-health gradient. The ATSDR used U.S. census data to develop the Social Vulnerability Index (SVI) as a measurement of social inequity, but to date no one has investigated whether social vulnerability is correlated with disease risk. Moreover, few studies have reviewed how personal knowledge, attitudes, and practices (KAP) affect mosquito populations at a community scale. I reviewed whether community SVI and levels are predictive of mosquito population and WNV disease trends. I created areal interpolation maps using ArcGIS software to compare community SVI values against mosquito populations and WNV disease trends from two central Ohio health departments. I also administered a KAP survey that received approximately 308 usable responses from central Ohio residents that were spatially compared against mosquito populations and WNV disease trends from one central Ohio health department. Data analysis revealed that higher SVI levels were correlated with higher prevalence of WNV in mosquito populations. Notably, community-level KAP was not correlated with mosquito population or disease risk indicators. This study provides a foundation for future work to review the social and institutional factors affecting mosquito and WNV disease ecology, and thereby better equip public health institutions to protect their populations from mosquito-borne disease.
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    Heart Rate Variability and Anxiety in a Pediatric Sample Experiencing Chronic Unexplained Nausea
    (The Ohio State University, 2023-05) Ovestrud, Ilona; Kolacz, Jacek
    Background: Anxiety disorders have been identified as an area of public health concern due to their high prevalence and comorbidities. Previous studies have found a correlation between anxiety symptoms and low respiratory sinus arrythmia (RSA), a component of heart rate variability (HRV). RSA is an index of the parasympathetic nervous system which is responsible for bodily regulation during times of rest. A common comorbidity of anxiety disorders is gastrointestinal (GI) distress. Furthermore, there is also evidence that individuals facing chronic nausea and gastrointestinal problems commonly exhibit anxiety and a lowered RSA. Due to the relationship between RSA, anxiety, and GI distress, HRV monitoring wearable devices may prove to be an effective public health measure to monitor these conditions. A daily record of RSA values may provide insight into the severity of those conditions and effectiveness of treatment protocols. Methods: HRV and anxiety data was obtained from a group of 96 children and adolescents participating in a study concerning chronic unexplained nausea. HRV data was collected using the Firstbeat Bodyguard 2, a wearable sensor that records a participant's electrocardiogram (ECG). Sitting respiratory sinus arrythmia (RSA) and heart period (HP) were collected. Anxiety was coded from medical records using clinical diagnoses, health care provider notes, and validated self-report questionnaires (Patient-Reported Outcomes Measurement Information System; PROMIS). Analyses were performed in R comparing the anxiety positive and negative groups against sitting RSA and HP. Results: There was a trending effect toward lower sitting RSA in the anxiety positive group (mean difference = 0.56ln(ms2)), but the statistical tests were non-significant (t(95)=1.77, p=.09). HP and anxiety were not significantly associated (mean difference = 37.32ms, t(95)=1.20, p=0.23). Conclusion: The analyses performed do not appear to indicate a formal relationship between low HRV and anxiety in adolescents with chronic nausea. Despite non-significant results, there is evidence that HRV can be indicative of a variety of illnesses. Wearable sensors are low-cost, convenient, and widely available for HRV tracking, but more research is needed to understand how they can be used to provide meaningful results for monitoring anxiety.
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    Resilience and Human Connection in the Face of COVID-19: How Latines in Youngstown, Ohio are Experiencing and Recovering from the Disproportionate Impacts of the Pandemic
    (The Ohio State University, 2023-05) Scheeser, Anna; Padamsee, Tasleem J.
    During the COVID-19 pandemic, the burden of the disease has been unevenly distributed, leading to high caseloads, high mortality rates from COVID-19, and high job loss in certain "hardest-hit" communities. One of these communities is located within Youngstown, Ohio, where the Latine population has been uniquely affected by COVID-19. I worked with other members of the C3-REACH team to understand the impacts of COVID-19, barriers to recovery, and community strengths in the Latine community in Youngstown, Ohio. To accomplish this, we conducted driving audits to identify community partners and gathering spaces, as well as gain a fuller understanding of community boundaries. Next, we conducted interviews with four Latine community members and leaders in Youngstown to understand the impacts of COVID and community strengths that may aid recovery from the pandemic. My research found that the Latine community in Youngstown dealt with severe personal, social, and economic impacts as a result of COVID-19. Despite this, strengths such as resiliency and a community-oriented approach have allowed Latines in Youngstown to begin recovering from the impacts of the pandemic. Understanding the experience of Latine individuals in an area where they make up a substantial and important minority community is important to increasing health equity in partnership with the community themselves.
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    Fungal isolates from dust from the indoor environment: Isolation, identification, and evaluation of polyurethane-degradation potential
    (The Ohio State University, 2023-05) Stuart, Katelyn; Dannemiller, Karen
    Humans spend 90% of their time indoors where dust is ubiquitous. House dust is an important source of human exposure to microorganisms, many of which are associated with illness, such as asthma. However, many of the microbes that are commonly studied originated from the outdoor environment and may differ in important ways from those that we are commonly exposed to indoors. We need additional information on the specific organisms that commonly occur in our homes. Additionally, it is unclear how these organisms may interact with common indoor materials, such as plastics. This research aims to isolate microorganisms that are prevalent in house dust and evaluate their capability to degrade polyurethane, a common polymer in the indoor environment. Dust was collected from carpet and a vacuum bag from a home in San Francisco, California and another in Columbus, Ohio. Individual organisms were isolated from the samples on culture plates. DNA extractions were performed on 25 purified species and each sample was sent for Sanger sequencing to to detect the highly variable ITS1 and ITS2 sequences and to verify the identity of each species. A total of 18 unique fungal species were putatively identified, including four different species from the Penicillium genera, three from the Epicoccum genera, and two from the Aspergillus genera. Other species included Alternaria alternata, Aureobasidium pullulans, Nigrospora sphaerica, Rhodosporidiobolus colostri, Pithomyces chartarum, and Rhodotorula mucilaginosa. The species collected were further characterized and grown on Impranil-containing plates to determine their capacity for polyurethane degradation. The results of this experiment showed Impranil clearing by three of the species, including Aureobasidium pullulans, Aspergillus oryzae, and Holtermanniella wattica, indicating that there are fungal species in the home environment with the ability to degrade common plastics. This research provides a better understanding of which fungi thrive in our dust and the implications of this growth at home. Future work can further determine how microbes may interact with common materials in the indoor environment, such as plastics.
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    Factors Associated With Waterpipe Smoking Harm Perceptions Among Young Adult Users
    (The Ohio State University, 2023-05) Jankowski, Emma; Ferketich, Amy
    Background: Although young adults tend to incorrectly view waterpipe (WP) smoking as less harmful than cigarette smoking, limited research has explored predictors of harm perceptions in this group. Graphic warning labels (GWLs) may be leveraged to increase WP-associated harm perceptions. We therefore examined 1) demographic and smoking-related factors associated with WP harm perceptions, 2) changes to harm perceptions and quit motivations brought about by the COVID-19 pandemic, and 3) changes in harm perceptions after an acute laboratory WP smoking session in the presence of a GWL vs. blank label. Methods: Young adult, established WP smokers (n=92; mean age 26.2 years; 51% female) were randomized to one of two groups: 1) blank label + GWL or 2) blank label + blank label. In both groups, a label was attached to the WP hose below the mouthpiece. The GWL contained the text "Warning: Hookah smoke contains poisons that can cause mouth and lung cancers" paired with images of a diseased mouth and lungs. Prior to and following each smoking session, participants were asked how much people harmed themselves while smoking WP and how harmful WP is relative to cigarettes. They were also asked questions related to their smoking behaviors and perceptions, and how these may have been altered by COVID-19. Logistic regression models and chi-square tests were used to examine the participant-level characteristics associated with high absolute harm perceptions (> 6 on a 1-11 scale). Harm perceptions, both absolute and relative to cigarettes, following the second smoking session were compared between the two groups using a chi-square test. COVID-19 related variables were examined descriptively. Results: At baseline (pre-smoking on visit 1), more years of education was associated with higher harm perceptions, although the result was only borderline significant (p=0.048). No other demographic variables were significantly associated with harm perceptions at baseline. COVID-19 was shown to change the location in which people primarily smoked (home vs. cafés), but did not alter harm perceptions or quit motivations for a majority of participants. There was no difference in the percentage of participants with high harm perceptions between groups after smoking in visit 2 (46.3% in blank vs. 46.2% in GWL, p=0.99). Harm perceptions relative to cigarettes were not significantly different between groups after the experimental group's one exposure to the GWL (p=0.64). Conclusion: High harm perceptions were significantly associated with more years of education in our sample. COVID-19 did not significantly alter harm perceptions or quit motivations for young adults in our sample. Compared to a blank label, one exposure to a GWL did not significantly change absolute or relative harm perceptions. Future studies should examine this relationship, including strategies to increase harm perceptions in populations with lower educational attainment, and examine the effect of more frequent exposures to GWLs.
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    The association between the Gender-Equitable Men Scale and injection risk behaviors in Appalachian Ohio
    (The Ohio State University, 2020-05) Rinderle, Abigail; Lancaster, Kathryn
    Objectives: To assess levels of gender-inequitable norms among people who inject drugs (PWID) in rural Ohio and how respective Gender-Equitable Men Scale (GEMS) scores correlate to injection risk behaviors. Methods: Cross-sectional data from the Ohio Opioid Project was used in this study, which had GEMS questions embedded. A question regarding the number of times a participant shared a syringe in the last month was used as a proxy for injection risk behavior. Results: Poisson regression models revealed that overall GEMS scores did not have an effect on syringe sharing behavior. Chi-squared tests did indicate lower levels of inequity than were assumed in Appalachian Ohio, though women were more likely to approve of violence and men were more likely to disapprove of homosexuality. Conclusions: Gender norms play an important role in the cultural acceptability of violence, which could influence injection practices in rural Ohio. The deeper reasons why must be understood in order to address disparities in injection risk behaviors.
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    Investigation of PFOA Enrichment Mechanisms in Sea Spray Aerosol Proxy Surfaces and Potential Health Implications
    (The Ohio State University, 2020-05) Fiamingo, Michelle; Allen, Heather
    Perfluoroalkyl substances are man-made chemicals that have been widely used in industrial processes and military operations since World War II. While the exact toxicology of these substances has not been deciphered, perfluorooctanoic acid (PFOA) has been linked to liver, kidney, and testicular cancer, as well as hypertension and low birth weight in children. Additionally, PFOA is persistent in the environment and is transported globally, as it is enriched in sea spray aerosol (SSA) particles over the Arctic Ocean. We aim to characterize the surface activity of PFOA at SSA proxy surfaces to better understand the pollutant enrichment in SSA particles. Surface tensiometry and infrared reflection-absorption spectroscopy are used to determine the surface adsorption constants via fitting to the Langmuir-Szyswkoski equation. PFOA exhibits enhanced surface activity in the presence of seawater cations in the low concentration regime, and decreased surface activity in the high PFOA concentration regime. It is speculated that the critical micelle concentration of PFOA is changing in response to the addition of seawater cations. Further study is underway to characterize the interfacial packing structure of the surfactant monolayer and the effect that the seawater cations have on the 2-dimensional arrangement of the PFOA molecules at the air-water interface. Future studies involve determining the impacts of dissolved organic compounds on the interfacial activity of PFOA at SSA proxy surfaces.
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    A Secondary Data Analysis of the Professional Development Needs of Community Health Workers in Ohio
    (The Ohio State University, 2018-05) Drenkhan, Madeline; Andridge, Rebecca; Klein, Elizabeth
    In the state of Ohio, Community Health Workers (CHWs) are trained and certified under the Ohio Board of Nursing. This study aims to identify the professional needs and challenges faced by CHWs. Using a mixed methods sequential explanatory design, an online survey was distributed, and four key informant interviews were conducted. The data gathered from the survey and interviews were analyzed for common themes. Common areas of concern and need for development for CHWs included continued education and cooperation across sectors of the healthcare field. This information provides important insights into the need for better continuing education options for CHWs, as well as a more defined and integrated role for them within the healthcare field.
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    The Supply of DATA-waivered Providers and Opioid Treatment Programs for Medication-Assisted Treatments in Ohio
    (The Ohio State University, 2021-05) Pitcher, Ariana; Xu, Wendy
    Introduction: The United States' opioid crisis has hit Ohio especially hard with being among the top 5 states for the highest drug overdoses. The expansion of Medication Assisted Treatment (MAT) under the DATA of 2000 has enabled more providers outside of opioid treatment programs (OTPs) to prescribe treatment for opioid use disorder. This study aims to characterize the co-locations of waivered providers and OTPs authorized to perform MAT and the concentrations of drug overdose deaths in Ohio to understand whether capacity is available to meet the needs of reducing opioid mortality. Methods: Provider waiver data and a directory of OTPs for Ohio counties were obtained from the Substance Abuse and Mental Health Administration during 2019. Opioid overdose metrics were extracted from the County Health Rankings and Roadmaps program, and poverty and population levels were taken from the U.S Census. Waivered provider density was calculated as the number of DATA-waivered providers per 100,000 population for each county. Pearson correlational tests tested the correlations between waivered provider density, poverty rate, and opioid mortality rate, along with OTPs and overdose deaths. Results: Results indicated that most of the waivered practitioners across Ohio with waivers to prescribe buprenorphine for substance abuse were Physicians (57%), followed by Nurse Practitioners (NPs) (27%) and Physician Assistants (PAs) (4%). The average waivered provider density was 13.90 per 100,000 population. A significant positive relationship was observed between the density of providers and opioid overdose death rates across Ohio counties (P<0.001). Poverty rates weakly correlated with overdose rates overall. Also, a strong positive relationship was observed between the number of OTPs and drug overdoses in a county (P <.001). Conclusion: Although the Comprehensive Addiction and Recovery Act expanded prescribing capacity to include NPs and PAs, physicians still represent the majority of waivered providers in Ohio. A medium positive relationship between waivered provider density and opioid overdose mortality rates suggest that providers in high need regions are more likely to obtain waivers. But, a moderate correlation may still suggest an inadequate workforce supply to reduce opioid burdens. A strong relationship between OTPs and drug overdose deaths may indicate that these programs do locate to where high opioid burdens occur.
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    The association of neighborhood-level mass incarceration and psychological distress: An analysis of the Life-course Influences on Fetal Environment (LIFE) study
    (The Ohio State University, 2021-05) Miranda, Alexis; Sealy-Jefferson, Shawnita
    Background: Psychological distress is an important health problem because of the associated difficulties in social and occupational functioning. Psychological distress, measured by the K-6 Kessler Scale, may be higher among people who live in areas most affected by mass incarceration due to the increased stress that is associated with an overpoliced, under-resourced neighborhood. We examined the relationship between zip-code level incarceration rates and psychological distress in African American women from a Detroit metropolitan area sample. Methods: We used data from the Life-course Influences on Fetal Environment (LIFE) study, which surveyed a sample of African American women who had just given birth. We dichotomized the scores on the K-6 assessment into mild-to-moderate distress (scores from 6 to 12) and serious psychological distress (13 to 30). Log binomial regression was used to estimate the prevalence ratio and 95% confidence interval for the association between zip-code level incarceration rate and level of psychological distress. Results: The mean age of the total sample was approximately 27 years old. The median yearly family income was between 30,000 U.S. dollars - 34,999 U.S. dollars and the median years of education was 14 years. The median K6 score was 13, which corresponds with the cut-off for serious psychological distress. Psychological distress, as measured by the K-6 Scale, was not associated with zip code-level incarceration rate among the sample in the analysis. Conclusion: The findings do not support an association between zip code prison admission rates and serious psychological distress scores. Further research may be needed to determine the confounding effect of personal/family experiences of incarceration. Another suggestion for additional research includes using a sample with representative rates of diagnosed mental illness.
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    Analyzing the Connection between Sexual Minority Status and Suicide Outcomes: Defining the Role of Socioeconomic Status
    (The Ohio State University, 2021-05) Eidson, Bradley; Reczek, Rin
    While recent history has seen significant progress in the legal and social acceptance of non-heterosexual people in the United States, these changes have not necessarily resulted in improved health outcomes for all sexual minorities. The bounds of heterosexism and social prejudice against sexual minorities, and the normalized status of heterosexual orientations, have continued to result in disparate mental and physical health outcomes as sexual and gender minorities remain confined to the will of the heterosexual and cisgender majority. Research has identified sexual minority individuals as being at a heightened risk for mental health problems such as medically diagnosed mental disorders, deliberate self-harm, and suicidal ideation as compared to their strictly heterosexual counterparts. Furthermore, the association between mental health and suicidal ideation is more pronounced among sexual minority individuals, suggesting more significant health consequences of poor mental health for this population. Extant research has identified the powerful causal role of socioeconomic status in explaining disparities in suicide outcomes, but whether and to what extent this association is evident for sexual minority individuals has yet to be examined. Drawing on fundamental cause theory and the minority stress process model, I consider alternative hypotheses regarding the association between socioeconomic status and suicide outcomes of sexual minority individuals as compared to the sexual majority. To do so, I draw upon Wave IV (n = 15,701) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and logistic regression to assess whether and how the association between socioeconomic resources and suicidal ideation and suicidal behavior varies for sexual minority individuals compared to heterosexual individuals. Sexual minority status and socioeconomic status were associated with suicidal ideation and attempt, though the effects of SMS outweighed SES in effect. The results of this research contribute to health disparities literature by providing insight into factors preventative of suicidal outcomes, particularly for sexual minority individuals. Exploring this intersection might prompt additional research informing the ways in which structural and social intervention can address such group-level disparity.
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    Do Firefighters and Police Officers in the State of Ohio Have a Higher Incidence of Certain Cancer Types Compared to the General Population?
    (The Ohio State University, 2021-05) Singh, Shashank; Olivo-Marston, Susan
    Firefighters and police officers are exposed on a daily basis to several carcinogens and chemicals that can lead to multiple occupational hazards, which increases their risk of cancer. Studies have shown that firefighters are nine percent more likely to get cancer and they have a fourteen percent elevated risk for cancer mortality compared to the general population. Likewise, police officers who served thirty years in Buffalo, New York were shown to have a higher risk for brain cancer and Hodgkin's lymphoma compared to individuals in the tumor registry. However, there is very limited research on cancer incidence in the state of Ohio. The goal of this study is to provide descriptive data about cancer incidence among firefighters and police in Ohio as a first step towards determining whether there is a connection between their occupation and cancer risk. These data were obtained from the Ohio Department of Health's (ODH) Ohio Cancer Incidence Surveillance System (OCISS). In our study, about 1.49 million cancer cases occurred in the state of Ohio from 1996 to 2017 and were analyzed in four separate CSV files. After determining the coding for firefighters and police officers, SAS Studio, RStudio, and ArcGIS Pro were used to determine the demographics and cancer types. There were 2036 firefighters and 3906 police officers in the state of Ohio with some type of cancer. Firefighters and police officers both had a higher incidence of prostate cancer compared to the general population. Furthermore, both occupations had a high incidence of lung and bronchus cancer, colon cancer, and melanoma. The general population had similar results for all other cancer types with the exception of breast cancer, which was higher in the general population than in firefighters and police. The highest incidence of cancer occurred in Cuyahoga County for all three populations. Potential exposure to several carcinogens such as polycyclic aromatic hydrocarbons (PAHs), benzene, and toluene could have increased the risk of cancer among firefighters and police officers. In addition, the constant stress that firefighters and police officers undergo daily causes excess cytokine release. As a result, immunity is decreased which leads to cancer. The implementation of smoking cessation and nutrition programs as well as further education on using personal protective equipment effectively should be implemented to reduce the burden of disease. Further research should also be done to explore the possibilities of other physical, biological, and chemical agents that increase the risk of cancer among firefighters and police officers.
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    An examination of adolescent dental health by urban and Appalachian status
    (The Ohio State University, 2019-05) Bader, Kyle; Ferketich, Amy
    The objectives of this study were to examine the association between parent-rated dental health and urban vs. Appalachian residence among adolescent males, and to explore factors that may contribute to differences in dental health by region. Adolescent males from urban and Appalachian Ohio (n = 1220, age 11-16 years) completed a food frequency questionnaire to quantify fruit, vegetable, and sugar intake, and a self-administered survey to measure past 30-day tobacco use. Parents or guardians reported when the participants had last visited the dentist and rated their dental health. Analyses were conducted to determine the associations between fair/poor dental health and Appalachian residence, differences in poor dental health risk factors by Appalachia residence, and whether the effect of Appalachia residence on dental health was attenuated after controlling for risk factors. Boys in Appalachia had a marginally higher prevalence of fair/poor dental health compared to urban boys. Boys from Appalachia were more likely to have used tobacco in the past and consumed fewer fruit and vegetables, more added sugar and more sugary beverages than urban boys. The association between fair/poor dental health and residence was attenuated in the adjusted model. Our findings suggest that some of the disparities in dental health observed between people living in Appalachian and urban areas may be related to behavioral factors like tobacco use and diet. We provide support for behavioral interventions to these issues in the Appalachian community.
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    Geographic Location and Coping Strategies Among Primary Caregivers with Food Insecurity
    (The Ohio State University, 2017-05) Porter, Allison; Kaye, Gail
    The objective of this study is to explore differences in coping strategies among urban and rural primary caregivers with food insecurity. According to the USDA, food insecurity is a household-level economic and social condition of limited or uncertain access to adequate food. In 2014, there were 17.4 million American households classified as food insecure with the highest prevalence found in rural and urban settings. To mitigate the effects of food insecurity, primary caregivers use an array of coping strategies to feed their children, including foregoing basic needs like medication, rent, and utilities to purchase food. However, little is known about the use of these coping strategies by caregivers from urban and rural environments. Understanding these coping strategies used by caregivers could be useful in creating geography-specific strategies to address this debilitating issue. Primary caregivers, over the age of 18 with dependents under the age of 18, were recruited at two family practice clinics in Columbus, Ohio. Questionnaires were administered to assess presence and severity of food insecurity and food coping strategies. Place of residence, neighborhood characteristics and demographic information were also obtained. Recruitment is ongoing and will be completed by March 20, 2017. Initial responses indicate that there appears to be differences in coping strategies used in urban and rural environments. Urban primary caregivers appear to have a greater prevalence of food insecurity and appear more likely to forego utilities and rent whereas rural primary caregivers appear to forego medicine to obtain food. By understanding the coping strategies used by food insecure caregivers from rural and urban locations, public health professionals will be able to better understand the complex nature of food insecurity to plan more strategic interventions which can protect against poor nutrition and health outcomes and better serve the populations affected.
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    Support Factors that Influence Mothers' Decisions to Breastfeed Their Twins and Triplets Beyond 12 Months of Age
    (The Ohio State University, 2017-05) Jossart, Sarah; Keim, Sarah; Andridge, Rebecca
    This study aims to determine support factors that influence women's decisions to breastfeed their multiples for over 12 months and characterize this group of particularly successful breastfeeding mothers, with the intention of informing breastfeeding promotion interventions. The American Academy of Pediatrics recommends breastfeeding exclusively for 6 months. However, it is estimated that only 25% of twins and 15% of triplets still receive some human milk at 6 months. Multiple births comprise a relatively small proportion of births annually but are associated with a high frequency of complications, such as prematurity, that create breastfeeding difficulties. These circumstances make multiples an important target for breastfeeding interventions. Data were collected via a self-administered online survey that was distributed internationally via La Leche League. The survey included questions regarding the breastfeeding experience with each child and about various types of support that influenced the experiences. All the women breastfed multiples for over 12 months and a majority are white, well educated (80% with college degree), and 30 – 39 years old. Most live in the United States and have 2 – 3 children. Only 20% of respondents indicated that their child's primary care provider's recommendations were important/very important to their decision, and only 12% indicated the same regarding their doctor's recommendations. Factors highly rated as important included nutritional value of breast milk, other health benefits of breastfeeding, establishing a strong bond, and mother and child enjoying breastfeeding. A majority of the sample (71%) felt their partner was important/very important to their decision. This relationship is the most highly rated as influential. Including the woman's partner could enhance educational opportunities designed to encourage mothers of multiples to breastfeed. Additionally, emphasis on health benefits of breastfeeding may encourage mothers to breastfeed longer. Further research to test breastfeeding interventions should be completed with these results in mind.
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    The association of sexual orientation with allostatic load and cardiovascular health: An analysis of the National Health and Nutrition Examination Survey (NHANES)
    (The Ohio State University, 2020-05) Louden, Elaine; Sealy-Jefferson, Shawnita; Kamp-Dush, Claire
    Background: Cardiovascular disease (CVD) is an important health problem among sexual minorities given increased stress, according to minority stress theory. Allostatic load (AL), a measure of chronic wear and tear on the body's systems physiological regulation, may be higher among sexual minorities, who also exhibit increased risk factors for cardiovascular disease. We examined the relationship between AL and cardiovascular health (CVH) according to sexual orientation. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) 2001-2008 cycles to examine the relationship between sexual orientation, AL, and CVH. We categorized participants as straight/heterosexual, gay/lesbian, bisexual, or homosexually experienced, according to their sexual orientation. AL was defined based on ten biomarkers and CVH was quantified using the American Heart Association's (AHA) Life's Simple 7 ideal health score in addition to the use of self-reported medical diagnoses. Logistic regressions were used to estimate odds ratios and 95% CIs for associations between sexual orientation and AL, CVH, and self-reported CVD. Results: Sexual identity was not associated with AL or self-reported CVD among the population included in the analysis but was significantly associated with worse American Heart Association Simple 7 CVH scores among sexual minority females. Conclusion: Sexual minority females have elevated CVD risk factors, yet do not have increased rates of CVD diagnoses, which is not fully understood. The findings indicate the importance of continued research of health behaviors, biomarkers, and sociocultural stressors among sexual minority individuals. More research is needed to fully illuminate the mechanism between sexual minority status and the development of chronic disease.
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    Characterizing alcohol use and sexual risk behaviors across gender and HIV status among people attending STI clinics in Lilongwe, Malawi
    (The Ohio State University, 2020-05) Schwartz, Elli; Miller, William; Lancaster, Kathryn
    Alcohol consumption and participation in sexual risk behaviors are commonly discussed risk factors for HIV transmission. This thesis characterizes the prevalence of these behaviors among a population of STI clinic patients in Lilongwe, Malawi. Additionally, this thesis examines how these behaviors differ between men and women and patients with positive and negative HIV status. The data used for this thesis were originally collected for a two-armed, randomized cross-sectional study at two STI clinics in Lilongwe, Malawi from June 2015 to April 2019. Alcohol consumption was assessed using the AUDIT-C, a three-question survey that identifies patients who are hazardous drinkers. Sexual risk behaviors examined included condom use during the last sexual encounter and the number of sexual partners in the last six months. Stata version 16 was used to examine the prevalence of these behaviors in the study population. Approximately 85% of participants were HIV-negative, while 15% were HIV-positive. It was more common for women to be HIV-positive than men. Of the HIV-positive population interviewed about their alcohol use, 16% screened positive for hazardous alcohol consumption. Most participants reported to abstain from drinking. But, of those who did drink alcohol, men were found to drink more frequently and heavily than women. Most participants reported not using a condom during their most recent sexual encounter. This did not vary greatly between men, women, HIV positive participants, and HIV negative participants. Men reported having more sexual partners in the past six months than women, but this finding was not associated with a higher risk of HIV infection. Understanding alcohol use and sexual risk behaviors is important as it provides insight into the dynamics involved with HIV transmission among a high-risk group in a country where HIV prevalence is among the highest in the world.
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    The Public Health Significance of the Fibrinogen-binding MSCRAMMs of Staphylococcus aureus
    (The Ohio State University, 2019-05) Ibaraki, Makoto; Lower, Steven; Harris, Randall
    Infective endocarditis (IE) is a bacterial infection that has existed for multiple centuries and is a disease that has been constantly evolving. Recently, cases of IE caused by Staphylococcus aureus have been increasing gradually. To add to the problem, little is known about the mechanism in which S. aureus causes the heart infection. This study examined four different receptor proteins within the microbial surface components recognizing adhesive matrix molecules (MSCRAMM) family (ClfA, ClfB, FnbpA, FnbpB), that are present on the cell wall of S. aureus to understand each of their role when binding to fibrinogen (Fg), a key ligand in human hosts. The differences in binding to Fg for 7 different clinical isolates of S. aureus were analyzed using a 96-well microtiter plate apparatus. The binding to Fg for 5 reference strains of S. aureus (Newman strains and 8325-4) were also examined in the study. It was determined that the Newman strain that lacked ClfA had lower absorbance readings, indicating lower binding, than ones with ClfA and ones that lacked ClfB. In addition, clinical isolates, with an exception of one, exhibited comparably higher absorbance readings, indicating enhanced binding, relative to the Newman strains. The results pointed out that ClfA plays a critical role when binding to Fg, and both FnbpA and FnbpB are also equally important. Furthermore, it was discovered that the origin of the clinical isolates impacted binding to Fg. S. aureus specimens from the nasal cavity had lower absorbance readings compared to isolates that originated from the bloodstream of human patients.