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: https://cph.osu.edu/students/undergraduate/honors-program

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Characterizing the indoor microbiome in an unoccupied house used for research
(The Ohio State University, 2024-05) Farinas, Olivia; Dannemiller, Karen
Approximately 90% of our time spent is within the indoor environment where we are exposed to a diverse indoor microbiome. This indoor microbiome is influenced by a variety of factors, but especially ventilation, geographic location, and occupants. Occupancy can change both indoor bacterial and fungal communities in a home. Often, unoccupied homes (also known as “test houses”) are used to study processes that occur in indoor spaces. However, we need to better understand how well the indoor microbiome of an unoccupied test house might represent a standard occupied home, and therefore how well it might be used to study processes in the indoor environment. This study intends to evaluate the microbiome before and after ozone/smoke exposure in an unoccupied test home while comparing it to the composition of bacteria and fungi from undamaged, occupied homes across the continental United States. Smoke and ozone were injected into an unoccupied home located in Gaithersburg, Maryland, and dust was collected from the entire home before (n=2) and after (n=1) these perturbations. Homes across the United States (n=9) that were used for comparison were also vacuumed to retrieve dust. All dust samples were extracted, quantified with quantitative polymerase chain reaction (qPCR), and sequenced. From this experiment, the fungal concentrations of occupied home samples were significantly higher compared to the test home, and there were significant differences between Shannon diversity. Epicoccum was the most abundant genus for all test house samples and five of the nine occupied home samples, and there were variations among genera and ecological niches. Gram-negative bacteria dominated the test house samples, and overall were more diverse than the mycobiome. This study did not allow for us to assess viability. This suggests that occupancy and home use play a vital role in the indoor microbiome. Future directions may include increasing the number of dust samples from test homes, along with studying viability and function before and after smoke/ozone exposure.
Prevalence and correlates of reproductive coercion among young women in Kingston, Jamaica
(The Ohio State University, 2024-05) Postalakis, June; Gallo, Maria; Norris, Alison
Introduction: Jamaica has a relatively high abortion and unintended pregnancy rate compared to other countries, which may be mediated by various barriers to contraception. Prior research has explored reproductive coercion and its influence on contraceptive uptake, but few studies examine correlates of reproductive coercion. We sought to identify the correlates of reproductive coercion among young women in Kingston, Jamaica. Study design: We analyzed data from a study of young women (N=222) attending a public clinic in Kingston in November 2018 to March 2019. To be eligible, women had to be 18-25 years of age, sexually active, and not desire pregnancy in the next 12 months. We categorized women as experiencing reproductive coercion if they agreed that their partner had pressured them to become pregnant, had ever stopped them from using a method to prevent pregnancy, had messed with or made it difficult to use a method to prevent pregnancy, or that their partner would stop them if they wanted to use a method to prevent pregnancy. We used logistic regression to examine associations between demographic and other factors (age, education, union status, employment, live children, contraception use) and reporting reproductive coercion. Results: Overall, 44.1% of women reported experiencing at least one form of reproductive coercion. Women agreed that their partner pressured them to become pregnant (20.4%), had ever stopped them from using a method to prevent pregnancy (16.7%), had messed with or made it difficult to use a method to prevent pregnancy (20.7%), and that their partner would stop them if they wanted to use a method to prevent pregnancy (24.4%). Women who had completed high school or less had higher odds of reporting reproductive coercion relative to those with more education (OR, 2.8, 95% CI: 1.2–6.5). Women aged 20-23 years also had higher odds of reporting reproductive coercion compared to women aged 24-25 years (OR 1.9, 95% CI 1.0–3.9). No other factor appeared to be associated. Conclusions: Reproductive coercion was a common issue in Jamaica, and was associated with lower educational attainment and younger age. Considering the role of partners is critical in efforts to increase contraception use for avoiding unintended pregnancy.
Major depressive disorder, drug use complicating pregnancy, and preterm birth: An analysis of independent and interdependent effects
(The Ohio State University, 2024-05) Patel, Shivani; Gillespie, Shannon
Background. Preterm birth is the leading cause of neonatal death. Major depressive disorder and prenatal drug use have each been linked to heightened risk for preterm birth. However, the two commonly co-occur, making it difficult to isolate their effects, which is pertinent to optimizing healthcare interventions. Therefore, using data from a large, diverse prenatal cohort, we investigated these variables independently and interdependently in the prediction of preterm birth. Methods. Using a retrospective cohort design, we analyzed 18,042 de-identified medical records from a large Midwestern academic medical center. ICD-9 and ICD-10 codes identified individuals with a diagnosis of major depressive disorder and/or drug use complicating pregnancy. Preterm births were identified according to the estimated and actual date of birth in the medical record. Logistic regression models first examined each predictor independently. Next, an interaction term was included. Results. The sample was an average age of 29 (SD 5.7) and primarily White (60.1%). When examined independently, major depressive disorder (OR 1.13, 95%CI 0.995-1.277) and drug use (OR 1.23, 95%CI 0.997-1.529) were both marginally but not significantly associated with greater odds of preterm birth. However, we also identified a significant interaction between major depressive disorder and drug use in estimating the odds of preterm birth. Specifically, among individuals without major depressive disorder, drug use was associated with greater odds of preterm birth (OR 1.388, 95%CI 1.092-1.765). Similarly, among individuals without drug use, major depressive disorder was associated with greater odds of preterm birth (OR 1.159, 95%CI 1.019-1.318). Neither variable was associated with odds of preterm birth among individuals with a diagnosis of major depressive disorder that also engaged in drug use (OR 0.895, 95%CI 0.562-1.425). Conclusions. Findings add to literature that has primarily focused on the independent effects of major depressive disorder and drug use on odds of preterm birth. The identification of an interaction between the two variables in the prediction of preterm birth reinforces the complicated nature of the risk factors and the syndrome of preterm birth. Future research should aim to clarify the mechanisms linking these exposures to birth timing by directly measuring hypothesized biological mediators.
Understanding the scope of claim denials within the Affordable Care Act Insurance Marketplace due to "Out of Network" providers
(The Ohio State University, 2024-05) Del Valle, Miguel; Xu, Wendy
Introduction Through the passing and implementation of the Patient Protection and Affordable Care Act, creation of an available health insurance marketplace took place in which all states must offer their own exchange or rely on that of the federal government. There have been policy concerns on health care access among enrollees in the Marketplace plans. One issue within this realm is the prevalence of insurance claims denials. Multiple possible explanations for these denials exist, however, a potentially alarming reason is that of providers being deemed “Out of Network”. This poses a threat to the validity or worth of insurance plans included on the marketplace and the ability for individuals to both locate in-network providers and pay for health services out of pocket. This study aimed at examining the proportion of claims denials for “Out of Network” providers and identify geographic patterns and differences in plan types. Methods Public data was used, compiled by the Center for Medicare and Medicaid services for the years 2019 through 2021 to examine the proportion of insurance claims denied due to “Out of Network” providers across the years, states, and given insurance plan types. Additionally, separate analyses were performed to understand the implications for lack of numeric information within the datasets. I conducted separate analyses. The first examined overall relevance of claims denials due to “Out of Network” providers and the other addressed the non-numeric missing data included within CMS data files. Each of these subsections then attempted to find trends observed across the three study years, determined if there are any identifiable geographic implications associated with this data, and finally identified trends amongst the different insurance types included within the marketplace. Results Overall, 5.92% claims were denied on average for reasoning of Out-of-network providers, each year. The findings revealed that the areas of the United States more disproportionately impacted are states located either in the central and southeastern regions. More denials were observed for those enrolled with either Health Maintenance Plan (HMO) or Exclusive Provider Organization (EPO) insurance plans than other plan types. I further found that there was a substantial amount of non-numeric or missing data. On average 67.92% of insurance carriers did not report data for reasons of denied claims due to out-of-network providers. This came in the form of character responses including data outside the scope of what is possible and omitted information on all states using a State-Based Health Insurance Marketplace. The non-numeric missing data varied by geographic regions and health plan types too. Discussion The magnitude of “Out of Network” denials may be explained by a number of reasons such as limited contracting with providers, and inaccurate information through the provider directories. However, patients have to bear the consequences, including delayed health services and substantial out-of-pocket costs drawn from savings to pay for the denied claims, and increased prevalence of surprise bills. Despite this knowledge learnt from my study, lack of complete quantified data hinders the public inquiries. Further analysis is needed to fully understand the scope of the issue as, in which additional years after the enactment of the Affordable Care Act will be assessed along with delving into publicly accessible state-based marketplace information. Conclusion Overall, a fair number of discernible associations were observed between claims denials for an “Out of Network” provider across the three study years, at a state level, and for certain plan types. Improvements in monitoring reasons of denied claims by the CMS system are needed to eliminate the broadened impact denied claims have on patients.
A mixed methods study exploring how physical activity may be incorporated into a cessation intervention to best support youth experiencing homelessness in the quit process.
(The Ohio State University, 2024-05) Kaur, Ramandeep; Nemeth, Julianna
Introduction/Significance: Seventy percent of youth and young adults experiencing homelessness (YYEH), aged 14-24 years old, smoke combusted commercial tobacco--a smoking prevalence 2.5 times higher than housed peers. The purpose of this study is to consider how physical activity may be incorporated into cessation intervention to meet the needs of YYEH. Methods: This study used a mixed methods design using secondary data collected at a drop-in center for YYEH in a midwestern city. For the quantitative data, the aim of the univariable analysis was to understand if there were differences in tobacco use and psychosocial factors between YYEH who used the gym at the drop-in center and those that did not. Through focus groups, qualitative data was collected to understand thoughts about implementation of cessation interventions. The aim of the qualitative analysis was to understand how youth were mentioning sports and physical activity so it could be incorporated into targeted cessation intervention design. Results: Samples for this study included YYEH using combusted tobacco products in the past week (Quantitative: N=96, Qualitative: N=45). Quantitative results indicated individuals that used electronic vaping products used the gym less frequently (p=0.04). Individuals older (p=0.04), identifying as straight (p=0.02), and identifying as male (p<0.01) used the gym more frequently. No differences in distribution of psychosocial factors by participants’ use of gym. In the qualitative analysis, YYEH mentioned smoking at drop-in shelters due to lack of activities, using smoking as a de-stressor. YYEH mentioned that having an individual, like a personal trainer would be helpful. Conclusion: Qualitative findings revealed YYEH asked for organized sports to socialize in a sober, reduced stress environment and to develop a relationship with “a wellness coach” who could act as a personal trainer in the gym and aid their cessation journey. We concluded that no significant differences in psychosocial factors and use of gym may be because youth were asked about their individual use of the gym at the drop-in center. Just having a gym available is not enough to benefit all youth, it is necessary to focus social engagement through physical activity to aid the cessation process.
Providers percieved barriers to opioid treatment access in Franklin County, Ohio
(The Ohio State University, 2024-05) Hall, Emma; Hyder, Ayaz
Background: The amount of people suffering from Opioid Use Disorder continues to increase in Franklin County, Ohio. With this rise comes an increase in the need to provide access to appropriate treatment. The concept of access must be understood through multiple dimensions to accurately assess the barriers patients face when seeking treatment. These dimensions are acceptability, accommodation, affordability, accessibility, and availability. Methods: We developed and administered an online survey to employees in addiction services at The Ohio State University Wexner Medical Center. This survey asked about and assessed various perceptions as to why people in Franklin County may have difficulty locating and receiving OUD treatment. The survey was created based on previous questionnaires and surveys that measure healthcare access, along with definitions of five dimensions of access outlined in an article by Penchansky and Thomas. 22 Results: There were seven respondents, all employed through the Ohio State Wexner Medical Center. Of these respondents, four identified as Social Workers, two identified as ‘Other’, and one identified as a Peer Navigator. All but one respondent is a full-time employee. Participants were asked to rank the five dimensions of access based on what they perceived to be their patients’ most pressing barriers and the results were as follows: 1. Acceptability, 2. Accommodation, 3. Affordability, 4. Accessibility, 5. Availability. When asked about their patients’ health literacy, 71% of participants said most of their patients would be classified as having basic health literacy. Providers also stated there is a waiting list to receive treatment and people are likely to wait one to three weeks. Other notable findings were 85% of respondents feeling there are ‘definitely’ or ‘probably not’ a sufficient number of specialists in Central Ohio to treat the number of people seeking treatment for opioid use disorder. Conclusion: Overall, providers highlighted acceptability, accommodation, and affordability as the most important concerns among the patients they see. Answers to other survey questions, however, highlight issues mainly among accommodation and availability. The survey results call attention to multiple areas The Ohio State Wexner Medical Center could focus on to expand access for people seeking opioid use disorder treatment in Franklin County, Ohio.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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