Mitigating Opioid Use Disorder and the Opioid Epidemic in the United States

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Description
Latest estimates show that roughly 188 individuals in the United States die everyday due to an opioid-related overdose. This dissertation explores three avenues for mitigating opioid use disorder (OUD) and the opioid epidemic in the United States (1.) How can researchers and

Latest estimates show that roughly 188 individuals in the United States die everyday due to an opioid-related overdose. This dissertation explores three avenues for mitigating opioid use disorder (OUD) and the opioid epidemic in the United States (1.) How can researchers and public health professionals identify areas most in need of treatment for OUD in an easy-to-use and publicly accessible interface?; (2.) What do practitioners see as opportunities for reducing barriers to treatment?; and (3.) Why do differences in opioid mortality exist between demographic groups? To address question one, I developed an interactive web-based to assist in identifying those counties with the greatest unmet need of medically assisted treatment (MAT). To answer question two, I conducted a study of stakeholders (medical providers, peer support specialists, public health practitioners, etc.) in four New Mexico counties with high unmet need of MAT. to identify cultural and structural barriers to MAT provision in underserved areas as well as opportunities for improving access. To answer the third question. I conducted a systematic review of peer-reviewed literature and government reports to identify how previous research accounts for race/ethnic and sex disparities in opioid-related mortality. While many opioid mortality studies show demographic differences, little is known about why they exist. According to the findings of this systematic review, research needs to go beyond identifying demographic differences in opioid-related mortality to understand the reasons for those differences to reduce these inequities.
Date Created
2023
Agent

Mathematical Modeling of Infectious Diseases

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Description
The current coronavirus disease 2019 (COVID-19) pandemic has highlighted the crucial role of mathematical models in predicting, assessing, and controlling potential outbreaks. Numerous modeling studies using statistics or differential equations have been proposed to analyze the COVID-19 dynamics, with network

The current coronavirus disease 2019 (COVID-19) pandemic has highlighted the crucial role of mathematical models in predicting, assessing, and controlling potential outbreaks. Numerous modeling studies using statistics or differential equations have been proposed to analyze the COVID-19 dynamics, with network analysis and cluster analysis also being adapted to understand disease transmission from multiple perspectives. This dissertation explores the use of network science and mathematical models to improve the understanding of infectious diseases. Chapter 1 provides an introduction to infectious disease modeling, its history, importance, and challenges. It also introduces network science as a powerful tool for understanding the complex interactions between individuals that can facilitate disease spread. Chapter 2 develops a statistical model that describes HIV infection and disease progression in a men who have sex with men cohort in Japan receiving a Pre-Exposure Prophylaxis (PrEP) program. The cost-effectiveness of the PrEP programwas evaluated by comparing the incremental cost-effectiveness ratio over a 30-year period against the willingness to pay threshold. Chapter 3 presents an ordinary differential equations model to describe disease transmission and the effects of vaccination and mobility restrictions. Chapter 4 extends the ODE model to include spatial heterogeneity and presents partial differential equations models. These models describe the combined effects of local transmission, transboundary transmission, and human intervention on COVID-19 dynamics. Finally, Chapter 5 concludes the dissertation by emphasizing the importance of developing relevant disease models to understand and predict the spread of infectious diseases by combining network science and mathematical tools.
Date Created
2023
Agent

Evaluation of a Novel Citizen Scientist Library Loan Program: A Community-Based Indoor Air Quality Initiative

Description

The COVID-19 pandemic has renewed interest in the importance of indoor air quality for health. The spread of respiratory aerosols is the primary mechanism for COVID-19 transmission, making it crucial to understand the role of effective ventilation in managing the

The COVID-19 pandemic has renewed interest in the importance of indoor air quality for health. The spread of respiratory aerosols is the primary mechanism for COVID-19 transmission, making it crucial to understand the role of effective ventilation in managing the risk of disease transmission. The concentration of exhaled carbon dioxide (CO2) in indoor spaces can be used as a proxy measure of ventilation efficiency. Poor indoor air quality has been associated with a range of acute and chronic health problems, including respiratory issues, cardiovascular disease, and cancer. Poor air quality may also impair cognitive performance and productivity. Social and economic inequalities exacerbate the impact of indoor air quality issues, making it crucial to address these problems in an equitable manner. Public libraries have been identified as an effective intermediary for providing education and free air quality monitoring technology to communities, with the ultimate goal of promoting awareness and increasing access to tools to promote accountability for maintaining high indoor air quality standards. The primary objectives of this initiative are to: 1) develop a citizen science toolkit for assessing indoor air quality in public spaces and deploy the toolkit to public libraries in Arizona; and 2) to conduct a program evaluation to determine whether this kit can be effectively deployed through public libraries to promote citizen science efforts and engage community members in promoting healthier indoor air quality, identify areas where improvements can be made, and prepare the program to be scaled to a larger audience.

Date Created
2023-05
Agent

Parental Perceptions of Child Mental Health Stigma: Mixed-Method Study

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Description
This study considered three main aims of (1) developing and validating a tool to measure parental perceived child mental health (MH) stigma, (2) determining whether perceived stigma levels corresponded in any way to parental identities, and (3) producing a decision-making

This study considered three main aims of (1) developing and validating a tool to measure parental perceived child mental health (MH) stigma, (2) determining whether perceived stigma levels corresponded in any way to parental identities, and (3) producing a decision-making process flow identifying where barriers such as perceived child MH stigma may affect families dealing with child MH issues. Recruitment of parents/guardians (18 years or older) with children (under the age of 18 years) was done through convenience and respondent-driven sampling in Phoenix, Arizona. A 44-prompt MH stigma tool was developed and validated (N=65, Cronbach's alpha 0.89) prior to utilizing (N=623) it to measure levels of perceived child MH stigma in the community. Analysis of variance showed potential significant (p<.005) interactions among education, income, and race/ethnicity (white, non-Hispanic/Latinx and Hispanic/Latinx) and levels of stigma. Specifically, higher education and lower income among the Hispanic/Latinx population in Phoenix showed a greater likelihood for higher levels of perceived child MH stigma. Factor analysis yielded three underlying factors of this stigma: interaction with MH, discrimination, and positive aspects. Content and thematic analysis of free response questions in the survey conveyed parents talk about MH diagnoses differently between general MH and child MH (e.g., child MH included ADD/ADHD while general MH included anxiety and schizophrenia). Fifteen, one hour-long, semi-structured interviews were completed, transcribed, and analyzed using narrative analysis to develop a parental decision-making process flow. The resulting flow showed parents went through informal methods of accessing MH care (e.g., research, awareness of MH issue) prior to formal methods such as seeking medical experts or school support. While the study was able to address these three aims, a significant shift in the landscape of MH occurred with the COVID-19 pandemic, increasing child MH risk and decreasing care access. This study developed a tool and set of methods that may be applied to identify changes in perceived child MH stigma and in how parents make decisions to access child MH care.
Date Created
2022
Agent

Short-Term Medical Missions to Guatemala: the Preparation, Organization and Execution of STMMs Under the Enduring Influence of Neoliberalism

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Description
Short-term medical missions (STMMs) are groups of volunteer medical providers who travel to provide health care, including basic services and surgeries, to global low-income populations. STMM organizations present their work as contrary to both public and private systems within Guatemala

Short-term medical missions (STMMs) are groups of volunteer medical providers who travel to provide health care, including basic services and surgeries, to global low-income populations. STMM organizations present their work as contrary to both public and private systems within Guatemala that do not adequately serve the patient population, though they operate within the same framework as other providers and mirror the same neoliberal ideology in their planning, organization and strategy, and execution. STMMs strive to offer free, high-quality access to surgeries and basic health care services via volunteer medical providers willing to dedicate their time and skill to low-income patients. The patient population of STMMs in Guatemala, who are often rural, indigenous, and low-income, already experience diminishing access to health care due to neoliberal health policies and discrimination within the existing health care landscape, going to great lengths to access quality health care services. This research investigates the planning, organization and strategy, and execution of STMMs through the lens of the enduring influence of neoliberal health ideologies on volunteer medical providers and existing health resources in Guatemala. Organizational strategies that prioritize the ease of travel for volunteer medical providers mirror the geographical lack of health care access, neglect of indigenous language services in the health care context, and urban focus already existing in the country’s public health care system. The patient population experiences heightened vulnerability exacerbated by STMMs when seeking care because of their low adherence to Guatemalan law surrounding registration requirements for foreign medical providers and poor institutional accountability, burdening patients, who lack legal literacy and financial resources, with denouncing malpractice or post-operative problems. Finally, STMM providers expect patients to both demonstrate passivity, humility, and material deficiency and show that they can be ‘good’ patients—able to understand and abide by the authority of the medical providers, know what information to provide, and communicate effectively—essentially, to be good health consumers. Ultimately, this research demonstrates how neoliberal health ideologies remain deeply engrained in the psyche of STMM organizations, despite their targeted approach to deliver health care to patients struggling to access services in Guatemala’s chaotic health care landscape.
Date Created
2022
Agent

Contact Tracing in An Active Pandemic: The Gap Between Practice and Academic Discourse

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Description
Contact tracing was deployed widely during the COVID-19 pandemic to attempt to stop the spread of SARS Co-V-2. This dissertation investigates the research on contact tracing from a scientometric perspective and looks qualitatively at how case investigators and contact

Contact tracing was deployed widely during the COVID-19 pandemic to attempt to stop the spread of SARS Co-V-2. This dissertation investigates the research on contact tracing from a scientometric perspective and looks qualitatively at how case investigators and contact tracers conducted public health practice during the pandemic. Through approaching the public health practice of contact tracing from both a broad, top-down angle, and an on the ground experiential approach, this dissertation provides insight into the issues facing contact tracing as a public health tool.
Date Created
2022
Agent

The Association Between School COVID-19 Mitigation Policies and School-Associated COVID-19 Outbreaks

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Description

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is an enveloped single-stranded positive-sense RNA virus that originated in China and has rapidly spread worldwide. With the Delta variant arriving before many K-12 schools in Arizona resumed in-person learning for the 2021-2022

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is an enveloped single-stranded positive-sense RNA virus that originated in China and has rapidly spread worldwide. With the Delta variant arriving before many K-12 schools in Arizona resumed in-person learning for the 2021-2022 academic year, a plethora of mitigation measures were utilized by schools. Public schools in both Maricopa and Pima county without mask mandates were found to be 3.5 times more likely to have COVID-19 outbreaks in comparison to those with mask requirements at the start of the school year. In addition, when analyzing the presence of three other mitigation measures (cohorting, random testing, and use of improved air filtration), only 5.42% were found to use all four mitigation measures.

Date Created
2022-05
Agent

A Comparative Analysis of HIV & AIDS Health Policies in Botswana, Eswatini and South Africa

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Description

HIV &AIDS is a global epidemic that has affected the lives of millions of people across the world. According to the World Health Organization (WHO), 37.7 million people were living with HIV in 2020. Sub-Saharan Africa has been particularly affected

HIV &AIDS is a global epidemic that has affected the lives of millions of people across the world. According to the World Health Organization (WHO), 37.7 million people were living with HIV in 2020. Sub-Saharan Africa has been particularly affected by the epidemic, specifically, the Southern and Eastern Africa region which accounts for the highest number of new HIV infections, the highest number of people living with HIV, and the highest number of AIDS-related deaths. Botswana, Eswatini and South Africa are countries located in Southern Africa and have been greatly affected by the HIV & AIDS epidemic as Botswana had the highest HIV prevalence from the late 90s to the early 2000s while Eswatini currently has the HIV highest prevalence rate, and South Africa currently has the highest number of people living with HIV in the world. This paper examines the HIV & AIDS health policies adopted by these three countries in their responses to the HIV & AIDS epidemic.

Date Created
2021-12
Agent

An Assessment of Arizona College Students’ Knowledge, Preventive Strategies, Preparedness, and Risk Perception during Covid-19

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Description

The SARS-CoV-2 (Covid-19) virus has had severe impacts on college students' ways of life. To examine how students were coping and perceiving the Covid-19 pandemic, a secondary analysis of an online survey across the three Arizona public universities investigated students’

The SARS-CoV-2 (Covid-19) virus has had severe impacts on college students' ways of life. To examine how students were coping and perceiving the Covid-19 pandemic, a secondary analysis of an online survey across the three Arizona public universities investigated students’ knowledge about Covid-19, engagement with preventive strategies, pandemic preparedness and gauged their risk-perception. Results from our analysis indicate that the students were knowledgeable about Covid-19 and were changing their habits and engaging with preventive measures. Results further suggest that students were prepared for the pandemic in terms of resources and were exhibiting high-risk perceptions. The data also revealed that students who were being cautious and engaging with preventive behaviors had a higher risk-perception than individuals who were not. As for individuals who were prepared for the pandemic in terms of supplies, their risk perception was similar to those who did not have supplies. Individuals who were prepared and capable of providing a single caretaker to tend to their sick household members and isolate them in a separate room had a higher risk perception than those who could not. These results can help describe how college students will react to a future significant event, what resources students may be in need of, and how universities can take additional steps to keep their students safe and healthy. The results from this study and recommendations will provide for a stronger and more understanding campus community during times of distress and can improve upon already established university protocols for health crises and even natural disasters.

Date Created
2021-05
Agent

An Assessment of Arizona College Students’ Knowledge, Preventative Strategies, Preparedness, and Risk Perception during Covid-19

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Description

The SARS-CoV-2 (Covid-19) virus has had severe impacts on college students' ways of life. To examine how students were coping and perceiving the Covid-19 pandemic, a secondary analysis of an online survey across the three Arizona public universities investigated students’

The SARS-CoV-2 (Covid-19) virus has had severe impacts on college students' ways of life. To examine how students were coping and perceiving the Covid-19 pandemic, a secondary analysis of an online survey across the three Arizona public universities investigated students’ knowledge about Covid-19, engagement with preventive strategies, pandemic preparedness and gauged their risk perception. Results from our analysis indicate that the students were knowledgeable about Covid-19 and were changing their habits and engaging with preventive measures. Results further suggest that students were prepared for the pandemic in terms of resources and were exhibiting high-risk perceptions. The data also revealed that students who were being cautious and engaging with preventive behaviors had a higher risk-perception than individuals who were not. As for individuals who were prepared for the pandemic in terms of supplies, their risk perception was similar to those who did not have supplies. Individuals who were prepared and capable of providing a single caretaker to tend to their sick household members and isolate them in a separate room had a higher risk perception than those who could not. These results can help describe how college students will react to a future significant event, what resources students may be in need of, and how universities can take additional steps to keep their students safe and healthy. The results from this study and recommendations will provide for a stronger and more understanding campus community during times of distress and can improve upon already established university protocols for health crises and even natural disasters.

Date Created
2021-05
Agent