Ph.D - Public Health
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Item EXPLORING PAIWAN ELDER VIEWS OF HEALTH, AGING, AND SERVICE PREFERENCES(2024) Huang, Yu-Chi; Braun, Kathryn; Public HealthItem Unveiling Ghost Provider Networks for Hawaiʻi Medicaid Members, 2023(2024) Holmes, Joshua Ryan; Wu, Yanyan; Public HealthItem UNDERSTANDING HOW TO BEST UTILIZE SOCIAL MEDIA TO ENCOURAGE PHYSICAL ACTIVITY AMONG ADOLESCENTS(2024) Santilena, Katharine; Keliʻikoa, L. Brooke; Public HealthItem Towards a Healthier Future in the Northern Mariana Islands: Understanding Influences of Diet and Physical Activity on Overweight and Obesity of Young Children(2024) Dela Cruz, Rica Ann; Novotny, Rachel; Public HealthItem How deep is your kaumaha? Unfolding the experiences of historical and intergenerational trauma among Wāhine(2022) Keaulana-Scott, Samantha; Chung-Do, Jane; Public HealthItem HEALTHY WRITING: INTEGRATING WRITING SKILL DEVELOPMENT INTO UNDERGRADUATE PUBLIC HEALTH CURRICULA(2023) Patil, Uday; Nelson-Hurwitz, Denise; Public HealthItem Is PrEP for me? Knowledge, Attitudes, Behaviors, and Perspectives about PrEP among Black Women Living in the South(University of Hawaii at Manoa, 2022) Sophus, Amber; Braun, Kathryn L.; Public HealthSignificant racial and regional disparities are associated with HIV incidence rates among Black women in the United States, particularly of those who live in the South. While strides to improve HIV prevention efforts with Black, heterosexual women have occurred, more is needed. Pre-exposure prophylaxis (PrEP) is a woman-controlled HIV prevention strategy that can combat high rates of HIV and be used without the need to negotiate with a sexual partner. Although Black women are at the highest risk for HIV acquisition, they have the lowest rates of PrEP uptake in the U.S. The purpose of this dissertation was to expand public health understanding of the current status of HIV and AIDS prevention interventions for Black women in the U.S., highlight key aspects of recruitment ads that appeal to Black women to improve recruitment efforts for this population, and expand PrEP-related research on population characteristics and health behaviors associated with PrEP use among Black women who live in the South. This dissertation reports on findings from three studies. Study 1 was a systematic review that provided an examination of the status of HIV/AIDS prevention interventions for Black, heterosexual women in the U.S. from 2012-2019. Findings highlight gaps in HIV/AIDS prevention interventions for Black women in the U.S., specifies sub-populations of Black women that may need more attention in terms of HIV/AIDS services and programs, and provides recommendations for current and future HIV/AIDS prevention interventions that are specified for Black women. Study 2 used formative qualitative research to examine Black women’s general likes and dislikes about women-focused ads, and their preferences for ad content and ad locations in order to gain the interest of Black women to participate in health-related research. Findings not only extend the existing literature by describing aspects of online and physical ads that may appeal to Black women but highlight a specific area of featuring Black health providers as well as patients within ads that has not yet been identified in the current literature. Study 3 used quantitative methods through the use of an online survey to identify population characteristics and health behaviors associated with general likelihood to use PrEP and whether an individual planned to start PrEP soon (i.e., in the next 3 months) among a sample of at-risk HIV-negative cisgender Black women. Findings extend current PrEP-related literature about PrEP uptake among Black women by providing insight into additional factors associated with likelihood to use PrEP and future plan to use PrEP within this population. Findings also indicate a need to further examine how PrEP stigma may affect PrEP use among Black women.Overall, findings from this dissertation highlight the need for additional programs and resources that improve HIV prevention strategies for Black women and help promote PrEP uptake within this vulnerable population.Item Program Evaluation Of The Kūpuna Food Security Coalition In Honolulu County: Effectiveness Of Community-based Intervention To Address Food Insecurity Among Older Adults(University of Hawaii at Manoa, 2022) LEE, JIN YOUNG; Braun, Kathryn L.; Public HealthAccording to the U.S. Census, about 5.3 million older adults in the U.S. are food insecure despite the availability of multiple federally supported supplemental food programs. The reality is that this number likely underestimates the number of food-insecure older adults due to inadequate measurement methods. Food insecurity for older adults is a highly complex issue that goes beyond the financial resource constraints captured in the census to include factors at all levels of the Social-Ecological Model. COVID-19 made the problem even worse due to increased demand and reduced accessibility for older adults. Public/non-profit partnerships are a proven way to address this kind of complex social issue. However, there are no published studies that systematically investigated the success of this type of coalition approach in addressing older adult food insecurity. The Kūpuna Food Security Coalition (Coalition) is a community partnership formed in 2020 to address the complex issue of food insecurity among older adults in Honolulu County. This dissertation evaluated the Coalition's approach to addressing food insecurity for older adults and assessed whether their work could be replicated in other communities and whether the approach was scalable to meet demand across broad, diverse geographies. Study 1 evaluated the operating model of the Coalition, which was based on Collective Impact framework. Looking at the successes and lesson learned in the Coalition's strategy and structure, the study found that their approach worked well in addressing food insecurity among older adults in the short term and that this framework could be replicated by other public/non-profit partnerships. Study 2 developed a model, called the Older Adult Food Insecurity Index, to predict the number of food-insecure older adults at a local and national level, addressing a significant gap in available tools. Multiple factors associated with food insecurity for older adults across all levels of the Social-Ecological Model were identified, weighted by relative impact, and combined with publicly available data at a local level to create the predictive model. Using this model to predict the number of older adults in Honolulu County, which was the geographic focus of the Coalition, resulted in the likely number of food insecure older adults being 2.5 times higher than identified in the most recent census. Study 3 leveraged an adequacy performance evaluation approach to assess the scalability of the Coalition's approach, incorporating both cross-sectional and longitudinal assessments relative to the number of food insecure older adults identified in Study 2. This study found that there were no barriers to the scalability of the Coalition's approach to address food insecurity for older adults across geographies, demographics, or changes in market demand. This multi-faceted assessment of the Coalition’s approach, while identifying several opportunities, confirmed that the model was replicable and scalable for other communities and coalitions that want to address the issue of food insecurity for older adults.Item Addressing the Needs of Food Insecure Children(University of Hawaii at Manoa, 2020) Monlux, Amalie; Braun, Kathryn L.; Public HealthFood insecurity affects 50 million Americans, which is about 14% of the population (Gundersen & Zilliak, 2015). Seventeen percent of households with children are food insecure (Hunt et al., 2018). A recent study reported that 15% of children ages 2-5 living in a food-insecure household are obese, compared to 11% of children in food-secure homes (Kaur, Lamb & Ogden, 2015). Children who are food insecure are more likely to present with poor nutritional outcomes (Hunt et al., 2018). There exist few studies on household food insecurity in sub-populations, so this dissertation focused on several understudied sub-populations. The purpose of this dissertation was to determine the needs of children in food insecure households in specific populations. This dissertation included three studies, and was guided by the Social Ecological Model framework. The first study was a secondary analysis of data from Hawaiʻi-based children in the Children’s Healthy Living (CHL) Program to determine differing characteristics of food-secure and food-insecure children. I found that food-insecure children were more likely to be living with overweight or obesity, and their caregivers were more likely to not have a college education and not be employed. The second study was a systematic literature review on the effects of school-based food pantries on children’s diets. The articles included in this review reported that children who participate in school-based food pantries increased their consumption of fruits and vegetables and decreased their consumption of unhealthy food intake. For the third study, I completed a series of one-on-one interviews with food-insecure parents who are college students. This study found that college students who are parents utilize a variety of strategies to increase their household food-security status, including focusing on price versus nutritional quality of food, reaching out to family and friends, attending food banks or food pantries, and prioritizing their children before themselves. Taken together, the findings show four things. First, financial resources are a strong predictor of household food insecurity. They are also a determining factor in food purchasing decisions. Households with limited financial resources are more likely to be food insecure. They are also more likely to purchase food based on price, not on nutritional quality. Secondly, children who are food insecure are more likely to be overweight or obese (OWOB). Third, food assistance programs are helpful, but do not prevent food insecurity. Lastly, food security status does not seem to influence the amount of fruits and vegetables in a child’s diet. The quantitative study using CHL data showed no significant difference in fruit and vegetable consumption in children who were food secure or food insecure. The studies included in the literature review reported that children ate more fruits and vegetables when offered, with no mention of food security status. The parents who were interviewed for the qualitative study discussed that they are more worried about price of a food than nutritional value, which limited the amount of fresh food they would buy. This study offers several recommendations. First, food distribution programs such as school pantries and food banks, should increase their focus on supplying fruits and vegetables. Second, increasing minimum wage and providing affordable housing would help families have more disposable income for healthy foods. Third, the income criterion for eligibility for federal food assistance should be increased so that more families qualify.Item Inflammation, Type 2 Diabetes, and Cancer: Identifying Biomarkers Associated with Colorectal Cancer and Type 2 Diabetes, and the Use of microRNA Molecules as a Therapeutic Use for Cancer Treatment(University of Hawaii at Manoa, 2020) Guillen, Jenni Kimiko; Grandinetti, Andrew; Public HealthABSTRACT Chronic disease has been a growing epidemic for the past few decades. Approximately 70% of the world’s population dies from a noncommunicable disease every year. This accounts for over 38 million annual deaths worldwide. Cardiovascular disease, cancer and diabetes account for a large proportion of chronic death cases. The methods for controlling and reducing cases of chronic disease have been focused on the reduction of lifestyle risk factors, such as poor nutrition and a lack of physical activity, and increasing screening, surveillance and treatment. These preventive measures and early surveillance tools are considered more effective at reducing loss and less costly than treating those with later stages of chronic disease. Diagnostic, prognostic, and treatment methods come in a variety of forms. One of the more recent methods is the screening of molecular biomarkers. The field of molecular biomarkers has recently exploded. In 2016, it was reported that over 768,000 papers were directly linked with biomarkers, and that the number of publications have exponentially grown within the last few years. With the overwhelming amount of publications, it has become necessary to systematically review the information so that health care providers, policy makers, researchers and other key public health members can access these novel markers readily. The aim of this dissertation was to focus on early screening for prevention and early detection of colorectal cancer (CRC) and on novel treatment techniques for patients with CRC. Through the implementation of systematic review and meta-analysis approaches, this dissertation had 3 main study objectives: 1) to identify and quantify acylcarnitine and carnitine biomarkers that are upregulated or downregulated in three diabetic conditions (type 1, type 2, and gestational diabetes) and in prediabetes, 2) to explore 5 key microRNA molecules upregulated in CRC patients that have been found to have high sensitivity and specificity percentages (>60%), and 3) to identify microRNA molecules that act as tumor suppressors in patients with CRC and their target gene(s) or gene product(s) whose expression is affected by tumor-suppressing miRNAs. In the first study, the systematic review and meta-analysis of the acylcarnitine and carnitine biomarkers in the prediabetic and diabetic conditions revealed that these biomarkers are, for the most part, upregulated in those with diabetes when compared to non-glycemic participants. An upregulation of acylcarnitine, a short-chain fatty acid, was found in participants diagnosed with gestational diabetes, prediabetes, and type 2 diabetes, but not in type 1 diabetes, an autoimmune disease. In addition, the systematic review found 30 more acylcarnitine/ carnitine molecules were upregulated and 3 were downregulated in patients with type 2 diabetes. The meta-analysis of type 2 diabetes confirmed the findings of the systematic review for 4 acylcarnitine derivates: an upregulation of acylcarnitine, propionylcarnitine, isovalerylcarnitine, and palmitoylcarnitine. However, in contrast to the other diabetic conditions, type 1 diabetes was found to have a downregulation of free carnitine with no other biomarkers clearly upregulated. In the second study, the systematic review of miRNA-1246, miRNA-202, miRNA-532, miRNA- 1229, and miRNA-21 found that all 5 key microRNAs were significantly upregulated (p<0.05) in those with CRC and additionally in patients with colorectal adenoma (CRA), which can develop into colorectal cancer. All of the studies for miRNA-1246, miRNA-202, miRNA-532, miRNA- 1229 and most of the studies for miRNA-21 also reported high sensitivity and specificity percentages (>60%). The meta-analyses of miR-21 supported the systematic review and was found to have significant overall pooled estimate effects for both the odds ratio (OR = 7.37 [2.25, 24.14] with outlier and 4.14 [1.91, 8.98] without outlier) and the overall survival hazard ratio (OS HR = 2.97 [1.73, 5.09] with outlier and 2.13 [1.67, 2.72] without outlier). However the overall pooled disease free survival HR was not significantly different between CRC patients and non-CRC participants, HR = 2.12 (0.94, 4.79), which could be due to the number of included studies (n=3). In the third study, a systematic review of the tumor-suppressing microRNAs that regulate target genes and gene products known to directly affect the development of CRC was conducted. These tumor-suppressing miRNA molecules are irregularly expressed and their downregulation can lead to the overexpression of oncogenic genes. Therefore, recovery or reintroduction of these tumor suppressing miRNAs could be a potential treatment for individuals diagnosed with cancer. The analysis of this study identified 93 microRNAs and 61 target genes. Of the microRNAs and gene targets found, only 5 miRNAs (miR-22, miR-23a, miR-137, miR-375, miR-425-5p) and 4 genes (ZEB2, LGR5, BCL2, CCND1) were reported in more than one study. With the lack of published results on the same miRNAs and target genes, it is difficult to assess whether these biomarkers can be used in a clinical setting. More research needs to be conducted on tumor-suppressing miRNAs and their target genes in order to accurately assess the value of using miRNAs as a treatment for CRC. The development of using biomarkers for diagnostic, prognostic, and therapeutic purposes requires the continuous identification and quantification of these molecules in patients with chronic diseases at various stages. The body’s processes are complex and sometimes not well understood, but with continued research, a better understanding of how these mechanisms work will lead to better prevention, control, and treatment.