M.S. - Epidemiology

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https://hdl.handle.net/10125/61891

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    Detecting Underreported Sexually Transmitted Infections (STIs) in the Homeless Population of O'ahu
    (University of Hawaii at Manoa, 2021) Ho, Jeannie; Hurwitz, Eric; Epidemiology
    Sexually transmitted infections (STIs) have been a large public health issue for many years. The stigma that surrounds STIs as well as the fact that many people are asymptomatic for it has made it increasingly difficult to screen and diagnose those who contract them. This is especially true for the homeless population who are migratory in nature and difficult to track. The homeless population is exposed to many factors such as social, behavioral, or environmental factors that can be associated with a higher risk of STIs. Due to the limited studies of STIs in the homeless population, we conducted a free STI screening service in collaboration with the HOME project at their clinic. This study aims to address the possible risk factors associated with STIs in the homeless population on the island of O’ahu through the use of a questionnaire and results obtained through laboratory testing on urine samples. There were eight participants in total who were included in the study with equal amounts of males and females. All the urine samples, except for one, were negative for both gonorrhea and chlamydia. A few trends and risk factors mentioned in previous studies were observed in this homeless population. As expected, there were more women who had been tested for STIs prior to this study than men and the majority of this population did not use condoms during intercourse. The study was conducted during the COVID-19 pandemic, and the limited number of study subjects impacts the ability to generalize the study’s findings to the target population.
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    Body Mass Index (bmi) Change and All-Cause Mortality in the Middle-aged and Older Population
    (University of Hawaii at Manoa, 2017-05) Zhang, Naiyuan; Epidemiology
    Objectives (i) To investigate the BMI change distribution among middle-aged and older adults; (ii) to assess the magnitudes of the effect of BMI change on all-cause mortality; (iii) to examine the effect modification of the BMI change-mortality associations by gender and ethnicity among the middle-aged and older population. Design This study utilizes a nationally representative dataset from the U.S. Health and Retirement Study (HRS). The HRS is an on-going biennial longitudinal survey began in 1992 and the survey is based on a multi-stage area probability design involving geographical stratification and clustering. Participants There are a total of 24,984 participants (13,887 females and 11,097 males) aged 60 years or older with an average age of 75.68 after excluding participants without clear responses. Main exposures BMI change. Main outcomes Survival time and mortality. Results The BMI change of our study sample is normally distributed, in which most participants cluster in the stable group and fewer participants are distributed in the severe loss and gain groups. Compared with participants with stable BMI, participants with severe BMI loss, severe BMI gain, and moderate BMI gain have greater risk of mortality, the hazard ratios (HRs) and 95% confidence intervals (CIs) are: 1.13 (1.06, 1.19); 1.11 (1.03, 1.20), and 1.15 (1.06, 1.24), respectively. For females, severe BMI loss, moderate BMI gain, and severe BMI gain are associated with increased mortality (Severe loss: 1.14 (1.06, 1.23); Moderate loss: 1.02 (0.94, 1.11); Moderate gain: 1.17 (1.05, 1.29); Severe gain: 1.19 (1.08, 1.32)). The association is weaker for males (Severe loss: 1.09 (1.00, 1.19); Moderate loss: 1.02 (0.94, 1.11); Moderate gain: 1.06 (0.95, 1.18); Severe gain: 1.12 (0.99, 1.27)). Conclusion Severe BMI loss, severe BMI gain, and moderate BMI gain are associated with increased all-cause mortality among the middle-aged and older population in the United States, but moderate BMI loss is not a risk factor for mortality. The results of subgroup analysis suggest gender and racial differences in the association between BMI change and all-cause mortality. These results of subgroup analysis indicate that females are more sensitive than males, and Caucasians are more sensitive than African Americans. Public health efforts should encourage weight control among the middle-aged and older population.