<p> Appalachian has many social, economic, and biologic factors impacting dental health over the life-course.</p><p> <i><b>Purpose:</b></i> This study examined dental caries experience and family structure, dental fear, and fatalism in West Virginia and Pennsylvania. </p><p> <i><b>Method:</b></i> Using a cross-sectional study design, 2002-2009 Center for Oral Health Research in Appalachia data were analyzed utilizing the World Health Organization definitions for caries experience, dichotomized into low and high. Three groups were studied: 1) children, 11-13 years (N=237); 2) adolescents, 14-17 years (N=191); and 3) adults, 18 years and above (N=1125). For multivariable model development, generalized estimating equations with exchangeable working structures accounted for family clusters. </p><p> <i><b>Results.</b></i> For <b>children,</b> family (second biological child vs. first biological child and niece/nephew/step-/grandchild/other vs. first biological child) Fatalism Scale, Dental Fear Survey, and Short Form Fear of Pain Questionnaire failed to reach a significant difference with caries experience. There were 38.0% reporting fear on the Dental Fear Survey, and 80.2% on the Short Form Fear of Pain Survey. There were 62.0% reporting fatalism. There were 44.7% first biological children, 32.1% second biological children, and 23.2% with other family relationships.</p><p> Overall, for <b>adolescents,</b> family (single parent vs. both parents, same home; and second biological child vs. first biological child and niece/nephew/step-/grandchild/other vs. first biological child) failed to reach a significant difference with caries experience. However, in gender sub-group analysis, living with a single parent was protective for males, with an adjusted odds ratio (AOR) of 0.08 (95% Confidence Interval [CI]: 0.01, 0.42; p = 0.0249). The Fatalism Scale failed to reach a significant difference with caries experience in the overall model. For females, there was an AOR of 6.60 (95% CI: 1.89, 9.64; p = 0.0076). Although the Short Form Fear of Pain Questionnaire failed to reach a significant difference with caries experience in the overall model, for males, the AOR was 12.86 (95% CI: 1.71, 96.59; p = 0.0130) and for females, the AOR was 0.08 (95% CI: 0.01, 0.55; p = 0.100). There were 36.1% reporting fear on the Dental Fear Survey; 63.9% on the Short Form Fear of Pain Survey; and 43.5% reporting fatalism on the Fatalism Scale. There were 54.6% first biological children; 20.6% second biological children, and 24.8% with other family relationships; 53.5% lived in single parent homes.</p><p> For <b>adults,</b> a high Dental Fear Survey score was associated with a high caries experience. The AOR was 1.76 (95% CI: 1.29, 2.40; p = .0003). It remained significant for females (AOR= 2.11[95% CI: 1.41, 3.14; p = 0.0003]). For males, those never married, divorced, widowed, separated, or had other living arrangements vs. married/domestic partnering had an AOR of 0.12 (95% CI: 0.04, 0.36; p = .0002).</p><p> <i><b>Conclusion:</b></i> Caries is a complex disease with many influences. Gender differences exist in age categories in terms of family relationships, fear, and fatalism. Further exploration of these factors is needed to aid in the development of successful interventions to decrease caries severity.</p>

<p> As a disease emerges, one of the greatest challenges for public health practitioners is to differentiate between a normal event and a serious outbreak. Typically, information from official sources and surveillance systems had been the only resource. More recently, the field of infodemiology has emerged with a focus on the distribution and determinants of health information on the internet. This research compared official reports of whooping cough with infodemiology sources, specifically news articles, search engine patterns, and Twitter, to assess the timeliness, accuracy, and correlation of these content sources. Within California, Michigan and Ohio, internet search patterns identified the outbreak of pertussis in 2010 four to eleven weeks in advance of official sources, and there was strong correlation between the epidemic curve and search pattern in Michigan and Ohio. Twitter also provided an indicator in advance of official sources in all three states, but only with a single Tweet. Using all three sources to identify indicators was better than any single source used independently. </p><p> While understanding the data utility is important, it is equally critical to understand the attitudes and perceptions amongst public health leaders regarding infodemiology data to improve situational awareness. A survey of such leaders showed that infodemiology content had the most value in the first stage of situational awareness for identifying early indications of disease outbreaks. News media and internet search were moderately to highly valuable for 70% of respondents, while social media was moderately to highly valuable to 60% of respondents. For both strengthening comprehension of an outbreak and informing future predictions, beliefs were split regarding the level of potential value (if any) that exists. This led to a framework on how to include infodemiology content in public health situational awareness strategies going forward, so limited resources are used as effectively as possible.</p>

<p> Using longitudinal data from Panel Study of Income and Dynamic (PSID) and multivariate analyses, this dissertation examines the dynamic and longitudinal relationship between gender, occupational career and health among people of working age under the new economy. The major concern is whether there are gender differences in the health returns to occupation/employment resources across life course, whether the gendered health gap diverges with age, and whether health affect men' and women's employment transitions and occupational mobility differently. </p><p> Results show that women experience significantly poorer health than men, but this health gap reduces with aging. The health disadvantages experienced by women are entirely explained by SES status. Working becomes increasingly important to maintain health as people age. However, women receive far fewer health rewards from employment than men, and this unequal health returns to employment are compounded with age. The health benefit from a higher occupational status is similar for men and women across the life course. More importantly, all else being equal, health of women declines at a rate half that of men, showing a reversed gender health gap toward old age. Regarding health selection, results show that health is not a predictor of occupational status for either men or women, but is an important predictor for employment status and downward mobility of both genders. </p><p> From a theoretical standpoint, this research illustrates the limitation of using one dominate life course theory, and calls for a more prominent theory that examine both biological and social processes that contribute to the life course gender health inequality. Methodologically, results suggest the superiority of combining longitudinal designs with hierarchical longitudinal models, which are able entangle the within-person health change and between-person effects of time. From a policy standpoint, the study suggests that family-friendly policies should be able to improve both women's employment and, by extension, their health status.</p>

The goal of pandemic influenza planning is to minimize health and economic losses in the event of a future pandemic. One of the numerous challenges associated with this goal is the need to ration limited medical supplies such as vaccines and antivirals. This thesis seeks to formulate an ethical framework for priority access to these resources. Prioritization strategies must be consistent with the goal of pandemic planning and should reflect societal norms for equitable distribution. According to an ethics framework based on the principles of utility and equity, three groups were granted highest priority for influenza vaccine, namely health care workers, emergency service workers, and high-risk individuals predisposed to severe outcomes following influenza infection. In the case of antivirals, the expectation is that there will be competition between treatment and prophylaxis uses of these drugs. The resulting dilemma---providing primary access to the critically ill in respect of the medical profession's duty of care or prioritizing prophylaxis of health care workers in respect of their right to protection---is the major question which the framework presented in this thesis seeks to resolve.

Objective. The use of cyclooxygenase-2 (COX-2) inhibitors may impair load-induced bone formation but also prevent menopause-associated bone loss. We hypothesized that COX-2 inhibitor use would be associated with an increased bone mineral density (BMD) in postmenopausal women not using estrogen therapy and conversely, a decreased BMD in men. / Methods. We used data from the Canadian Multicenter Osteoporosis Study, a longitudinal, randomly selected, population-based community cohort study. The outcome measure was percent difference in bone mineral density (g/cm2). Using linear regression, we estimated the effect of COX-2 inhibitors on this outcome, while adjusting for important potential confounders. / Results. There were 4780 subjects available for study, of which 394 subjects reported daily COX-2 inhibitor use. In males, daily use of COX-2 inhibitors was associated with a lower BMD at all hip sites (percent difference between users and non-users at total hip: -3.1% [95% confidence interval (CI), -6.0, -0.3]. In post-menopausal women not using estrogen replacement therapy, daily COX-2 inhibitor use was associated with higher BMD at most sites (percent difference at total hip: +3.0% [95% Cl, 0.3, 5.8]). / Conclusions. COX-2 inhibitor use was associated with a lower BMD in men and, on the other hand, a higher BMD in post-menopausal women not using estrogen replacement therapy. Men who have used COX-2 inhibitors may wish to seek a BMD measurement to assess their fracture risk. However, COX-2 inhibitors may have utility in post-menopausal women if bone-selective analogues can be developed.

Objectives. Few studies have identified longitudinal predictors of smoking cessation in disadvantaged communities. This study identified predictors of cessation in a 5-year longitudinal cohort of adults aged 18-65 years and living in low-income, inner-city neighborhoods of Montreal, Canada. / Methods. Secondary analysis of data from the non-randomized evaluation of Coeur en Sante St. Henri, a community-based intervention program designed to decrease cardiovascular disease risk (CVD) factors. Data on lifestyle behaviors were collected in telephone interviews of a representative sample of residents at baseline and five years later. Independent predictors of cessation were identified among 303 subjects who smoked at baseline, using multiple logistic regression. / Results. After 5 years, 20% of baseline smokers reported quitting including 22% of female smokers, and 17% of male smokers. From among 7 potential predictors only two were retained in multivariable analysis, including having a post-secondary or higher education relative to secondary school or less (OR=1.88, 95%CI: 1.01-3.51), and number of cigarettes smoked per day (OR=0.95, 95%CI: 0.91-0.98). / Conclusions. Few predictors of cessation emerged in this disadvantaged community. It is notable that even in a disadvantaged community, increased education predicts cessation. Improved understanding of the mechanisms by which education leads to higher quit rates may help the development of cessation programs targeting disadvantaged communities.

<p> Though eating disorders are a serious public health threat, misinformation about these potentially deadly diseases is widespread. This study examines eating disorder information from a wide variety of sources including medical journals, news reports, and popular social activist authors. Examples of misinformation were identified, and three aspects of eating disorders (prevalence, mortality, and etiology) were chosen as key indicators of scientific illiteracy about those illnesses. A case study approach was then adopted to trace examples of misinformation to their original sources whenever possible. A dozen examples include best-selling books, national eating disorder information clearinghouses; the news media; documentary feature films; and a PBS television Nova documentary program. The results provide an overview of the ways in which valid information becomes flawed, including poor journalism, lack of fact-checking, plagiarism, and typographical errors. Less obvious&mdash;and perhaps even more important&mdash;much of the misinformation results from scientific research being co-opted to promote specific sociopolitical agendas. These results highlight a significant gap in science communication between researchers, the medical community, and the public regarding these diseases, and recommendations to address the problem are offered.</p>

Rationale. In Quebec, 6.2% of all Mycobacterium tuberculosis (TB) isolates from Canadian-born patients are resistant to pyrazinamide alone (mono-PZA-R). Over 90% of mono-PZA-R isolates in Quebec have been characterized by a specific and unique mutation in the pncA gene. The unusually high prevalence of mono-PZA-R disease and its associated mutational profile in Quebec provided an exceptional opportunity to study the epidemiologic and clinical significance of mono-PZA-resistance in patients with active TB. Methods. 67 patients with mono-PZA-R TB diagnosed between 1 Jan 1990 and 31 Dec 2000 were compared to 211 randomly selected patients with pan-sensitive (Pan-S) isolates diagnosed within the same time period. Demographic, laboratory, and clinical information pertaining to patients diagnosed with TB from the provincial database of Maladies a declarations obligatoires (MADO) were linked to drug resistance profiles derived from the provincial laboratory. Data from MADO were supplemented by other clinical information abstracted from chart review, the provincial drug insurance database, and the provincial registry for Bacillus Calmette Guerin vaccination. Results. There were no statistically significant differences in demographics or clinical characteristics between patients infected with mono-PZA-R compared to Pan-S strains. Among patients with mono-PZA-R TB, 51 (76%) were cured, 3 (4%) relapsed, and 13 (19%) died within 6 months of diagnosis. In comparison, for subjects with Pan-S TB, 181 (86%) were cured, 2 (1%) relapsed, 2 (1%) failed treatment, and 26 (12%) died within 6 months of diagnosis. In multivariate logistic regression analysis, mono-PZA-R was associated with decreased odds of successful clinical outcomes compared with Pan-S TB (OR=0.38, 95% CI = 0.18-0.81). Conclusion. PZA-resistance had a clinically significant impact on outcome of TB disease.

<p> Background: Incident rates of dengue fever are rapidly increasing worldwide. Contributing factors including climate change, urbanization, globalization, and vector mutation, are creating significant public health challenges. Dengue fever has no vaccination, and no cure; therefore prevention through vector control is the primary method of public protection. Research indicates that community involvement is critical in achieving vector control, and that children, disproportionally burdened by this disease, are an effective and appropriate population to target with interventions. Innovative, sustainable, cost effective strategies are needed. Objective: It was theorized that an educational animation regarding dengue fever, created using CDC guidelines, would be effective at improving knowledge, attitude, and practices in primary school children in Florida. An animation entitled "Dengue Fever Comes To Town" was developed to assess this concept. Methods: A pretest/posttest study was conducted. Knowledge changes were statistically evaluated using a Two-tailed Paired Sample t-test. Attitude changes were evaluated using a Wilcoxon Matched Pair Signed Rank. Practice changes were evaluated using a chi-square test. Results: The animation was effective at improving knowledge, attitude, and practices in third through fifth grade levels, for both males and females. Recommendations: Given the vulnerability of the population, and the increasing risk of dengue fever, establishment of preventive education is recommended, including adding the educational animation to school curricula in Florida.</p>

<p> In the United States, half of all pregnancies are classified as unintended. This measure fails to capture the complexity of cognitive and affective processes that result in conflicted or ambivalent attitudes toward pregnancy. Accurately measuring women's reproductive plans is essential for providing appropriate interventions to improve maternal-child health. The purpose of this study was to explore the concept of pregnancy ambivalence by estimating a multidimensional measure of pregnancy desire in the 2006-2010 National Survey of Family Growth data, and to examine the social and demographic characteristics associated with pregnancy ambivalence. For each female participant reporting exactly one live birth within a three-year time period (<i>n</i> = 2,298), a pregnancy desire score was calculated from five existing survey items. Weighted mean pregnancy desire scores were calculated for levels of the following covariates: maternal age, race, marital status, educational level, income, employment status, and birth order. Weighted multiple linear regression analysis was used to examine the associations between pregnancy desire and the same covariates. On a 0&ndash;100 scale, the mean pregnancy desire score was 68.7 (standard error 1.0). Pregnancy desire scores were highest for married, highly educated non-Hispanic White women between the ages of 35 and 39, with income greater than 300% of the federal poverty level, giving birth to their second child. After controlling for covariates, Hispanic women had a mean pregnancy desire score five points higher than non-Hispanic White women, and the difference in pregnancy desire score for a first birth versus a second birth was not statistically significant. The distribution of pregnancy desire score revealed that about one-quarter of pregnancies are highly desired, highlighting the large number of women with conflicting or ambivalent feelings about their pregnancies. Further research to explore alternatives to the traditional measure of pregnancy intention is warranted.</p>