Preterm birth, defined as birth prior to 37 completed weeks gestation, is a serious health concern. Despite advances in health care screening and interventions, the rate of preterm birth in the United States has risen more than 30 percent since 1981. In 2006, Menon and associates reported the first multilocus genetic interaction in three single nucleotide polymorphisms predictive of spontaneous preterm birth in a population of White mothers. A gene association study using a case-control design was conducted to determine whether the results of the Menon study were also true for Black women and their infants. The case group included 22 preterm mothers and 22 preterm infants. The control group included 106 term mothers and 108 term infants. Study variables included high-risk and low-risk genetic combinations of the three single nucleotide polymorphisms. Birth certificate applications were reviewed to determine subject eligibility. Blood samples obtained by hospital personnel were sent to a laboratory for genotyping. It was predicted that there would be no statistically significant difference in the occurrence of the high-risk genetic patterns in the preterm Black mothers or their infants. Data analysis suggested that the multilocus genetic combinations reported by Menon were not predictors for preterm birth in Black mothers or their infants. Further study is recommended to identify genetic variations predictive of preterm birth across ethnic groups.

No description available.

Assessing hormone receptors (the estrogen and progesterone receptors) and the human epidermal growth factor receptor 2 (HER2) to guide clinical decision making revolutionized treatment for breast cancer patients. However, in the years since these biomarkers were first incorporated into routine clinical care, only a few others have been validated as clinically useful in guiding adjuvant chemotherapy decisions and are recommended by the American Society of Clinical Oncology (ASCO) for patients with hormone-positive breast cancer. For patients with triple-negative breast cancer (TNBC), which lacks hormone and HER2 receptors, not any of these biomarkers are recommended by ASCO due to insufficient evidence that they meaningfully improve clinical outcomes. Breast cancer is the second-leading cause of cancer-related death among women in the US, indicating an unmet need to improve treatments, which can be accomplished in part by identifying and validating novel predictive and prognostic biomarkers that yield actionable information about the clinical course of breast cancers, especially TNBCs. A major obstacle to improving outcomes for breast cancer patients is intratumor heterogeneity (ITH), which can be extensive in breast cancer and drives treatment resistance and relapse. I envision that assaying drivers of ITH can inform clinicians about which breast tumors may be intrinsically more aggressive and carry a greater risk of breast cancer-related morbidity and mortality. My research, presented here, primarily focuses on testing the impact of drivers of ITH (namely, centrosome amplification [CA], the clustering protein KIFC1, and mitotic propensity and its drivers) on clinical outcomes in breast cancer in multivariable models as well as the correlates of in vitro efficacy of centrosome declustering drugs (which can selectively eliminate cancer cells with CA). Collectively, these studies reveal gene signatures and immunohistochemical biomarkers that are independent predictors of aggressive breast cancer course and rational strategies to optimize targeted therapy to combat cancer cells exhibiting CA, thereby contributing to the literature on the development of precision medicine for breast cancer patients, including TNBC patients.

The primary goal of this study was to analyze existing racial profiling data collected and reported by law enforcement agencies in Texas. The internet-based data used was obtained through TCOLE, as it is the state mandated repository in which all law enforcement agencies must submit their annual racial profiling reports to. In analyzing a collection requirement of these reports, this study sought to determine how frequently law enforcement officers know the race or ethnicity of drivers prior to traffic stops. Furthermore, the study sought to determine if there are differences in the rates of race or ethnicity known prior to stops across Texas geographical regions, county population sizes, agency types, as well as between counties with and without interstate thoroughfares. This analysis consisted of 3,250,984 traffic stops conducted by 1,186 law enforcement agencies in 2014. Findings revealed that law enforcement officers rarely know the race or ethnicity of drivers prior to traffic stops, as was consistently found across all measures. Findings and implications are discussed.

African American communities have been subject to institutional and societal inequalities for much of our nation’s history. A review of the literature has shown that these families have unequal access to resources and opportunities, especially in the comparison to the rest of the population. These factors may contribute to African American children having higher rates of substantiated cases of abuse and neglect, as well as the amount of time that these children spend in the foster care system. A qualitative study was conducted in the form of focus groups. The study examined the African American community’s perspective of the child welfare system and the social workers they may have come in contact with in the scope of their possible child welfare experience. Common themes that emerged included a lack of understanding of both the system and services provided, a sense of mistrust between the community and government agencies, and the need for more resources specifically for the African American community. Proposed solutions to alleviate the disproportionality problems in child welfare included social workers teaming with families, mentorships between African Americans, and collaborations with other agencies.

Prostate cancer is the most common cancer occurring in the men in USA and Europe. According to CDC, incidence of Prostate cancer in African American men in the year 2008 was 234.6 cases per 100,000 compared to 150 cases per 100,000 in Caucasian men, reasons for this disparity remain unclear. Castration resistant prostate cancer is an advanced form of prostate cancer with poor survival rates. 10-20% of prostate cancer patients develop metastatic castration resistant prostate cancer (CRPC) within approximately 5 years of follow-up. Androgen deprivation therapy which is at the center of metastatic prostate cancer is often impeded by development of CRPC. Previous studies have demonstrated that prostatic androgen concentration ranging between 10-25 percent in the treated patients versus the untreated could still continue AR signaling. Previous in vitro studies have demonstrated higher tumor homing potential in normal adipose derived mesenchymal stem cells (ADMSC) from African American patient compared to ADMSC derived from a Caucasian patient when grown in prostate cancer cell condition media. This study attempts to exploit this tumortropicity of ADMSC for selective delivery of alpha keto reductases in the metastasized prostate cancer cells to hydrolyse DHT and other androgens into weaker androgens. Enriched ADMSC were plated in a 6 well plate and were co-transfected with transfected with AKRC14 and GFP. Gene expression was confirmed by PCR and WB. ADMSCs are capable of expressing AKR1C14 on transfection with plasmid. Stem cells expressing AKR1C4 open the avenues for furthering therapeutic strategies in metastatic CRPC by hydrolyzing the androgens. / 1 / Manish Ranjan

Head and neck cancer (HNC) is one of the top ten cancers in the world, and is caused by tobacco use, alcohol consumption and Human Papillomavirus (HPV). HPV associated HNC patients have improved survival rates compared to non -HPV associated HNC patients. This improved survival is due to HPV- positive tumors favorable response to chemotherapy and radiation. The literature has shown that there is a racial disparity in survival rates between Caucasians and African Americans, with African Americans having poorer survival rates. The aim of this study is to determine if the racial disparity among HNC patients is due to a difference in HPV prevalence between races. HPV prevalence in HNC was assessed by a meta-analysis of published articles (30/247) that reported race specific HPV prevalence. We also conducted a pooled analysis in which authors that assessed HPV in HNC were invited to submit their datasets. Meta-pooled prevalence estimates revealed that 20% of African American HNC patients had HPV-positive tumors, compared to 44% in Caucasians. However for both African American HNC patients and Caucasian HNC patients there was low to moderate heterogeneity between the studies (Q-test p-value = p < 0.001, I2 = 18.87%, and p= 0.008. I2 =65.47% respectively). The prevalence of HPV in African Americans was 60% and in Caucasians it was 39%. African Americans had a risk of oropharyngeal cancer that was no different from Caucasians (OR: 1.38, 95% CI: 0.53-3.62) but had an increased risk of death from oropharyngeal cancer (HR: 2.39, 95% CI 1.03-5.55) compared to Caucasians. The results of the pooled analysis does not support the concept that African Americans HNC patients have a lower prevalence of HPV, but substantiates the notion that African Americans have worse survival than Caucasians. However, these are preliminary results as the pooled analysis is still being conducted, the inclusion of more datasets in the analysis could alter these preliminary findings. / Public Health

No description available.

This dissertation consists of three essays in Health Economics relating to the recent challenges in the U.S. The first essay studies the impact of retirement on subsequent health and investigates the mediation effect of social network in the relationship between retirement and health. Findings reveal that retirement adversely impacts physical and mental health outcomes and a considerable portion of these effects are explained by social network changes post-retirement. In particular, shrinkage in the size of social network post-retirement deteriorates physical health and increases depression in retirees. In the second essay, we assess the differential effect of social distancing on the daily growth rate of COVID-19 infections in the US counties by considering the spatial pattern of COVID-19 spread. We also conduct a comparative analysis of the effect on urban versus rural counties, as well as low versus high socially vulnerable counties. Our analysis illustrates that a high level of social distancing compliance is needed in urban counties and in socially vulnerable areas to achieve the largest impact at curve flattening, whereas moderate-compliance is enough in reaching the peak marginal impact in rural regions and counties with low social vulnerability. In the third essay, by combining multiple data sources, we investigate how racial disparities in access to healthcare contribute to the disparity in COVID-19 infections and mortality in black versus white sub-groups. The multilevel analysis demonstrates that a higher probability of having health insurance significantly reduces disparity in COVID-19 mortality in black sub-group while it has no impact on the disparity in whites. / Doctor of Philosophy / This dissertation uses various quantitative methods to investigate policy-relevant questions regarding the recent challenges in the U.S. economy. In the first chapter, we explore how the physical and mental health of individuals changes by retirement. The results show that retirement decreases physical health while increases depression and anxiety. We also analyze how social network changes after retirement might cause changes in the health of retirees. We find that retirees may experience worse physical and mental health than non-retirees due to losing some of their relationships after retirement. In particular, the loss of contacts increases depression and deteriorates general health. In the second chapter, we investigate how compliance with social distancing within a typical county and its neighbor counties can reduce the spread of COVID-19. We examine this question for urban versus rural counties in the US and socially vulnerable versus socially not vulnerable counties. We find a high compliance level of social distancing is needed in urban counties and in socially vulnerable areas to reach the highest impact at slowing down the COVID-19 virus spread. In the third chapter, we examine whether healthcare access inequalities (e.g., having health insurance) increase the risk of COVID-19 infections and mortality for black communities. Our results show that having health insurance decreases COVID-19 mortality in communities of color but not whites.

Numerous studies have indicated racial and ethnic disparities in the vocational rehabilitation (VR) system, including differences in eligibility, services provided, and employment outcomes. Few of these studies, however, have utilized advanced multivariate techniques or latent constructs to measure quality of employment outcomes (QEO) or tested hypothesized models for the relationship between race, personal history characteristics, and VR outcomes. Furthermore, few VR disparities studies have examined southwestern states such as Texas, which has large Hispanic and Black populations. The purpose of this study was to utilize structural equation modeling (SEM) to examine several implied conceptual models for the relationship between race, personal history characteristics, and VR outcomes for White, Black, and Hispanic participants in the Texas VR system. The implied conceptual models were tested for goodness of fit and multiple-group invariance. A measurement model for QEO, a latent construct, was tested and used in the study. QEO was measured by three indicator variables and evaluated using confirmatory factor analysis. A MIMIC model was tested to assess racial/ethnic variation in QEO. The MIMIC results were compared to a multiple regression approach. In addition, a path model and logistic regressions were conducted to assess racial variation in VR closure status among consumers who were unemployed at application to VR. All models were retested with an independent sample to assess predictive validity. The study results indicated good model fit and measurement invariance for the QEO construct. The structural model for race, personal history characteristics, and QEO indicated moderate model fit. It also indicated interaction effects for race by gender and for race by public support. The MIMIC model results suggest that QEO decreased for Blacks and Hispanics compared to Whites. Furthermore, the MIMIC results, which utilized QEO as an endogenous variable, differed from the multiple regression findings, which utilized one criterion. The multiple regression findings indicated no statistically significant difference between Blacks and Whites. The path model for race and VR closure status indicated poor model fit. The logistic regression indicated no racial/ethnic differences in VR closure status. Several model estimates did not cross-validate. Study limitations and suggestions for future research are described. / text