Public Health Department Masters Theses Collection Copyright (c) 2013 University of Massachusetts - Amherst All rights reserved. http://scholarworks.umass.edu/pubhl_theses Recent documents in Public Health Department Masters Theses Collection en-us Fri, 25 Jan 2013 23:24:24 PST 3600 The Impact of Gestational Diabetes on Maternal and Cord Blood Lipids Among Prenatal Care Patients in Western MA http://scholarworks.umass.edu/theses/941 http://scholarworks.umass.edu/theses/941 Fri, 23 Nov 2012 07:36:56 PST Gestational diabetes mellitus (GDM), a pregnancy-induced metabolic disorder that affects 2-10% of pregnancies poses future risk for diabetes mellitus (DM) and cardiovascular disease in mother and child. However, few prospective studies have examined the effect of GDM on altered maternal and cord blood lipids, specifically HDL, LDL, triglycerides, and total cholesterol, both during and after pregnancy. We have evaluated the association between GDM and lipid metabolism in pregnant mothers and their infants using data from a prospective cohort study conducted at Baystate Medical Center’s Wesson Women and Infant’s Unit. GDM was assessed prenatally by 3-hr GTT blood samples and was confirmed by obstetrician review. Lipids were assessed via fasting and non-fasting blood samples obtained during 3-hr GTTs performed at 24-28 weeks of gestation and 6-8 weeks post-partum. Data for covariates were collected via an interview form administered at the time of recruitment. We used multivariable linear regression to evaluate the association between GDM status and maternal lipids during and after pregnancy as well as cord lipids. These study results inform future research on GDM as a risk factor for future metabolic disorders in mother and child.

]]> Raj, Preethi Urinary Melatonin Levels and Risk of Postmenopausal Breast Cancer in the Women's Health Initiative Observational Study http://scholarworks.umass.edu/theses/843 http://scholarworks.umass.edu/theses/843 Thu, 23 Aug 2012 05:59:01 PDT Prior studies have observed a link between night shift work and increased risk of breast cancer. Melatonin, a hormone related to circadian rhythm, has been proposed to lower breast cancer risk by inhibiting cell proliferation. The disruption of peak melatonin that occurs during night shift work could explain the increase in risk observed. Several studies have assessed whether higher melatonin levels are associated with decreased breast cancer risk, but results have been conflicting. We examined the relationship between urinary melatonin levels and breast cancer risk in a nested case-control study conducted within the Women’s Health Initiative Observational Study. First morning urine samples collected at baseline were assayed for melatonin levels in 258 women diagnosed with invasive breast cancer and 515 matched controls from three enrollment sites. Using conditional logistic regression to adjust for matching factors and established risk factors, results indicate no association between urinary melatonin levels and breast cancer risk. The mean creatinine adjusted melatonin levels for cases and controls were 16.30 ng/mg and 16.05 ng/mg, respectively. Compared to the lowest quartile of creatinine adjusted melatonin, the odds of breast cancer did not vary by quartile of creatinine adjusted melatonin, adjusted for known breast cancer risk factors: second quartile 0.84 (95% CI 0.52-1.38), third quartile 1.05 (95% CI 0.65-1.72) and fourth quartile 1.09 (95% CI 0.66-1.81). This study does not suggest that melatonin is protective against breast cancer and suggests that reasons other than melatonin suppression may explain the increased risk of breast cancer seen in night shift workers.

]]> Doherty, Ashley The Relationship Between Seroreactivity to Trypanosoma Cruzi and Electrocardiographic Abnormalities in Two Endemic Areas For Chagas Disease in Guatemala http://scholarworks.umass.edu/theses/682 http://scholarworks.umass.edu/theses/682 Mon, 21 Nov 2011 09:25:40 PST Chagas disease caused by the protozoan Trypanosoma cruzi is the leading cause of heart disease in Latin America. After an acute phase that typically includes few symptoms, a chronic cardiac phase occurs for many infected individuals. The progression to chronic heart disease is not fully understood in Guatemala. The objective of this study was to determine the association between T. cruzi infection and progression to Chagas heart disease in Guatemala and determine if the relation is modified according to vector predominance.

Using a community-based cross-sectional approach, 813 individuals from two areas of Guatemala were included in the study: 478 (58.8%) from Jalapa and 335 (41.2%) from Chiquimula. Data including serologic evaluation, electrocardiography (ECGs) and demographics were collected to compare the degree of detectable cardiac abnormalities in infected and uninfected individuals.

Overall, T. cruzi seroprevalence was 28.8%, 247 (30.4%) presented an abnormal electrocardiography and 79 (9.7%) were diagnosed as Chagas heart disease. Seroreactivity was statistically (p-value<0.05) associated with abnormal ECG, Chagas heart disease, community, age, occupation, time living in the area, knowledge of the vector, ventricular condition defects and ST-T waves changes. The age and sex-adjusted association between a positive seroreactive and abnormal ECG was higher in Jalapa OR=2.0 (CI95% 1.2, 3.1) than in Chiquimula OR=1.2 (CI95% 0.9, 1.8).

These results show the high Chagas-cardiac burden in this population and support the idea that the vector predominance plays an importance role in the association and that this should be taken into account in the design of intervention for vector control.

]]> Gramajo-Rodriguez, Rodrigo Antonio Coffee, Tea Consumption and Endometrial Cancer Risk: Women's Health Initiative Observational Study http://scholarworks.umass.edu/theses/680 http://scholarworks.umass.edu/theses/680 Mon, 21 Nov 2011 09:25:17 PST Approximately 40,000 women in the U.S. are diagnosed with endometrial cancer annually. Biological data suggest coffee or tea consumption may lower endometrial cancer risk through estrogenic and insulin-mediated pathways. Epidemiologic data are inconsistent, with two of three prospective cohort studies showing an inverse association with coffee consumption and two prospective cohort studies finding no association with tea consumption. We used publicly available data from the Women's Health Initiative Observational Study to evaluate the association between coffee, tea and endometrial cancer risk. We identified 48,912 eligible post-menopausal women with a mean follow-up time of 7.5 years. During this period there were 452 incident endometrial cancer cases. We used Cox-proportional hazard models to evaluate the effects of coffee and tea consumption on endometrial cancer risk, while adjusting for potential confounders including age, body mass index and hormone therapy use. Overall, we did not find an association between coffee consumption and endometrial cancer risk. Compared to women who did not drink coffee on a daily basis (none or < 1 cup/day), the multivariable adjusted hazard ratios for women who drank 2-3 cups/day was 0.95 [95% confidence interval (CI) 0.74,1.22] for total coffee, 0.91 (95% CI 0.68,1.23) for regular coffee, and 0.94 (0.62,1.42) for decaf coffee. Compared to obese women who did not drink coffee on a daily basis (none or < 1 cup/day), the multivariable adjusted hazard ratios (HR) for obese women who drank ≥ 2cups/day as reported at baseline were: 0.79 (95% CI 0.53,1.17] for total coffee, 0.62 (95% CI 0.39,1.00) for regular coffee, and 0.78 (95% CI 0.40,1.50) for decaf coffee. Furthermore, obese women who consistently reported drinking ≥2 cups of regular coffee/day had an even further reduced risk [HR 0.40 (95% CI 0.18,0.91)]. In comparison to women who did not drink tea on a daily basis, obese women who drank 1 cup and ≥ 2cups of tea/day had multivariable adjusted hazard ratios of 0.45 (95% CI 0.22,0.92) and 0.99 (95% CI 0.60,1.62), respectively. The results from our study suggest that regular coffee consumption may be protective against endometrial cancer among obese postmenopausal women, with inconclusive results for tea. Our study adds to the biological understanding and to the small body of prevalent epidemiologic literature on coffee consumption and endometrial cancer risk.

]]> Giri, Ayush Beverage Consumption and Body Composition Among College-aged Women http://scholarworks.umass.edu/theses/646 http://scholarworks.umass.edu/theses/646 Fri, 30 Sep 2011 11:31:39 PDT In the U.S., over 67 million adults are obese and 300,000 annual deaths are related to obesity. Among college-aged women, over 60% report daily consumption of caloric beverages. Prior studies indicate positive associations between these beverages and obesity, but conflicting results for diet drinks. Studies were limited, however, by obesity measures that failed to accurately assess abdominal adiposity or percent body fat, and few studies included college-aged women.

We examined this relationship among participants aged 18-30 in the University of Massachusetts Vitamin D Status Study (n=237). We assessed average diet in the past two months using a modified version of the Harvard Food Frequency Questionnaire and calculated percent body fat by dual-energy X-ray absorptiomtery. Confounding factors were assessed using a lifestyle questionnaire. Multiple logistic regression was used to adjust for important risk factors.

We found no association between intake of sugar-sweetened beverages or juice and obesity after controlling for confounding factors. However, high consumption of diet drinks (i.e., >2 servings per week) was associated with an increased risk of overweight (BMI>25) (OR=2.88, 95% CI 1.34, 6.21), high waist circumference (>80 cm) (OR=3.14, 95% CI 1.56, 6.35) and high percent body fat (>33%) (OR=2.86, 95% CI 1.42, 5.77) as compared to light consumption (i.e, <1 serving per>month). These associations were not attenuated by controlling for total caloric intake. Findings should be evaluated in additional longitudinal studies to determine whether diet drinks contribute to adiposity or if the association is due to higher diet drink consumption by overweight women.

]]> Sloan, Matthew Selective Serotonin Reuptake Inhibitors and Bone Mineral Density in a Population of U. S. Premenopausal Women http://scholarworks.umass.edu/theses/633 http://scholarworks.umass.edu/theses/633 Wed, 24 Aug 2011 10:02:02 PDT Selective Serotonin Reuptake Inhibitors and Bone mineral Density in a Population of U.S. Premenopausal Women

May 2011

M.S., UNIVERSITY of Massachusetts Amherst

Directed by: Professor Elizabeth R. Bertone-Johnson

Low bone mineral density (BMD) in post-menopausal women is a risk factor for bone fractures and osteoporosis development. Prior studies in post-menopausal women have shown the use of antidepressant medications, specifically selective serotonin reuptake inhibitors (SSRIs) to be inversely related to BMD. However, the association has not been studied in pre-menopausal women. Current SSRI use is widespread with 8% of U.S. women age 18-44 reporting use. We evaluated the association between SSRIs and BMD and bone mineral content (BMC) cross-sectionally using data from the University of Massachusetts Vitamin D Status Study. SSRI use, diet, and lifestyle factors were assessed by questionnaire. BMD and BMC were measured using dual-energy x-ray absorptiometry (DEXA). The study included 256 women aged 18-30 (mean=21.6 years, SD=4.3 years). In this population, SSRI use was 5%, BMD values ranged from 0.97-1.38 g/cm2 (mean 1.16, SD 0.08), and BMC values ranged from 1833g to 3682g (mean 2541.5, SD=349.2). After adjustment for age, body mass index, and physical activity, mean BMD in the 13 users of SSRIs was 1.15g/cm2 (SD=0.06) compared to 1.16g/cm2 (SD=0.77) in the 243 non-users (p =0.66). After the same adjustments, mean BMC in the 13 users was 2467.1g (SD=285.0) compared to 2547.6g (SD=352.6) in the 243 non-users (p=0.94). Our findings do not support an inverse association between SSRI use and BMD or BMC. However, given the prevalence of SSRI use in young women and the potential for adverse effects on bone health, further study of this association is warranted.

]]> Peterson, Lori J. Vitamin D Levels and Risk of Dyslipidemia among US Children with Diabetes and Obesity http://scholarworks.umass.edu/theses/611 http://scholarworks.umass.edu/theses/611 Wed, 24 Aug 2011 09:56:50 PDT Dyslipidemia is increasing among U.S. children, and the prevalence is highest among children with diabetes and obesity. Recently, vitamin D deficiency has been suggested as a possible dietary risk factor for dyslipidemia. Despite the high prevalence of vitamin D deficiency amongst children, virtually no studies have evaluated the association between vitamin D and dyslipidemia among children. We evaluated the vitamin D and dyslipidemia relationship among 240 children and adolescents aged 2 through 21 years who were outpatients of a pediatric endocrinology unit at a large tertiary care facility in Western Massachusetts from April 2008 to April 2010. Eligible children were those with either obesity and/or type 1 or 2 diabetes mellitus. A total of 17.4% of children had severe (<15.0 ng/ml) vitamin D deficiency, 19.2% had moderate (15.0-19.9 ng/ml) deficiency, 36.3% were insufficient (20.0-29.9 ng/ml), and 27.1% had normal (≥30.0 ng/ml) levels. A total of 28.8% of children had high total cholesterol (TC ≥180 mg/dL), 19.6% had high triglycerides (TG; <10years: ≥110 mg/dL, ≥10years: ≥130 mg/dL), 21.3% had low high density lipoprotein (HDL <40 mg/dL), and 6.7% had high low density lipoprotein (LDL ≥130 mg/dL). Moderate vitamin D deficiency was associated with increased risk of high TC (adjusted odds ratio [OR adj] = 2.9, 95% confidence interval (CI): 1.0, 8.8) compared to children with normal vitamin D levels. Severe vitamin D deficiency was associated with an increased risk of low HDL (OR adj = 3.5, 95% CI: 1.0-12.3) and high TG (OR adj = 11.7, 95% CI: 1.9, 70.3) compared to children with normal vitamin D levels. Children with moderate vitamin D deficiency had approximately 3-fold increased risk of high TC compared to children with normal vitamin D levels. In comparison to children with normal vitamin D levels, severe vitamin D deficiency was associated with a strong and significant increased risk of low HDL and high TG; with a significant dose-response relationship. Additionally, in linear regression analyses, we found that an increase in vitamin D deficiency was associated with a significant mean increase in all four measures of dyslipidemia. Vitamin D adequacy may reduce the risk of dyslipidemia in children.

]]> Hagan, Elsina E. Perineal Talc Use and Risk of Endometrial Cancer in Postmenopausal Women http://scholarworks.umass.edu/theses/591 http://scholarworks.umass.edu/theses/591 Wed, 24 Aug 2011 09:51:56 PDT Endometrial cancer is the most common female reproductive cancer in the United States. Most known risk factors for endometrial cancer are either genetic or related to exposure to estrogens; less is known about risk due to environmental exposures. While several studies have examined the relationship between perineal powder use and ovarian cancer risk, only one study has addressed the relationship with endometrial cancer risk. The Women's Health Initiative Observational Study, a prospective cohort study of 93,676 United States postmenopausal women from 1993-2005, measured perineal powder use at baseline via self-report. Cases of endometrial cancer were self-reported and confirmed by both local and central physician adjudicators. Cox proportional hazards regression was used to examine the association between perineal powder use and endometrial cancer, adjusting for known risk factors. Of the 48,912 women in our analysis, 25,181 (52%) reported ever use of perineal powders. There were 452 incident cases of endometrial cancer diagnosed during 366,872 person-years of follow-up. Ever use of perineal powder was not significantly associated with increased risk of endometrial cancer (hazard ratio 1.05, 95% confidence interval 0.87-1.27). However, use of any perineal powder for 20 or more years was associated with a 30% increase in risk (hazard ratio 1.30, 95% CI 1.01-1.67) compared to never users. Use of powder on both a diaphragm and the perineal area was associated with a 39% increase in risk (hazard ratio 1.39, 95% CI 1.00-1.93). Cessation of perineal powder use, particularly on a diaphragm, may help reduce risk of endometrial cancer.

]]> Crawford, Lori B. Education, Occupation, and Migration as Predictors of Multiple Sexual Partnerships Among People Tested for HIV in Luderitz, Namibia http://scholarworks.umass.edu/theses/583 http://scholarworks.umass.edu/theses/583 Wed, 24 Aug 2011 09:50:00 PDT Multiple sexual partnerships are associated with greater risk of HIV, sexually transmitted infections (STIs) and intimate partner violence. Namibia has an HIV prevalence of 18% and surveys have shown that up to 40% of men in parts of the country have multiple sexual partners; however, no studies have evaluated characteristics associated with this behavior.

We evaluated the relationship between education, occupation, and migration and multiple sexual partnerships among people tested for HIV in Lüderitz, Namibia. Data are taken from a cross-sectional study of 570 men and women conducted in a Voluntary Counseling and Testing Center from September-November 2009. Multinomial logistic regressions adjusted for relevant confounders suggest that employment other than manual labor is associated with a three-fold increase in the odds of having 4-6 partners over the lifetime (OR=3.44 95%CI: 1.29-9.15) and a non-significant two-fold increase in the risk of having 7 or more partners over the lifetime (OR=1.93 95%CI: 0.57-6.57). Stratification by gender shows that among women, employment other than manual labor is associated with almost a five-fold increase in the odds of having 4 or more sexual partners over the lifetime (OR=4.58 95%CI: 1.48-14.23). Women with an education of grade 12 or higher also have increased odds of having 4 or more sexual partners over the lifetime (OR=3.78 95%CI: 1.26-11.36). Results show no significant associations with migration, or among men for any exposure variables. Although further studies are warranted, results suggest that programs for HIV and STI intervention and family planning among women should be aimed at workplaces.

]]> Blank, Sima The Association between Vitamin D and Depression among College-Aged Women http://scholarworks.umass.edu/theses/577 http://scholarworks.umass.edu/theses/577 Wed, 24 Aug 2011 09:48:50 PDT Approximately 15 million Americans are diagnosed with a major depressive disorder each year, with higher rates among women and college-aged adults. Recent research suggests a vitamin D insufficiency may be associated with an increased risk of depression among the elderly. However, studies have not been conducted among young women. A recent study of young adults in Massachusetts suggests that two-thirds of this population is vitamin D deficient. We evaluated the association between dietary vitamin D intake and serum levels of 25-hydroxyvitamin D (25(OH)D3) and history of depression using data from the UMass Vitamin D Status Study, a cross-sectional study of 237 college-aged women. Information on depression and health-related factors was collected by questionnaire at a single clinic visit. Dietary vitamin D intake was assessed by a Food Frequency Questionnaire, and serum 25(OH)D3 levels were assessed in fasting blood samples by radioimmunoassay. In multivariable analyses, we observed the suggestion of an association between vitamin D from food sources and history of depression. For each 100 IU/day increase of dietary vitamin D there is a 13% decreased risk of depression (95% CI: 0.6, 1.2). However, total vitamin D intake (foods and supplements combined) was not associated with history of depression. Compared to women in the lowest tertile (median=51 nmol/L) of serum 25(OH)D3, women in the second tertile (median=72 nmol/L) had an 82% decreased risk of depression (95% CI: 0.04, 0.90; ptrend=0.008). The results of this study are consistent with vitamin D as a modifiable risk factor for depression and may inform intervention studies among college-aged women.

]]> Barysauskas, Constance M.